What is the diagnosis and treatment for Temporomandibular Joint (TMJ) dysfunction?

From the Guidelines

Temporomandibular joint (TMJ) dysfunction should be managed with a combination of conservative treatments, prioritizing cognitive behavioral therapy (CBT), therapist-assisted mobilisation, and supervised jaw exercise and stretching, as recommended by the most recent guideline 1. The management of TMJ dysfunction involves a multi-faceted approach, considering the various factors that contribute to the condition, including jaw misalignment, teeth grinding, arthritis, stress, and trauma to the jaw area.

Key Recommendations

• Start with self-care measures, including a soft diet, avoiding extreme jaw movements, and applying moist heat or ice packs to the affected area for 10-15 minutes several times daily.
• For pain relief, consider over-the-counter NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) or naproxen (220-440mg twice daily), as recommended by recent guidelines 1.
• Custom-fitted occlusal splints or night guards worn while sleeping can prevent teeth grinding and reduce joint stress, although their use should be considered on a case-by-case basis due to conditional recommendations against reversible occlusal splints 1.
• Physical therapy exercises focusing on gentle jaw stretching and strengthening can improve mobility and function.
• Stress management techniques, including meditation, deep breathing, or counseling, may be beneficial as stress often exacerbates TMJ symptoms.

Treatment Approach

Most TMJ dysfunction improves within 2-3 months with these conservative approaches. It is essential to prioritize strong recommendations in favor of cognitive behavioral therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care, as outlined in the recent guideline 1. Conditional recommendations should be considered on a case-by-case basis, taking into account the individual patient's needs and circumstances. Strong recommendations against irreversible oral splints, discectomy, and NSAIDS with opioids should be adhered to, prioritizing the patient's safety and well-being 1.

From the Research

Definition and Symptoms of TMJ Dysfunction

• Temporomandibular joint disorder is defined by pain and/or loss of function of the temporomandibular joint and its associated muscles and structures 2
• Disorders of the Temporomandibular joint (TMJ) may clinically present with jaw pain and restricted mouth opening that may limit a patient's access to comprehensive dental care 3
• Temporomandibular joint disorders (TMJDs) are associated with pain and reduced jaw mobility 4

Treatment Options for TMJ Dysfunction

• Treatments include noninvasive pharmacologic therapies, minimally invasive muscular and articular injections, and surgery 2
• Conservative therapies include nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants 2
• Minimally invasive injections include botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose 2
• A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients so that treatment can be specifically tailored to individual patient needs 3
• Bite splints are often used in the treatment of patients with oral parafunctions, temporomandibular joint (TMJ) dysfunction, or temporomandibular disorders 5

Efficacy of Different Treatment Modalities

• The results showed that maximum pain-free mouth opening improved in all the groups that made up the sample, with either a reduction in pain severity or with no pain 4
• The group injected with platelet-rich plasma yielded the best results after six months, while patients treated with sodium hyaluronate or betamethasone obtained the best results at the end of the first week 4
• Occlusal splint therapy has better long-term results in reducing the symptoms of MPDS, with better patient compliance, fewer side effects, and is more cost-effective than pharmacotherapy 6
• Soft occlusal splint therapy can be chosen for the treatment of patients with Myofascial Pain Dysfunction Syndrome (MPDS) due to its efficacy and safety 6

Risks and Complications of Treatment

• The risk for negative side effects is small in conservative bite splint treatment, but complications from long-term use of splints can be severe and irreversible 5
• The risks are especially high when mandibular advancement splints, or splints that make contact only with parts of the opposing dentition, are used for more than 4 to 6 weeks without appropriate supervision 5