Guidelines for the treatment of temporomandibular disorders

These guidelines include the usual and customary treatment approaches recommended for each of the diagnostic categories described in a previous article on the examination and diagnosis of temporomandibular disorders. The current article describes when it is appropriate to use initial therapy, behavior modification therapy, pharmacotherapy, occlusal appliances, physical therapy, and surgical treatment for temporomandibular disorders. The physical therapy procedures described include various exercises as well as pain-relief techniques such as vapocoolant spray, massage, electrical stimulation of muscles and nerves, ultrasound, and trigger-point injections. Pharmacotherapy using muscle relaxant, nonsteroidal anti-inflammatory, tricyclic antidepressant, and narcotic pain medications are also discussed. Occlusal stabilization and repositioning appliances are reviewed as well. Finally, the broad indications for arthroscopic surgery, open surgery, and steroid injections are described.