What are the discharge instructions from the Emergency Department (ED) for a patient with Temporomandibular Joint Disorder (TMJD)?

From the Guidelines

Discharge instructions for a patient with Temporomandibular Joint Disorder (TMJD) from the Emergency Department should prioritize conservative and reversible treatment modalities, focusing on pain management, lifestyle modifications, and follow-up care. The most recent guideline recommends conservative approaches as the first line of treatment, including 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, and physiotherapy 1. Patients should be advised to take ibuprofen 400-600mg every 6 hours or naproxen 500mg twice daily as needed for pain and inflammation, for no more than 10 days without physician consultation.

Key Recommendations

• Apply moist heat or ice packs to the jaw area for 15-20 minutes several times daily to reduce pain and inflammation
• Eat soft foods like yogurt, mashed potatoes, and smoothies while avoiding hard, chewy, or crunchy foods
• Avoid extreme jaw movements including wide yawning, gum chewing, and biting fingernails
• Practice gentle jaw stretching exercises by slowly opening and closing your mouth 5-10 times, several times daily
• Use stress reduction techniques such as deep breathing or meditation, as stress can worsen TMJD symptoms through increased muscle tension

Follow-up Care

Patients should follow up with their primary care provider within 1-2 weeks, who may refer them to a dentist or oral surgeon specializing in TMJD. It is essential to return to the ED immediately if severe worsening pain, inability to open or close the mouth, or new facial numbness occurs. These instructions address the inflammatory and muscular components of TMJD while preventing further strain on the temporomandibular joint during the healing process, as recommended by recent guidelines 1.

From the Research

Discharge Instructions for TMJD Patients from the ED

Discharge instructions for patients with Temporomandibular Joint Disorder (TMJD) from the Emergency Department (ED) should focus on pain management and follow-up care. The following points should be considered:

• Pain management: Patients should be advised to take over-the-counter pain medications such as ibuprofen or acetaminophen as directed 2, 3.
• Follow-up care: Patients should be instructed to follow up with their primary care physician or a specialist, such as an oral surgeon or a dentist, for further evaluation and treatment 4, 5.
• Jaw rest: Patients should be advised to rest their jaw and avoid heavy chewing or biting 2, 3.
• Soft food diet: Patients should be instructed to eat a soft food diet to reduce strain on the jaw joint 2, 3.
• Stress reduction: Patients should be advised to practice stress-reducing techniques, such as meditation or deep breathing, to help manage TMJD symptoms 4.

Medications

Medications that may be prescribed for TMJD patients include:

• Ibuprofen: A non-steroidal anti-inflammatory drug (NSAID) that can help reduce pain and inflammation 2, 3.
• Glucosamine sulfate: A natural compound that can help reduce pain and inflammation in the jaw joint 2, 3.
• Muscle relaxants: Medications that can help relax the muscles of the jaw and face 4.

Potential Complications

Potential complications of TMJD that patients should be aware of include:

• Abscess formation: A serious infection that can occur in the masticator space, which requires prompt medical attention 5.
• Autoimmune disorders: Certain autoimmune disorders, such as rheumatism, may be associated with an increased risk of TMJD 6.
• Inflammatory conditions: Certain inflammatory conditions, such as pneumonia or asthma, may be associated with an increased risk of TMJD 6.