Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Approach to managing temporomandibular joint (TMJ) pain in patients with a history of bruxism:
- Reassure and educate: Explain that temporomandibular disorders (TMDs) are usually non-progressive and symptoms often fluctuate but tend to improve. Educate about the anatomy, contributing factors including bruxism, and management goals NICE CKS.
- Encourage self-management: Advise a soft diet and jaw rest during acute pain episodes. Recommend avoiding parafunctional activities such as teeth grinding, jaw clenching, chewing gum, nail biting, and wide yawning that may exacerbate symptoms NICE CKS.
- Local symptomatic measures: Suggest applying covered ice or warm compresses and gentle massage of affected muscles to relieve pain and muscle spasm NICE CKS.
- Prescribe analgesia: Use simple analgesics like paracetamol or NSAIDs for short-term pain relief NICE CKS.
- Consider adjunctive drug therapy: For acute severe myogenous pain, a short course of low-dose benzodiazepines (e.g., diazepam 2 mg up to three times daily for max 5 days) may be considered. For chronic pain, trials of amitriptyline or gabapentin can be considered NICE CKS.
- Refer to physiotherapy: For advice on passive jaw stretching exercises, posture training, massage, or acupuncture to relax muscle spasm and improve joint function NICE CKS.
- Consider referral to a dentist: For assessment of dental health, malocclusion, or to consider intra-oral devices such as occlusal splints to reduce bruxism-related damage NICE CKS.
- Address psychosocial factors: Screen for psychological distress, anxiety, depression, and sleep dysfunction, which can influence TMD prognosis. Consider referral for cognitive behavioural therapy (CBT) to help manage pain-related anxiety and chronic pain NICE CKS.
- Specialist referral: If symptoms worsen, persist beyond 6-8 weeks despite primary care management, or if there is significant functional impairment, consider referral to oral and maxillofacial surgery, ENT, neurology, or multidisciplinary pain clinics for further investigation and management NICE CKS.