From the Guidelines
Treatment for TMJ disorder typically begins with conservative, non-surgical approaches before considering more invasive options. Initial treatments include over-the-counter pain relievers such as ibuprofen (400-800mg every 6-8 hours) or naproxen (250-500mg twice daily) to reduce inflammation and pain 1. Muscle relaxants like cyclobenzaprine (5-10mg at bedtime) may be prescribed for short-term use (2-3 weeks) to relieve muscle spasms. Physical therapy involving gentle jaw exercises, massage, and heat/cold therapy can help improve jaw mobility and reduce pain. Custom-fitted oral splints or night guards worn while sleeping prevent teeth grinding and help position the jaw properly. Lifestyle modifications are essential, including eating soft foods, avoiding extreme jaw movements like wide yawning, practicing stress-reduction techniques, and maintaining good posture.
Some key treatment options for TMJ disorder include:
- Conservative approaches such as reassurance and education, avoidance of wide mouth opening or aggravating activities, soft diet, jaw exercises, massage, non-steroidal anti-inflammatory drugs (NSAIDs), heat and/or cold, bite plate in the presence of bruxism, physiotherapy, mindfulness, yoga, meditation, acupuncture, splint therapy, cognitive behavioural therapy, paracetamol, and neuromodulatory medications (eg, amitriptyline, gabapentin) 1
- Occlusal splints and/or physical therapy may be beneficial in patients with orofacial symptoms and/or TMJ dysfunction 1
- Intraarticular glucocorticoid injection may be indicated in skeletally mature patients with active TMJ arthritis and orofacial symptoms, but is not recommended for first-line management in skeletally immature patients 1
For persistent cases, corticosteroid injections into the joint may provide temporary relief. More advanced treatments include arthrocentesis (joint fluid removal), arthroscopy, or open-joint surgery, but these are reserved for severe cases that don't respond to conservative measures. TMJ disorders often involve inflammation of the joint connecting the jawbone to the skull and/or dysfunction of the surrounding muscles, which is why anti-inflammatory medications and muscle relaxation techniques form the cornerstone of treatment. It is essential to note that the management of TMJ arthritis requires an interdisciplinary approach and should be recognized as an integrated part of contemporary JIA disease control 1.
From the Research
Treatment Options for Temporomandibular Joint (TMJ) Disorder
The treatment options for TMJ disorder can be categorized into conservative and surgical approaches.
- Conservative therapies include noninvasive pharmacologic therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants 2.
- Minimally invasive injections, including botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose, can also be used to manage TMJ disorder 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.
Conservative Treatment Strategies
Conservative treatment strategies for TMJ disorder have been evaluated in several studies.
- Low-level laser therapy, self-exercise, and stabilization splints have been found to be effective in improving pain and maximal mouth opening in patients with TMJ disorder, although the certainty of evidence is very low 4.
- Occlusal splint alone or in combination with other therapeutic modalities has been shown to be effective in reducing short-term post-treatment TMD pain 5.
- Laser and photobiomodulation therapy have also been found to have a significant role in short-term pain relief 5.
Manual Therapies
Manual therapies, such as non-thrust mobilization and high-velocity, low amplitude thrust manipulation techniques, have been found to be effective in reducing pain and disability in patients with TMJ disorder.
- Dry needling or acupuncture of the lateral pterygoid and posterior, peri-articular connective tissue has also been found to lead to significant improvements in pain and disability in patients with TMD 6.
- However, there is limited evidence to support the use of strengthening exercises targeting the muscles of mastication, manual soft tissue work targeting muscles of mastication, and electrophysical modalities, including laser therapy, ultrasound, TENs, and iontophoresis 6.