Can Buspar (buspirone) be used to treat Temporomandibular Joint (TMJ) disorder, particularly in patients with anxiety?

Buspirone is NOT Recommended for TMJ Disorder

Buspirone (Buspar) should not be used to treat TMJ disorder, even in patients with comorbid anxiety. The available evidence provides no support for buspirone in managing TMJ-related pain, dysfunction, or inflammation, and established treatment guidelines make no mention of this medication for TMJ conditions.

Why Buspirone is Not Appropriate for TMJ

Mechanism and Indication Mismatch

• Buspirone is a 5-HT1A partial agonist anxiolytic that lacks the anti-inflammatory, analgesic, or muscle relaxant properties needed to address TMJ pathology 1, 2
• Unlike benzodiazepines, buspirone has no muscle relaxant effects, which eliminates any theoretical benefit for TMJ-related muscle tension 1
• The drug's mechanism targets generalized anxiety disorder through serotonergic pathways, not musculoskeletal or inflammatory pain 3, 4

Potential for Worsening Symptoms

• Buspirone can paradoxically increase anxiety, agitation, and restlessness in some patients, particularly those with panic-spectrum disorders 5
• This "jitteriness" effect could theoretically worsen jaw clenching or bruxism behaviors that contribute to TMJ dysfunction 5

Evidence-Based Treatment Approach for TMJ

First-Line Conservative Management

Physical therapy with supervised jaw exercises should be the cornerstone of TMJ treatment, providing approximately 1.5 times the minimally important difference in pain reduction 6

• Manual trigger point therapy delivers the largest pain reductions, approaching twice the minimally important difference 6
• Cognitive behavioral therapy (CBT) with or without biofeedback is strongly recommended for pain reduction and addressing pain perception 6
• Occlusal splints and physical therapy may be beneficial for orofacial symptoms and TMJ dysfunction, though evidence is limited 7, 6

When to Escalate Treatment

If inflammatory TMJ arthritis is present (confirmed by contrast-enhanced MRI), systemic treatment is required 7, 8

• NSAIDs may be used as part of initial therapy for active TMJ arthritis, though the trial should be brief 7
• Conventional synthetic DMARDs (methotrexate preferred) are strongly recommended for inadequate response to NSAIDs 7
• Biologic DMARDs may be needed for refractory cases after failing at least one csDMARD 7

Critical Interventions to Avoid

• Never perform irreversible procedures like permanent dental alterations or discectomy 6
• Do not combine NSAIDs with opioids due to increased risks without clear additional benefits 6
• Intraarticular glucocorticoid injections are not recommended as first-line treatment, especially in skeletally immature patients, due to risks of growth suppression and calcifications 7

Managing Comorbid Anxiety in TMJ Patients

If Anxiety Treatment is Needed Separately

If a patient with TMJ disorder has significant generalized anxiety requiring pharmacologic treatment, this should be addressed as a separate condition:

• Buspirone could theoretically be used for the anxiety component alone, but has no direct benefit for TMJ symptoms 1, 3, 4
• The 1-2 week lag time to anxiolytic effect makes buspirone less suitable for acute symptom management 1
• CBT is strongly preferred as it addresses both anxiety and pain perception simultaneously 6

Referral Pathway

• Refer to a physical therapist with TMJ expertise for manual trigger point therapy and jaw mobilization 6
• Consider referral to a multidisciplinary team if conservative treatments fail after 3-6 months 6
• If systemic inflammatory arthritis is suspected (especially in patients under 30 or with other joint involvement), refer to rheumatology for evaluation 6, 8

Common Pitfalls to Avoid

• Do not prescribe buspirone expecting any direct TMJ benefit—it lacks the pharmacologic properties to address musculoskeletal or inflammatory pathology
• Do not delay appropriate TMJ-specific treatments (physical therapy, occlusal splints, or systemic anti-inflammatory therapy if indicated) while waiting for buspirone's anxiolytic effects
• Do not assume anxiety is the primary driver of TMJ symptoms—mechanical overloading, inflammatory arthritis, and degenerative changes are the actual pathologic mechanisms requiring targeted intervention 6, 9