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Temporomandibular joint (TMJ) syndrome is a disorder involving the two joints (one on each side) that attach the lower jaw to the skull. These two joints open and close the mouth, and are located directly in front of each of the ears. In TMJ syndrome, the area around the temporomandibular joints becomes chronically tender and inflamed. Symptoms include the following:
TMJ syndrome often occurs in people who have had accidents or injuries involving their jaw, but many others have had no such incident. It is believed that grinding the teeth or clenching the jaw in response to stress may trigger the condition in many cases. Other possible causes include arthritis of the temporomandibular joint, facial bone defects, and misalignments of the jaw or of the bite.
The underlying cause of TMJ syndrome is not known. In most cases, the joint appears to be healthy, suggesting that it is the soft tissue around the joint rather than the joint itself that has the problem. However, some cases of TMJ syndrome may be caused by TMJ arthritis, TMJ dislocation, or other forms of true joint injury.
Treatment of TMJ includes stress management, avoidance of certain foods that trigger discomfort (such as gum or beef jerky), and anti-inflammatory medications. The older antidepressant drug amitriptyline, taken in low doses,1 as well as the muscle relaxant cyclobenzaprine 2 may help as well.
According to a few controlled trials, some people with more severe forms of TMJ may benefit from the use of a dental appliance.3–6 Finally, on rare occasions, surgery may be necessary.
Proposed Natural Treatments
The supplement glucosamine, taken alone or in combination with chondroitin, has shown considerable promise for the treatment of osteoarthritis. Because osteoarthritis of the temporomandibular joint can play a role in some cases of TMJ syndrome, researchers have begun to investigate the potential role of these supplements in treating the condition. Promising results were seen in a double-blind study that compared glucosamine to ibuprofen in the treatment of 45 people with TMJ arthritis.7 Over the 3-month study period, the supplement proved equal in effectiveness to the drug. However, because this study lacked a placebo group, it cannot be taken as fully reliable. Another double-blind study, this one involving glucosamine without chondroitin, did have a placebo group, but too many participants dropped out to allow meaningful conclusions to be drawn.8
EMG biofeedback is a form of biofeedback therapy that involves teaching a person to gain conscious control of muscle tension. A meta-analysis (formal statistical review) of published studies suggests that EMG biofeedback might be helpful for TMJ pain.9 However, the reviewers noted that the evidence is as yet incomplete, and more (and better quality) research is needed.
A small randomized trial involving 39 women with TMJ found hypnosis to be more effective in reducing pain than relaxation.15
Similarly, while preliminary controlled trials suggest that acupuncture may be helpful for TMJ syndrome, more research is needed.10, 12, 14 A preliminary study compared Traditional Chinese Medicine (TCM incorporates acupuncture among other treatments) and Naturopathic Medicine (NM) against care given by clinic staffed by TMJ specialists. Researchers found that both TCM and NM provided greater benefit among 128 women.13 Although subjects were randomized into the different groups, there was no blinding and practitioners were permitted to treat each subject in any way they saw fit.
A cream made from cayenne and other hot peppers (capsaicin cream) has shown promise for a variety of painful conditions. However, one study failed to find capsaicin cream more effective than placebo cream for TMJ syndrome.11
References[ + ]
1. Plesh O, Curtis D, Levine J, et al. Amitriptyline treatment of chronic pain in patients with temporomandibular disorders. Oral Rehabil. 2000;27:834–841.
2. Herman CR, Schiffman EL, Look JO, et al. The effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient education and self-care for the treatment of jaw pain upon awakening: a randomized clinical trial. J Orofac Pain. 2002;16:64–70.
3. Kuttila M, Le Bell Y, Savolainen-Niemi E, et al. Efficiency of occlusal appliance therapy in secondary otalgia and temporomandibular disorders. Acta Odontol Scand. 2002;60:248–254.
4. Minakuchi H, Kuboki T, Matsuka Y, et al. Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction. J Dent Res. 2001;80:924–928.
5. Raphael KG, Marbach JJ. Widespread pain and the effectiveness of oral splints in myofascial face pain. J Am Dent Assoc. 2001;132:305–316.
6. Ekberg EC, Vallon D, Nilner M. Occlusal appliance therapy in patients with temporomandibular disorders. A double-blind controlled study in a short-term perspective. Acta Odontol Scand. 1998;56:122–128.
7. Thie NM, Prasad NG, Major PW. Evaluation of glucosamine sulfate compared to ibuprofen for the treatment of temporomandibular joint osteoarthritis: a randomized double blind controlled 3 month clinical trial. J Rheumatol. 2001;28:1347–1355.
8. Nguyen P, Mohamed SE, Gardiner D, et al. randomized double-blind clinical trial of the effect of chondroitin sulfate and glucosamine hydrochloride on temporomandibular joint disorders: a pilot study. Cranio. 2001;19:130–139.
9. Crider AB, Glaros AG. A meta-analysis of EMG biofeedback treatment of temporomandibular disorders. J Orofac Pain. 1999;13:29–37.
10. Ernst E, White AR. Acupuncture as a treatment for temporomandibular joint dysfunction: a systematic review of randomized trials. Arch Otolaryngol Head Neck Surg. 1999;125:269–272.
11. Winocur E, Gavish A, Halachmi M, et al. Topical application of capsaicin for the treatment of localized pain in the temporomandibular joint area. J Orofac Pain. 2000;14:31–36.
12. Smith P, Mosscrop D, Davies S et al. The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: A randomised controlled trial. J Dent. 2006 Nov 7 [Epub ahead of print].
13. Ritenbaugh C, Hammerschlag R, Calabrese C, et al. A pilot whole systems clinical trial of traditional Chinese medicine and naturopathic medicine for the treatment of temporomandibular disorders. J Altern Complement Med. 2008;14:475-487.
14. La Touche R, Angulo-Díaz-Parreño S, et al. Effectiveness of acupuncture in the treatment of temporomandibular disorders of muscular origin: a systematic review of the last decade. J Altern Complement Med. 2010;16:107.
15. Abrahamsen R, Baad-Hansen L, Zachariae R, Svensson P. Effect of hypnosis on pain and blink reflexes in patients with painful temporomandibular disorders. Clin J Pain. 2011;27(4):344-351.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 12/15/2015
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