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Non-surgical and Pharmacological Management of the Temporomandibular Joint Disorders

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Temporomandibular Joint Disorders

Abstract

There are several non-surgical and pharmacologic strategies for the management of temporomandibular joint disorders (TMDs). They can be used alone or in combination for the management, where indicated. The goal is to decrease overloading of the masticatory system, pain/dysfunction and promote healing. The treatment for TMDs should initially begin with conservative and pharmacological management followed by invasive methods, if required.

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References

  1. Miloro M, Ghaji GE, Larsen PE, Waite PD. Peterson’s principles of oral and maxillofacial surgery, vol. 6. 3rd ed. London: BC Decker; 2011. p. 1031–68.

    Google Scholar 

  2. de Bont LGM, Kijkgraaf LC, Stegenga B. Epidemiology and natural progression of articular temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83:72–6.

    Article  PubMed  Google Scholar 

  3. Carlsson GE. Epidemiology and treatment needed for temporomandibular disorders. J Orofac Pain. 1999;13:232–7.

    CAS  PubMed  Google Scholar 

  4. Indresano A, Alpha C. Nonsurgical management of temporomandibular joint disorders. In: Oral and maxillofacial surgery. 2nd ed. St. Louis, MO: Saunders/Elsevier; 2009. p. 881–97.

    Google Scholar 

  5. Al-Ani MZ, Davies SJ, Gray RJ, et al. Stabilisation splint therapy for temporomandibular pain dysfunction syndrome. Cochrane Database Syst Rev. 2004;1:0126.

    Google Scholar 

  6. Mujakperuo HR, Watson M, Morrison R, Macfarlane TV. Pharmacological interventions for pain in patients with temporomandibular disorders. Cochrane Database Syst Rev. 2010;10:1006.

    Google Scholar 

  7. Greene CS. Orthodontics and temporomandibular disorders. Dent Clin N Am. 1988;32:529–38.

    Article  CAS  PubMed  Google Scholar 

  8. Clark GT. A critical evaluation of orthopedic interocclusal appliance therapy: design, theory and overall effectiveness. J Am Dent Assoc. 1984;108:359–64.

    Article  CAS  PubMed  Google Scholar 

  9. Magnusson T, Syren M. Therapeutic jaw exercises and interocclusal appliance therapy. A comparison between two common treatments of temporomandibular disorders. Swed Dent J. 1999;23(1):27–37.

    CAS  PubMed  Google Scholar 

  10. McNeill C, editor. Temporomandibular disorders: guidelines for classification, assessment and management. 2nd ed. Chicago, IL: Quintessence Publishing; 1993.

    Google Scholar 

  11. Mejersjo C, Carlsson GE. Long-term results of treatment for temporomandibular pain-dysfunction. J Prosthet Dent. 1983;49:805–15.

    Article  Google Scholar 

  12. Cooper BC. Temporomandibular disorders: a position paper of the International College of Cranio-Mandibular Orthopedics (ICCMO). Cranio. 2011;29(3):237–44.

    Article  PubMed  Google Scholar 

  13. Medlicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Phys Ther. 2006;86(7):955–73.

    Article  PubMed  Google Scholar 

  14. Kaneyama K, Segami N, Nishimura M, et al. Importance of proinflammatory cytokines in synovial fluid from 121 joints with temporomandibular disorders. Br J Oral Maxillofac Surg. 2002;40:418–23.

    Article  CAS  PubMed  Google Scholar 

  15. Israel H, Syrop S. The important role of motion in the rehabilitation of patients with mandibular hypomobility: a review of the literature. J Craniomandib Pract. 1993;II:298–307.

    Google Scholar 

  16. Simons DG, Travell JG, Simons LS. Travell & Simons’ myofascial pain and dysfunction: a trigger point manual. 2nd ed. Baltimore, MD: Williams & Wilkins; 1999.

    Google Scholar 

  17. Karlis V, Andreopoulos N, Kinney L, Glickman R. Effectiveness of supervised calibrated exercise therapy on jaw mobility and temporomandibular dysfunction. J Oral Maxillofac Surg. 1994;52(8 Suppl 2):147.

    Google Scholar 

  18. Sebastian MH, Moffet BC. The effect of continuous passive motion on the temporomandibular joint after surgery. Oral Surg Oral Med Oral Pathol. 1989;67:644–53.

    Article  CAS  PubMed  Google Scholar 

  19. Maloney G. Effect of a passive jaw motion device on pain and range of motion in TMD patients not responding to flat plane intraoral appliances. J Craniomandib Pract. 2002;20:55–6.

    Google Scholar 

  20. Adler RC, Adachi NY. Physical medicine in the management of myofascial pain and dysfunction: medical management of temporomandibular disorders. Oral Maxillofac Surg Clin North Am. 1995;7:99–106.

    Article  Google Scholar 

  21. Furlan RM, Giovanardi RS, Britto AT, Oliveira Britto e DB. The use of superficial heat for treatment of temporomandibular disorders: an integrative review. Codas. 2015;27(2):207–12.

    Article  PubMed  Google Scholar 

  22. Nelson SJ, Ash MM Jr. An evaluation of a moist heating pad for the treatment of TMJ/muscle pain dysfunction. Cranio. 1988;6(4):355–9.

    Article  CAS  PubMed  Google Scholar 

  23. Schwartz LL. Ethyl chloride treatment of limited painful mandibular movement. J Am Dent Assoc. 1954;48:497–507.

    Article  CAS  PubMed  Google Scholar 

  24. Travell J. Ethyl chloride spray for painful muscle spasms. Arch Phys Med Rehabil. 1952;33:291–8.

    CAS  PubMed  Google Scholar 

  25. Reid KI, Dionne RA, Sicard-Rosenbaum L, Lord D, Dubner R. Evaluation of iontophoretically applied dexamethasone for painful pathologic temporomandibular joints. Oral Surg Oral Med Oral Pathol. 1994;77:605–9.

    Article  CAS  PubMed  Google Scholar 

  26. Srbely JZ, Dickey JP, Lowerison M, et al. Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study. Pain. 2008;139(2):260–6.

    Article  PubMed  Google Scholar 

  27. Kleinkort JA, Wood F. Phonophoresis with 1 percent versus 10 percent hydrocortisone. Phys Ther. 1975;55:1320–4.

    Article  CAS  PubMed  Google Scholar 

  28. Cameron MH, Monroe LG. Relative transmission of ultrasound by media customarily used for phonophoresis (see comments). Phys Ther. 1992;72(2):142–8.

    Article  CAS  PubMed  Google Scholar 

  29. Rai S, Ranjan V, Misra D, Panjwani S. Management of myofascial pain by therapeutic ultrasound and transcutaneous electrical nerve stimulation: a comparative study. Eur J Dent. 2016;10(1):46–53.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Shanavas M, Chatra L, Shenai P, et al. Transcutaneous electrical nerve stimulation therapy: an adjuvant pain controlling modality in TMD patients – a clinical study. Dent Res J (Isfahan). 2014;11(6):676–9.

    Google Scholar 

  31. Ernest EA. Temporomandibular joint and craniofacial pain. 2nd ed. Montgomery, AL: Ernest Publications; 1983.

    Google Scholar 

  32. Murphy GJ. Physical medicine modalities and trigger point injections in the management of temporomandibular disorders and assessing treatment outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83(1):118–22.

    Article  CAS  PubMed  Google Scholar 

  33. Moller E, Sheik-Ol-Eslam A, Lous I. Deliberate relaxation of the temporal and masseter muscles in subjects with functional disorders of the chewing apparatus. Scand J Dent Res. 1971;79(7):478–82.

    CAS  PubMed  Google Scholar 

  34. Gessel AH, Alderman MM. Management of myofascial pain dysfunction syndrome of the temporomandibular joint by tension control training. Psychosomatics. 1971;12(5):302–9.

    Article  CAS  PubMed  Google Scholar 

  35. Flor H, Birbaumer N. Comparison of the efficacy of electromyographic biofeedback, cognitive-behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain. J Consult Clin Psychol. 1993;61(4):653–8.

    Article  CAS  PubMed  Google Scholar 

  36. Santoro F, Maiorana C, Campiotti A. Neuromuscular relaxation and CCMDP. Biofeedback and TENS. 4. Dent Cadmos. 1989;57(18):88–9.

    CAS  PubMed  Google Scholar 

  37. Goldstein L, Gilbert S. Acupuncture: new approach for temporomandibular disorders. Pract Pain Manag. 2017;11(16):1–20.

    Google Scholar 

  38. Madani A, Ahrari F, Fallahrastegar A, Daghestani N. A randomized clinical trial comparing the efficacy of low-level laser therapy (LLLT) and laser acupuncture therapy (LAT) in patients with temporomandibular disorders. Lasers Med Sci. 2019 Aug;8:1–12.

    Google Scholar 

  39. Katon W, Egan K, Miller D. Chronic pain: lifetime psychiatric diagnoses and family history. Am J Psychiatry. 1985;142:1156–60.

    Article  CAS  PubMed  Google Scholar 

  40. Licini F, Nojelli A, Segu M, Collesano V. Role of psychosocial factors in the etiology of temporomandibular disorders: relevance of a biaxial diagnosis. Minerva Stomatol. 2009;58(11–12):557–66.

    CAS  PubMed  Google Scholar 

  41. Kuritzky L, Samraj GP. Nonsteroidal anti-inflammatory drugs in the treatment of low back pain. J Pain Res. 2012;5:579–90.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Hersh EV, Balasubramaniam R, Pinto A. Pharmacologic management of temporomandibular disorders. Oral Maxillofac Surg Clin North Am. 2008 May;20(2):197–210.

    Article  PubMed  Google Scholar 

  43. Hargreaves KM, Troullos ES, Dionne RA. Pharmacologic rationale for the treatment of acute pain. Dent Clin N Am. 1987;31:675–94.

    Article  CAS  PubMed  Google Scholar 

  44. Garcia RLA, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet. 1994;343(8900):769–72.

    Article  Google Scholar 

  45. Cicconetti A, Bartoli A, Ripari F, Ripari A. COX-2 selective inhibitors: a literature review of analgesic efficacy and safety in oralmaxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97(2):139–46.

    Article  PubMed  Google Scholar 

  46. Zhang J, Ding EL, Song Y. Adverse effects of cyclooxygenase 2 inhibitors on renal and arrhythmia events. JAMA. 2006;296:1619–32.

    Article  CAS  PubMed  Google Scholar 

  47. Ta LE, Dionne RA. Treatment of painful temporomandibular joints with a cyclooxygenase-2 inhibitor: a randomized placebo controlled comparison of celecoxib to naproxen. Pain. 2004;111(1–2):13–21.

    Article  CAS  PubMed  Google Scholar 

  48. Wright EF, North SL. Management and treatment of temporomandibular disorders: a clinical perspective. J Man Manip Ther. 2009;17(4):247–54.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Dionne RA. Pharmacologic treatments for temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Jan;83(1):134–42.

    Article  CAS  PubMed  Google Scholar 

  50. Turk DC, Rudy TE, Kubinski JA, Zaki HS, Greco CM. Dysfunctional patients with temporomandibular disorders: evaluating the efficacy of a tailored treatment protocol. J Consult Clin Psychol. 1996;64(1):139–46.

    Article  CAS  PubMed  Google Scholar 

  51. Harkins S, Linford J, Cohen J, et al. Administration of clonazepam in the treatment of TMD and associated myofascial pain: a double-blind pilot study. Craniomandib Disord. 1991;5(3):179–86.

    CAS  Google Scholar 

  52. Russell IJ, Fletcher EM, Michalek JE, McBroom PC, Hester GG. Treatment of primary fibrositis/fibromyalgia syndrome with ibuprofen and alprazolam. A double-blind, placebo-controlled study. Arthritis Rheum. 1991 May;34(5):552–60.

    Article  CAS  PubMed  Google Scholar 

  53. Stanko JR. Review of oral skeletal muscle relaxants for the craniomandibular disorder (CMD) practitioner. Cranio. 1990;8:234–43.

    Article  CAS  PubMed  Google Scholar 

  54. Tseng TC, Wang SC. Locus of action of centrally acting muscle relaxants, diazepam and tybamate. J Pharmacol Exp Ther. 1971;178(2):350–60.

    CAS  PubMed  Google Scholar 

  55. Chou R, Peterson K, Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. J Pain Symptom Manag. 2004;28:140–75.

    Article  CAS  Google Scholar 

  56. Pal US, Kumar L, Mehta G, et al. Trends in management of myofascial pain. Natl J Maxillofac Surg. 2014;5(2):109–16.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Gatchel RJ, Garofalo JP, Ellis E, Holt C. Major psychological disorders in acute and chronic TMD: an initial examination. J Am Dent Assoc. 1996;127(9):1365–70. 1372, 1374

    Article  CAS  PubMed  Google Scholar 

  58. Kinney RK, Gatchel RJ, Ellis E, et al. Major psychological disorders in TMD patients: impactions for successful management. J Am Dent Assoc. 1992;123:49–54.

    Article  CAS  PubMed  Google Scholar 

  59. Fiedorowicz JG, Swartz KL. The role of monoamine oxidase inhibitors in current psychiatric practice. J Psychiatr Pract. 2004;10(4):239–48.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Kinney RK, Gatchel RJ, Ellis E, et al. Major psychological disorders in TMD patients: impaction for successful management. J Am Dent Assoc. 1992;123:49–54.

    Article  CAS  PubMed  Google Scholar 

  61. Fiedorowicz J, Swartz K, Brown RS, Bottomley WK. The utilization and mechanism of action of TCA in the treatment of chronic facial pain: a review of the literature. Anesth Prog. 1990;37:223–9.

    Google Scholar 

  62. Lee YC, Chen PP. A review of SSRIs and SNRIs in neuropathic pain. Expert Opin Pharmacother. 2010;11(17):2813–25.

    Article  CAS  PubMed  Google Scholar 

  63. Syrop SB. Pharmacological therapy. In: Kaplan AS, Assael LA, editors. Temporomandibular disorders-diagnosis and treatment. Philadelphia: WB Saunders; 1991. p. 501–14.

    Google Scholar 

  64. Moore RA, Wiffen PJ, Derry S, McQuay HJ. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2011;3:CD007938.

    Google Scholar 

  65. Ifuku M, Iseki M, Hidaka I, et al. Replacement of gabapentin with pregabalin in postherpetic neuralgia therapy. Pain Med. 2011;12(7):1112–6.

    Article  PubMed  Google Scholar 

  66. Poswillo D. Experimental investigation of the effects of intraarticular hydrocortisone and high condylectomy on the mandibular condyle. Oral Surg Oral Med Oral Pathol. 1970;30(2):161–73.

    Article  CAS  PubMed  Google Scholar 

  67. Jankovic J, Brin MF. Therapeutic uses of botulinum toxin. N Engl J Med. 1991;324(17):1186–94.

    Article  CAS  PubMed  Google Scholar 

  68. Clark GT. The management of oromandibular motor disorders and facial spasms with injections of botulinum toxin. Phys Med Rehabil Clin N Am. 2003;14(4):727–48.

    Article  PubMed  Google Scholar 

  69. Srivastava R, Jyoti B, Devi P. Oral splint for temporomandibular joint disorders with revolutionary fluid system. Dent Res J (Isfahan). 2013;10(3):307–13.

    Google Scholar 

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Correspondence to Darpan Bhargava .

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Kannan, S.K., Bhargava, D., Shrivastava, S., Shrivastava, T., Pandey, A.K. (2021). Non-surgical and Pharmacological Management of the Temporomandibular Joint Disorders. In: Bhargava, D. (eds) Temporomandibular Joint Disorders. Springer, Singapore. https://doi.org/10.1007/978-981-16-2754-5_9

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  • DOI: https://doi.org/10.1007/978-981-16-2754-5_9

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