From the Guidelines
The recommended management approach for patients with Temporomandibular Joint (TMJ) disorders should begin with conservative, reversible treatments before considering more invasive options. Initial management includes patient education about the condition, self-care practices, and behavioral modifications. Patients should be advised to rest the jaw, eat soft foods, avoid extreme jaw movements like wide yawning, and discontinue harmful habits such as nail biting or gum chewing. Physical therapy with jaw exercises and massage can help improve mobility and reduce pain. For pain management, over-the-counter analgesics like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 2-3 weeks can be effective, as suggested by recent guidelines 1.
Some key points to consider in the management of TMJ disorders include:
- Patient education and self-care practices
- Avoidance of aggravating activities
- Use of physical therapy and jaw exercises
- Pain management with over-the-counter analgesics
- Consideration of custom-made oral splints or occlusal appliances
- Application of heat or cold packs for symptomatic relief
According to the most recent guidelines, cognitive behavioral therapy (CBT) with or without biofeedback or relaxation therapy is strongly recommended for patients with chronic pain associated with TMJ disorders 1. Additionally, supervised postural exercise, supervised jaw exercise and stretching, and usual care (such as home exercises, stretching, reassurance, and education) are also strongly recommended.
It is essential to note that more invasive treatments like corticosteroid injections, arthrocentesis, or surgery should only be considered when conservative measures fail and symptoms are severe and persistent, as stated in the guidelines 1. This stepped approach is recommended because TMJ disorders often involve complex interactions between jaw mechanics, muscle tension, and psychological factors, and conservative treatments address these multiple contributing factors while avoiding potential complications of more invasive procedures.
The guidelines also emphasize the importance of shared decision-making between clinicians and patients, taking into account individual patient circumstances, values, and preferences 1. By following this approach, patients with TMJ disorders can receive effective management and improve their quality of life.
From the Research
TMJ Presentation
- 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
Management Approach
- 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
- Most patients improve with a combination of noninvasive therapies, including patient education, self-care, cognitive behavior therapy, pharmacotherapy, physical therapy, and occlusal devices 4
Treatment Guidelines
- There are general treatment guidelines but, while some methods apply to an individual, there is no panacea - individual patient treatment needs vary 5
- All treatments delivered to a TMD patient should be evidenced-based and should always be in the patient's best interests 5
- Current evidence supports primarily conservative multidisciplinary treatment including self-management strategies, behavioural therapy, physical therapy and pharmacotherapy 6