From the Guidelines
The first line treatment for Temporomandibular Joint (TMJ) disorders should prioritize conservative, non-invasive approaches, including self-care practices, over-the-counter pain medications, physical therapy, and custom-fitted occlusal splints or night guards, as recommended by recent guidelines 1. These conservative measures are preferred due to their effectiveness in managing TMJ disorders and the lower risk of complications compared to invasive procedures.
Key Components of First Line Treatment
- Self-care practices: eating soft foods, avoiding extreme jaw movements, applying ice or moist heat to the affected area, and practicing gentle jaw stretching exercises
- Over-the-counter pain medications: ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to manage pain and inflammation
- Physical therapy: focusing on jaw exercises and massage
- Custom-fitted occlusal splint or night guard: for nighttime teeth grinding
Referral to Specialists
If conservative measures fail after 4-6 weeks, referral to specialists may be necessary, including:
- Dentists specializing in TMJ disorders: for advanced splint therapy or occlusal adjustments
- Oral and maxillofacial surgeons: for severe cases requiring arthrocentesis, arthroscopy, or open joint surgery
- Pain management specialists: for trigger point injections or botulinum toxin treatments
- Physical therapists specializing in orofacial pain: for targeted exercises and manual therapy As supported by the most recent guideline 1, strong recommendations are made in favor of cognitive behavioral therapy, therapist-assisted mobilization, and supervised jaw exercise and stretching, among other conservative approaches, highlighting the importance of non-invasive treatments in the management of TMJ disorders.
From the Research
First Line Treatment for TMJ Disorders
- The first line treatment for Temporomandibular Joint (TMJ) disorders includes noninvasive pharmacologic therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants 2.
- Conservative therapies, including reassurance, occlusal appliances, physical therapy, and medication, are also commonly used to manage TMJ osteoarthritis 3.
- Massage therapy, individually fabricated occlusal splints, manual therapy, and taping are also reported as effective conservative treatments for TMJ disorders 4.
Specialist Referrals
- Referral to an oral and maxillofacial surgeon may be necessary for patients with severe TMJ disorders, as they can provide minimally invasive muscular and articular injections, and surgery if needed 2.
- Patients with posttraumatic TMJ disorders may require referral to a specialist for treatment of complications such as facial asymmetry, malocclusion, and osteoarthritis 5.
- In cases of severe acute pain or chronic pain resulting from serious disorders, inflammation, and/or degeneration, referral to a pain management specialist or a surgeon for pharmacotherapy, minimally invasive, or invasive procedures may be necessary 4.
- For patients requiring temporomandibular joint total joint replacement (TJR), referral to a surgeon with expertise in this area may be necessary 6.