How Self-Care Techniques Benefit Patients With Facial Pain

Jaw exercises and warm compresses may be more beneficial for patients with facial pain from temporomandibular disorders (TMD) than the traditional splints and bite guards commonly prescribed for managing orofacial pain. Findings from a New York University (NYU) College of Dentistry study suggest that self-care techniques should be the first line of treatment for TMD.

The study, “Perceived Helpfulness of Treatments for Myofascial TMD as a Function of Comorbid Widespread Pain,” published in Clinical Oral Investigations, examined what nonmedication treatments women with the muscular condition of TMD, myofascial temporomandibular disorder (mTMD), use to manage facial pain. Because individuals with TMD often have fibromyalgia, the team examined if patients with both conditions respond differently to treatments than mTMD-only patients.

Because facial pain is not straightforward, pain management can be challenging. Dentists commonly recommend oral appliances, such as splints and bite guards, or nonsteroidal anti-inflammatory drugs to help with facial pain. However, it was the self-care and nonmedication treatments that outperformed oral appliances, according to patients in the study.

“Our findings converge with those from clinical trials that provide unclear evidence regarding the efficacy of oral appliances. Given this unclear evidence and the cost of oral appliances … try self-management strategies first,” says Karen Raphael, PhD, a professor at NYU College of Dentistry, and the study’s coauthor.

Of the 125 subjects with mTMD, including 26 women who had both mTMD and fibromyalgia, participants reported the most improvement in their pain from several self-care activities. Researchers did not find significant differences between the number of treatments reported by subjects with or without fibromyalgia.

More than 84% reported that activities—such as jaw exercises, yoga or exercise, meditation, massage, and warm compresses—helped them at least a little, whereas only 64% of those who used oral appliances said that they helped at least a little.

“In treatment planning, clinicians should consider the overall pain experience of the patient, including complaints of widespread pain,” notes Vivian Santiago, PhD, an assistant research scientist and adjunct assistant professor at NYU College of Dentistry, and the study’s lead author. “It would be terrific to see all dentists, even those who may eventually recommend oral appliances, to start out by first offering multiple self-management tools for all their myofascial-pain patients.”

The most common treatments reported by study participants were oral appliances (59%), physical therapy (54%), and at-home jaw exercises (34%). Less common treatments included acupuncture (20%), seeing a chiropractor (18%), trigger point injection (14%), exercise or yoga (7%), and meditation or breathing exercises (6%).

Based on these findings, the authors recommend oral health professionals offer patients an educational packet on self-management strategies before offering more expensive, appliance-based treatments. Clinicians should also remain current on facial pain conditions and management treatments.