From the Guidelines
Treatment for temporomandibular joint (TMJ) disorders should begin with conservative, non-surgical approaches, prioritizing cognitive behavioral therapy (CBT) with or without biofeedback or relaxation therapy, as strongly recommended by recent guidelines 1. The management of TMJ disorders involves a range of therapies aimed at decreasing pain and functional limitation, and improving quality of life. Key components of conservative management include:
- Over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) to reduce inflammation and pain
- Applying moist heat or ice packs to the jaw for 10-15 minutes several times daily to ease discomfort
- Practicing gentle jaw stretching exercises and avoiding extreme jaw movements like wide yawning or aggressive chewing
- A soft diet that eliminates hard, crunchy, or chewy foods to help rest the jaw
- Stress management techniques such as meditation or deep breathing to reduce teeth clenching or grinding that often worsens TMJ pain
- Using a mouth guard or splint (available over-the-counter or custom-made by dentists) at night to prevent teeth grinding Recent guidelines also conditionally recommend manipulation, supervised jaw exercise with mobilisation, CBT with non-steroidal anti-inflammatory drugs (NSAIDS), manipulation with postural exercise, and acupuncture 1. However, strong recommendations are made against irreversible oral splints, discectomy, and NSAIDS with opioids due to their potential for harm and lack of benefit 1. It's essential to consult a healthcare provider if these measures don't provide relief within 2-3 weeks, as they may recommend additional therapies such as physical therapy, prescription muscle relaxants, or corticosteroid injections for severe cases, always prioritizing the patient's quality of life and minimizing the risk of morbidity and mortality 1.
From the Research
Treatment Options for TMJ
- Conservative treatment options are available for temporomandibular joint (TMJ) disorders, including drug therapy, physical therapy, and occlusal splint therapy 2, 3.
- Botulinum toxin injection is a viable treatment option for muscular temporomandibular joint disorder, particularly for patients who do not respond to conservative treatment methods 4, 5.
- Non-thrust mobilization and high-velocity, low amplitude thrust manipulation techniques to the TMJ and/or upper cervical articulations can be effective in reducing pain and disability associated with TMD 6.
- Dry needling or acupuncture of the lateral pterygoid and posterior, peri-articular connective tissue may also lead to significant improvements in pain and disability in patients with TMD 6.
Comparison of Treatment Options
- A study comparing the efficacy of occlusal splinting with botulinum toxin administration in the treatment of TMJ pain found that both methods were effective in pain reduction, but botulinum toxin injection was less effective in reducing pain 5.
- Another study found that botulinum toxin injection was successful in treating muscular TMD in patients who did not respond to other treatments, with no side effects observed at six months follow-up 4.
Multidisciplinary Approach
- A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients, allowing treatment to be specifically tailored to individual patient needs 2.
- Treatment should be evidenced-based and in the patient's best interests, with a focus on reducing pain and disability associated with TMD 3, 6.