What are the treatment options for jaw pain?

Treatment Options for Jaw Pain

Start with jaw exercises, jaw stretching, manual trigger point therapy, jaw mobilization, and postural exercises—these are the most effective first-line treatments for chronic jaw pain related to temporomandibular disorders (TMD), with strong evidence showing pain reduction approximately 1.5 to 2 times the minimally important clinical difference. 1

Initial Assessment: Rule Out Life-Threatening Causes First

Before treating as TMD, immediately evaluate for:

• Giant cell arteritis if patient is >50 years old with jaw claudication (pain with chewing), temporal headache, scalp tenderness, visual changes, fever, or malaise—check ESR and CRP urgently and start prednisone 40+ mg daily immediately without waiting for temporal artery biopsy to prevent permanent vision loss 2
• Trigeminal neuralgia if pain is sharp, electric shock-like, triggered by light touch/washing/eating, with refractory periods between attacks—obtain MRI to exclude tumors or multiple sclerosis 2
• Glossopharyngeal neuralgia if pain is deep in ear/back of tongue triggered by swallowing, which can provoke syncope 2
• Salivary stones or tumors if pain occurs just before eating with tender, swollen salivary gland—perform bimanual palpation and ultrasound 2

First-Line Treatments (Start Here for TMD-Related Jaw Pain)

These interventions have strong recommendations and should be initiated together:

• Supervised jaw exercises and stretching: Perform 3-5 times daily with specific movements including opening, lateral excursions, and protrusion exercises 1, 3, 4
• Manual trigger point therapy: Apply sustained pressure to tender points in masseter, temporalis, and pterygoid muscles by a trained therapist 1
• Jaw mobilization: Therapist-assisted manual techniques to improve joint mobility and reduce pain 1
• Postural exercises: Correct forward head posture and neck alignment to reduce TMJ strain 1
• Patient education and usual care: Soft diet, avoid gum chewing and wide yawning, apply moist heat for 20 minutes once daily to facial and cervical regions, and use ice for acute flares 1, 5
• Augmented cognitive behavioral therapy (CBT): Address pain catastrophizing, sleep disturbance, and psychological factors contributing to chronic pain 1

Pharmacological Management

• NSAIDs: Use for pain relief and inflammation reduction as needed 1
• Avoid acetaminophen with or without muscle relaxants—evidence shows uncertain benefits 1
• Muscle relaxants (cyclobenzaprine, tizanidine) added to self-care are no more effective than placebo for jaw pain 6
• Consider amitriptyline or gabapentin only for chronic refractory pain after first-line treatments fail 1
• Never combine NSAIDs with opioids—this is strongly recommended against due to increased harms without additional benefit 1

Second-Line Treatments (If Inadequate Response After 3 Months)

Consider these interventions next, though benefits are less certain:

• Manipulation techniques: Joint realignment by trained practitioner 1
• Acupuncture: Moderate evidence for effectiveness 1
• Combined jaw exercise with mobilization: If single modalities insufficient 1
• CBT combined with NSAIDs: If medications remain partially effective 1

Interventions to Use Cautiously or Avoid

Conditional recommendations against (uncertain benefits, potential harms):

• Occlusal splints: Despite widespread use, evidence is limited; consider only for documented nocturnal bruxism 1
• Arthrocentesis (joint lavage): May provide temporary relief but benefits are uncertain and short-lived 1
• Botulinum toxin injections: No benefit demonstrated in randomized trials 1
• Low-level laser therapy: Insufficient evidence 1
• Transcutaneous electrical nerve stimulation (TENS): Limited effectiveness 1
• Biofeedback or relaxation therapy alone: Insufficient evidence when used without CBT 1
• Benzodiazepines or beta-blockers: Potential harms outweigh uncertain benefits 1
• Hyaluronic acid or steroid injections: Uncertain benefits 1

Strong recommendations against (do not offer):

• Irreversible oral splints (permanent dental alterations): Associated with important harms including malocclusion and tooth movement 1
• Discectomy (surgical disc removal): Benefits uncertain with significant surgical risks 1
• NSAIDs combined with opioids: Increased harm without additional benefit 1

Treatment Algorithm

Weeks 0-4:

• Rule out life-threatening causes (giant cell arteritis, trigeminal neuralgia) 2
• Initiate patient education, soft diet, moist heat application 1, 5
• Start NSAIDs as needed 1
• Begin jaw exercises and stretching at home 1

Weeks 4-12:

• Add supervised physical therapy with manual trigger point therapy and jaw mobilization 1
• Add postural exercises 1
• Initiate augmented CBT if psychological factors present 1

After 12 weeks if inadequate response:

• Consider manipulation or acupuncture 1
• Reassess diagnosis and compliance with exercises 1

After 6 months if refractory:

• Consider arthrocentesis only in skeletally mature patients with documented TMJ arthritis on MRI 1, 7
• Refer to multidisciplinary TMD clinic including oral surgeon, orofacial pain specialist, physical therapist, and psychologist 7

Critical Pitfalls to Avoid

• Never proceed to invasive procedures (arthrocentesis, arthroscopy, surgery) before at least 3-6 months of conservative treatment 1, 7
• Do not rely solely on occlusal splints despite their popularity—they have limited evidence and can cause harm if improperly fitted 1
• Avoid irreversible dental procedures (grinding teeth, permanent splints) without clear structural indication 1
• Do not prescribe opioids for TMD pain, especially combined with NSAIDs 1
• Do not delay referral for physical therapy—manual techniques are among the most effective treatments and should start early 1, 7
• Always check ESR/CRP in patients >50 with new-onset jaw pain to avoid missing giant cell arteritis 2