In some cases, the symptoms of a TMJ disorder may go away without treatment. If they persist, most experts agree that treatment should begin with conservative, nonsurgical therapies, which may include using hot or cold packs, eating soft foods, avoiding overuse of the jaw muscles, night guards, biteplates, and/or anti-inflammatory medications.
If nonsurgical treatments do not reduce pain or discomfort, a healthcare provider or dentist may recommend corrective dental treatment, medications called corticosteroids, arthrocentesis (removal of fluid from a joint), or surgery.
Exercises and stretches. A healthcare provider, dentist, or physical therapist can recommend specific exercises to stretch the jaw and reduce symptoms of TMJ disorders. Exercising the neck and shoulders may also help improve bad posture that may be contributing to the disorder. In addition, a healthcare professional may also teach the patient how to massage the jaw muscles to help reduce pain and soreness.
Hot or cold packs: Doctors often recommend applying an ice pack to the side of the lower jaw (near the TMJ) for about 10 minutes. Next, the patient should perform some of the recommended stretches and/or exercises. Then, the patient should apply a warm towel or heat pack to the joint for about five minutes. This routine should be repeated a few times each day.
Eat soft foods: Jaw pain is often the worst during eating because the jaw must open and close to chew food. Eating soft foods, such as eggs, yogurt, fish, beans, mashed potatoes, and cooked fruits and vegetables, may help reduce jaw discomfort during eating. It may also help to cut foods into smaller pieces. This is because less chewing is necessary when food is already cut into small pieces. The most difficult foods to eat are hard, crunchy, and chewy foods, such as bagels, raw carrots, hard rolls, and caramels.
Biteplate: A plastic biteplate, also called a splint, may be recommended if the TMJ is misaligned. A biteplate is a plastic guard that is worn over the teeth. It is the most common treatment for TMJ disorders. It helps align the upper and lower jaws. In addition, biteplates may also help reduce the pressure in the joint, which reduces the harmful effects of clenching or grinding the teeth. As a result, patients experience less pain.
Biteplates should not be used long term and should not cause permanent changes in the bite. Patients should visit their healthcare providers if a biteplate increases pain or discomfort.
Night guard: Some individuals with TMJ disorders grind their teeth during their sleep. This behavior often worsens symptoms of jaw pain. A night guard is a plastic mouthpiece that is placed into the mouth during sleep. A night guard protects the teeth from becoming worn down and damaged when the individual grinds his/her teeth. Night guards are generally considered safe and are available at local drug stores.
Anti-inflammatory medications: Medications called nonsteroidal anti-inflammatory drugs (NSAIDs) are often taken to reduce pain and inflammation associated with TMJ disorders. An example of a common NSAID is ibuprofen (Motrin® or Advil®).
The frequency and severity of NSAID side effects vary. The most common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. The most serious side effects include kidney failure, liver failure, ulcers, heart-related problems, and prolonged bleeding after an injury or surgery. About 15% of patients who receive long-term NSAID treatment develop ulcers in the stomach or duodenum.
Celecoxib (Celebrex®) has been taken by mouth to reduce more severe pain and inflammation. Celecoxib is currently the only COX-2 inhibitor that is approved by the U.S. Food and Drug Administration (FDA). Celecoxib is generally taken long term to manage symptoms.
COX-2 inhibitors have been linked to an increased risk of serious heart-related side effects, including heart attack and stroke. Selective COX-2 inhibitors have also been shown to increase the risk of stomach bleeding, fluid retention, kidney problems, and liver damage. Less serious side effects may include headache, indigestion, upper respiratory tract infection, diarrhea, sinus inflammation, stomach pain, and nausea.
Corrective dental treatment: In some cases, corrective dental procedures may be necessary to help reduce symptoms of TMJ disorders. For instance, if a patient has an uneven bite, a dentist may balance the surfaces of the teeth by grinding down some of the teeth, replacing missing teeth, or adding crowns or fillings. However, corrective dental treatment has not been scientifically proven to effectively treat TMJ disorders. In fact, some evidence suggests that this treatment may worsen symptoms of TMJ disorders. Therefore, patients should discuss all of the potential benefits and risks associated with medical procedures before making any decisions about treatments.
Corticosteroid drugs: Corticosteroid drugs may be prescribed to relieve severe pain and inflammation caused by TMJ disorders. These drugs are typically injected into the joint for immediate pain relief.
These drugs are generally very effective when used short-term. However, if these drugs are used for many months to years, they may become less effective and serious side effects may develop. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face, and diabetes.
Arthrocentesis: During a minor surgical procedure, called arthrocentesis, a needle is inserted into the TMJ, and a small amount of fluid is removed. This technique has been shown to help relieve pain and inflammation in the joint. According to one study, 94% of patients with locked TMJs experienced long-term relief after arthrocentesis.
After treatment, patients may experience minor bleeding in the joint, local bruising, and loss of skin pigment in the treated area. In rare cases, infections in the joints have developed.
Surgery: If all other therapies are unsuccessful, a healthcare provider may recommend an oral and maxillofacial surgeon. However, failure to respond to other treatments does not necessarily mean that surgery is the best option.
If a TMJ injury is causing symptoms of a TMJ disorder, patients may need to undergo surgery to repair or remove the disk between the mandible and temporal bone.
In some cases, TMJ disorders that are caused by arthritis may lead to permanent joint damage. In such instances, joint replacement surgery may be necessary. During the procedure, the damaged joint is surgically removed and it is replaced with a plastic or metal device called a prosthesis.
Researchers are currently studying the use of human tissue to replace damaged cartilage in the TMJ.
No long-term human studies have evaluated the safety and effectiveness of surgical treatments for TMJ disorders. There are also risks associated with surgical procedures, including infection and bleeding. Patients should discuss the potential health risks and benefits of surgery with their healthcare provider.
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