From the Guidelines
Temporomandibular joint (TMJ) disorders should be managed with a strong recommendation 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. Diagnosis of TMJ disorders typically involves evaluating jaw pain, limited movement, clicking or popping sounds, and muscle tenderness through a combination of clinical examination, patient history, and sometimes imaging studies 1.
Diagnosis
Diagnosis typically involves:
- Clinical examination
- Patient history
- Imaging studies (when necessary)
Treatment Options
Treatment begins with conservative approaches including:
- Rest
- Soft diet
- Avoiding extreme jaw movements like wide yawning
- Over-the-counter pain medications such as ibuprofen or naproxen to reduce inflammation and pain
- Muscle relaxants like cyclobenzaprine to help with muscle spasms
- Physical therapy exercises to strengthen jaw muscles and improve range of motion
- Hot/cold packs applied for 10-20 minutes several times daily
- Custom-fitted oral splints or night guards worn during sleep to prevent teeth grinding and reduce joint stress
Advanced Interventions
For persistent cases, more advanced interventions may include:
- Corticosteroid injections into the joint
- Arthrocentesis (joint fluid removal)
- Rarely, surgery
According to the most recent guideline 1, strong recommendations are made against irreversible oral splints, discectomy, and NSAIDS with opioids. Conditional recommendations are made against reversible occlusal splints, arthrocentesis, cartilage supplement with or without hyaluronic acid injection, and other interventions.
It's essential to note that TMJ disorders often result from a combination of factors, including jaw misalignment, arthritis, stress-related teeth grinding, and muscle tension, which explains why a multi-faceted treatment approach is most effective 1.
From the Research
Diagnosis of Temporomandibular Joint (TMJ) Disorders
- The diagnosis of TMJ disorders is based on a combination of patient history, physical examination, and diagnostic imaging 2.
- The Diagnostic Criteria for TMD (DC/TMD) is a reliable and valid tool for diagnosing TMJ disorders, covering 12 common TMD diagnoses, including painful and non-painful conditions 3.
- Diagnostic imaging, such as X-rays or MRI, may be beneficial when malocclusion or intra-articular abnormalities are suspected 2.
Treatment Options for TMJ Disorders
- Conservative therapies, including nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants, are often recommended as the first line of treatment 4, 2.
- Minimally invasive injections, such as botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose, may also be effective in managing TMJ disorders 4.
- Physical therapy, cognitive behavior therapy, and occlusal devices may also be beneficial in treating TMJ disorders 3, 2.
- Surgery may be indicated for refractory cases or when other treatment options have failed 5, 2.
Multidisciplinary Approach to Management
- A multidisciplinary team approach to management is essential in the fundamental care of all TMJ disorder patients, allowing treatment to be specifically tailored to individual patient needs 5, 3.
- Self-management strategies, behavioral therapy, physical therapy, and pharmacotherapy may be combined to provide effective treatment for TMJ disorders 3.