What are the treatment options for Temporomandibular Joint (TMJ) disorder?

From the Guidelines

Treatment for TMJ disorder should begin with conservative, non-surgical approaches, including reassurance, education, avoidance of aggravating activities, soft diet, jaw exercises, massage, non-steroidal anti-inflammatory drugs (NSAIDs), heat and/or cold, and physiotherapy, as recommended by the most recent guidelines 1. The goal of treatment is to reduce pain, improve jaw function, and prevent further joint damage.

• Initial treatments may include:
  • Over-the-counter pain relievers such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) to reduce inflammation and pain
  • Muscle relaxants like cyclobenzaprine (5-10mg at bedtime) for short-term use (2-3 weeks) to relieve muscle spasms
  • Applying moist heat or ice packs to the jaw for 10-15 minutes several times daily to manage pain
  • Physical therapy exercises focusing on gentle jaw stretching and strengthening to improve jaw mobility and function
• Custom-fitted oral splints or night guards worn while sleeping can prevent teeth grinding and reduce joint stress, as supported by recent recommendations 1.
• Lifestyle modifications are essential, including eating soft foods, avoiding extreme jaw movements like wide yawning, practicing stress management techniques, and maintaining proper posture.
• For persistent cases, cognitive behavioral therapy (CBT) with or without biofeedback or relaxation therapy is strongly recommended 1, as well as supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy.
• Surgery is reserved only for severe cases that don't respond to other treatments, and strong recommendations are made against irreversible oral splints, discectomy, and NSAIDs with opioids 1.

From the Research

Treatment Options for Temporomandibular Joint (TMJ) Disorder

The treatment options for TMJ disorder can be categorized into conservative and surgical approaches.

• Conservative treatment options include:
  • Occlusal appliances or splints 2
  • Physical therapy 2
  • Medication 3
  • Intra-articular injections of sodium hyaluronate or corticosteroids 4, 5, 3
• Surgical treatment options include:
  • Arthrocentesis 4
  • Conservative resection of the ankylotic mass followed by interpositional gap arthroplasty with collagen membrane 6
  • Other surgical modalities 3

Efficacy of Treatment Options

Studies have shown that:

• Intra-articular injections of sodium hyaluronate can reduce pain intensity and improve mouth opening in patients with TMJ disorder 4, 5
• A two-phase physiotherapy protocol following conservative resection of the ankylotic mass can improve mouth opening and reduce the risk of reankylosis in patients with TMJ ankylosis 6
• Glucosamine and ibuprofen can be effective in managing TMJ osteoarthritis 3
• Diclofenac sodium and occlusal splints can also reduce pain in patients with TMJ osteoarthritis 3

Considerations for Treatment

It is essential to note that:

• A multidisciplinary team approach is necessary for the management of TMJ disorders 2
• Treatment should be tailored to individual patient needs 2
• More research is needed to determine the effectiveness of different treatment options for TMJ osteoarthritis 3