Clinical Practice Guidelines for the Management of Temporomandibular Joint Disorders – A Review

Abstract

BACKGROUND Temporomandibular joint disorders (TMD) are a group of disorders associated with temporomandibular joints, their associated muscles, and other related structures. TMD present with pain in the joints and related structures which can radiate to the neighbouring areas mimicking ear pains, headaches, neuropathic pain and odontogenic pain. Even though TMDs are more seen in both genders, the ratio of women reporting with TMD is higher (2:1) than men. Pain, the commonest symptom encountered, is usually chronic in duration and mild to severe in intensity. Various other signs and symptoms described are clicking or popping noise, deviation of the mandible, restricted mouth opening and jaw movements. Multiple factors have been reported as an aetiology, however, there is no definite established aetiology to cause TMD. Approaches to the management of TMDs require thorough history taking, clinical and radiological assessment and proper treatment planning. The signs, symptoms, and prevalence of the diseases are also necessary considerations in the treatment planning of TMDs. Traditional approaches in the management of TMDs involve systemic medications, physical therapies, and surgical interventions. The first line of systemic medications to be advised to relieve pain are analgesics. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, muscle relaxants, barbiturates like benzodiazepine have been frequently administered. In recent times, extraction of impacted or buccoverted third molar teeth has also proven to be effective in reducing the pain associated with TMDs. The purpose of this study is to provide new clinical practice guidelines to establish a multidisciplinary approach in the management of patients with TMDs and to improve the patient’s quality of life (QoL). KEY WORDS Pain, Temporomandibular Joint Disorder, TMD, Treatment Guidelines