What is the diagnosis and treatment for Temporomandibular Joint (TMJ) disorder?

From the Guidelines

Temporomandibular joint (TMJ) disorders should be managed with conservative approaches, including cognitive behavioural therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching, and usual care, as these interventions have been shown to be effective in reducing pain and improving quality of life 1. The management of TMJ disorders typically begins with conservative approaches, including over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) for pain management. Some key points to consider in the management of TMJ disorders include:

• Apply moist heat or ice packs to the affected area for 10-15 minutes several times daily to reduce inflammation
• Soft diet modifications are essential—avoid hard, chewy foods and cut food into smaller pieces
• Practice jaw relaxation by keeping teeth slightly apart when not eating, and perform gentle jaw stretching exercises 3-4 times daily
• A custom-fitted night guard from a dentist can prevent teeth grinding during sleep
• Physical therapy focusing on jaw exercises may help improve mobility and reduce pain
• Education and self-management are crucial in improving symptoms and quality of life, as they lead to improved self-efficacy and fewer symptoms 1
• Intraoral appliances, such as hard full coverage stabilization splints, may be effective in some cases, but their use should be carefully considered and monitored to avoid adverse events 1 TMJ disorders often result from jaw muscle overuse, teeth grinding, stress, or arthritis affecting the joint's cartilage disc. Most cases improve with these conservative measures within 2-3 weeks, but persistent symptoms warrant dental or medical evaluation for more specialized treatment options. It is essential to note that strong recommendations have been made against irreversible oral splints, discectomy, and NSAIDS with opioids, due to the potential for harm and lack of evidence supporting their effectiveness 1. Overall, a comprehensive approach to managing TMJ disorders, including conservative interventions, education, and self-management, can help improve symptoms and quality of life for individuals affected by this condition.

From the Research

Definition and Symptoms of TMJ

• 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 may clinically present with jaw pain and restricted mouth opening that may limit a patient's access to comprehensive dental care 3
• Temporomandibular disorders (TMD) is a collective term for a group of musculoskeletal conditions involving pain and/or dysfunction in the masticatory muscles, temporomandibular joints (TMJ) and associated structures 4

Treatment Options for TMJ

• Treatments for TMJ disorders include noninvasive pharmacologic therapies, minimally invasive muscular and articular injections, and surgery 2
• Conservative therapies include nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants 2
• Minimally invasive injections include botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose 2
• Physiotherapy treatment techniques, such as therapeutic exercise protocols and manual therapy techniques, are effective in controlling the primary symptoms of TMD 5
• Exercise therapy and occlusal splint therapy have been found to be equivalent in terms of pain reduction and improvement in mouth-opening range for patients with painful TMD 6

Management and Diagnosis of TMJ

• A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients so that treatment can be specifically tailored to individual patient needs 3
• 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 4
• The pathophysiology of common painful TMD is biopsychosocial and multifactorial, where no one factor is responsible for its development 4