What is the treatment for lock jaw (temporomandibular joint disorder)?

From the Guidelines

Treatment for temporomandibular joint disorder (TMJ), commonly known as lock jaw, typically begins with conservative approaches, prioritizing reassurance, education, and avoidance of aggravating activities, as recommended by the most recent guidelines 1. The initial management should focus on reducing pain and inflammation, using over-the-counter pain relievers like ibuprofen (400-800mg every 6-8 hours) or naproxen (220-500mg twice daily), and applying moist heat or ice packs to the jaw for 10-15 minutes several times daily.

• Gentle jaw stretching exercises and maintaining a soft diet, avoiding chewy foods, wide yawning, and gum chewing, are also essential.
• A custom-fitted night guard or splint prescribed by a dentist can prevent teeth grinding and reduce jaw tension.
• Physical therapy focusing on jaw exercises may help improve mobility and reduce pain, as supported by recent recommendations 1. For severe cases, muscle relaxants like cyclobenzaprine (5-10mg before bed) or prescription-strength NSAIDs might be necessary.
• Stress management techniques such as meditation or counseling can be beneficial since stress often worsens TMJ symptoms by causing jaw clenching. It is crucial to note that surgery should be considered only after non-response to conservative therapy, including arthrocentesis, arthroscopy, or open surgery of the temporomandibular joint, as emphasized by recent guidelines 1. Most TMJ cases improve with these conservative treatments within weeks to months as they address the underlying causes of muscle tension and joint inflammation.

From the FDA Drug Label

Animal studies indicate that cyclobenzaprine does not act at the neuromuscular junction or directly on skeletal muscle. Cyclobenzaprine caused slight to moderate increase in heart rate in animals Eight double-blind controlled clinical studies were performed in 642 patients comparing cyclobenzaprine hydrochloride 10 mg, diazepam, and placebo. Muscle spasm, local pain and tenderness, limitation of motion, and restriction in activities of daily living were evaluated

The treatment for lock jaw (temporomandibular joint disorder) may include cyclobenzaprine as it has been shown to be effective in relieving muscle spasm, local pain and tenderness, limitation of motion, and restriction in activities of daily living in clinical studies 2. Key points to consider when using cyclobenzaprine for lock jaw treatment include:

• Starting with a low dose, such as 5 mg, and titrating slowly upward
• Being cautious when using cyclobenzaprine in patients with hepatic impairment
• Monitoring for adverse reactions, such as dry mouth and drowsiness
• Considering alternative treatments if cyclobenzaprine is not effective or is not well-tolerated.

From the Research

Treatment Options for Lock Jaw (Temporomandibular Joint Disorder)

• Noninvasive pharmacologic therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants, are commonly used to treat temporomandibular joint disorder 3, 4.
• Minimally invasive injections, including botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose, can also be effective in managing symptoms 3.
• Conservative therapies, such as self-care, physical therapy, and appliance therapy, are often recommended as initial treatments for temporomandibular joint disorder 4, 5.
• Orally administered nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to alleviate pain in temporomandibular joint osteoarthritis, but it is recommended to use the lowest effective dose for the shortest possible time 6.
• Glucosamine sulfate has been shown to be a more effective and safer therapeutic agent than ibuprofen in treating patients with temporomandibular joint degenerative joint disorder 7.

Pharmacological Agents

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat temporomandibular joint disorder, with diclofenac sodium being one of the most commonly used NSAIDs 3, 4, 6.
• Muscle relaxants, such as benzodiazepines, can be used to relieve muscle tension and pain associated with temporomandibular joint disorder 3, 4.
• Antidepressants and anticonvulsants can also be used to manage pain and other symptoms of temporomandibular joint disorder 3, 4.

Important Considerations

• Treatment for temporomandibular joint disorder should be directed toward reducing pain and improving function 4.
• The decision to select a particular treatment option depends on a full understanding of the risks and benefits associated with each agent 4.
• Patients with increased risk of gastrointestinal complications should be prescribed supplementary gastroprotective agents when using NSAIDs 6.