What is the treatment for arthralgia of the tempomandibular joint?

Treatment of Temporomandibular Joint Arthralgia

Start with jaw exercises, manual trigger point therapy, and patient education as first-line treatment, combined with NSAIDs for pain control—these conservative approaches provide the most substantial and evidence-based pain relief for TMJ arthralgia. 1, 2

Initial Conservative Management (First 4-12 Weeks)

Strongly Recommended First-Line Therapies

• Jaw exercises and stretching provide approximately 1.5 times the minimally important difference in pain reduction and should be initiated immediately 1, 2
• Manual trigger point therapy delivers one of the largest reductions in pain severity, approaching twice the minimally important difference 1, 2
• Patient education about avoiding aggravating activities, maintaining a soft diet, and applying heat/cold therapy reduces pain and inflammation 1, 2
• NSAIDs serve as first-line pharmacological treatment for both pain relief and inflammation reduction 1, 2
• Cognitive behavioral therapy (CBT) provides substantial pain reduction, particularly when psychological factors contribute to symptoms 1, 2

Additional Conservative Options

• Jaw mobilization (therapist-assisted manual techniques) improves joint mobility and reduces pain 1, 3
• Postural exercises correct head and neck alignment to reduce TMJ strain 1, 3
• Physical therapy with TMJ expertise should not be delayed, as these interventions are among the most effective treatments 1

Second-Line Approaches (After 12 Weeks Without Adequate Response)

• Manipulation techniques for joint realignment may benefit patients who haven't responded to first-line interventions 1, 3
• Acupuncture shows moderate evidence of effectiveness for TMJ pain relief 1, 3
• Occlusal splints may be beneficial specifically for patients with documented bruxism, though evidence for general use is limited 4, 1
• Muscle relaxants may help overcome muscle spasm when other approaches fail 1, 2
• Neuromodulatory medications (amitriptyline, gabapentin) can be considered for chronic refractory pain 1, 2

Interventional Approaches for Refractory Cases (After 6 Months)

For Skeletally Mature Patients

• Intra-articular lavage (arthrocentesis) without steroids may provide symptomatic relief and can be used in both growing and skeletally mature patients 4, 1
• Intra-articular glucocorticoid injections may be indicated for arthritis-induced refractory and symptomatic TMJ dysfunction in skeletally mature patients, but are NOT recommended as first-line management 4, 1, 2
• The effects of glucocorticoid injections are highly variable and temporary, with significant concerns about side effects 4

For Skeletally Immature Patients

• Avoid intra-articular glucocorticoid injections as first-line management due to concerns about growth disturbances 4, 1, 2
• Arthrocentesis without steroids is preferred if interventional treatment is necessary 4

When TMJ Arthritis is Present

If imaging confirms active TMJ arthritis with inadequate response to conservative measures:

• Conventional synthetic DMARDs are strongly recommended for inadequate response to NSAIDs and/or intra-articular glucocorticoids 2
• Biologic DMARDs are conditionally recommended for inadequate response to NSAIDs, intra-articular glucocorticoids, and at least one conventional synthetic DMARD 2

Critical Pitfalls to Avoid

• Never combine NSAIDs with opioids—this increases risks without providing clear additional benefits 1, 2
• Do not proceed to invasive procedures before exhausting 3-6 months of conservative options 1, 2
• Avoid relying solely on occlusal splints despite their popularity; evidence for effectiveness is limited except in bruxism 1, 2
• Never perform irreversible procedures like permanent dental alterations or discectomy without clear structural indication 1, 2
• Avoid repeated glucocorticoid injections in skeletally immature patients due to potential growth disturbances 4, 1, 2
• Do not neglect patient education about self-management strategies, as this forms the foundation of successful treatment 1, 2

Important Clinical Considerations

The relationship between TMJ inflammation and symptoms is complex—many patients with TMJ inflammation have no symptoms, while others develop symptoms despite well-controlled inflammation 4. This dissociation means you must monitor and address TMJ-related dysfunction and symptoms regardless of inflammatory status 4. Mechanical dysfunction from previous joint damage can perpetuate symptoms even without active inflammation 4.