Short-Term Evaluation of the Effectiveness of Concurrent Multi-Modal Conservative Therapy in Management of Temporomandibular Joint Dysfunction

Abstract

Temporomandibular joint dysfunction (TMD) affects 4.6% of adults in the United States.1 Though surgical techniques are available for management, non-surgical regimens should be considered first. Studies have evaluated the effectiveness of non-surgical therapies, showing improvement in around 80% of individuals.2 To our knowledge, evaluation of a concurrent multi-modal approach to conservative management of TMD remains limited. The purpose of the present study was to evaluate the effectiveness of concurrent multi-modal conservative therapy in the management of TMD. A retrospective chart review was carried out to evaluate all patients presenting to a TMD practice of a single oral and maxillofacial surgeon for 1 year. Patients who underwent a course of multi-modal conservative therapy for at least 1 month concurrently were evaluated. Therapy consisted of a soft chew diet, flat-plane occlusal splint, pharmacotherapy with an NSAID and muscle relaxant, as well as consultation with a physical therapist. The outcomes measured included subjective improvement in symptoms, change in maximum incisal opening (MIO) with and without pain, and the need for additional surgery. Statistical data analysis was utilized to evaluate the rate of subjective improvement and changes in the pre- and post-treatment MIO with and without pain. The Wilcoxon rank sum test and Wilcoxon signed rank test were used to evaluate for significant differences between pre- and post-treatment MIO with and without pain. Logistic regression was used to evaluate for factors associated with subjective improvement after treatment. A significance value of 0.05 was chosen for all analyses. Fifty-four patients presented from February 2018 to February 2019 with TMD. Of these patients, 19 met the inclusion criteria. Subjective improvement was found in 58% of patients; 68% of patients did not require any further surgical intervention; 74% of patients experienced improvement of MIO without pain. MIO without pain increased by an average of 4.947mm (SD 6.924) for all patients. In the patients who improved, MIO without pain increased by 7.545mm (SD 7.367). The Wilcoxon rank sum test suggests a significant difference in the post-treatment MIO without pain between the group that showed subjective improvement and the group that did not. The Wilcoxon signed rank test suggests that there is a significant difference between the pre- and post-treatment MIO without pain in all participants, regardless of improvement (P-value .005), and in the improvement group alone (P-value .008). Finally, logistic regression showed that a 1mm increase in post-treatment MIO without pain was associated with a 23% increase in the odds of a patient improving. Our analysis shows that multi-modal conservative therapy is effective in management of patients with TMD. Over half of the patients followed showed subjective improvement. Those that subjectively improved showed an increase in MIO without pain to an average of greater than 40mm. It is also important to note that patients who did not subjectively improve also revealed a lack of improvement in MIO with and without pain. Additionally, despite reporting subjective improvement, a few patients still went on to undergo additional surgical intervention. Finally, if we consider lack of follow-up as a possible indicator of improvement, the rate of subjective improvement rises to 82%. A multi-modal approach to conservative therapy in the management of TMD is a reasonable treatment course and has a good chance of eliminating the need for surgical intervention. Additional studies with larger samples are needed to further evaluate the effectiveness of this concurrent multi-modal approach.