Temporomandibular disorders (TMD) are conditions affecting how the jaw works. The temporomandibular joint (TMJ) functions like a sliding hinge, connecting your jawbone to your skull. Signs of TMD condition include clenching, dentition, and other symptoms that promote articular, periarticular, and muscular pain.
There is also Orofacial pain which is pain occurring in the oral cavity or around the face. An orofacial pain specialist can treat these disorders. Disorders like TMD are included because they are part of nonodontogenic orofacial pain. The effects or impacts of TMD are mainly physical and psychosocial. Temporomandibular joint dysfunction is a collection of painful symptoms affecting the jaw joints. These two joints are formed by the temporal bone of the skull, the jawbone, and the jaw muscles.
In this article are ten methods that you can use to manage TMJ pain. Let us get started;
Oral and Topical Pharmacotherapy
Typically, there are a lot of medications prescribed as treatment of TMD. Although many of these prescriptions lack evidence for this condition, they have proven beneficial in solving other musculoskeletal disorders. Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the commonly used drugs. Other drugs used in place of NSAIDs include analgesics, corticoids, opiates, anxiolytics, muscle relaxants, lidocaine, gabapentin, and tricyclic antidepressants (TCAs).
Sodium Diclofenac and Naproxen Sodium are the most common NSAIDs which have demonstrated abilities to reduce jaw joint pains. Palmitoylethanolamide is another substance that can offer treatment for the condition. Jaw function is first assessed by evaluating the patient’s levels of pain free jaw opening, maximum unassisted jaw opening, maximum assisted jaw opening, maximum protrusion and right and left excursion.
Studies support the use of sodium hyaluronate and corticosteroid betamethasone injections for TMJ pain. The hyaluronate improves lubrication on the joints, while corticosteroid offers anti-inflammatory effects on the joints. But both may work together to help dilute inflammatory substances that manifest in the joints of TMD pain. From reviews, double or inferior TMJ-space injection technique does well than superior-space injection.
Botox injections may be tried when treating TMJ by altering the movement of the muscles supporting your jaw. Injections have been found to improve teeth grinding, lock jaw, and overall issues with jaw tension. These adjustments may temporarily reduce jaw pain and headaches brought on by TMJ. Treatments usually take less than 30 minutes and are not painful.
Surgical solutions can also treat the TMD condition but should not be a first option. Here, you can use options like arthroscopy and arthrocentesis based on articular lavage. The above two are effective for degenerative pathology or internal derangements of TMJ.
When comparing arthrocentesis with arthroscopy, there are no differences between mandibular function and pain. Unfortunately, there is no evidence to support arthrocentesis as a better alternative to nonsurgical options. Medical rehabilitation is preferred over other surgical options when considering internal derangement of TMJ.
Dental management involves two main approaches: odontologists and orthopedic stabilization therapy. Doctors use splint therapy in the first method, while occlusal adjustment and orthodontics offer correct stable occlusion.
Because signs and symptoms of TMD are not directly linked to any malocclusion, it hinders specialists from recommending occlusal adjustment or orthodontic intervention for TMD treatment.
Physical therapy is another method that has proven beneficial in the treatment of TMD. The therapy helps restore motor functions, reduce inflammation, and relieve pain through various techniques like manual therapy. Manual therapy can be soft-tissue mobilization or joint manipulation/mobilization.
Other effective methods include electro-treatment, like transcutaneous electrical nerve stimulation (TENS), low-level laser therapy (LLLT), acupuncture, and tonic exercise.
As aforementioned, manual therapy includes soft-tissue techniques and joint mobilization regardless of its origin. The treatment aims at reducing pain symptoms and improving standard functions as well. These techniques promote neurophysiological mechanisms that help in the reduction of muscle activity or for relieving TMJ pain.
According to some specialists, it is relevant to apply manual therapy to the upper cervical spine. There has always been a debate among manual therapists regarding the best approach for treating the cervical spine. Most authors recommend cervical mobilizations because they look more effective in reducing orofacial manipulation or pain.
This can be classified under physical therapy, as mentioned earlier. Exercise used to improve the endurance of masticatory muscles and motor control may help alleviate some symptoms of patients with TMD. Exercise does not significantly relieve pain compared to other interventions like occlusal splints, acupuncture, and patient education.
The previously used exercises in controlled trials include masticatory and lingual relaxation, coordination exercises, stretching, etc. If the proper program is applied, therapeutic exercises are likely to offer superior results.
Manual Therapy and Exercise
Exercise and manual therapy can be combined to offer enhanced results. The two alleviate symptoms associated with TMD while improving the effects of intervention in isolation. Benefits provided by the two are a summary of the impact linked with manual therapy alongside exercise effects like the adoption of an active role and improvement in physical condition.
It is effective when both interventions happen in cervical regions. However, better results can appear when applied in the cervical and orofacial areas.
Dry Needling and Acupuncture
Dry Needling (DN) is an intervention for pain produced by myofascial trigger points. DN helps in the improvement of mandibular functions and the reduction of pain. The benefits of DN are comparable to the effects of corticosteroid and lidocaine injections.
For patients experiencing myofascial TMD, therapists recommend acupuncture as a better therapeutic modality, although it offers short-term pain relief. For enhanced effects, physicians select points in the orofacial regions before applying.
Although electrotherapy appears the best among the physical therapy, the current evidence does not fully support its use to relieve pain among TMD patients. There are claims that non of the electrotherapy methods, including LLLT, TENS, offer better results than placebo.
However, the application criteria play a significant role in the effectiveness of the methods mentioned above. Other factors that may influence the effects include choosing parameters like frequency and intensity and TMD type, among others.
One can use different methods to treat TMJ. However, the best method for managing the condition depends on the available treatment options and the kind of TMJ a patient suffers from. A jaw pain specialist can review each case to determine the best approach to use to manage.