Management

Goals of the presented modalities are to:

• 1) increase mandibular range of motion,
• 2) decrease joint and masticatory muscle pain and inflammation, and
• 3) prevent further degenerative change in articulating tissues, including direct or indirect joint damage
  
  
• generally, the signs and symptoms of TMJ disorders improve over time with or without treatment (1)
• about 50 % improve in one year and 85 % improve completely in three years (1)
  
  
• conservative treatments (2)
  • self-care practices
    • these steps may be helpful in easing symptoms, such as:
      • eating soft foods
      • warm compress over the region of pain (5)
      • avoiding extreme jaw movements
      • stress-relieving relaxation techniques for relaxing and reducing stress (3)
      • practicing gentle jaw stretching and relaxing exercises
        
        
  • medications
    • nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may provide temporary relief from jaw discomfort.
    • muscle relaxants
    • anti-depressants
      • tricyclic antidepressants can be used to treat pain (including pain from nighttime bruxism) (1)
      • antidepressants that are used in chronic pain syndromes may also be helpful
      • care should be taken when prescribing selective serotonin reuptake inhibitors
        • these may rarely cause bruxism (1)
          
          
  • stabilization splints
    • non-invasive, occlusal splints and occlusal adjustments work to establish balance in the occlusion and TMJs (4)
      • the occlusion, or bite position, is a third and important element in the joint system and is the element often addressed by general dentists
        • ultimate goal of splints and adjustments is to minimize pain in the joint and masticatory muscles by establishing stability
        • splints may be used to control bruxism, which has been associated with tooth attrition, malocclusion, myofacial pain, and masticatory muscle strain, fatigue, and fibrosis
        • long-term effectiveness of this therapy remains controversial
          
          
• irreversible treatments (2)
  • surgery
  • implants

For NICE guidance regarding management of chronic pain (pain that lasts for more than 3 months) then see linked item.

Reference:

• (1) Jennifer J. Buescher. Temporomandibular Joint Disorders. Am Fam Physician 2007;76:1477-82, 1483-84.
• (2) TMJ disorders. National Institute of Dental and Craniofacial Research. National Institutes of Health.
• (3) TMJ disorders.Coping skills. Mayo Foundation for Medical Education and Research (MFMER). 1998-2008.
• (4) Murphy MK et al. Temporomandibular Joint Disorders: A Review of Etiology, Clinical Management, and Tissue Engineering Strategies.Int J Oral Maxillofac Implants. 2013 Nov-Dec; 28(6): e393-e414.
• (5) Lomas J, Gurgenci T, Jackson C, Campbell D. Temporomandibular dysfunction. Aust J Gen Pract. 2018 Apr;47(4):212-215.