From the Guidelines
The recommended treatment for TMJ pain is cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, as it has been shown to be effective in managing chronic pain associated with temporomandibular disorders. This approach is supported by the most recent and highest quality study, which issued strong recommendations in favour of CBT and other non-invasive interventions 1. The treatment of TMJ pain should prioritize conservative, non-invasive approaches, and the following options are recommended:
- 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 These interventions have been shown to be effective in reducing pain and improving physical and emotional functioning in patients with chronic TMJ pain 1. It is essential to note that the recommendations apply to adult patients living with moderate chronic pain (4-6 cm on a 10 cm pain scale for ≥3 months duration) associated with temporomandibular disorders (TMD) as a group of conditions, and do not apply to the management of acute TMD pain (<3 months duration) 1.
The treatment plan should be individualized, and patients should be encouraged to participate in shared decision-making to ensure that their values and preferences are taken into account. The use of reversible occlusal splints, arthrocentesis, and other invasive or irreversible therapies should be avoided, as they have been conditionally recommended against due to limited evidence of their effectiveness and potential risks 1. By prioritizing conservative, non-invasive approaches and involving patients in the decision-making process, healthcare providers can help improve outcomes and reduce the morbidity and mortality associated with TMJ pain.
From the Research
Treatment Options for TMJ Pain
- Conservative therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants, can be used to manage mild to moderate TMJ disorder 2.
- Minimally invasive injections, including botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose, can also be effective in reducing TMJ pain 2.
- A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients, as treatment can 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, betamethasone, sodium hyaluronate, and platelet-rich plasma, caused a reduction in pain and increased pain-free mouth opening 4.
- The study also 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.
- A network meta-analysis of randomized clinical trials found that low-level laser therapy, self-exercise, and stabilization splints may be effective in improving pain and maximal mouth opening in patients with TMD 5.
Biomechanics and Treatment of TMJ Disorders
- Evaluating the kinetics and kinematics of the TMJ enables the understanding of structure and function of normal and diseased TMJ to predict changes due to alterations, and to propose more efficient methods of treatment 6.
- A comprehensive analysis of the TMJ anatomy, TMD, treatment options, and TMJ biomechanics is necessary for better understanding of different movements and resulting forces and stresses in the joint components 6.