Non-Surgical TMJ Treatments are the New Standard

By Dr. James Fricton

The first treatment of choice for temporomandibular joint (TMJ) problems should avoid irreversible surgical treatments.

People suffering from temporomandibular joint (TMJ) issues often go through a tremendous amount of jaw, ear, head, and neck pain. They deserve not only early and proper diagnosis but a compassionate approach to non-surgical TMJ treatments and pain management.

Non-Surgical TMJ Treatments are the New Standard
Conservative and Non-invasive Approach to TMJ Treatment
Common Non-Surgical TMJ Treatments
CONCLUSION: Conservative Care for Individuals with TMJ

Temporomandibular disorders (TMD) is a collective medical term for over 30 different conditions that affect the TMJ and connected soft tissue. To add to its unique complexity, it involves two joints on one or both sides of your face and the dental occlusion that all need to function together. The joints and occlusion involve coordinated muscle movements to function properly.

Conservative and Non-invasive Approach to TMJ Treatment

Many oral and facial activities normally occur without thought. This means that they carry out various movements and a considerable range of combined functions. TMJ facial pain and dysfunction may disrupt normal functioning during chewing, smiling, yawning, speaking, and other activities.

Previously, we’ve covered suggested causes of TMJ pain. What can be frustrating is that your treatment depends on the root cause — which can be difficult to identify. Commonly, it is recognized due to jaw strain or trauma, such as clenching or grinding the teeth, sports injury to the face, or opening wide during dental visits.

Your TMJ specialist will assess your pain severity . Common signs on physical examination of TMJ patients include tenderness of the pterygoid muscles, temporomandibular joints, temporalis muscles, and malocclusion of a person’s jaw and crepitus. (Crepitus is a popping, clicking or crackling sound in the TMJ joint.)^[1]

The bigger mystery is when symptoms surface without an obvious reason. Signs of TMJ may even be triggered by the surrounding muscles and ligaments instead of the TMJ itself. Careful diagnosis and starting with simple treatments are best. Then we can come up with your custom plan to help manage jaw clenching and related symptoms.

TMJ treatments that pose little risk to patients

“In light of these significant challenges, it is paramount to adopt a treatment approach that is effective and cost-efficient and poses minimal risk to patients. While surgical approaches are hindered by certain complications conservative and non-invasive therapies possess all these characteristics, and for this reason, now represent the first line of treatment for TMDs.

The conservative and non-invasive approach to TMD treatment is generally characterized by its emphasis on risk minimization and patient education. Rather than opting immediately for invasive procedures, the first line of therapy focuses on empowering patients by providing knowledge about their condition and equipping them with tools to effectively manage their symptoms.” – Temporomandibular Joint Disorders: Functional and Conservative Treatment, NIH, July 2023

The study also reports that “dynamic splint therapy was more effective than stabilization splint therapy in increasing maximum jaw opening, reducing pain, and improving functional movements in patients with acute anterior disc displacement without reduction.”

At the Minnesota Head & Neck Pain Clinics, each provider comes with experience and shared common best practices. The following treatments are more frequently recommended.

Non-invasive TMJ treatments may include:

Resting the jaw may be the best initial treatment. This gives the jaw joint a chance to heal and regain stability.
Heat or ice therapy for jaw pain.
Self-management training in how to reduce stressors and strain to the jaw, head, and neck, such as relaxation, stretching, diet, and TMJ-related sleep improvement activities.
Manual physical therapy and jaw exercises to enhance jaw mobility and strengthen jaw muscles.
Ultrasound or electrical stimulation.
Dry needling.
Trigger point injections that relax taunt jaw muscles.
Intra-oral orthopedic TMJ splints
Behavioral therapies meant to assist TMJ patients with pain coping skills to reduce stressors known to intensify issues.
Pharmacological treatments as part of a conservative approach to TMJ treatment, providing they are closely supervised and used cautiously.

Non-invasive TMJ therapy – insurance coverage questions

You can comfortably prevent future TMJ flare-ups and dental problems once you are ready to proceed.

There is no standard for costs for TMJ treatments. Costs vary by provider, policy, and location. “Insurance reimbursement for TMJ treatments can be complex and difficult to navigate. Insurance coverage varies from state to state, company to company, and policy to policy. Some policies have specific exclusion clauses for TMJ treatment and some have limitations on the dollar amount or type of coverage available,” according to the TMJ Association ^[2].

For individuals taking insurance coverage into consideration, United Healthcare provided a new list as of October 2023, for Individual Exchange benefit plans. (Only Colorado residents are exempt). It states that the following i.e. TMJ treatment coverage.

Non-surgical TMJ services that are “proven and medically necessary”:

Biofeedback.
Craniosacral manipulation/therapy.
Passive rehabilitation therapy.
Low-load prolonged-duration stretch (LLPS) devices.
Multiple occlusal splints (i.e., daytime, and nighttime splints, maxillary, and mandibular splints).

Patients often find it difficult to interpret these terms. We recommendd always talking to your insurance provider ahead of your office visit to avoid surprises.

Common Non-Surgical TMJ Treatments

Arthrocentesis – (NOTE: TMJ arthrocentesis procedure bridges the gap between surgical and nonsurgical treatment).
Trigger point injections.
Cognitive-behavioral therapies.

The following comments may be helpful and assist in aligning with your non-invasive TMJ treatment at our clinics.

Physical therapy may fall under “Biofeedback” in the context of teaching patients’ self-control, such as in breathing patterns. “Intra-articular injections of corticosteroids” can be described as “Craniosacral manipulation/therapy.” (LLPS) devices have been used by some providers to help set the level of tension in jaw muscles. Under “Multiple occlusal splints,” we find Occlusal splints (stabilization and repositioning splints) are effective.

We’ll wrap with additional quotes that helps answer “What is arthrocentesis in TMJ?”

“It appears reasonable to conclude that TMJ arthrocentesis is a simple, less invasive, inexpensive, and highly effective procedure. It is a method with a minimum number of complications and significant clinical benefits. These features make arthrocentesis a valid treatment option for patients with TMJ disorders not responding to (other) nonsurgical therapies.” – Arthrocentesis of Temporomandibular Joint- Bridging the Gap Between Non-Surgical and Surgical Treatment ^[3]

“Occlusal splints are removable artificial occlusal surfaces that affect the relationship of the mandible to the maxilla and are used for diagnosis or therapy. The mechanisms of action as a treatment involve restoring the vertical dimension of occlusion, occlusal disengagement, joint unloading, masticatory muscle relaxation, or TMJ repositioning.

Arthrocentesis occurs in three steps: forcing apart the joint constituents, washing away inflammation and degradable products, and eliminating intra-articular effusion to decrease intra-articular pressure, control pain, and improve function. High success rates have been reported for internal derangements (ID) and closed lock.” – Non-invasive different modalities of treatment for temporomandibular disorders, NIH, April 25, 2018,

This above article by Amira Mokhtar Abouelhuda for the National Institute of Health concludes as we do, that TMJ care should begin with conservative, nonsurgical therapies, with surgery left as the last resort. If diagnosis and treatment are delayed, a person may face increased levels of clicking, facial pain, limited mandibular movements, and even masticatory difficulties. ^[4]

CONCLUSION: Conservative Care for Individuals with TMJ

If your symptoms persist, your pain provider may recommend a variety of temporomandibular joint pain treatment options. Often, multiple non-surgical methods are done simultaneously.

Schedule your TMJ office visit today:

Plymouth: (763) 577-2484

St. Paul: (651) 332-7474

Burnsville: (952) 892-6222

St. Cloud: 763-233-7252

About the Author

James Fricton DDS, MS is a leading pain and TMJ Disorder specialist at the Minnesota Head and Neck Pain Clinic, Chair of the Specialty Committee for the AAOP, and University of Minnesota Professor Emeritus

References:

[1] Eric M. Matheson, et al, “Temporomandibular Disorders: Rapid Evidence Review”, 2023, https://www.aafp.org/pubs/afp/issues/2023/0100/temporomandibular-disorders.html

[2] “What Do TMJ Treatments Cost?”, current, https://tmj.org/living-with-tmj/treatments/costs/

[3] Abhishek Soni, “Arthrocentesis of Temporomandibular Joint- Bridging the Gap Between Non-Surgical and Surgical Treatment,” January 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585213/

[4] Qiuhao Wang, et al, “A Bibliometric Analysis of Research on Temporomandibular Joint Disc Displacement from 1992 to 2022,” July 2023, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10379638/