From the Guidelines
Treatment options for TMJ disorders should begin with conservative, non-surgical approaches, prioritizing self-care measures, over-the-counter pain medications, and physical therapy, before considering more invasive interventions, as recommended by the most recent guidelines 1. The initial approach to managing TMJ disorders involves a combination of self-care measures and non-pharmacological interventions. Patients are advised to eat soft foods, avoid extreme jaw movements, apply ice or heat packs, and practice gentle jaw stretching exercises. Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) can help manage pain and inflammation.
- Key aspects of conservative management include:
- Self-care measures to reduce jaw strain
- Over-the-counter pain medications for pain and inflammation
- Physical therapy focusing on jaw exercises and massage to improve jaw mobility and reduce pain
- Custom-fitted oral splints or night guards for teeth grinding or clenching For more severe cases, prescription medications might include muscle relaxants like cyclobenzaprine (5-10mg at bedtime), tricyclic antidepressants such as amitriptyline (10-25mg at bedtime), or corticosteroid injections directly into the joint. Minimally invasive procedures include arthrocentesis (joint fluid removal) or arthroscopy for internal joint derangement.
- The most recent and highest quality studies support the use of cognitive behavioral therapy (CBT) and physiotherapy as effective treatments for TMJ disorders, with strong recommendations in favor of these interventions 1. Surgery is reserved for the most severe cases that don't respond to other treatments. These options work by addressing different aspects of TMJ disorders: reducing inflammation, relaxing tense muscles, correcting misalignments, and improving joint function. Most patients find relief with conservative treatments, making surgery rarely necessary, as emphasized by the guidelines 1.
From the Research
Treatment Options for Temporomandibular Joint (TMJ) Disorders
- Conservative treatment options include muscle exercises, occlusal splint therapy, and physiotherapy 2, 3, 4
- Surgical treatment options include arthrocentesis, arthroscopy, and open joint surgery 2, 3, 5
- Minimally invasive procedures, such as intraarticular injection of hyaluronic acid or corticosteroid, may be effective for pain reduction and improvement of mouth opening 3
- Arthrocentesis, a procedure that involves flushing out the joint with a fluid, may be used to treat TMJ disorders, especially those with limited mouth opening or pain 5, 6
Comparison of Treatment Options
- A network meta-analysis of randomized clinical trials found that minimally invasive procedures, such as arthrocentesis and intraarticular injection, were more effective than conservative treatments for pain reduction and improvement of mouth opening 3
- A systematic review and meta-analysis found that arthrocentesis may result in a significant but small improvement in pain scores compared to conservative therapies, but without any additional improvement in mouth opening 6
Specific Treatments
- Intraarticular injection of hyaluronic acid (IAI-HA) and intraarticular injection of corticosteroid (IAI-CS) were found to be effective for pain reduction in the short term (≤5 months) 3
- Arthroscopy with platelet-rich plasma (PRP) and arthrocentesis with PRP were found to be effective for pain reduction and improvement of mouth opening in the intermediate term (≥6 months) 3