From the Research
Emergency department treatment for Temporomandibular Joint Disorder (TMJD) should focus on pain relief and reducing inflammation, with initial management including NSAIDs such as ibuprofen 400-600mg every 6 hours or naproxen 500mg twice daily for 5-7 days, as supported by the most recent study 1. The goal of treatment is to reduce pain and improve function, and pharmacological agents commonly used for the treatment of TMJDs include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, muscle relaxants, antidepressants, anticonvulsants, and benzodiazepines 2. For moderate to severe pain, muscle relaxants like cyclobenzaprine 5-10mg at bedtime or diazepam 2-5mg every 8 hours for 3-5 days may be prescribed, with cyclobenzaprine showing statistically significant superiority to placebo and clonazepam in one study 3. Patients should be instructed to rest the jaw by eating soft foods, avoiding wide mouth opening, and applying moist heat or ice packs for 10-20 minutes several times daily. A short course of oral corticosteroids such as prednisone 40mg daily for 3-5 days with a taper may be considered for significant inflammation. Patient education is crucial, advising against gum chewing, nail biting, and clenching teeth. Most TMJD cases are self-limiting and respond well to conservative measures, and patients should be referred to a dentist or oral surgeon for follow-up care, especially if symptoms persist beyond 2 weeks. These interventions work by reducing inflammation in the joint space, relaxing the masticatory muscles, and allowing the joint to heal through limited movement. Key considerations in treatment include:
- Reducing pain and inflammation
- Relaxing the masticatory muscles
- Allowing the joint to heal through limited movement
- Patient education and self-care
- Referral to a dentist or oral surgeon for follow-up care. It's also important to note that the effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient education and self-care for the treatment of jaw pain upon awakening has been studied, with cyclobenzaprine showing superiority to placebo and clonazepam 3. Additionally, a survey of dentists found that most general dentists treat TMJD-related pain, and initial reversible care typically is provided, with splints or mouthguards, self-care, and over-the-counter or prescribed medications being the most frequently used treatments 4. However, the most recent and highest quality study on the topic of NSAIDs for acute pain in the emergency department found that oral ibuprofen at doses of 400,600, and 800 mg has similar analgesic efficacy for short-term pain relief in adult patients presenting to the ED with acute pain 1. Therefore, the most appropriate initial management for TMJD in the emergency department is NSAIDs, such as ibuprofen 400-600mg every 6 hours or naproxen 500mg twice daily for 5-7 days, with consideration of muscle relaxants and oral corticosteroids as needed, and referral to a dentist or oral surgeon for follow-up care.