From the Guidelines
Treatment for TMJ pain should begin with conservative approaches, including over-the-counter pain relievers like ibuprofen (400-800mg every 6-8 hours) or naproxen (220-500mg twice daily), as well as applying moist heat or ice packs to the jaw for 10-15 minutes several times daily, as recommended by the most recent guidelines 1. The goal of these treatments is to reduce inflammation and pain, and to relax tense muscles around the joint. Some key points to consider when treating TMJ pain include:
- Eating soft foods to reduce strain on the jaw
- Avoiding extreme jaw movements like wide yawning or gum chewing
- Practicing gentle jaw stretching exercises to help reduce strain
- Using stress management techniques, as tension often worsens TMJ pain
- Considering a dental night guard (occlusal splint) to prevent teeth grinding and reduce pressure on the joint
- For persistent cases, prescription muscle relaxants like cyclobenzaprine (5-10mg before bed) or physical therapy focusing on jaw exercises might be recommended, as supported by recent studies 1. It's also important to note that most TMJ pain resolves with these conservative treatments, though severe cases may require dental work, injections, or rarely, surgery. Recent guidelines have issued strong recommendations in favour of 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, and usual care, as outlined in the BMJ study 1. Additionally, conditional recommendations have been made in favour of manipulation, supervised jaw exercise with mobilisation, CBT with non-steroidal anti-inflammatory drugs (NSAIDS), manipulation with postural exercise, and acupuncture, as supported by the evidence 1.
From the Research
Treatment Options for TMJ Pain
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for alleviation of pain localized in the orofacial area, including TMJ pain 2
- Conservative treatments such as massage therapy, individually fabricated occlusal splints, manual therapy, and taping are also reported to be effective in managing TMJ pain 3
- In some cases, surgical restoration of the joint may be necessary, especially in severe cases of temporomandibular joint degeneration 3
- Naproxen-loaded nanostructured lipid carriers (NLC) have shown improved efficacy in reducing inflammatory pain conditions of the TMJ 4
- Intra-articular injections of corticosteroids, hyaluronate, or placebo may also be used to treat TMJ osteoarthritis, with corticosteroid injections being superior to placebo in relieving pain in the long-term 5
Pharmacological Interventions
- NSAIDs, such as diclofenac sodium, are commonly used to treat TMJ pain, but it is recommended to use the lowest effective dose for the shortest possible time to minimize side effects 2
- Naproxen-loaded NLC have shown promise in reducing inflammatory pain conditions of the TMJ, with sustained delivery of naproxen directly in the TMJ significantly reducing leukocytes migration and levels of pro-inflammatory cytokines 4
Non-Pharmacological Interventions
- Massage therapy, manual therapy, and taping are popular methods used to manage TMJ pain, in addition to occlusal splint therapy and counselling 3
- Conservative treatment, including exercises and occlusal splint therapy, should be considered as a first choice therapy for TMJ pain due to their low risk of side effects 3