Treatment of Temporomandibular Disorders

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

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

  • Pain and / or dysfunction associated with TMD (joint and / or muscles)

Side effects and interactions

  • Increased pain and / or dysfunction

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

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

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