What are the treatment options for Temporomandibular Joint (TMJ) dysfunction?

From the Guidelines

Treatment for TMJ dysfunction should prioritize conservative, non-surgical approaches, focusing on self-care measures, physical therapy, and reversible interventions, as recommended by the most recent guidelines 1. The initial management of TMJ dysfunction involves a combination of self-care measures, including eating soft foods, avoiding extreme jaw movements, applying ice packs for acute pain, and using moist heat for chronic discomfort.

• Over-the-counter pain medications such as ibuprofen (400-800mg three times daily with food) or acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) can help manage pain and inflammation, as suggested by various guidelines 1.
• Muscle relaxants like cyclobenzaprine (5-10mg before bed) may be prescribed for short-term use if muscle spasms are present, although their use should be cautious and monitored 1.
• Physical therapy focusing on jaw exercises and proper posture can improve jaw function and reduce pain, and is strongly recommended by recent guidelines 1.
• Oral splints or night guards custom-fitted by dentists can help prevent teeth grinding and reduce joint stress, but should be used with caution and under professional guidance 1. The most recent and highest quality study 1 provides strong recommendations in favour of cognitive behavioural 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. It is essential to note that most patients improve with conservative treatment, and severe cases may eventually require surgical intervention if significant structural problems exist or if pain persists despite comprehensive non-surgical management 1.
• Surgical options should be considered only after non-response to conservative therapy, including arthrocentesis, arthroscopy, or open surgery of the temporomandibular joint, as recommended by various guidelines 1.

From the Research

Treatment Options for TMJ Dysfunction

• Conservative treatment options are available for temporomandibular joint (TMJ) disorders, including 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, allowing treatment to be specifically tailored to individual patient needs 3

Comparative Studies of Treatment Options

• A comparative randomized study found that all treatments used, including a bite splint alone or in combination with intra-articular injections of substances with anti-inflammatory properties, caused a reduction in pain and increased pain-free mouth opening 4
• The study found that 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

Tissue Engineering and Future Directions

• Tissue engineering strategies may be capable of integration and adaptation in the TMJ, carrying significant potential for the development of repair and replacement tissues 5
• An analysis of native tissue characterization can assist clinicians in identifying tissue engineering objectives and validation metrics for restoring healthy and functional structures of the TMJ 5

Conservative Management

• Conservative management of temporomandibular dysfunction may include non-thrust mobilization and high-velocity, low amplitude thrust manipulation techniques to the TMJ and/or upper cervical articulations 6
• Dry needling or acupuncture of the lateral pterygoid and posterior, peri-articular connective tissue may also lead to significant improvements in pain and disability in patients with TMD 6