Further Outpatient Care
Outpatient therapies for temporomandicular joint (TMJ) syndrome should begin with conservative measures and become more invasive when other options have been exhausted. Initial treatment may include the following:
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Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants
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Patients should eat a soft diet, and avoid habits such as excessive gum chewing. Warm and cold compresses should be used at night along with gentle massage of the TMJ area. Patients need to avoid jaw clenching and teeth grinding if possible.
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If conservative therapies fail, or for severe acute exacerbations, intra-articular injection of local anesthetics or steroids may be used for TMJ syndrome. However, repeated intra-articular injections are not recommended.
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Dental splints can be used to keep the jaw more properly aligned. They also help limit nocturnal bruxism and teeth grinding.
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Some patients also find benefit from ultrasonic therapy. This provides deep heat to the area of tenderness and may alleviate some patients' symptoms. High-voltage electrogalvanic stimulation is sometimes used to reduce muscle spasms.
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Low-intensity laser therapy has been investigated as a form of therapy, and it has been shown to reduce pain in TMJ syndrome. [19]
If failure of these more conservative treatments occurs, operative repair may be considered. Operative repair can range from arthroscopic procedures, which can wash out the joint and allow for small repairs, [20] to open procedures. Open procedures can utilize jaw implants, synthetic articular disks, or total TMJ replacement with custom-made alloplastic prostheses. [21] With TMJ ankylosis associated with juvenile idiopathic arthritis, reconstruction with a costochondral graft is the gold standard. [22]
However, in a long-term study by Fricton et al, synthetic implants did not lead to an improved outcome compared with nonimplant surgical repair or nonsurgical rehabilitation. [23] This was determined by looking at subjective and objective measures of symptom severity and functional deficits.
Handa et al reported on a complication of TMJ surgery termed first bite syndrome, in which pain (most often in the parotid region) is triggered by a taste stimulus and subsides with subsequent bites of food. In 19 patients who had undergone TMJ surgery, the median duration of onset was 2.75 months postoperatively. The syndrome resolved spontaneously in two patients and resolved completely with onabotulinum toxin A (BTX) injections in one patient. [24]
Inpatient & Outpatient Medications
See the list below:
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NSAIDs are the first line of treatment for TMJ pain.
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Prescribe benzodiazepines for significant muscle pain or spasm.
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Cyclobenzaprine may be prescribed in patients unable to tolerate benzodiazepines. The clinical efficacy of this drug for TMJ syndrome has not been studied.
Complications
Complications may include the following:
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Alterations in dentition
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Chronic facial pain
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Malocclusion
Prognosis
See the list below:
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Prognosis of TMJ disorders is improved with early diagnosis.
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TMJ disorders often progress to a chronic state.
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Some cases may be self-limiting.
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Patients with ear symptoms tend to have a prolonged course of illness.
Patient Education
Patient education measures may include the following:
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Instruct patients to apply moist heat to affected area for no longer than 15 minutes per application.
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Educate patients about bruxism and the need to avoid clenching and grinding teeth.
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Suggest that stress can play a major role in illness; teach stress reduction strategies and provide behavior modification and counseling.
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Prescribe a soft diet for patients with chewing pain, and advise them to chew more slowly and take smaller bites.
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Instruct patient in jaw-opening exercises.
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For patient education information, see Temporomandibular Joint (TMJ) Syndrome.
