From the Guidelines
The most recent and highest quality evidence recommends a conservative, multidisciplinary approach for managing temporomandibular joint (TMJ) disorders and associated pain, prioritizing non-surgical treatments such as reassurance, education, jaw exercises, massage, non-steroidal anti-inflammatory drugs (NSAIDs), and physiotherapy 1.
Key Recommendations
- First-line treatments should include conservative approaches like reassurance, education, avoidance of wide mouth opening or aggravating activities, soft diet, jaw exercises, massage, NSAIDs, heat and/or cold, and bite plate in the presence of bruxism 1.
- Physical therapy focusing on jaw exercises, massage, and stretching techniques should be performed 2-3 times daily for 5-10 minutes per session.
- Custom-made oral splints worn at night can reduce teeth grinding and joint stress.
- Cognitive behavioral therapy has shown effectiveness for chronic TMJ pain by addressing pain catastrophizing and improving coping strategies.
- Recent research suggests that central sensitization plays a significant role in chronic TMJ pain, explaining why some patients develop persistent symptoms despite minimal structural abnormalities 1.
Treatment Options
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for acute pain, typically used for 7-14 days to minimize side effects.
- Muscle relaxants like cyclobenzaprine (5-10mg at bedtime) may help with associated muscle spasms.
- Intra-articular injections with corticosteroids or sodium hyaluronate may provide temporary relief for patients not responding to conservative measures, though these should be limited to avoid joint damage.
Important Considerations
- Surgery should be considered only after non-response to conservative therapy, including arthrocentesis, arthroscopy, or open surgery of the temporomandibular joint 1.
- Emerging evidence points to inflammatory mediators and neurogenic inflammation as key factors in TMJ pain, supporting the use of targeted anti-inflammatory approaches.
- Education and self-management are crucial for improving quality of life and reducing symptoms in patients with TMJ disorders 1.
From the Research
TMJ Issues and Associated Pain
- Temporomandibular joint disorder is defined by pain and/or loss of function of the temporomandibular joint and its associated muscles and structures 2.
- TMJ disorders are associated with pain and reduced jaw mobility, and can be managed with various treatment modalities, including noninvasive pharmacologic therapies, minimally invasive injections, and surgery 2, 3.
- The aim of treatment is to improve symptoms of pain and function of the temporomandibular joint, and can be achieved through conservative therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, and antidepressants 2, 4.
Treatment Options
- Different treatment modalities have been compared in patients with TMJ disorders, including intra-articular injections of substances with anti-inflammatory properties, such as betamethasone, sodium hyaluronate, and platelet-rich plasma, as well as a more conservative approach consisting only of a bite splint 3.
- The results of these studies have shown that all treatments used caused a reduction in pain and increased pain-free mouth opening, with the group injected with platelet-rich plasma yielding the best results after six months 3.
- Pharmacological agents commonly used for the treatment of TMJ disorders include non-steroidal anti-inflammatory drugs, opioids, corticosteroids, muscle relaxants, antidepressants, anticonvulsants, and benzodiazepines 4.
Management and Diagnosis
- The management of TMJ disorders requires a multidisciplinary team approach, with treatment tailored to individual patient needs 5, 6.
- The diagnosis of TMJ disorders has significantly improved over time, with the recent Diagnostic Criteria for TMD (DC/TMD) being reliable and valid for most common diagnoses 6.
- Current evidence supports primarily conservative multidisciplinary treatment, including self-management strategies, behavioral therapy, physical therapy, and pharmacotherapy 6.