Management Of Temporomandibular Disorders Research Articles

Knowledge, Attitude and Practice of The Dental Practitioners About Temporomandibular Disorder in the Union Territory of Jammu & Kashmir and Ladakh Region of India – A Cross – Sectional Study

Introduction: Temporomandibular Disorder (TMD) is a disorder including temporomandibular joint (TMJ) and of the masticatory muscles and their associated structures. TMD accounts for the most common orofacial pains arising from musculoskeletal origin or non-dental origin with a prevalence of 5-12% in the population.
 Aim: The aim of the current study was to assess the knowledge, attitude and practice of the dental practitioners about temporomandibular disorder in the Union Territory of Jammu & Kashmir and Ladakh region of India.
 Materials and Methods: A cross-sectional study was conducted wherein a self-structured questionnaire, which consisted of 31 close ended questions, was sent online via Google forms to the dental practitioners residing in the Union Territory of Jammu & Kashmir and Ladakh region of India. A total of 500 subjects selected by Convenience sampling, were contacted for the study, out of which only 206 returned the completed questionnaire who were included in the study.
 Results: A statistical significance was noted between knowledge to practice (-0.22), knowledge to attitude (0.03) and between attitude and practice (-0.26), attitude to knowledge ( -0.03) and practice to knowledge (0.22), practice to attitude (0.26).
 Conclusion: The results obtained by analyzing data obtained in present study reflect that the knowledge of physiological anatomy along with the management of symptomatic TMD is insufficient.

Management of Temporomandibular Disorders in Patients with Fixed Dental Prosthesis

Managing temporomandibular disorders (TMD) in patients with fixed dental prosthesis presents a multifaceted dilemma for healthcare professionals. TMD involves a range of issues impacting the muscles used for chewing, the temporomandibular joint (TMJ), and associated structures, frequently resulting in discomfort, limited jaw mobility, and joint sounds. This review explores the prevalence and classification of TMD, highlighting the significance of considering psychological factors in chronic pain conditions. Diagnosis involves a comprehensive history-taking and clinical examination to identify contributing factors. Conservative, evidence-based treatment modalities are recommended for TMD management. Among them, occlusal splints are commonly used and evaluated. Dental prostheses, including dentures, implant-supported prostheses, and full mouth rehabilitation, play essential roles in restoring occlusion and improving oral function for TMD patients.

Occlusal Splint for the Treatment of Temporomandibular Disorders

Introduction: Occlusal splints are intraoral appliances used for the treatment of temporomandibular disorders. There is wide variety of occlusal splints according to their size, their form, the material they are made of, and their actions. Their efficacy varies from one type to another according to the initial diagnosis. However, the occlusal splints have an undoubtable favourable therapeutic effect in the management of temporomandibular disorders when used properly, unless this one is limited. Objectives: To provide an understanding of various aspects of splint therapy and update the practicians about their proper use. Materials and Methods: Reviews articles, systematic reviews, original research published in various electronic database such as Pubmed, Google scholar, and Cross reference were examined and the informations provided were analysed and resumed. Result and Conclusion: This review presents the occlusal splints in their different aspects such as their functions and how they work, their types, their uses, and the general considerations on how to ensure their proper design.

Evaluation of Turkish dentists’ knowledge and awareness of temporomandibular disorders

Aim: The aim of this study was to evaluate the awareness and treatment approaches of general dentists about temporomandibular disorders (TMD).Methods: A cross-sectional 21-item questionnaire study was performed and was sent to general practitioner dentists in Turkey. The demographics, length of professional experience, and their level of knowledge about TMD management were evaluated. Results: Eighty general practitioner dentists responded to the questionnaire. In the first part of the questionnaire, a statistically significant difference was found for the statement ‘One of the symptoms of TMD is headache.’ between the responses of dentists with more than 5 years of professional experience and those with less than 5 years of professional experience (p=0.012). No statistically significant difference was found in the responses to the other questions about TMD in other part of the questionnaire (p>0.05). Conclusion: The knowledge and awareness about the diagnosis and treatment of TMD is low among general practitioner dentists. Informative seminars or courses should be organized to increase the knowledge of TMD among general practitioner dentists.

Occlusal splints-types and effectiveness in temporomandibular disorder management

BackgroundOcclusal splints are routinely used in dental offices to diagnose and treat abnormalities of the masticatory system. There are different occlusal splints, each of which can address various conditions. They may treat individuals with temporomandibular disorders (TMDs) and bruxism or be used for occlusal stabilization and dentition wear reduction. MethodsThe literature in the National Library of Medicine's Medline Database was reviewed using the Mesh terms 'occlusal splints' AND 'Temporomandibular Disorders. ConclusionOcclusal splints can treat a wide variety of TMDs. They can treat bruxism, headaches, postural imbalances related to TMDs, and decreased vertical dimension of occlusion (VDO). However, there is no clear evidence that occlusal splints are superior to physiotherapy in treating TMDs. In the long-term follow-up, they were equally effective as other therapies.

53. TMD: A Headache for all? Assessing the management of Temporomandibular Disorder (TMD) in both Primary and Secondary Care

53. TMD: A Headache for all? Assessing the management of Temporomandibular Disorder (TMD) in both Primary and Secondary Care

Botulinum toxin in the management of myalgia in temporomandibular disorders: are all injections equal?

Botulinum toxin (BTX) is becoming widely used as an adjunct to conservative management of myalgia-predominant temporomandibular disorders (TMDs) with reports of improved quality of life. There is, however, no consensus on the optimal dosage. Based on previous studies, dose regimens vary between clinicians, and we know of no standard dose protocol for the administration of BTX for the purpose of TMD management. A survey was sent to members of the British Association of Oral and Maxillofacial Surgeons (BAOMS) Temporomandibular Joint Sub-Specialty Interest Group (TMJ SSIG) and an international mailing list of high-volume TMJ surgeons (the TMJ Internetwork) to ascertain variations in dose regimens between different clinicians. The survey found that 41 respondents offered BTX to patients. The masseter muscle group was the most commonly injected site, and the majority of respondents (34/41) used Botox® (Allergan). Brands less commonly used included Dysport® (Ipsen), and Xeomin® (Merz Pharma). Botox® doses varied between 30 and 100 units, whilst Dysport® doses ranged from 50 - 300 units/muscle. The number of injection sites/muscle also varied. This survey demonstrates the wide variation in practice amongst clinicians with respect to BTX administration. To ensure optimal dose and response titration, further studies and evidence-based research are needed to standardise its use for the treatment of TMDs.

Effectiveness of conservative therapeutic modalities for temporomandibular disorders-related pain: a systematic review

Purpose The aim of this systematic review was to evaluate the effectiveness of conservative different therapeutic modalities for temporomandibular disorders (TMD) pain. Materials and methods An electronic systematic search was conducted in the MEDLINE (PubMed) database to identify the randomized clinical trials (RCTs) published between 2001 and 2021. The following, simple or multiple conjunctions, search keywords were selected: TMD pain, TMD management or conservative treatment or treatment strategies and TMD pain, therapeutic modalities or interventions and TMD. Studies included must have patients older than 18 years, with painful TMD, which diagnosis was performed by Research Diagnostic Criteria for TMD or Diagnostic Criteria for TMD. Outcome variables were pain relief and post treatment pain intensity reduction. Data were analysed with non-parametric tests and the level of significance was set at p<.05. Results Out of 1599 articles obtained, 28 RCTs fulfilled all selection criteria and were included. The results of this study show that there was a significant decrease in short-term post-treatment TMD pain with the use of occlusal splint alone or in combination with other therapeutic modalities when compared with the control group. Statistically significant differences were also detected between laser and photobiomodulation group and the control, in short-term treatment TMD-related pain. Conclusions The primary findings of the present systematic review showed that the occlusal splint alone or combined with other therapeutic intervention presented positive effect on short-term TMD pain reduction. Secondary outcome suggests that laser and photobiomodulation therapy had, also, a significant role in short term pain relief.

Physiotherapists and Osteopaths' Attitudes: Training in Management of Temporomandibular Disorders.

Temporomandibular disorders (TMDs) are a condition which has multifactorial etiology. The most acknowledged method to classify TMDs is the diagnostic criteria (DC) introduced firstly by Dworkin. This protocol considers different aspects that are not only biological, but even psychosocial. Diagnosis is often based on anamnesis, physical examination and instrumental diagnosis. TMDs are classified as intra-articular and/or extra-articular disorders. Common signs and symptoms include jaw pain and dysfunction, earache, headache, facial pain, limitation to opening the mouth, ear pain and temporomandibular joint (TMJ) noises. This study regards two kind of clinicians that started in the last years to be more involved in the treatment of TMDs: osteopaths (OOs) and physiotherapists (PTs). The purpose is to analyze their attitude and clinical approach on patients affected by TMDs. Four hundred therapists answered an anonymous questionnaire regarding TMJ and TMDs. OOs showed greater knowledges on TMDs and TMJ and, the therapists with both qualifications seemed to be most confident in treating patients with TMDs. In conclusion this study highlights OOs and all the clinicians with this qualification, have a higher confidence in treating patients with TMD than the others. Dentists and orthodontists, according to this study, should co-work with OOs and PTs, because they are the specialists more requested by them than other kinds of specialists.

Lavage Volume of Arthrocentesis in the Management of Temporomandibular Disorders: A Systematic Review and Meta-Analysis.

The aim of this study was to investigate the most effective lavage volume of arthrocentesis in the management of temporomandibular disorders. A comprehensive electronic search, based on the PRISMA guidelines, was performed, which included a computer search with specific keywords, a reference list search and a manual search. The inclusion criteria were the following: a randomized controlled trial, at least 20 subjects who underwent arthrocentesis, mention of the irrigation materials used for the arthrocentesis, mention of the irrigation volumes used for the arthrocentesis, MMO and pain measured as VAS or NRS, were reported as outcome figures, mention of a specific diagnosis or signs and symptoms, and inclusion of the data on the MMO or VAS/NRS at 6-month follow-up. Sixteen publications were enrolled in the meta-analysis, comparing arthrocentesis with a lavage volume &lt;150 mL and arthrocentesis with a lavage volume ≥150 mL, in the efficacy of the improvement in the mouth opening and pain reduction. The results revealed the group with a lavage volume &lt;150 mL had a greater improvement in the mouth opening and pain reduction. However, results are to be interpreted with caution, due to the paucity of the randomized controlled literature and other confounding factors. Further high-quality studies are required to provide a better conclusion to the treatment outcomes of the different lavage volumes.

Evaluation and management of temporomandibular disorders. Part 1: an orthopedic physical therapy update on examination and clinical reasoning

ABSTRACT Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.

A Short Commentary on Physiotherapeutic Management of Temporomandibular Disorders in the United Kingdom: A Call to Holism and Compassion

The ‘journey’ for such patients to find suitable care can be protracted thereby compounding the patients suffering and likely contributing to the embedment of the condition for the patient [7]. The provision of care for patients with a TMD within the UK can also be disparate leading to inconsistencies in care nationally creating a ‘post-code lottery’ and national inequity for patients seeking a solution or management of their TMD [7].

Temporomandibular disorders. Part 6: related irreversible restorative interventions

Considering the complex biopsychosocial nature of temporomandibular disorders (TMD), irreversible interventions of any kind should be used with extreme caution. Frequently they are reserved for those patients who have not achieved adequate control with reversible measures and in whom a significant improvement is anticipated. Irreversible restorative interventions range from the simple adjustment of a single restoration or tooth up to an occlusal equilibration, and may use a subtractive, additive or combined approach. This article, the last in a series of six, reviews the available evidence in the use of irreversible restorative interventions in the management of TMD, demonstrates some of the commonly used techniques and provides some guidance for the general dental practitioner (GDP) considering this approach. CPD/Clinical Relevance: The GDP needs to be aware of when to, and more importantly when not to, consider making irreversible changes to a patient's dentition with the aim of managing their TMD.

Evaluation and management of temporomandibular disorders. Part 2: an orthopaedic physical therapy update on examination and clinical reasoning

ABSTRACT Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.

Influences of decision preferences and health literacy on temporomandibular disorder treatment outcome

BackgroundShared decision-making is defined as the process by which physicians and informed patients make a shared medical decision, taking into account the preferences and values of the patients. It is well known that shared decision-making practices improve both clinicians’ and patients’ satisfaction and lead to better treatment outcomes. The aim of the study was to assess associations between patients’ roles in decision-making, health literacy levels, and treatment outcomes of temporomandibular disorders (TMDs).MethodsIn total, 131 participants were enrolled. Participants underwent interview and physical examination at baseline and six months after TMD management. TMD was diagnosed according to Diagnostic Criteria/TMD criteria. Myofascial trigger points were bilaterally evaluated in the two masticatory muscles including the temporalis and masseter muscles. The roles that participants preferred to play or had perceived during decision-making and their health literacy levels were assessed using Control Preferences Scale and Newest Vital Sign, respectively.ResultsParticipants who perceived themselves as occupying active roles in decision-making showed higher health literacy levels than those with passive perceived roles. Participants with appropriate health literacy showed higher perceived participation levels in decision-making than did those with limited health literacy. The extent of subjective symptomatic improvement after six months of treatment showed significant associations with perceived role in decision-making, despite lack of significant relationships between perceived role in decision-making and the extent of improvement of objective parameters.ConclusionActive participation of patients in decision-making improves the satisfaction but limited health literacy constitutes barriers to effective patient engagement during TMD management.

Psychological therapies for temporomandibular disorders (TMDs).

Psychological therapies for temporomandibular disorders (TMDs).

Occlusal splint therapy in TMD pain management: A review

The temporomandibular joint (TMJ) acts as a hinge that connects the mandible to the skull. TMJ dysfunction can lead to difficulty chewing, clicking sounds while opening and closing the jaw, pain, discomfort, and locking of the jaw joint. American Academy of Orofacial Pain stated that temporomandibular disorder (TMD) is referred to as a combined term of clinical problems that involve the masticatory musculature, the TMJ, and its associated structures. A variety of treatment modalities have been proposed for the management of TMDs, such as behavioral therapy, physiotherapy, intraoral appliances, orthopedic stabilization, and collective treatment. This topic aims to provide insight and detailed information regarding the various types and functions of occlusal splint therapy in TMD pain management.

Predictors of pain reduction following a program of manual therapies for patients with temporomandibular disorders: A prospective observational study

BackgroundClinical guidelines recommend conservative treatment for the management of temporomandibular disorders (TMD), and manual therapy (MT) is commonly applied to reduce pain and improve function. ObjectivesTo identify predictors of pain reduction and functional improvement following a program of manual therapies (MTP) in patients with TMD and develop a first screening tool that could be used in clinical practice to facilitate decision-making. DesignA cohort of 102 adults with a diagnosis of TMD were treated with four weekly sessions within a MTP applied to craniomandibular structures. Candidate predictors were demographic variables, general health variables, psychosocial features, TMD characteristics and related clinical tests. A reduction of pain intensity by at least 30% after the MTP was considered a good outcome. Logistic regression was adopted to develop the predictive model and its performance was assessed considering the explained variance, calibration, and discrimination. Internal validation of the prediction models was further evaluated in 500 bootstrapped samples. ResultsPatients experiencing pain intensity greater than 2/10 during mouth opening, positive expectations of outcome following a MTP, pain localized in the craniocervical region, and a low Central Sensitization Inventory score obtained a good outcome following the MTP. Predictive performance of the identified physical and psychological variables was characterized by high explained variance (R2 = 58%) and discrimination (AUC = 89%) after internal validation. A preliminary screening clinical tool was developed and presented as a nomogram. ConclusionsThe high discrimination of the prediction model revealed promising findings, although these need to be externally validated in future research. Trial registration numberNCT03990662.

Temporomandibular disorders. Part 4: appliance therapy

Appliances have been used in the management of temporomandibular disorders (TMD) for many years, and over this time designs have waxed and waned in popularity. The majority of appliance designs have few studies to support their use and what evidence is available, is often of low quality. This article, the fourth in a series of six, reviews the mechanisms of action, evidential support for, and provides advice on when to use commonly used appliance designs. CPD/Clinical Relevance: There are a plethora of splint designs in use, but it is essential that the evidence supporting each is understood so that the most appropriate design is used for each individual situation.

Can Photobiomodulation Support the Management of Temporomandibular Joint Pain? Molecular Mechanisms and a Systematic Review of Human Clinical Trials

This study aims to point out the correlation between photobiomodulation (PBM) targets and effects and management of temporomandibular disorders (TMDs) pain using diode lasers with infrared wavelengths ranging from 780 up to 980 nanometers (nm). A systematic search of multiple electronic databases was done to identify the clinical trials published between 1st January 2010 and 18th December 2021. The included studies were limited to human subjects who had TMD pain, involving two genders with age &gt; 18 years, and were treated with PBM using a diode laser (780–980 nm) as a non-pharmacological therapy to decrease the intensity of the pain associated to TMDs. The risk of bias for included studies was assessed using the Cochrane RoB tool (for randomized studies). The methodologic quality was rated using the Delphi list. The findings suggest that PBM is an effective tool in alleviating TMDs’ pain and increasing the range of movement in patients with Axis 1 of TMDs. However, TMDs’ pain related to underlying pathology cannot be solely treated by PBM. The causative factors must be treated first. Studies displaying the highest quality Delphi score may represent a suggested PBM therapy protocol to follow for TMDs pain management.