From the Guidelines
Treatment for temporomandibular joint (TMJ) disorders should begin with conservative, self-care approaches, prioritizing cognitive behavioral therapy, therapist-assisted mobilisation, and supervised jaw exercise and stretching, as recommended by the most recent guideline 1. The goal of treatment is to decrease pain and functional limitation, and improve quality of life. Conservative measures include:
- Applying moist heat or ice packs to the jaw for 10-15 minutes several times daily to reduce pain and inflammation
- Taking over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) to manage pain and reduce inflammation
- Practicing gentle jaw stretching exercises and avoiding extreme jaw movements like wide yawning or aggressive chewing
- Eating soft foods and cutting food into smaller pieces to reduce jaw strain
- Using a dental night guard (occlusal splint) worn while sleeping to prevent teeth grinding and reduce pressure on the TMJ These measures are recommended as first-line treatments, as they are supported by strong evidence from recent guidelines 1. For persistent cases, a healthcare provider might prescribe muscle relaxants, stronger anti-inflammatories, or recommend physical therapy focusing on jaw exercises. It is essential to note that more severe or persistent cases may require dental interventions, corticosteroid injections, or rarely, surgical options, but these should only be considered after non-response to conservative therapy, as recommended by the guidelines 1. The use of certain treatments, such as irreversible oral splints, discectomy, and NSAIDS with opioids, is strongly recommended against due to the lack of evidence supporting their effectiveness and potential harm 1.
From the Research
Treatment Options for Temporomandibular Joint Disorder
The treatment for temporomandibular joint (TMJ) disorder can be divided into several categories, including:
- Noninvasive pharmacologic therapies
- Minimally invasive muscular and articular injections
- Surgery
- Conservative therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants 2
- Minimally invasive injections, including botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose 2
Conservative Management
Conservative management of TMJ disorder is a common approach, which includes:
- Appliance or intraoral splint placement
- Physical therapy 3
- Self-care
- Physical therapy and appliance therapy 4 This approach is often less expensive than surgery and can be effective in managing symptoms of TMJ disorder 3
Pharmacological Intervention
Pharmacological intervention is also a common approach, which includes:
- Analgesics
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Opioids
- Corticosteroids
- Anxiolytics
- Muscle relaxants
- Antidepressants
- Anticonvulsants
- Benzodiazepines 4 The decision to select any of these agents depends on a full understanding of the drug's risks and benefits 4
Multidisciplinary Team Approach
A multidisciplinary team approach to management is essential in the fundamental care of all TMJ disorder patients, as treatment can be specifically tailored to individual patient needs 5