What type of specialist treats Temporomandibular Joint (TMJ) disorders?

From the Guidelines

A specialist for TMJ disorders is typically an oral and maxillofacial surgeon or a dentist who specializes in TMJ disorders, and the first line of treatment should include conservative approaches such as reassurance, jaw rest, avoiding irritating behaviors, heat, NSAIDs, and oral appliance in the presence of bruxism, as recommended by the most recent guidelines 1. To find a TMJ specialist, start by consulting your primary care physician or dentist for a referral. You might also consider seeing an otolaryngologist (ear, nose, and throat doctor) or a pain management specialist, as they often treat TMJ-related issues. Some key points to consider when seeking treatment for TMJ disorders include:

• Conservative approaches should be pursued first, including reassurance and education, avoidance of wide mouth opening or aggravating activities, soft diet, jaw exercises, massage, non-steroidal anti-inflammatory drugs (NSAIDs), heat and/or cold, bite plate in the presence of bruxism, physiotherapy, mindfulness, yoga, meditation, acupuncture, splint therapy, cognitive behavioural therapy, paracetamol, and neuromodulatory medications (eg, amitriptyline, gabapentin) 1.
• Surgery should be considered only after non-response to conservative therapy, including arthrocentesis, arthroscopy, or open surgery of the temporomandibular joint 1.
• The prevalence of chronic TMD pain ranges from 6% to 9% in the general population, and psychological comorbidities are common 1.
• Treatment for TMJ disorders usually begins with conservative approaches like over-the-counter pain relievers (ibuprofen 400-800mg every 6-8 hours or naproxen 500mg twice daily), muscle relaxants, physical therapy, and wearing a night guard or splint 1.
• These specialists can provide more advanced treatments if needed, such as corticosteroid injections, arthrocentesis (joint fluid removal), or in severe cases, surgery 1. Some important considerations for treatment include:
• Cost and access to care, as expense may be a barrier to accessing care delivered by therapists unless patients have private coverage 1.
• The potential for remote delivery of cognitive behavioural therapy, which may be less costly and similarly effective to in-person therapy 1.

From the Research

Specialist for TMJ

• A specialist for Temporomandibular Joint (TMJ) disorders may include a surgeon, as discussed in the study 2, which highlights the importance of a multidisciplinary team approach to management.
• The management of TMJ disorders may involve both conservative and surgical treatment options, as noted in the study 2.
• Occlusal interventions, such as splints and adjustments, may be used to manage TMJ disorders, as discussed in the study 3.
• The study 3 found that occlusal splints may reduce muscle pain when chewing compared to no treatment, but the evidence is very uncertain.
• Dentists' knowledge of occlusal splint therapy for bruxism and TMJ disorders was found to be insufficient, as reported in the study 4.
• The management of TMJ disorders in oral and maxillofacial surgery is discussed in the study 5, which highlights the importance of proper diagnosis and the impact of comorbid conditions and patient expectations on outcomes.
• Interventions for the management of TMJ osteoarthritis, including reassurance, occlusal appliances, physical therapy, and medication, are discussed in the study 6.

Treatment Options

• Conservative treatment options for TMJ disorders may include occlusal interventions, physical therapy, and medication, as discussed in the studies 3 and 6.
• Surgical treatment options for TMJ disorders may include procedures such as intra-articular injections and joint replacement, as noted in the study 6.
• The study 3 found that orofacial myofunctional therapy may reduce severity of joint noise compared to occlusal splint, but the evidence is very uncertain.

Importance of Proper Diagnosis

• Proper diagnosis is essential for effective management of TMJ disorders, as highlighted in the studies 2 and 5.
• The study 5 notes that initial misdiagnosis can lead to multiple failed procedures and poor outcomes.
• A clear diagnosis of TMJ osteoarthritis is necessary for effective management, as discussed in the study 6.