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

Treatment for Temporomandibular Joint Disorder (Lock Jaw)

Conservative, reversible treatments should be pursued first for temporomandibular joint disorder (TMD), including reassurance, jaw rest, avoiding irritating behaviors, heat application, NSAIDs, and physiotherapy, before considering more invasive options. 1

First-Line Treatment Options

Non-Pharmacological Approaches

• Jaw rest and behavioral modifications:

  • Avoid wide mouth opening or aggravating activities 1
  • Adopt a soft diet 1
  • Avoid irritating behaviors (excessive jaw movement) 1

• Physical therapies:

  • Application of heat and/or cold to affected areas 1
  • Jaw exercises and massage 1
  • Physiotherapy including manual mobilization 1
  • Low-intensity laser therapy 1

• Oral appliances:

  • Bite plate or stabilization-type occlusal appliance if bruxism is present 1
  • Splint therapy 1

Pharmacological Approaches

• Anti-inflammatory medications:

  • NSAIDs as first-line pain management 1, 2
  • Muscle relaxants for muscle tension 1, 2, 3

• Additional medications for persistent pain:

  • Tricyclic antidepressants (e.g., amitriptyline) 1, 3
  • Anticonvulsants (e.g., gabapentin) 1, 2
  • Benzodiazepines for chronic cases 2, 3

Second-Line Treatment Options

Minimally Invasive Interventions

• Injection therapies (for refractory cases):
  • Trigger/tender point injections with local anesthetics 1
  • Botulinum toxin injections 1, 2
  • Intra-articular injections (with caution, especially in skeletally immature patients) 1
  • Consider platelet-rich plasma or hyaluronic acid injections 2

Complementary Approaches

• Mind-body therapies:
  • Cognitive behavioral therapy 1, 4
  • Meditation/relaxation strategies 1
  • Education about sleep hygiene 1
  • Acupuncture (moderate evidence) 1
  • Biofeedback 1
  • Hypnotherapy 1

Third-Line Treatment Options (for non-responsive cases)

Surgical Interventions

• Only consider after failure of conservative therapy 1:
  • Arthrocentesis 1
  • Arthroscopic procedures 1
  • Open surgery of the temporomandibular joint 1
  • More extensive procedures for severe cases (disc surgery, joint replacement) 1

Treatment Algorithm

1. Begin with conservative approaches:

   • Patient education and reassurance
   • Self-care measures (jaw rest, soft diet, heat/cold application)
   • NSAIDs and/or muscle relaxants
   • Oral appliance if bruxism is present

2. If inadequate response after 2-4 weeks:

   • Add physiotherapy/jaw exercises
   • Consider tricyclic antidepressants or anticonvulsants
   • Implement cognitive behavioral therapy or other mind-body approaches

3. For persistent symptoms (after 1-3 months of conservative treatment):

   • Consider minimally invasive injections
   • Referral to specialist (oral and maxillofacial surgeon, TMD specialist)

4. For refractory cases with significant dysfunction:

   • Surgical consultation
   • Select least invasive surgical option first

Important Considerations and Pitfalls

• Avoid premature invasive treatments: Surgery should only be considered after exhausting conservative options 1
• Prevent chronicity: Early intervention with appropriate conservative measures may prevent development of chronic pain syndrome 4
• Avoid irreversible treatments: Routine irreversible alteration of temporomandibular joints, jaws, occlusion, or dentition is not recommended 1
• Monitor for infection risk: When surgical intervention is necessary, implement proper infection prevention protocols, including prophylactic antibiotics 1
• Consider patient factors: Age is important when considering certain treatments; intra-articular steroid injections should be used with extreme caution in skeletally immature patients 1

The treatment of TMD requires a stepwise approach, starting with the least invasive options and progressing only when necessary. Most patients will respond to conservative measures, making them the cornerstone of TMD management.