From the Guidelines
Temporomandibular joint (TMJ) disorder treatment should prioritize conservative approaches, including reassurance, education, avoidance of aggravating activities, soft diet, jaw exercises, massage, non-steroidal anti-inflammatory drugs (NSAIDs), heat and/or cold, and bite plate in the presence of bruxism, as recommended by the most recent guidelines 1.
Symptoms of TMJ Disorder
The symptoms of TMJ disorder can include pain, clicking sounds, and limited jaw movement. These symptoms can be exacerbated by stress, jaw misalignment, arthritis, jaw injury, or chronic teeth grinding.
Treatment Options
Treatment typically begins with conservative approaches, including:
- Over-the-counter pain relievers like ibuprofen (400-800mg every 6-8 hours) or naproxen (220-500mg twice daily) for pain and inflammation 1
- Apply moist heat or ice packs to the affected area for 10-20 minutes several times daily
- Practice soft diet modifications by avoiding hard, chewy foods and cutting food into smaller pieces
- Gentle jaw stretching exercises performed 3-4 times daily can help improve mobility
- Stress reduction techniques such as meditation or deep breathing may help, as stress often worsens TMJ symptoms through increased muscle tension
- Night guards or oral splints prescribed by dentists can prevent teeth grinding and reduce joint strain during sleep
Further Evaluation and Treatment
If conservative measures fail after 2-3 weeks, seek professional evaluation from a dentist or oral surgeon who might recommend:
- Physical therapy
- Prescription muscle relaxants
- Corticosteroid injections
- Rarely, surgical intervention, such as arthrocentesis, arthroscopy, or open surgery of the temporomandibular joint, should be considered only after non-response to conservative therapy 1
Key Recommendations
The most recent guidelines recommend strong recommendations in favour of cognitive behavioural 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 1. It is essential to prioritize conservative and reversible treatment modalities, avoiding irreversible alterations of the temporomandibular joints, jaws, occlusion, or dentition, unless absolutely necessary 1.
From the Research
Symptoms of Temporomandibular Joint (TMJ) Disorder
- Pain and/or loss of function of the temporomandibular joint and its associated muscles and structures 2
- Jaw pain and restricted mouth opening that may limit a patient's access to comprehensive dental care 3
- Limitation or deviation of mandibular movement, and joint sounds 4
- Pain intensity and reduced jaw mobility 5
Treatment Options for TMJ Disorder
- 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, 6, 5
- Surgery 2, 3
- Conservative therapies, such as occlusal splint therapy and physical therapy 6, 4
- Intra-articular injections of substances with anti-inflammatory properties, such as betamethasone and sodium hyaluronate 5
Efficacy of Treatment Options
- Botulinum toxin injection has been found to be a viable treatment option for muscular temporomandibular joint disorder in patients who do not respond to conservative treatment methods 6
- Platelet-rich plasma injection has been found to achieve long-term success in reducing pain and increasing pain-free mouth opening 5
- All treatments used in the study, including bite splint, betamethasone, sodium hyaluronate, and platelet-rich plasma injection, caused a reduction in pain and increased pain-free mouth opening 5