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Temporomandibular Disorders: Rapid Evidence Review
Eric M Matheson1, Joli D Fermo2, Russell S Blackwelder1
1Medical University of South Carolina, Charleston, South Carolina.
American Family Physician
|January 23, 2023
Summary
Temporomandibular disorders (TMDs) affect millions, causing jaw pain, headaches, and clicking. Diagnosis relies on history and exam, with imaging for uncertainty, and treatment ranges from conservative to surgical.
Area of Science:
- Dentistry
- Orthodontics
- Neurology
Background:
- Temporomandibular disorders (TMDs) affect 5-12% of the population.
- Symptoms include headache, bruxism, jaw joint pain, clicking, neck pain, tinnitus, dizziness, hearing changes, and sound hyperacuity.
- Physical signs involve muscle tenderness (pterygoid, temporalis), temporomandibular joints, jaw malocclusion, and crepitus.
Purpose of the Study:
- To provide a comprehensive overview of temporomandibular disorders.
- To outline diagnostic criteria and imaging recommendations.
- To review current therapeutic strategies for TMDs.
Main Methods:
- Diagnosis based on patient history and physical examination.
- Imaging (CT, MRI) utilized when diagnosis is uncertain.
- Review of nonpharmacologic, pharmacologic, and interventional therapies.
Main Results:
- Nonpharmacologic treatments include patient education, cognitive behavioral therapy, and physical therapy.
- Pharmacologic options encompass NSAIDs, cyclobenzaprine, tricyclic antidepressants, and gabapentin.
- Injections (sodium hyaluronate, PRP, dextrose prolotherapy) show weak evidence of benefit.
Conclusions:
- TMD diagnosis relies on clinical assessment, supplemented by imaging if needed.
- A multimodal treatment approach is often necessary.
- Oral and maxillofacial surgery referral is reserved for refractory cases.
