Temporomandibular joint disorders and treatment options
Temporomandibular disorders (TMD), commonly referred to as TMJ (temporomandibular joint) disorders, affect up to 25-30% of people during their lifetime, with approximately 5-12% of patients requiring treatment. TMJ disorders can cause a variety of symptoms, including jaw pain, muscle tenderness, clicking, popping, or grinding when opening or closing the mouth, joint dysfunction including a locked jaw, headaches, neck and shoulder pain, ear fullness, ringing in the ears (tinnitus), or ear pain without an ear infection. Risk factors for developing TMD include stress and anxiety, teeth grinding or clenching, previous jaw injury, arthritis, connective tissue disorders, excessive gum chewing, and poor posture. Symptoms may become chronic and can vary from mild discomfort to significant pain and functional limitations.
Acupuncture is one of the most studied complementary medicine interventions for TMD. Multiple systematic reviews and meta-analyses have found that acupuncture can significantly reduce pain intensity and improve jaw function compared with sham acupuncture* or conventional care alone. The following clinical trial randomized 60 participants into 2 treatment groups: acupuncture versus sham acupuncture, with 3 sessions per week for 4 weeks. The trial found that “the acupuncture group showed significantly reduced pain intensity compared to the sham group at week 4. Acupuncture's effectiveness surpassed sham's at 4 weeks and lasted 8 weeks. In summary, acupuncture provided marked pain relief and improvement in physical and emotional function for patients with TMD compared with sham acupuncture.”
Effect of acupuncture for temporomandibular disorders: a randomized clinical trial - PubMed
This study, along with other recent evidence, suggests that acupuncture may improve both physical function and quality of life in patients with TMD. As a result, acupuncture is increasingly considered a useful adjunctive therapy alongside standard dental and physical therapy treatments.
Massage therapy and other manual soft-tissue techniques may also provide symptom relief for individuals with TMD. Evidence suggests that massage can decrease muscle tenderness, improve range of motion, and reduce pain associated with masticatory muscle dysfunction. Since TMD is more common in women, the following study evaluated 82 women with TMD and found that after 10 days of treatment, the group receiving massage plus therapeutic exercises had the best analgesic effects with reduced jaw pain, improved mouth opening and jaw mobility, and reduced masseter muscle tension.
This and other studies have shown that massage therapy is particularly effective when combined with therapeutic exercises or post-isometric relaxation techniques.
“Chiropractic therapy is emerging as a promising non-invasive treatment option” for certain patients with TMD, as quoted in the following case study. Research is limited, but there are some small studies and case reports of successful chiropractic treatment of TMD when symptoms are associated with neck pain, poor posture, or muscle tension. The following case study is of a “39-year-old female patient with TMD who underwent chiropractic therapy, including spinal adjustments, soft tissue therapy, and exercise rehabilitation. After 4 weeks of treatment, the patient reported complete resolution of symptoms and an improved quality-of-life score. Thereafter, the patient continued chiropractic treatment monthly for six months, during which she reported no symptoms.”
Temporomandibular Disorder Treated With Chiropractic Therapy - PMC
Nutritional counseling may be important for patients during an acute TMD flare, when dietary modifications such as a soft diet are required. Soft foods are considered a supportive treatment that can decrease the workload on the jaw muscles and joint. Some evidence suggests that reducing overall inflammation may help with chronic pain conditions, so an anti-inflammatory diet may also be considered.
Acupuncture, massage therapy, chiropractic treatment, and nutritional counseling offer multimodal, nonpharmacologic approaches that may improve pain control and functional outcomes in patients with TMJ disorders.
*sham acupuncture - is a fake or placebo version of acupuncture that is mainly used as a scientific research tool to test whether acupuncture treatment has effects beyond placebo. Sham acupuncture includes methods of using needles that don’t penetrate the skin, placing needles in non-acupuncture points, inserting needles only superficially, or using a device that simulates needling without real insertion.
References:
Liu, Lu et al. “Effect of acupuncture for temporomandibular disorders: a randomized clinical trial.” QJM : monthly journal of the Association of Physicians vol. 117,9 (2024): 647-656. doi:10.1093/qjmed/hcae094
Gębska, Magdalena et al. “Evaluation of the efficacy of manual soft tissue therapy and therapeutic exercises in patients with pain and limited mobility TMJ: a randomized control trial (RCT).” Head & Face Medicine vol. 19,1 42. 8 Sep. 2023, doi:10.1186/s13005-023-00385-y
Chu, Eric Chun-Pu et al. “Temporomandibular Disorder Treated With Chiropractic Therapy.” Cureus vol. 15,3 e36377. 19 Mar. 2023, doi:10.7759/cureus.36377
