Basic Clinical Management of Temporomandibular Disorders (TMDs)

Temporomandibular disorders (TMDs) are a group of diseases that affect temporomandibular joint (TMJ), masticatory muscles, and associated structures. An accurate diagnosis depends on proper history and thoroughness of the physical exam. Initial management should include proper patient education, avoidance of parafunctional habits, resting the joint and muscles, and appropriate pharmacological therapy. A night guard or a bite splint is a common device used as a management tool for TMD. The material and design used for these devices can vary. Physical therapy and acupuncture therapy are common adjunctive modalities to treat TMD. There are various injection techniques used for the management of TMD, which include trigger-point injections, botulinum toxin (Botox), or corticosteroids. Patients who are not responding to conservative therapy can be referred to oral and maxillofacial surgeons for surgical options. The least invasive surgical intervention is arthrocentesis, which is a surgical method for lavage of the TMJ. There are situations where you may need to refer refractory cases of TMD to other specialists including otolaryngologist-head and neck surgeon, neurologist, rheumatologist, or pain specialists. There are other treatment modalities that have been used by many practitioners for TMD. Occlusal equilibration has been a treatment modality for years, but there is lack of evidence to support this modality. There are also other treatment modalities like ultrasound therapy, laser therapy, and chiropractic therapy. Any treatment that relieves pain and other symptoms of the patient is acceptable if the treatment is not harmful to the patient.