Chronic temporomandibular pain (CTMP) is a complex and often debilitating condition affecting the temporomandibular joint (TMJ), masticatory muscles, and surrounding structures.
It is characterized by persistent pain lasting more than three months and may be accompanied by joint noises, limited jaw mobility, and functional impairment.
CTMP is commonly associated with temporomandibular disorders (TMDs), a group of musculoskeletal conditions that affect up to 15% of the adult population, especially women between 20 and 50 years of age.
In recent years, advances in neuroscience, pain management, and behavioral medicine have significantly influenced how CTMP is diagnosed and managed.
Understanding the multifactorial etiology of TMDs—ranging from biomechanical, psychological, and neurophysiological factors—has led to more individualized and evidence-based treatment protocols.
Current Perspectives on Diagnosis
The diagnosis of chronic temporomandibular pain requires a multidisciplinary approach.
The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), established in 2014 and updated regularly, remains the most validated tool.
It incorporates both Axis I (physical assessment) and Axis II (psychosocial evaluation), allowing clinicians to assess not only the anatomical and functional aspects of the disorder but also its psychological impact.
Advanced imaging such as MRI and CBCT may be employed in selected cases to assess joint structures or rule out internal derangement, while surface electromyography and jaw tracking systems provide additional insights into muscle function.
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Evidence-Based Treatment Strategies
1. Conservative Therapies (First-Line Approach)
✔ Self-care and behavior modification
Patients are educated about avoiding parafunctional habits (e.g., clenching, gum chewing), maintaining good posture, and performing jaw exercises.
✔ Pharmacologic management
NSAIDs, muscle relaxants, and, in some cases, low-dose tricyclic antidepressants are effective for muscle-related TMD pain. Topical NSAIDs and botulinum toxin type A have also shown promise in resistant cases.
✔ Occlusal splints
Stabilization splints are widely used, although their efficacy remains debated. Current literature supports their short-term benefit in reducing pain and protecting teeth from bruxism.
2. Physical Therapy and Manual Techniques
Physical therapy remains a cornerstone in CTMP treatment, focusing on jaw mobility, myofascial release, and cervical spine alignment. Therapies may include ultrasound, dry needling, low-level laser therapy (LLLT), and transcutaneous electrical nerve stimulation (TENS).
3. Psychological and Behavioral Interventions
Chronic pain is closely linked with psychological stress, anxiety, and depression. Cognitive behavioral therapy (CBT) and biofeedback are highly effective in patients with psychosocial contributors to their pain. These approaches help manage central sensitization and reduce pain catastrophizing.
4. Minimally Invasive Procedures
✔ Intra-articular injections of corticosteroids or hyaluronic acid may be considered in joint-related pain or inflammation.
✔ Arthrocentesis, a lavage procedure of the joint space, can provide relief in cases of joint effusion or limited jaw opening.
5. Surgical Interventions (Last Resort)
Open joint surgery or arthroscopy may be indicated in rare, refractory cases where significant joint damage, ankylosis, or degenerative changes are present. However, surgery should only be pursued after all conservative avenues have failed and the source of pain is well established.
Emerging Therapies and Future Directions
Recent research highlights the role of central sensitization, altered pain processing, and chronic overlapping pain conditions (COPCs) such as fibromyalgia in CTMP patients.
Future treatments are likely to involve neuromodulation, personalized medicine, and artificial intelligence-based diagnostic tools.
Moreover, regenerative medicine—such as platelet-rich plasma (PRP) and stem cell therapy—is being investigated for its potential to repair joint tissues and reduce inflammation.
Conclusion
Managing chronic temporomandibular pain requires a tailored, biopsychosocial approach that integrates conservative care, patient education, psychological support, and, in select cases, interventional procedures.
As our understanding of the neurobiology of pain continues to grow, interdisciplinary collaboration remains key to improving patient outcomes.
Recommended Reading for Professionals
- the bmj | BMJ 2023;383:e076227 | doi: 10.1136/bmj-2023-076227. Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline.
- FREYNE, B.; BOADUM, O.; LONE, M. & BALTA, J. Y. Pain patterns of the temporomandibular joint dysfunction and implications of stress-related behaviors: A pilot study. Int. J. Morphol., 42(1):1-8, 2024.
- Schiffman E, Ohrbach R, Truelove E, et al. "Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group." Journal of Oral & Facial Pain and Headache. 2014;28(1):6–27.
