From the Guidelines
Temporomandibular joint (TMJ) 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 physiotherapy, before considering more invasive options.
Key Recommendations
- Start with over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) to reduce inflammation and pain, as recommended by recent guidelines 1.
- Apply moist heat or ice packs to the jaw for 10-15 minutes several times daily to help reduce pain and inflammation.
- Practice soft diet modifications by avoiding hard, chewy foods and cutting food into smaller pieces to reduce strain on the jaw.
- Gentle jaw exercises, including controlled opening and closing movements for 5-10 repetitions several times daily, can improve mobility and reduce pain.
- A custom-fitted night guard from your dentist can prevent teeth grinding and clenching during sleep, which can exacerbate TMJ disorders.
- Stress management techniques such as deep breathing, meditation, or physical activity may help reduce jaw tension and improve overall well-being.
Additional Considerations
- If conservative measures don't provide relief after 2-3 weeks, consult a healthcare provider who might recommend physical therapy, prescription muscle relaxants like cyclobenzaprine (5-10mg at bedtime), or corticosteroid injections 1.
- 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 (such as home exercises, stretching, reassurance, and education) are strongly recommended for patients living with chronic pain associated with TMD 1.
- Irreversible oral splints, discectomy, and NSAIDS with opioids are strongly recommended against due to the potential for harm and lack of evidence supporting their effectiveness 1.
From the Research
TMJ Treatment Options
- Noninvasive pharmacologic therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants, can be used to manage mild to moderate temporomandibular joint disorder 2
- Minimally invasive injections, including botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose, can also be effective in reducing pain and improving function 2
- A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients, as treatment can be specifically tailored to individual patient needs 3
Comparative Studies of TMJ Treatments
- A comparative randomized study found that all treatments used, including a bite splint alone or in combination with intra-articular injections of substances with anti-inflammatory properties, caused a reduction in pain and increased pain-free mouth opening 4
- The study also found that the group injected with platelet-rich plasma yielded the best results after six months, while patients treated with sodium hyaluronate or betamethasone obtained the best results at the end of the first week 4
Pharmacologic Treatment for TMJ Disorders
- Antidepressants, such as amitriptyline, can be an efficient alternative treatment for chronic pain in TMD patients, with a significant reduction in pain and discomfort compared to a placebo 5
- Conservative multidisciplinary treatment, including self-management strategies, behavioural therapy, physical therapy, and pharmacotherapy, is supported by current evidence for the management of TMD 6
Diagnosis and Management of TMD
- The diagnosis of TMD has significantly improved over time, with the recent Diagnostic Criteria for TMD (DC/TMD) being reliable and valid for most common diagnoses 6
- The pathophysiology of common painful TMD is biopsychosocial and multifactorial, and research has suggested different predisposing, initiating, and perpetuating factors, including both peripheral and central mechanisms 6