Accurate Diagnosis and Treatment of Painful Temporomandibular Disorders: A Literature Review Supplemented by Own Clinical Experience

Abstract

Introduction. Temporomandibular disorders (TMD) is a multifactorial group of musculoskeletal disorders often with combined etiologies that demand different treatment plans. While pain is the most common reason why patients decide to seek help, TMD is not always painful. Pain is often described by patients as a headache, prompting patients to seek the help of neurologists, surgeons, and ultimately dentists. Due to the unique characteristics of this anatomical area, appropriate diagnostic tools are needed, as well as therapeutic regimens to alleviate and/or eliminate the pain experienced by patients. Aim of the Study. The aim of this study is to collect and organize information on the diagnosis and treatment of pain in TMD, through a review of the literature supplemented by our own clinical experience. Material and Methods. The study was conducted by searching scientific databases PubMed, Scopus, and Google Scholar for documents published from 2002–2022. The following keywords were used to build the full list of references: TMD, pain, temporomandibular joint (TMJ), TMJ disorders, occlusal splint, relaxing splints, physiotherapy TMD, pharmacology TMD, natural therapy TMD, diagnostic criteria for TMD, and DC/TMD. The literature review included 168 selected manuscripts, the content of which was important for pain diagnosis and clinical treatment of TMD. Results. An accurate diagnosis of TMD is the foundation of appropriate treatment. The most commonly described treatments include physiotherapy, occlusal splints therapy, and pharmacological treatment tailored to the type of TMD. Conclusions. Based on the literature review and their own experience, the authors concluded that there is no single ideal form of pain therapy for TMD. Treatment of TMD should be based on a thorough diagnostic process, including the DC/TMD examination protocol, psychological evaluation, and cone beam computer tomography (CBCT) imaging. Following the diagnostic process, once a diagnosis is established, a treatment plan can be constructed to address the patient’s complaints.

MRI of Temporomandibular Joint Disorders: A Comparative Study of 0.55 T and 1.5 T MRI

“…Based on our results, 0.55 T MRI seems feasible to provide information about structural damage of the TMJ, especially internal derangement. Apart from clinical symptoms, imaging findings drive potential therapeutic strategies, which mainly include medications (eg, corticosteroids, nonsteroidal anti-inflammatory drugs, opioids), physiotherapy, and occlusal splint therapy 32 . However, a minority of patients (5%–10%) require surgical procedures, especially arthrocentesis, arthroscopy, and arthrotomy 33 .…”

“…Apart from clinical symptoms, imaging findings drive potential therapeutic strategies, which mainly include medications (eg, corticosteroids, nonsteroidal anti-inflammatory drugs, opioids), physiotherapy, and occlusal splint therapy. 32 However, a minority of patients (5%-10%) require surgical procedures, especially arthrocentesis, arthroscopy, and arthrotomy. 33 Despite our promising results, it has to kept in mind that gains in SNR at higher magnetic field strengths such as 3 T can be used to increase the spatial resolution when imaging the TMJ, which translates into increased visibility and delineation of anatomical structures.…”

Temporomandibular Disorder Treated With Chiropractic Therapy

“…Effective management of TMD requires a comprehensive understanding of the underlying pathoanatomic factors at play [ 10 ]. There is currently no gold standard for treating TMD [ 11 ]. Conservative treatment strategies that can best reduce the pain and disability associated with TMD depend on TMD etiology, severity, and patient preferences.…”

Balancing the bite: A comprehensive guide to temporomandibular joint disorder

“…This examination may encompass a review of medical history, a physical assessment of the jaw and adjacent areas, and potentially advanced imaging techniques like X-rays or MRI scans. 13 Treatment options for TMD are designed to alleviate pain, restore proper jaw function, and prevent further deterioration. Depending on the severity of the condition, treatments may include.…”

“…Depending on the severity of the condition, treatments may include. 13,14 Lifestyle modifications: Stress management techniques, relaxation exercises, and avoiding activities like chewing gum or consuming hard foods can assist in mitigating symptoms.…”