In the last few of years, guidelines have been released by the Royal College of Surgeons, British Medical Association, British Orthodontic Society, and NICE Guidelines regarding the best treatment options for issues with the temporomandibular joint (TMJ) and temporomandibular joint disorders (TMD. The more recent guidelines place a larger emphasis on using physiotherapy, manual therapy and physchological interventions such as relaxation and counselling to improve TMD symptoms.

It is not thought that poor dental occlusion is the main cause of TMD.  It is associated with neck dysfunction, migraine, headaches, tinnitus and dizziness. Physiotherapy and psychology can help to manage TMD.

Links to the Royal College of Surgeons and British Medical Association guidelines are shown below. They provide an excellent summary of the current evidence for the causes and best treatments for TMD.

 

Royal College of Surgeons guidelines for TMD 2024.

https://www.rcseng.ac.uk/dental-faculties/fds/publications-guidelines/clinical-guidelines/

The dentist is usually the first person that a person with TMD will see, and they should teach self management techniques to alter clenching and posture, teach basic self manual therapy and advise on the use of heat to help relax the jaw muscles.

If this does not help, then physiotherapy and acupuncture are recommended. It may be that physiotherapy, acupuncture and psychological therapys may be needed to help maintain improvement in symptoms. This may be when flare ups happen, or periodically to help prevent flare ups.

Splints may help some sub-types of TMD but not all. The evidence for this is difficult to interpret as to which conditions benefit and which do not. For some people, splints can make their symptoms worse.

Medications can be considered for pain and muscle tension, but this may not be appropriate for all people. For more persistent muscular TMD issues, neuromodulatory medications can be considered.

Only if this does not work should surgery be considered for TMD.

 

BMJ GUIDELINES

https://www.bmj.com/content/383/bmj-2023-076227

Strongly recommends TMJ manual therapy and psychological therapy and also recommends acupuncture, neck manual therapy, and exercise. This should be provided before using and injections or surgery. It is likely that a number of interventions will be required to be effective.

These guidelines do not recommend medications, TENS, laser, or surgery as they are likely to be ineffective.

 

References

British Medial Journal TMJ Guidelines. https://www.bmj.com/content/383/bmj-2023-076227

https://www.bos.org.uk/wp-content/uploads/2022/09/Tmdsandtheothodonticpatient2020.pdf

https://cks.nice.org.uk/topics/temporomandibular-disorders-tmds/management/management/

Weden, Alexander & Bateman, Phillip & Gordon, Cathy & Hodgson, Nicola & Durham, Justin. (2021). Physiotherapy for the Management of Temporomandibular Disorders: Findings from United Kingdom Practice. Oral Surgery. 15. 10.1111/ors.12712.

Weden A, Haig H. Current thinking in physiotherapy for the management of idiopathic and postsurgical temporomandibular disorders: a narrative review. Br J Oral Maxillofac Surg. 2024 Jul;62(6):588-593. doi: 10.1016/j.bjoms.2024.05.008. Epub 2024 Jun 4. PMID: 38906764.

Royal College of Surgeons TMJ Guidelines. https://www.rcseng.ac.uk/dental-faculties/fds/publications-guidelines/clinical-guidelines/