From the Guidelines
Treatment for temporomandibular joint (TMJ) disorders should always begin with conservative, reversible, and evidence-based approaches, prioritizing patient education, reassurance, and avoidance of aggravating activities. The most recent and highest quality study, 1, published in 2023 in the BMJ, emphasizes the importance of conservative management, 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.
Key Conservative Approaches
- Start with over-the-counter pain relievers like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain and inflammation, as recommended by 1 and supported by 1.
- Apply moist heat or ice packs to the jaw for 10-15 minutes several times daily to reduce pain and inflammation.
- Practice soft diet modifications by avoiding hard, chewy foods and cutting food into smaller pieces to reduce strain on the TMJ.
- Perform gentle jaw stretching exercises 3-4 times daily, including controlled opening/closing and side-to-side movements, as part of a comprehensive physical therapy program focusing on jaw exercises and massage.
- Stress management techniques like deep breathing and progressive muscle relaxation can help reduce jaw tension, and are recommended in conjunction with cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, as strongly recommended by 1.
Additional Considerations
- A custom-fitted night guard from a dentist may prevent teeth grinding and clenching during sleep, addressing bruxism as a contributing factor to TMJ disorders.
- For persistent cases, prescription muscle relaxants like cyclobenzaprine (5-10mg at bedtime) might be considered, although their use should be carefully evaluated against the potential benefits and risks, and in line with the conditional recommendations against certain interventions as outlined in 1.
- Surgery should only be considered after non-response to conservative therapy, including arthrocentesis, arthroscopy, or open surgery of the temporomandibular joint, as a last resort and in accordance with the guidelines provided by 1 and the strong recommendations against irreversible procedures by 1.
Prioritizing Patient Outcomes
The primary goal of TMJ treatment is to improve patient outcomes in terms of morbidity, mortality, and quality of life. By prioritizing conservative, reversible, and evidence-based approaches, healthcare providers can minimize the risk of adverse effects and maximize the potential for successful management of TMJ disorders, as supported by the highest quality evidence available, including 1 and 1.
From the Research
TMJ Treatment Options
- Conservative treatment options are available for temporomandibular joint (TMJ) disorders, including physical therapy, joint and soft tissue mobilization, trigger point dry needling, friction massage, therapeutic exercise, patient education, and modalities 2
- Surgical treatment options may also be considered, and a multidisciplinary team approach to management is essential in the fundamental care of all TMD patients 3
- Intra-articular injections of substances with anti-inflammatory properties, such as betamethasone, sodium hyaluronate, or platelet-rich plasma, may be used in addition to conservative approaches like bite splints 4
Effectiveness of Treatment Options
- Studies have shown that all treatments used, including bite splints, intra-articular injections, and conservative management, can cause a reduction in pain and increase pain-free mouth opening 4
- Non-thrust mobilization and high-velocity, low amplitude thrust manipulation techniques to the TMJ and/or upper cervical articulations may be effective in reducing pain and disability in patients with TMD 5
- Dry needling or acupuncture of the lateral pterygoid and posterior, peri-articular connective tissue may also lead to significant improvements in pain and disability in patients with TMD 5
Comparison of Treatment Options
- A systematic review and meta-analysis found that arthrocentesis as the first line of therapy may result in a significant but small improvement in pain scores, but without any additional improvement in maximum mouth opening (MMO) as compared to conservative therapies 6
- The use of platelet-rich plasma injection in addition to a bite splint may yield the best results after six months, while patients treated with sodium hyaluronate or betamethasone may obtain the best results at the end of the first week 4