From the Guidelines
For severe degeneration of the right temporomandibular joint (TMJ), conservative approaches should be pursued first, including reassurance and education, avoidance of wide mouth opening or aggravating activities, soft diet, jaw exercises, massage, non-steroidal anti-inflammatory drugs (NSAIDs), heat and/or cold, bite plate in the presence of bruxism, physiotherapy, mindfulness, yoga, meditation, acupuncture, splint therapy, cognitive behavioural therapy, paracetamol, and neuromodulatory medications. According to the most recent guideline 1, the initial management of chronic pain associated with temporomandibular disorders should focus on conservative, reversible, and evidence-based treatment modalities. Key components of this approach include:
- Avoiding irritating behaviors such as excessive movement and wide mouth opening
- Using NSAIDs for pain and inflammation
- Applying heat or cold for relief
- Utilizing oral appliances like a bite plate for bruxism
- Engaging in physiotherapy and mindfulness exercises
- Considering pharmacotherapy with medications like amitriptyline or gabapentin for neuromodulation If these conservative measures fail to provide adequate relief after 3-6 months, more invasive options such as arthrocentesis, arthroscopy, or open surgery of the temporomandibular joint may be considered 1. It's crucial to address underlying causes of TMJ degeneration, such as osteoarthritis, disc displacement, or chronic bruxism, for effective long-term management. Surgery should only be considered after non-response to conservative therapy, emphasizing the importance of exhausting all non-invasive options first 1.
From the Research
Treatment Options for Severe Degeneration of the Right-Sided Temporomandibular Joint (TMJ)
- The treatment for severe degeneration of the right-sided Temporomandibular Joint (TMJ) may involve various options, including noninvasive pharmacologic therapies, minimally invasive muscular and articular injections, and surgery 2.
- Conservative therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants, can be used to manage mild to moderate TMJ disorder 2.
- Minimally invasive injections, including botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose, can also be effective in managing TMJ disorders 2.
- Arthrocentesis, which involves the injection of sodium hyaluronate (Hyalgan) into the TMJ, has been shown to be effective in improving symptoms of pain and function in patients with degenerative joint disease (DJD) 3.
- Intra-articular steroid injection and arthrocentesis have been compared as treatment options for internal derangement of the TMJ, with both procedures showing success in reducing pain and improving mouth opening 4, 5.
- The use of a mixture of hyaluronic acid and corticosteroid for intra-articular injection has been found to be effective in the management of TMJ internal derangement, with similar results to arthrocentesis 5.
- Current understanding of the pathogenesis and treatment of TMJ osteoarthritis suggests that conservative therapy with nonsteroidal anti-inflammatory drugs, splint, and physical therapy, such as low-energy laser and arthrocentesis, are the most common treatments, but their long-term therapeutic effect on the pathologic articular structure is unsatisfactory 6.
Specific Treatment Approaches
- Arthrocentesis with sodium hyaluronate injection has been shown to improve mouth opening, sideways movements, pain at rest and on movement, and masticatory efficiency in patients with DJD 3.
- Intra-articular steroid injection has been found to be effective in reducing pain and improving mouth opening in patients with internal derangement of the TMJ 4, 5.
- The use of a mixture of hyaluronic acid and corticosteroid for intra-articular injection has been found to be effective in the management of TMJ internal derangement, with similar results to arthrocentesis 5.