From the Guidelines
Treatment for temporomandibular joint (TMJ) disorders should begin with conservative, non-surgical approaches, prioritizing patient education, reassurance, and avoidance of aggravating activities, as recommended by the most recent guidelines 1.
Key Recommendations
- Start with over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) to reduce inflammation and pain, as suggested by recent studies 1.
- Apply moist heat or ice packs to the affected area for 10-15 minutes several times daily, and practice gentle jaw stretching exercises to reduce strain on the jaw, as recommended by the BMJ guideline 1.
- Avoid extreme jaw movements like wide yawning or aggressive chewing, and use a soft diet that excludes chewy or hard foods to reduce strain on the jaw.
- At night, use a mouth guard or splint (available over-the-counter or custom-fitted by a dentist) to prevent teeth grinding and reduce pressure on the joint, as suggested by the Arthritis and Rheumatology study 1.
- Stress management techniques such as meditation or physical therapy may also help, as tension often worsens TMJ pain, as noted in the interdisciplinary consensus-based recommendations 1.
Additional Considerations
- If these measures don't provide relief within 2-3 weeks, consult a healthcare provider who might prescribe muscle relaxants like cyclobenzaprine (5-10mg before bed), stronger anti-inflammatories, or refer you to a specialist for procedures like corticosteroid injections or, rarely, surgery, as recommended by the guidelines 1.
- Most TMJ disorders improve with conservative treatment as they allow the joint and surrounding muscles to heal from inflammation and overuse, highlighting the importance of a non-surgical approach 1.
Evidence-Based Approach
- The recent BMJ guideline 1 provides strong recommendations in favor of cognitive behavioral therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care.
- The Arthritis and Rheumatology study 1 suggests that occlusal splints and/or physical therapy may be beneficial in patients with orofacial symptoms and/or TMJ dysfunction, with a level of evidence of 4 and a strength of recommendation of 8.3 ± 2.2.
- The interdisciplinary consensus-based recommendations 1 emphasize the importance of an interdisciplinary approach and longitudinal evaluation into adulthood, regardless of the current TMJ disease activity, with a focus on patient-centered care and evidence-based treatment.
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 therapies include:
- Noninvasive pharmacologic therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants 2
- Minimally invasive muscular and articular injections, including botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose 2
- Use of a nocturnal bite splint 3
- Physical therapy 4
- Surgical treatment options may be considered for patients who do not respond to conservative measures, and may include:
Comparative Effectiveness of Treatment Options
Studies have compared the outcome of different treatment modalities for TMJ disorder, including:
- A comparative randomized study that found all treatments used, including a bite splint alone or in combination with intra-articular injections of substances with anti-inflammatory properties, caused a reduction in pain and increased pain-free mouth opening 3
- A study that found arthrocentesis with intra-articular morphine injection to be an effective, minimally invasive technique in patients with continuing pain in the TMJ that is unresponsive to conservative management 5