Temporomandibular Joint Disorders: Therapy [Clinical Review Discussion]

Temporomandibular disorder (TMD) is a diagnosis that serves as an umbrella for a variety of underlying conditions. These conditions manifest themselves as pain or dysfunction in the region of the temporomandibular joint. In order to properly treat this condition the root cause of the problem must first be identified. Unfortunately not all studies testing efficacy of treatment identify the category of TMD being treated. When possible, treatments will be linked to categories that have been established by the American Dental Association (1). These categories are as follows:

1. Myalgia/myofascial (MF).

2. Internal derangement due to disk displacement with and without reduction (ID).

3. Arthralgia due to osteoarthritis, trauma, capsulitis/synovitis (AR).

The physiological changes described above do not include psychosocial causes that are common in this disorder. The physician should always keep these in mind.

Although the author has attempted to rank order conservative treatments the reader should be aware that no single treatment has been found to be clearly superior to others. The order presented is a “best estimate” of strength of evidence, based primarily on the number and quality of studies available. It should not be taken as an absolute value.