Temporomandibular Joint Dysfunction Medications

If you are suffering from TMJ related pain or discomfort, the first line of defense starts with over-the-counter pain medications. OTC meds and non-steroidal anti-inflammatory drugs can provide instant relief from minor pain and discomfort. However, if TMJ pain persists of worsens after taking these types of medications, a stronger medication may need to be prescribed. Qualified healthcare professionals can examine the TMJ structures and determine if more powerful medications are needed. They can prescribe more powerful pain meds, muscle relaxants, and even antidepressants or benzodiazepines. Some of these other medications may not be labeled as TMJ treatment options but they assist by addressing some of the underlying causes of TMJ pain. Muscle relaxers, anti-depressants, and benzodiazepines can all help reduce muscle strain and stress which can exacerbate TMJD symptoms. Before taking any of these medications, it is important to check with your doctor to minimize the risk of side effects and adverse medication interactions. It’s also important to remember that while these medications may provide relief, they are not a cure for TMJD. They are designed to reduce pain and discomfort while the underlying cause of the pain or discomfort is treated and heals.

What is TMJ?

The temporomandibular joint (TMJ) is the joint located on both sides of the face that connects the lower mandible to the temporal bone. This hinge joint is responsible for the movements related to talking and eating. Locating the TMJ is easy and can be done by placing a finger in front of either ear and feeling where the TMJ joint opens and closes the mouth. Sometimes, TMJ disorders occur which can result in pain in or around the jaw joint and difficulty opening the mouth. This can be the result of trauma, degeneration, or something else entirely and can be short lived or result in chronic pain and discomfort.

TMJ Symptoms

People with TMJ disorders experience a range of symptoms from mild discomfort to limitations in movement. Recognizing common TMJD symptoms can help with properly diagnosing and treating the TMJ disfunction:

• Jaw pain and tenderness
• Restricted or limited jaw movement
• Jaw clicking or popping
• Jaw swelling
• Face, neck, or head discomfort
• Ringing in ears
• Headaches
• Toothaches

If any of these symptoms present themselves individually or together, it is important to consult with a qualified TMJ expert. Immediate treatment can help prevent symptoms from getting worse and alleviate discomfort.

Medications for TMJ Disorders

Various medications can be prescribed to treat symptoms associated with TMJD, but effective treatment depends on the root cause and intensity of the symptoms. While no drugs are specifically FDA-approved for TMJ disorders, several classes of medications have been found effective in managing the discomfort associated with TMJ dysfunction:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Benzodiazepines
• Tricyclic antidepressants
• Muscle relaxants
• Anticonvulsants
• Corticosteroids

In cases of extreme pain, short-term use of opioids might also be worth consideration. However, it is important to note that this class of drugs comes with potential dependency risks which is why opioids are not the primary recommendation for TMJ related pain management. Speaking with a healthcare professional to determine the most suitable treatment approach for an individual’s unique needs is recommended.

How Different TMJ Medications Affect Different People

Individuals with TMJ disorders can have different underlying causes in addition to reacting differently to specific medications. This often results in one person’s treatment being completely different from another’s. It’s important to remember that the effectiveness or side effects of one particular drug can vary significantly among patients, which is why a trial of a drug is often the only way to gauge its impact on a patient. Working with a primary care physician is crucial during this process so both doctor and patient can monitor the effects of the medication, any potential side effects, and any adverse drug interactions.

TMJ Medication Classifications

TMJ medication classifications primarily fall into two main categories: over the counter (OTC) and prescription drugs. OTC options include drugs like acetaminophen and NSAIDs which offer relief from pain and inflammation but do not address the underlying cause of TMJD. More severe or persistent symptoms may require prescription strength drugs like muscle relaxants, corticosteroids, and certain antidepressants which help alleviate exacerbating factors like muscle tension and stress.

Over the Counter Drugs

Over the counter (OTC) medications are usually the first line of defense against TMJ related pain. OTC pain relievers include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). Acetaminophen offers temporary pain relief from jaw pain but doesn’t address inflammation. NSAIDs are often the preferred choice because they help manage both inflammation and pain.

Prescription Drugs

When over-the-counter medications prove inadequate for treating TMJ related pain, prescription-strength drugs are a more powerful alternative. These generally require a prescription from a doctor after they determine the specific symptoms and their associated severity. The following are all prescription strength TMJD medications that are often utilized to help reduce TMJD symptoms:

• Prescription NSAIDs – like OTC NSAIDs but stronger
• Muscle Relaxants – These work by relaxing tight face and jaw muscles
• Anti-Anxiety Medications – Help reduce stress often associated with TMJD
• Corticosteroids – Can be taken orally or injected directly into the joint for temporary relief from intense pain and inflammation around the TMJ
• Antidepressants – Can help manage pain by modifying the body’s pain perception

Modes of Delivery

TMJ medications can be delivered through various modes. Oral medications are often taken as tablets or capsules while topical treatments can be applied directly to the affected area. For extreme instances of TMJD that do not respond to less invasive treatment options, injected medications can provide targeted treatment that delivers the drug directly into or near the temporomandibular joint.

Oral Medications

Oral medications for TMJ dysfunction generally come in the form of tablets or capsules and are designed to alleviate symptoms associated with temporomandibular joint disorders. These medications include over-the-counter pain relievers as well as stronger prescription drug that work by addressing pain and inflammation that may be caused or exacerbated by TMJD.

Acetaminophen

Acetaminophen is commonly recognized by the brand name Tylenol and is frequently used to alleviate pain. While it offers temporary relief from jaw pain associated with TMJ disorders, it does little to reduce swelling as it does not possess anti-inflammatory properties. So, while it can help manage pain, it doesn’t target the underlying inflammation that might be present in some TMJ cases.

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are another class of common pain relievers that addresses both pain and inflammation associated with TMJ disorders. Common NSAIDs include:

• Aspirin
• Celecoxib (Celebrex)
• Diclofenac (Voltaren)
• Ibuprofen (Motrin, Advil)
• Naproxen (Aleve)

While these drugs can be effective for acute TMJ inflammation, their efficacy in treating chronic TMJ pain requires further research. It’s essential to exercise caution with NSAIDs because prolonged use can lead to complications such as gastric ulcers, kidney and heart issues, and problems with blood clotting. NSAIDs can also interact negatively with other medications like lithium, methotrexate, and ACE inhibitors. Common TMJ related conditions that can be treated with NSAIDs include capsulitis, osteoarthritis, and inflammation resulting from surgical trauma. When prescribed, it’s crucial to follow recommended dosages and take these medications with food to minimize potential side effects, especially when used for extended periods.

Corticosteroids

Corticosteroids like prednisone and dexamethasone are potent anti-inflammatory medications that can be effective in managing inflammation that causes TMJ pain. However, they come with notable risks. Corticosteroids are naturally produced in the adrenal glands so elevated levels of synthetic variants can lead to adverse effects like adrenal damage, hypertension, electrolyte imbalances, bone resorption reduction, soft tissue degeneration, and weakened immune defenses. Due to these potential side effects, corticosteroids are not typically the primary treatment for chronic TMJ pain. When corticosteroids are the chosen medication to treat TMJ related symptoms, they are usually used for a limited time only. It’s essential to work closely with a healthcare professional when considering or using corticosteroids to ensure proper use.

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Antidepressants

Tricyclic antidepressants (TCAs) like amitriptyline and nortriptyline and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) such as duloxetine can be prescribed for chronic TMJ pain. They have known benefits in treating neuropathic and musculoskeletal pains, including conditions like fibromyalgia, which makes a strong case for their ability to treat TMJ related symptoms. While TCAs and SNRIs have shown better results in managing chronic pain compared to Selective Serotonin Reuptake Inhibitors (SSRIs), it’s essential to approach their use with caution. TCAs can lead to side effects like constipation, low blood pressure, dizziness, and sedation which makes them less suitable for cardiac and elderly patients. SNRIs are associated with side effects that include dizziness, nausea, insomnia, headache, fatigue, anxiety, and sexual dysfunction. When considering antidepressants for TMJ-related pain, it’s crucial to consult with a healthcare professional to ensure the medication aligns with the patient’s specific needs and medical history.

Muscle Relaxants

Muscle relaxants are often prescribed to alleviate the discomfort associated with TMJ disorders when the pain is believed to stem from tense or overactive muscles in the jaw and face. These medications include cyclobenzaprine (Flexeril), carisoprodol (Soma), and metaxalone (Skelaxin). They function by depressing the central nervous system which leads to sedative and musculoskeletal relaxant effects. It’s crucial for patients to be aware of potential side effects which include drowsiness. As a result, it’s best to take these medications before bedtime. Other side effects include dizziness, headaches, and low blood pressure upon standing. It is important to note that some muscle relaxants, like carisoprodol, can be habit-forming which emphasizes the importance of short-term use and close monitoring by a healthcare professional.

Anticonvulsants

Anticonvulsants are primarily designed to treat seizure disorders but have proven to be an effective treatment for managing certain chronic pain conditions. Notable examples of these medications include gabapentin (Neurontin) and pregabalin (Lyrica) which have been used to treat neuropathic pain conditions like fibromyalgia. Recent evidence suggests the use of anticonvulsants for treating orofacial pain disorders like TMJ pain. However, while these medications can be beneficial, they are not without potential side effects. Common adverse reactions to gabapentin and pregabalin include dizziness, blurred vision, and drowsiness. It’s essential for patients to be informed about these potential side effects and to maintain open communication with their healthcare provider when considering or undergoing treatment with anticonvulsants.

Benzodiazepines

Benzodiazepines are a class of medications that are primarily known for their anxiolytic properties but are also sometimes prescribed to alleviate symptoms of TMJ disorders. It is important to note that the evidence supporting their efficacy in treating TMJ-related pain remains limited. These drugs, which include lorazepam (Ativan), alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium), may offer relief from TMJ pain both directly and indirectly due to their ability to reduce anxiety and muscle spasms. The potential for developing tolerance and dependence is a significant concern which is why it’s crucial for patients and clinicians to approach the use of benzodiazepines with caution. Side effects such as drowsiness, confusion, and amnesia can occur, and they can interact with certain medications and foods. It’s also worth noting that these medications are not suitable for individuals with conditions like myasthenia gravis, certain allergies, or acute glaucoma.

Cannabis

Medical cannabis has been suggested as a potential treatment for various painful conditions, including those related to the temporomandibular joint (TMJ). Preliminary research on rats, indicates that the cannabinoids found in cannabis might enhance the efficacy of other pain-relieving medications which help reduce TMJ-related inflammatory pain. The current body of evidence regarding the effectiveness of cannabis for chronic pain, and specifically TMJ pain, remains limited. Despite the growing interest and media attention surrounding medical cannabis, more rigorous research is essential to establish its therapeutic potential. Potential side effects and risks associated with cannabis use include increased heart rate, dizziness, impaired concentration, memory issues, slower reaction times, potential drug interactions, heightened risk of heart attack and stroke, increased appetite, addiction potential, cyclic vomiting syndrome, hallucinations, mental health concerns, and withdrawal symptoms. Additionally, the inconsistency in dosing and quality of cannabis products poses a significant challenge.

Topical Medications

Topical medications offer a targeted approach to managing temporomandibular joint (TMJ) pain and discomfort. Applied directly to the skin over the affected area, these treatments can provide relief without the systemic effects often associated with oral medications.

Capsaicin

Capsaicin is derived from chili peppers and possesses analgesic properties that can potentially alleviate TMJ pain. Preliminary research, including a study involving an 8% capsaicin cream, indicated a reduction in TMJ pain after a week from a single application. However, more comprehensive studies are needed to validate these findings. It’s crucial for patients to be aware that capsaicin can lead to side effects like burning, itching, and redness at the application site. In rarer cases, respiratory symptoms like coughing, shortness of breath, and nasal congestion may occur.

Intramuscular Medication

Intramuscular TMJ medications offer a targeted approach to managing temporomandibular joint disorders. By delivering medication directly into the affected muscles, they aim to provide rapid relief from pain and inflammation associated with TMJD.

Botulinum Toxin

Botulinum toxin type A is commonly known as Botox and has been explored as a potential treatment for TMJD. This medication is injected into the masticatory muscles to reduce muscle spasms and any associated pain by inhibiting muscle contraction. While some studies have hinted at its potential benefits, the evidence remains inconclusive, especially concerning its effectiveness for myofascial pain in the neck and head muscles. It’s essential for patients to be aware of these findings and discuss potential risks with their healthcare provider.

Prolotherapy

Prolotherapy involves the injection of an irritant solution like dextrose or saline into ligaments or muscle tendons near areas of TMJ pain. The aim is to stimulate a reparative immune response which would strengthen weakened muscles and alleviate pain. However, current evidence supporting its use for TMJD is limited or mixed. Patients considering this treatment should be aware of potential side effects which include swelling, significant pain, stiffness, headaches, allergic reactions, and the risk of infection at the injection site.

Most Common TMJ Medications

When addressing TMJ disorders, the dosage of prescribed medications is typically determined by factors such as the patient’s medical condition, age, weight, and response to treatment. It’s imperative to always follow the guidance of your healthcare provider when taking medication. While medication guides can offer general instructions, it’s crucial to discuss your specific treatment parameters with your doctor because each individual case is unique. Before starting any treatment, inform your healthcare provider about any existing medical conditions and any other medications you’re currently taking. This will help in understanding potential side effects, drug interactions, and necessary precautions.

Drug Name	Drug Class	Administration Route	Recommended Dosage	Common Side Effects
Naprosyn	NSAID	Oral	500 mg 2x daily	Nausea, indigestion, stomachache, headache
Feldene	NSAID	Oral	20 mg daily	Nausea, stomachache, dizziness, diarrhea, constipation
Mobic	NSAID	Oral	7.5 mg daily	Diarrhea, indigestion, respiratory tract infections
Valium	Benzodiazepine	Oral	2 – 10 mg 2-4x daily	Drowsiness, muscle weakness, fatigue
Flexeril	Muscle Relaxant	Oral	5 mg 3x daily	Drowsiness, fatigue, headache
Skelaxin	Muscle Relaxant	Oral	800 mg 3-4x daily	Drowsiness, dizziness, headache, nausea
Neurontin	Anticonvulsant	Oral	300 mg daily	Drowsiness, dizziness, swelling in hands and feet
Elavil	Antidepressant	Oral	25 mg daily	Drowsiness, dizziness, headache, weight gain, constipation
Botox	Neurotoxin	Intramuscular Injection	Treated by doctor	Pain around injection site

 

Contact Dr Omrani if You Are Dealing with TMJ Pain

If you’re dealing with the discomfort and challenges of TMJ dysfunction, it’s essential to seek expert guidance. Dr. Omrani is renowned for her expertise in treating TMJD and has dedicated her practice to helping patients find relief from this often-debilitating condition. With a comprehensive approach and a deep understanding of the intricacies of TMJ disorders, Dr. Omrani is well-equipped to provide you with the care and solutions you need.

TMJ Medication FAQs

What is the best medication for TMJ?

The best medication for TMJ largely depends on the specific symptoms and underlying causes of the individual's condition. Commonly prescribed medications include pain relievers like NSAIDs, muscle relaxants, and in some cases, antidepressants or antianxiety medications. It's essential to consult with a TMJ specialist to determine the most appropriate treatment tailored to one's unique situation.

Is there a pill for TMJ?

There are several pills that can be prescribed for TMJ symptoms. Commonly prescribed medications include pain relievers, such as NSAIDs, and muscle relaxants to alleviate muscle tension and spasms. However, the most suitable medication depends on the individual's specific symptoms and should be determined in consultation with a healthcare professional.

What is the first line of treatment for TMJ?

The first line of treatment for TMJ typically involves conservative, non-invasive approaches. This can include self-care practices such as eating soft foods, avoiding extreme jaw movements, and practicing stress-reducing techniques. Additionally, over-the-counter pain relievers and the use of cold or warm compresses can help alleviate pain and inflammation.