Glossary
- Temporomandibular Disorder (TMD): collective term reflecting clinical problems that involve the masticatory muscles, temporomandibular joints (TMJs) and / or associated structures
- Myalgia: localized muscle soreness
- Myofascial pain: regional dull, aching muscle pain and the presence of trigger points, which upon palpation, may produce regional referred pain
- Synovitis: inflammation of the synovial lining of the TMJ
- Capsulitis: inflammation of the TMJ capsule
- Articular disc displacement: misalignment of the articular cartilage relative to the mandibular condyle
Additional Overviews of Module Materials
Myofascial Pain
- Dull ache and/or fatigue involving masticatory muscles
- Referred pain associated with regional muscle soreness
- Usually pain at rest which increases with jaw function
- Presence of trigger points
- Wide range of jaw dysfunction/pain complaints
- May be associated with TMJ articular disc and/or arthritic disorders
- May cause referred pain to other parts of the head and neck
Etodolac
Mechanism of action
- Non-steroidal anti-inflammatory drug
Recommended use
- Pain and / or dysfunction associated with TMD (joint and / or muscles)
Side effects and interactions
- Hypersensitivity, Nausea, Dyspepsia, GI bleeding, Nephrotoxicity, Toxic Epidermal Necrolysis
Clinical implications
- Decreased pain associated with TMD
- Increase TMJ function
- Increase jaw function and / or range-of-motion
Reference
Hersh EV, et al. Oral Maxillofac Surg Clin North Am, 2008
http://www.tarascon.com/products/pharmacopoeia/
Cyclobenzaprine
Mechanism of action
- Centrally-acting skeletal muscle relaxant
Recommended use
- Pain and / or dysfunction associated with TMD (muscles)
- Trismus
Side effects and interactions
- Sedation, Vertigo, Xerostomia, Blurred vision, Arrhythmia
Clinical implications
- Decreased pain associated with TMD
- Increase jaw function and / or range-of-motion
Reference
Hersh EV, et al. Oral Maxillofac Surg Clin North Am, 2008
http://www.tarascon.com/products/pharmacopoeia/
Metaxalone
Mechanism of action
- Centrally-acting skeletal muscle relaxant
Recommended use
- Pain and / or dysfunction associated with TMD (muscles)
- Trismus
Side effects and interactions
- Sedation, Vertigo, Nausea, Hypersensitivity, Jaundice
Clinical implications
- Decreased pain associated with TMD
- Increase jaw function and / or range-of-motion
Other anti-spasms medications could be considered*
Reference
Hersh EV, et al. Oral Maxillofac Surg Clin North Am, 2008
http://www.tarascon.com/products/pharmacopoeia/
Occlusal Appliance Therapy
Mechanism of action
- Alter TMJ structural relationships
- Reduce muscle activity
- Largely unknown
Recommended use
- Teeth clenching / grinding (bruxism)
- Pain and / or dysfunction associated with TMD (joint and / or muscles)
Side effects and interactions
- Tooth discomfort
Clinical implications
- Minimize tooth wear due to bruxism
- Decreased pain associated with TMD
- Increase TMJ function
- Increase jaw function and / or range-of-motion
Reference
Klasser GD, et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009
Physical Therapy
Mechanism of action
- Physical manipulation of structures of the TMJ complex
- Manage causative and perpetuating factors of TMD
- Enhance central inhibition
Recommended use
- Increased pain and / or dysfunction
Side effects and interactions
- Tooth discomfort
Clinical implications
- Decreased pain associated with TMD
- Increase TMJ function
- Increase jaw function and / or range-of-motion
Reference
Gradd-Radford SB, et al. Oral Maxillofac Surg Clin N Am, 2016
Trigger Point Injections
Mechanism of action
- Mechanical disruption to inactivate muscular trigger points
Recommended use
- Pain and / or dysfunction associated with TMD (muscles)
Side effects and interactions
- Nerve dysfunction and / or damage
- Syncope
- Anaphylaxis
- Hemorrhage
- Infection
Clinical implications
- Decreased pain associated with TMD
- Increase jaw function and / or range-of-motion
References
- Lavelle ED, et al. Anesthesiol Clin 2007
- Robbins MS, et al. Headache, 2014
- Gradd-Radford SB, et al. Oral Maxillofac Surg Clin N Am, 2016
Pharmacotherapy
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Muscle relaxants
- Corticosteroids
- Anxiolytics
- Anti-depressants
- Topical analgesics
- Acetaminophen
Reference
Hersh EV, Oral Maxillofac Surg Clin North Am, 2008
Complimentary/Alternative Medicine
Mechanism of action
- Address biopsychosocial aspects of TMD
- Address symptoms related to physical structures of TMD not responding to traditional conservative therapies
Recommended use
- Pain and / or dysfunction associated with TMD (joint and / or muscles)
- Biopsychosocial management of TMD
Side effects and interactions
- Dependent upon specific treatment / therapy
Clinical implications
- Decreased pain associated with TMD
- Increase TMJ function
- Increase jaw function and / or range-of-motion
Reference
DeBar LL, et al. J Orofac Pain, 2003
Invasive Procedures
Mechanism of action
- Physical manipulation of internal TMJ structures
Recommended use
- Failure of conservative therapies
- Intractable pain
- Significant functional limitation
Side effects and interactions
- Various (depending on procedure)
Clinical implications
- Decreased pain associated with TMJ internal derangements
- Increase TMJ function
- Increase jaw function and / or range-of-motion
Reference
De Rossi SS, et al. Med Clin N Am, 2014
References
- Balasubramaniam R, Klasser GD. Orofacial pain syndromes: evaluation and management. Med Clin North Am 2014; 98: 1385 – 1405.
- Benoliel R Eliav E: Primary headache disorders. Dent Clin North Am 57; 3:513-539, 2013
- Carlson CR. Psychological considerations for chronic orofacial pain. Oral Maxillofac Surg Clin North Am 2008; 20:185 – 195.
- Clark GT. Classification, causation and treatment of masticatory myogenous pain and dysfunction. Oral Maxillofac Surg Clin North Am 2008; 20: 145 – 157.
- DeBar LL, Vuckovic N, Schneider J Ritenbaugh C: Use of complementary and alternative medicine for temporomandibular disorders. J Orofac Pain 17 3:224-236, 2003
- De Leeuw R. Internal derangements of the temporomandibular joint. Oral Maxillofac Surg Clin North Am 2008: 20: 159 – 168.
- De Leeuw R. Orofacial pain. Guidelines for Assessment, Diagnosis and Management. 4th Edition. Quintessence Publishing. 2008
- De Rossi SS, Greenberg MS, Liu F Steinkeler A: Temporomandibular disorders: evaluation and management. Med Clin North Am 2014; 98:1353-1384.
- De Rossi SS, Stern I Sollecito TP: Disorders of the masticatory muscles. Dent Clin North Am 57 3:449-464, 2013
- Glick M (Editor). Burket’s Oral Medicine, 12th Edition, People’s Medical Publishing House; Shelton; 2015.
- Graff-Radford SB Abbott JJ: Temporomandibular Disorders and Headache. Oral Maxillofac Surg Clin North Am 28 3:335-349, 2016
- Greene CS: Managing the care of patients with temporomandibular disorders: a new guideline for care. J Am Dent Assoc 2010; 141:1086-1088.
- Hersh EV, Balasubramaniam R, Pinto A. Pharmacological management of temporomandibular disorders. Oral and Maxillofacial Surg Clin N Am 2008; 20: 197 – 210.
- Hupp WS Firriolo FJ: Cranial neuralgias. Dent Clin North Am 2013; 57:481-495.
- Klasser GD Greene CS: Oral appliances in the management of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107:212-223.
- Klasser G. Management of persistent idiopathic facial pain. J Can Dent Assoc 2013; 79:d71.
- Kumar A Brennan MT: Differential diagnosis of orofacial pain and temporomandibular disorder. Dent Clin North Am 2013; 57:419-428.
- Lavelle ED, Lavelle W Smith HS: Myofascial trigger points. Anesthesiol Clin 25 4:841-51, vii-iii, 2007
- Liu F Steinkeler A: Epidemiology, diagnosis, and treatment of temporomandibular disorders. Dent Clin North Am 2013; 57:465-479.
- Mercuri LG. Osteoarthritis, osteoarthrosis, and idiopathic condylar resorption. Oral Maxillofac Surg Clin North Am 2008: 20: 169 – 183.
- Myers CD: Complementary and alternative medicine for persistent facial pain. Dent Clin North Am 2007; 51:263-74, ix.
- Napenas JJ: Intraoral pain disorders. Dent Clin North Am 2013; 57:429-447.
- Okeson JP. The classification of orofacial pains. Oral Maxillofac Surg Clin North Am 2008; 20: 133 – 144.
- Okeson JP. Management of temporomandibular disorders and occlusion. 6th Edition; Mosby, Philadelphia; 2008
- Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med 2008; 359: 2693 – 2705.
- Suvinen TI, Reade PC, Kemppainen P, Konoen M, Dworkin SF. Review of aetiological concepts of temporomandibular pain disorders: towards a biopsychosocial model for integration of physical disorder factors with psychological and psychosocial illness impact factors. Eur J Pain 2005; 9: 613 – 633.
- Velly AM, Fricton J. The impact of comorbid conditions on treatment of temporomandibular disorders. J Am Dent Assoc 2011; 142: 170 – 172.
- Zakrzewska JM. Expert Opin Pharmacother 2010; 11: 1239-1254.
