TMJ Treatments and Medications

TMJ disorders can cause symptoms that range from uncomfortable to painful. Different factors may contribute to TMJ disorders, such as teeth grinding and arthritis. However, home remedies, medications, and other treatments are available to help manage TMJ disorders. Recently, COVID-19 has triggered a significant increase in TMJ disorders. This is likely due to increased stress levels, neurological impacts, bruxism (teeth grinding), and lifestyle changes.

What is TMJ?

TMJ is an abbreviation that stands for temporomandibular joint. There are two temporomandibular joints, one on each side of the face. The TMJ connects the lower jaw (also known as the mandible) to the skull at the temporal bone.

TMJ disorder symptoms

Symptoms of a TMJ disorder may include one or more of the following:

• Pain or stiffness in the jaw
• Limited mobility of the jaw
• Clicking or popping sounds that accompany jaw pain
• Soreness or swelling around the jaw joint area
• Pain that spreads from the jaw to the face, neck, or head
• Ringing or pain in the ears
• Headaches
• Toothaches

TMJ versus TMD

Temporomandibular disorders (TMD) include more than 30 conditions that can affect not only the jaw joint but also the surrounding facial muscles and nerves. TMJ disorders fall under the umbrella of TMDs and mainly involve problems with the jaw muscles and sometimes the joint. The abbreviation TMJ refers to the jaw joint itself, although it is sometimes used to describe TMJ disorders.

The National Institute of Dental and Craniofacial Research (NIDCR) reports that up to 12 million adults experience pain in or around the temporomandibular joint. In addition, women are twice as likely to have a temporomandibular disorder than men, especially women who are 35 to 44 years old.

TMJ Disorder Diagnosis

A dentist may diagnose a TMJ disorder during a checkup. In some cases, a dentist or healthcare provider may recommend visiting an orofacial pain specialist or oral surgeon to confirm a diagnosis. Orofacial Pain is the newest recognized specialty by the American Dental Association and this specialty deals with TMD and other chronic facial pain disorders.

TMJ disorders can be diagnosed through different examinations and tests. A healthcare provider may perform a physical examination of the jaw joints and observe any discomfort or limitations in jaw movement.

Diagnostic questions a healthcare provider may ask

A healthcare provider may ask different questions to diagnose a TMJ problem:

• What symptoms are you experiencing?
• How long have you had these symptoms?
• Is this the first time experiencing these symptoms or have you had them in the past?
• Does anything in particular trigger symptoms?
• Are you on any medications to treat your symptoms, such as prescription or over-the-counter (OTC) drugs?

TMJ symptoms may cause symptoms that could indicate other medical problems, such as dental pathology, auto-immune disorders, migraines, or ear infections. A physical examination and imaging studies can help eliminate other possible causes of symptoms.

Imaging tests

In addition to a physical exam and medical history, a healthcare provider can order specific imaging tests to get a better overall picture of the condition.

• X-ray: X-rays are used to identify problems with the bones or joints. Dental X-rays are initially used to provide a broad overview of the teeth and jawbone.
• CT scan: CT (computed tomography) scans are more powerful than X-rays and can provide a more detailed image of the teeth and jaw bone. They can be useful for identifying joint fractures and dislocations.
• MRI: MRI (magnetic resonance imaging) scans help show the soft tissue surrounding the jaw joints. These imaging scans can provide a clear image of inflammation and any problems with the disc that pads the TMJ.

TMJ treatments

A proper diagnosis is one of the most important aspects in TMJ disorders. If the condition is self-limiting which it often is, most treatments would be effective even if they are not warranted. A healthcare provider can make recommendations for treatment options after they have identified a TMJ disorder. The recommended treatment will depend on the symptoms, the cause of the symptoms, and the overall severity of the condition.

Nondrug treatment options for TMJ disorders

A study by NYU in 2019 showed that self-care was very effective in managing TMD. At-home treatment options, such as hot compresses and exercises, can be used for mild to moderate symptoms of TMJ disorders. Other treatment options, such as mouth guards, help prevent teeth grinding that may contribute to symptoms. In severe cases, a healthcare provider may recommend surgery to fix a structural problem with the joints.

Hot or cold compresses

Applying heat to the area of discomfort can help increase circulation and relax the jaw muscles. Applying a cold compress can help treat inflammation and numb jaw pain.

For a hot compress, heat a moist towel in the microwave or use a hot gel pack to apply to the affected area for 10 minutes. For a cold compress, you can wrap an ice pack with a thin cloth and apply that to the affected area for 15 to 20 minutes.

Eating soft foods

Avoid eating hard foods, such as nuts and hard candies, and chewy foods, such as gum and taffy, that can trigger jaw pain. If TMJ pain is flaring up, eating soft foods like bananas, yogurt, and eggs can help rest the jaw joint until facial pain is relieved.

Physical Therapy

Jaw exercises can help improve jaw movement and relieve pain in the joints. A physical therapist trained in TMJ disorders can help you perform jaw exercises or recommend specific techniques for you to do on your own.

Massage therapy

Massaging the jaw, neck, and temples may help relax the muscles and reduce stress contributing to TMJ pain. You can visit a massage therapist or do a self-massage at home.

Mouth Guard

A mouth guard or oral splint may help stabilize and support the jaw to relieve pain. Wearing a mouth guard throughout the day or at night can help prevent teeth grinding (bruxism) that may be contributing to TMJ pain. Talk to a dentist about whether a mouth device is a good option for you.

Surgery

Surgical procedures are typically reserved for serious jaw joint problems that are not managed with other treatments. If TMJ symptoms are persistent or particularly severe, a healthcare provider may recommend one of three types of TMJ surgery: arthroscopy, arthrocentesis, or open-joint surgery. These procedures can differ in how they are performed and the recovery time after they are performed.

Medications for TMJ disorders

A healthcare provider may prescribe a medication based on the cause and severity of symptoms. The most common classes of drugs used to treat TMJ disorders include nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, and tricyclic antidepressants. Other drugs used for TMJ disorders include muscle relaxants, anticonvulsants, and corticosteroids.

Prescription drugs are typically used off-label for the treatment of TMJ disorders. There are no drugs currently FDA-approved for TMJ disorders. Always consult a healthcare provider about the best treatment option for you.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve inflammation and pain from TMJ disorders. They may be used as first-line agents for acute pain and are often used to treat inflammatory conditions of the TMJ, such as arthritis. Examples of NSAIDs used for TMJ disorders include Naprosyn (naproxen), Feldene (piroxicam), and Mobic (meloxicam).

Benzodiazepines

Benzodiazepines are sedative drugs often used to treat anxiety. Some healthcare providers may prescribe benzodiazepines for short-term relief of TMJ symptoms. If prescribed, benzodiazepines are only used during the first stages of treatment for two to four weeks at most. Benzodiazepines include Valium (diazepam) and Klonopin (clonazepam).

Anticonvulsants

Anticonvulsants are anti-seizure medications that are often used to treat nerve pain (neuropathic pain). Anticonvulsants are sometimes prescribed to treat pain from TMJ disorders. Neurontin (gabapentin) and Lyrica (pregabalin) are examples of anticonvulsant drugs that may help relieve TMJ pain.

Muscle relaxants

Muscle relaxants are a class of drugs that treat muscle spasms. Healthcare providers may prescribe a muscle relaxant for TMJ problems involving the facial muscles. In some cases, they may be prescribed in addition to other pain medications for short-term use. Muscle relaxants include Flexeril (cyclobenzaprine) and Skelaxin (metaxalone).

Tricyclic antidepressants

Healthcare providers may prescribe a tricyclic antidepressant to help manage chronic TMJ pain. Tricyclic antidepressants work on certain neurotransmitters in the brain called serotonin and norepinephrine. Tricyclic antidepressants include Elavil (amitriptyline), Pamelor (nortriptyline), and Norpramin (desipramine).

Corticosteroids

Corticosteroids are another option for treating TMJ symptoms. Although they are not typically used as first-line agents, corticosteroids may help reduce inflammation in the TMJ. They are typically administered as an injection directly into the TMJ to reduce pain for four to six weeks.

Botox

Botulinum toxin Type A, also known as Botox, may be used for TMJ disorders that do not respond to other treatments. However, the overall evidence for Botox injections is weak. When used for TMJ disorders, Botox is usually injected into the jaw muscles instead of the joints.

The most common TMJ disorder medications

While there are numerous options of medicines that can be prescribed for TMJ, below is a list of some of the most common medications:

Dosage may be determined by your doctor based on your medical condition, response to treatment, age, or weight. Other possible side effects exist. This is not a complete list.

As with all medications, medications used to treat TMJ disorders can cause possible side effects. Benzodiazepines, muscle relaxants, tricyclic antidepressants, and anticonvulsants can cause side effects that affect the central nervous system (CNS), such as drowsiness, dizziness, and fatigue.

Always take medication as prescribed by your healthcare provider. You can also consult the medication guide and instructions to ensure you’re taking your medication correctly. Tell your healthcare provider about any medical conditions you have and other medication you are taking before starting treatment. Ask your healthcare provider about your medication’s possible side effects, drug interactions, and precautions.

Alternative treatment options for TMJ disorders

Relaxation techniques

Relaxation techniques, such as yoga and meditation, may reduce stress and help you cope with TMJ pain or discomfort. Research suggests that relaxation techniques may positively affect a patient’s perception of TMJ pain.

Acupuncture

Acupuncture, a traditional Chinese practice, is sometimes performed to help relieve TMJ symptoms. It involves inserting tiny needles into specific points of the body to stimulate the nerves in the skin and muscles. Sessions may last anywhere from 15 to 30 minutes. Research suggests that acupuncture can be an effective complementary treatment for short-term pain relief.

Biofeedback

Biofeedback techniques involve the use of sensors that measure specific bodily functions. During a biofeedback session, you’ll be able to monitor different processes, such as brain waves, breathing rate, heart rate, and muscle contractions. You can then learn to make adjustments based on the information you receive. Although the overall evidence is weak, some research suggests that biofeedback may help relieve orofacial pain.

Frequently asked questions about TMJ

Can TMJ go away on its own?

Most cases of TMJ disorders are self-limiting over the long term, and this has been shown in a few studies. For many individuals, mild and even moderate cases of TMJ will go away with little or no treatment. Resting the jaw and reducing stress or triggers can alleviate the discomfort associated with TMJ. In addition, using medications during TMJ flare-ups can minimize pain during the recovery and healing process.

Are TMJ disorders serious?

TMJ disorders are not usually serious. Depending on the cause of the TMJ disorder, symptoms are usually short-term and resolve on their own, with or without treatment. However, if the problem is left untreated, TMJ disorders may lead to chronic pain and other complications.

What are the symptoms of TMJ disorders?

The symptoms of TMJ disorders include facial aches and pain, tenderness of the jaw, pain in the jaw joints, and discomfort or trouble while chewing and opening the mouth. Other symptoms may include headaches, earaches, and a clicking or popping sound in the jaw.

What's the difference between TMJ and TMD?

TMJ is an abbreviation for temporomandibular joint. TMD is an abbreviation for temporomandibular disorder, which can refer to any condition affecting the jaw joints or surrounding muscles and nerves.

How long does it take for TMJ to go away?

TMJ symptoms can often clear up within a few days to a few weeks. The time it takes for TMJ symptoms to go away depends on the underlying cause of the condition and the severity of the symptoms.

Can physical therapy and chiropractic treatments help with TMJ?

There is debate on whether TMJ symptoms can be relieved with chiropractic care. A chiropractor may be able to make adjustments to relieve tension in the muscles and joints, and some studies suggest that chiropractic treatment may be useful for alleviating symptoms of temporomandibular dysfunction.

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