What are the treatment options for jaw pain?

Treatment of Jaw Pain

For chronic jaw pain related to temporomandibular disorders (TMD), start with jaw exercises, jaw stretching, trigger point therapy, and postural exercises—these are strongly recommended first-line treatments that provide substantial pain relief without significant harms. 1

Initial Assessment and Red Flags

Before initiating TMD treatment, rule out serious underlying conditions:

• Monitor for osteonecrosis: Jaw swelling and pain with exposed bone may indicate medication-related osteonecrosis of the jaw (MRONJ), particularly in patients on bisphosphonates or denosumab—refer immediately to oral surgery if suspected 1
• Consider malignancy: In head and neck cancer survivors, jaw pain warrants dental/periodontal evaluation 1
• Exclude inflammatory arthritis: Jaw pain with systemic symptoms may indicate rheumatoid arthritis or other connective tissue disease requiring disease-modifying therapy 2, 3

Treatment Algorithm for TMD-Related Chronic Jaw Pain

First-Line Strongly Recommended Interventions (Start Here)

These interventions have the strongest evidence for pain relief and functional improvement, with benefits clearly outweighing harms:

• Jaw exercises and stretching: Provides approximately 1.5 times the minimally important difference in pain reduction 1, 4
• Manual trigger point therapy: Delivers nearly twice the minimally important difference in pain severity reduction 1, 4
• Jaw mobilization: Therapist-assisted mobilization techniques 1
• Postural exercises: Supervised postural correction 1
• Combined approach: Jaw exercise + jaw stretching + trigger point therapy together 1
• Augmented cognitive behavioral therapy (CBT): Particularly when psychological factors or stress contribute to symptoms 1

Pharmacological Support

• NSAIDs (e.g., ibuprofen): First-line for pain and inflammation control 4, 5, 6
  • Ibuprofen possesses analgesic and antipyretic activities through prostaglandin synthetase inhibition 6
  • Critical warning: Never combine NSAIDs with opioids—this combination is strongly recommended against due to increased risks without additional benefit 1, 4, 5

Second-Line Conditionally Recommended Interventions

Consider these if first-line treatments provide insufficient relief after 12 weeks:

• Manipulation techniques: Joint realignment may benefit select patients 1, 4
• Acupuncture: Shows moderate evidence for TMJ pain relief 1, 4
• Combined jaw exercise + mobilization: 1
• CBT combined with NSAIDs: If medications remain partially effective 1, 4

Interventions to Avoid or Use with Extreme Caution

The 2023 BMJ guideline conditionally recommends against these commonly used treatments due to uncertain benefits and potential harms:

• Occlusal splints (reversible): Despite widespread use, evidence for effectiveness is limited 1, 4, 7
• Acetaminophen: With or without muscle relaxants, shows uncertain benefit 1
• Benzodiazepines: Associated with harms without clear benefit 1
• Botulinum toxin injections: Uncertain effectiveness 1, 4
• Low-level laser therapy: Limited evidence 1, 4, 7
• Arthrocentesis: Conditionally recommended against except in refractory cases 1, 4
• Gabapentin: Uncertain benefit for TMD pain 1

Strongly Recommended Against (Never Use)

• Irreversible oral splints: Permanent dental alterations without clear indication 1, 4, 5, 7
• Discectomy: Invasive procedure with uncertain benefit and potential harm 1, 4, 5, 7
• NSAIDs + opioid combinations: Increased risks without additional benefit 1, 4, 5

Special Considerations

For Suspected Osteonecrosis

If jaw pain presents with swelling and/or exposed bone:

• Early-stage lesions: Administer broad-spectrum antibiotics and daily saline or chlorhexidine gluconate irrigations 1
• Immediate referral: To oral surgeon, maxillofacial surgeon, or oral oncologist 1
• Note: Conservative non-surgical management of MRONJ stage I shows poor long-term outcomes (only 8.7% healing rate), with most cases progressing despite treatment 8

Patient Education and Self-Management

Essential components often overlooked:

• Avoid aggravating activities and parafunctional habits 4, 2, 9
• Maintain soft diet during acute phases 4, 2, 9
• Apply heat/cold therapy to affected areas 4, 2, 9
• Practice jaw rest and relaxation techniques 2, 9

Common Pitfalls to Avoid

• Premature invasive intervention: Exhaust conservative options before considering surgery 4, 5, 10
• Over-reliance on splints: Despite their popularity, occlusal splints have limited evidence and should not be the sole treatment 1, 4, 5, 7
• Polypharmacy without benefit: Combining multiple medications (especially NSAIDs with opioids or muscle relaxants) increases harm without improving outcomes 1, 4, 5
• Neglecting exercise therapy: Physical therapy with jaw exercises and stretching has the strongest evidence but is often underutilized 1, 4, 9
• Missing systemic disease: Jaw pain may be the presenting symptom of rheumatoid arthritis, fibromyalgia, or other systemic conditions requiring different management 3

Timeline Expectations

• 0-2 weeks: Initiate patient education, NSAIDs, jaw rest, and self-care measures 4, 2, 9
• 2-12 weeks: Begin supervised jaw exercises, stretching, trigger point therapy, and postural exercises 4, 9
• After 12 weeks: If inadequate response, consider second-line interventions like acupuncture or manipulation 4
• After 6 months: For truly refractory cases unresponsive to comprehensive conservative treatment, consider arthrocentesis or surgical consultation 4

Note: These recommendations apply specifically to chronic TMD pain (≥3 months duration) and do not apply to acute jaw pain, which may require different management 1