Therapy For Temporomandibular Disorders Research Articles

Therapy for Temporomandibular Disorders: 3D-Printed Splints from Planning to Evaluation

This article describes the authors' digital workflow-based method for fabricating intraoral occlusal splints, from planning to the evaluation phase. In our protocol, first, we had a registration phase. This included taking digital impressions, determining the centric relation (CR) position with the deprogrammer Luci Jig, and using the digital facebow for measuring the individual values. The laboratory phase was next, which included planning and manufacturing with a 3D printer. The last phase was delivery, when we checked the stability of the splint and adjusted the occlusal part. The average cost is lower for a fully digital splint than for conventional methods. In terms of time, there was also a significant difference between the classic and digital routes. From a dental technical point of view, the execution was much more predictable. The printed material was very rigid and, therefore, fragile. Compared to the analog method, the retention was much weaker. The presented method permits time-efficient laboratory production, and may also be performed chairside in a dental office. The technology is perfectly applicable to everyday life. In addition to its many beneficial properties, its negative properties must also be highlighted.

Accurate Diagnosis and Treatment of Painful Temporomandibular Disorders: A Literature Review Supplemented by Own Clinical Experience.

Temporomandibular disorders (TMD) is a multifactorial group of musculoskeletal disorders often with combined etiologies that demand different treatment plans. While pain is the most common reason why patients decide to seek help, TMD is not always painful. Pain is often described by patients as a headache, prompting patients to seek the help of neurologists, surgeons, and ultimately dentists. Due to the unique characteristics of this anatomical area, appropriate diagnostic tools are needed, as well as therapeutic regimens to alleviate and/or eliminate the pain experienced by patients. Aim of the Study. The aim of this study is to collect and organize information on the diagnosis and treatment of pain in TMD, through a review of the literature supplemented by our own clinical experience. Material and Methods. The study was conducted by searching scientific databases PubMed, Scopus, and Google Scholar for documents published from 2002-2022. The following keywords were used to build the full list of references: TMD, pain, temporomandibular joint (TMJ), TMJ disorders, occlusal splint, relaxing splints, physiotherapy TMD, pharmacology TMD, natural therapy TMD, diagnostic criteria for TMD, and DC/TMD. The literature review included 168 selected manuscripts, the content of which was important for pain diagnosis and clinical treatment of TMD. An accurate diagnosis of TMD is the foundation of appropriate treatment. The most commonly described treatments include physiotherapy, occlusal splints therapy, and pharmacological treatment tailored to the type of TMD. Based on the literature review and their own experience, the authors concluded that there is no single ideal form of pain therapy for TMD. Treatment of TMD should be based on a thorough diagnostic process, including the DC/TMD examination protocol, psychological evaluation, and cone beam computer tomography (CBCT) imaging. Following the diagnostic process, once a diagnosis is established, a treatment plan can be constructed to address the patient's complaints.

Manual therapy for temporomandibular disorder in older adults: an integrative literature review

ABSTRACT Purpose: to describe the manual therapy techniques used to treat the temporomandibular disorder in older adults. Methods: an integrative literature review assessing scientific publications indexed in six databases: MEDLINE/PubMed, Web of Science, CINAHL, Scopus, LILACS, and PEDro. Only intervention studies were included, with no restriction of date or language. The articles included in the review were assessed with the Critical Appraisal Skills Programme. Results: after consulting the databases, 88 articles were found, six of which were considered eligible. No study was found exclusively approaching older adults. According to the analysis of the risk of bias, two articles were classified as low-risk, two as intermediate, and two as high-risk. The manual therapy techniques were intra- and extraoral massage, temporomandibular joint and cervical spine mobilization, myofascial release, trigger-point finger pressure, and deep transverse massage. Conclusion: the studies observed improved mandibular movements and masticatory function, eased pain, and reduced anxiety.

Manual therapy for temporomandibular disorder in older adults: an integrative literature review

ABSTRACT Purpose: to describe the manual therapy techniques used to treat the temporomandibular disorder in older adults. Methods: an integrative literature review assessing scientific publications indexed in six databases: MEDLINE/PubMed, Web of Science, CINAHL, Scopus, LILACS, and PEDro. Only intervention studies were included, with no restriction of date or language. The articles included in the review were assessed with the Critical Appraisal Skills Programme. Results: after consulting the databases, 88 articles were found, six of which were considered eligible. No study was found exclusively approaching older adults. According to the analysis of the risk of bias, two articles were classified as low-risk, two as intermediate, and two as high-risk. The manual therapy techniques were intra- and extraoral massage, temporomandibular joint and cervical spine mobilization, myofascial release, trigger-point finger pressure, and deep transverse massage. Conclusion: the studies observed improved mandibular movements and masticatory function, eased pain, and reduced anxiety.

Is there an association between otologic symptoms and temporomandibular disorders?: An evidence-based review

BackgroundThe aim of this article is to discuss the scientific evidence available on the pathophysiology and management of otologic complaints in patients with temporomandibular disorders (TMDs). Types of Studies ReviewedThe authors conducted an electronic search in MEDLINE, Web of Science and ScienceDirect and retrieved all the relevant peer-reviewed journal articles available in English on the topic. No time restriction was applied. ResultsNo consensus exists on the management of otologic symptoms in patients with concomitant TMD. The scientific evidence suggests that conservative or reversible TMD therapy might provide relief. However, this evidence is scarce and low, thus further studies with larger sample sizes and better designed methodological frameworks are needed. Until such evidence is available, dentists and orofacial pain specialists should treat TMD patients using current guidelines and refer those with otologic symptoms to an otolaryngologist. Practical ImplicationsGiven the wide range of potential pathophysiologies and treatments for each otologic symptom described in the TMD patient, close collaboration with otolaryngologists is essential to achieve the best patient care.

Association of Hormonal Contraceptive Use with Headache and Temporomandibular Pain: The OPPERA Study.

To determine the relationship between hormonal contraceptive (HC) use and painful symptoms, particularly those associated with headache and painful temporomandibular disorders (TMD). Data from the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) prospective cohort study were used. During the 2.5-year median follow-up period, quarterly health update (QHU) questionnaires were completed by 1,475 women aged 18 to 44 years who did not have TMD, menopause, hysterectomy, or hormone replacement therapy use at baseline. QHU questionnaires evaluated HC use, symptoms of headache and TMD, and pain of ≥ 1 day duration in 12 body regions. Participants who developed TMD symptoms were examined to classify clinical TMD. Headache symptoms were classified based on the International Classification of Headache Disorders 3 (ICHD-3). Associations between HC use and pain symptoms were analyzed using generalized estimating equations and Cox models. HC use, endorsed in 33.7% of QHU questionnaires, was significantly associated with concurrent symptoms of TMD (odds ratio [OR]: 1.20, 95% CI: 1.06 to 1.35) and headache (OR: 1.26, 95% CI: 1.11 to 1.43). HC use was also significantly associated with concurrent pain of ≥ 1 day duration in the head (OR: 1.38, 95% CI: 1.16 to 1.63), face (OR: 1.44, 95% CI: 1.13 to 1.83), and legs (OR: 1.22, 95% CI: 1.01 to 1.47), but not elsewhere. Initiation of HC use was associated with increased odds of subsequent TMD symptoms (OR: 1.37, 95% CI: 1.13 to 1.66) and pain of ≥ 1 day in the head (OR: 1.37, 95% CI: 1.01 to 1.85). Discontinuing HC use was associated with lower odds of subsequent headache (OR: 0.82, 95% CI: 0.67 to 0.99). HC use was not significantly associated with subsequent onset of examiner-classified TMD. These findings imply that HC influences craniofacial pain, and that this pain diminishes after cessation of HC use.

Temporomandibular disorders and the use of traditional and laser acupuncture: a systematic review

ABSTRACT Objective: To evaluate current studies to establish and compare the efficacy of traditional and laser acupuncture in reducing the signs and symptoms of temporomandibular disorders (TMD). Methods: PubMed, Cochrane, Scopus, and Web of Science databases were searched. Clinical, controlled, and randomized trials written in English and having used traditional or laser acupuncture as therapy for TMD and RDC/TMD or DC/TMD as a diagnostic criterion for TMD were included. Results: Six studies that evaluated the intensity of pain and the level of mouth opening of the patients submitted to acupuncture were selected, and all showed improvement. However, similar results were also observed in the groups treated with occlusal splint and placebo acupuncture. Only one study evaluated laser acupuncture and showed a higher proportion of patients with remission of symptoms in the experimental group. Conclusion: The traditional acupuncture seems to relieve the signs and symptoms of TMD, as well as laser acupuncture when associated with occlusal splint. However, more rigorous and high-quality clinical trials are needed.

Awareness and Knowledge of General Dental Practitioners in Central India Towards Management of Patients with Temporomandibular Disorder: A Questionnaire-based Survey

Introduction: Temporomandibular Disorders (TMDs) accounts for common Orofacial Pain (OFP) arising from musculoskeletal origins, affecting almost 80% of the overall population. The multifactorial nature of the disease makes it difficult to diagnose and treat and is challenging to a considerable number of General Dental Practitioners (GDPs). They’re increasingly approached by patients for advice on TMD, but little is understood about how this disorder is addressed with in primary health care. Aim: To assess the awareness and knowledge regarding management of TMDs among GDPs in Central India. Materials and Methods: The cross-sectional study was conducted at Central India, Nagpur, Maharashtra, India from 20th June 2020 to 12th December 2020, including 200 general dental practitioners, who were registered under the Dental Council of India. A questionnaire consisting of 17 questions with reference to TMDs was designed and the questionnaire was circulated through a web designed program. The responses were collected, and data were analysed descriptively using Statistical Package for the Social Sciences (SPSS) statistics for windows version 24.0. Results: The mean age of the participants in the study was 24.80±1.63 years. Predominantly, participants were 164 females (82%). Among all the participants, about 181 (90.50%) of GDP’s were practicing Dentistry. The study findings suggest that the overall general practicing dentists encounter TMD cases and 162 (81%) of GDP’s treat patient at their clinic. A 76% of GDPs acknowledged the causative factor for TMD to be multifactorial and physical examination (88.50%) as the diagnostic tool. Most of the general practitioners around 126 (63%) preferred referring the patient to the specialist, maxillofacial surgeon. Among the practitioners who were confident in treating TMD, occlusal splint was the treatment of choice for 198 (96%) of the GDPs. Conclusion: Many GDPs lack standard protocol knowledge, felt insecure in TMD diagnosis, therapy decisions and treatment. There is a requirement for better quality evidence on which TMD diagnosis and treatment, including the event of a valid, reproducible patient-centered outcome measure to enable dental practitioners to feel confident in managing TMD. It is essential to train GDPs to identify individuals with TMDs through professional courses and training. It would be highly beneficial to educate the undergraduates regarding the diagnosis of TMDs in their curriculum.

Botulinum toxin type A and acupuncture for masticatory myofascial pain: a randomized clinical trial.

BoNT-A has been widely used for TMD therapy. However, the potential benefits compared to dry needling techniques are not clear. Objective this study aimed to compare the immediate effects of botulinum toxin type A (BoNT-A) injections and Acupuncture in myofascial temporomandibular disorders (TMD) patients.Methodology 54 women were divided into three groups (n=18). AC patients received four sessions of traditional acupuncture, being one session/week during 20-min. BoNT-A patients were bilaterally injected with 30U and 10U in masseter and anterior temporal muscles, respectively. Moreover, a control group received saline solution (SS) in the same muscles. Self-perceived pain was assessed by visual analog scale, while pressure pain threshold (PPT) was verified by a digital algometer. Electromyographic evaluations (EMG) of anterior temporal and masseter muscles were also measured. All variables were assessed before and 1-month after therapies. The mixed-design two-way repeated measures ANOVA and Tukey’s post-hoc tests were used for analysis, considering a=0.05.Results Self-perceived pain decreased in all groups after one month of therapy (P<.001). BoNT-A was not better than AC in pain reduction (P=0.05), but both therapies were more effective in reducing pain than SS (P<0.05). BoNT-A was the only treatment able to improve PPT values (P<0.05); however, a severe decrease of EMG activity was also found in this group, which is considered an adverse effect.Conclusion after one month of follow-up, all therapies reduced the self-perceived pain in myofascial TMD patients, but only BoNT-A enhanced PPT yet decreased EMG.

Effects of physical therapy for temporomandibular disorders on headache pain intensity: A systematic review

BackgroundPhysical therapy is regarded an effective treatment for temporomandibular disorders (TMD). Patients with TMD often report concomitant headache. There is, however, no overview of the effect of physical therapy for TMD on concomitant headache complaints. ObjectivesThe aim of this study is to systematically evaluate the literature on the effectiveness of physical therapy on concomitant headache pain intensity in patients with TMD. Data sourcesPubMed, Cochrane and PEDro were searched. Study eligibility criteriaRandomized or controlled clinical trials studying physical therapy interventions were included. ParticipantsPatients with TMD and headache. AppraisalThe Cochrane risk of bias tool was used to assess risk of bias. Synthesis methodsIndividual and pooled between-group effect sizes were calculated according to the standardized mean difference (SMD) and the quality of the evidence was rated using the GRADE approach.Results: and manual therapy on both orofacial region and cervical spine. There is a very low level of certainty that TMD-treatment is effective on headache pain intensity, downgraded by high risk of bias, inconsistency and imprecision. LimitationsThe methodological quality of most included articles was poor, and the interventions included were very different. ConclusionsPhysical therapy interventions presented small effect on reducing headache pain intensity on subjects with TMD, with low level of certainty. More studies of higher methodological quality are needed so better conclusions could be taken.

Hyaluronic Acid/Parecoxib-Loaded PLGA Microspheres for Therapy of Temporomandibular Disorders.

This study aimed to fabricate Hyaluronic Acid (HA)/parecoxib-loaded PLGA microspheres for the treatment of Temporomandibular Disorders (TMD) and investigate the in vitro and in vivo effect of the microsphere system to solve the issues of poor drug delivery and short duration on drug concentration in conventional TMD therapy. The microspheres were prepared by the double emulsion (w/o/w) method. Various formulations were compared in terms of particle size, drug loading rate and encapsulation rate. Scanning Electron Microscopy (SEM), Differential Scanning Calorimetry (DSC) and FT-IR spectroscopy were performed to evaluate physicochemical properties. The drug release behavior of microspheres and toxicity assay on synovial cells were investigated. The in vitro anti-inflammatory effect on inflammatory markers, such as IL-1β, TNF-α and COX-2, was assessed by real-time PCR. Then, the in vivo therapeutic effect of microspheres was investigated using mechanically-induced rat synovitis model. Protein levels of inflammatory cytokines (IL-1β, TNF-α and COX-2) from TMJ periarticular tissues were quantified by Enzyme-Linked Immunosorbent Assay (ELISA). The results showed that microspheres were morphologically regular, smooth and non-cohesive. The average particle size of the microspheres was (25.32 ± 1.01) μm. The drug loading rate of parecoxib was 17.12%-20.95% with encapsulation efficiency reaching 51.9%-54.7%. In vitro drug release tests showed a successful sustained release over 28 days with a burst of 19.98% of the total drug substance. Treatment with HA/parecoxib-loaded PLGA microspheres declined the mRNA expression of IL-1β, TNF-α and COX-2 induced by LPS in articular synovial cells. Moreover, in vivo results demonstrated that the intra-articular microspheres significantly reduced protein levels of inflammatory cytokines (IL-1β, TNF-α and COX-2) for more than two weeks and stopped the mechanically-induced synovitis in its tracks in rat models. The study presented new and potential insights into treatments of TMD using PLGA microspheres loaded with HA and parecoxib as a successful drug delivery system.

Self-Perceived Dentists' Knowledge of Temporomandibular Disorders in Krakow: A Pilot Study.

Introduction The most common nondental orofacial pain conditions are temporomandibular disorders (TMDs). TMD basic examination and clinical management are included in a curriculum of each dentistry programme taught in Poland, but it is not clear how the dentists cope with diagnosis and possible treatment in their routine dental practices. The objective of the present study was to assess a level of self-perceived knowledge of TMD amongst dentists in Poland. Materials and methods. The participants, of whom all studied and graduated from a Polish university, were randomly selected from dental offices in Krakow (Poland). The selected dentists were administered an anonymous questionnaire, which contained questions measuring self-assessment of knowledge of TMD diagnosis and therapy and assessing knowledge of ethology and TMD symptoms. Results Only 6.5% of the participants identified their TMD knowledge as very good, 32.3% assessed it as good, 39.3% thought it was sufficient, 20.4% as insufficient, and 1.49% considered it as poor. 9.4% of all participants have attempted to diagnose and treat TMD patients very often, 26.4% declared performing it often, 45.8% rarely, and 18.4% had never made such an attempt. There was a significant relationship between the dentists' knowledge and their attempts at diagnosing and treating TMD patients (p < 0.05). Conclusion The level of TMD knowledge amongst the Polish dentists is still insufficient. Raising its level would considerably help the dentists to refer their patients to right specialists for a diagnosis and TMD treatment and/or interdisciplinary management of TMD patients.

Comparison of the efficiency of two alternative therapies for the management of temporomandibular disorders

ABSTRACT Objective: To investigate the effect of ozone and low-level laser (LLL) therapies on pain and function in patients with disc displacement with reduction. Methods: Eighty temporomandibular joints were divided into four groups, namely ozone and laser treatment groups, and two placebo groups. Ozone and LLL therapies were applied over six sessions. Results: Pain on palpation scores demonstrated a statistically significant decrease over time in the treatment groups. Sham laser therapy only reduced the pain on palpation in temporomandibular joints; whereas, sham ozone only affected masseter muscle pain. The ozone treatment group demonstrated significantly better pressure pain threshold scores and mandibular movements than the other groups; however, pressure pain threshold scores of the masseter inferior were significantly higher in the laser group. Discussion: This study supports the use of ozone for pain reduction as an alternative treatment modality and LLL as a supportive therapy for temporomandibular disorders.

Changes of sensory and pain thresholds in healthy subjects after mandibular extension at maximum mouth opening: implications for temporomandibular disorders therapy.

There is evidence showing that increasing the vertical dimension of occlusion, or interocclusal distance, reduces pain symptoms in patients with temporomandibular disorders (TMD) and bruxism. The mechanism underlying the analgesic effect is still under investigation. Some researchers propose either a gate mechanism or the activation of the trigemino-cardiac reflex. In this study, sensory and pain thresholds changes in the mandibular district have been evaluated in twenty healthy subjects immediately after 5 minutes of mandibular stretching at maximum opening of the jaw. Results showed a 60% increment in sensory threshold and a 70% increment in pain threshold (p<0.001) compared with the baseline values. The magnitude of the analgesic effect seems proportional to the extent of mandibular opening. These and similar results are discussed as for the implication in the treatment of TMD related symptoms.

Associations among gastroesophageal reflux disease, mental disorders, sleep and chronic temporomandibular disorder: a case-control study.

Temporomandibular disorders (TMDs) are a family of pain-related disorders associated with impaired function in the jaw, temporomandibular joint and muscles of mastication. Our objectives were to evaluate the association between chronic TMD and gastresophageal reflux disease (GERD) and to determine whether mental disorders or undermined sleep mediates this association. We conducted a case-control study involving 1522 consecutive adult patients with chronic TMD and 1522 matched controls from 2 hospitals in China. All participants were aged between 18 and 70 years and were recruited from July 2017 to April 2018 Chronic TMD was diagnosed by trained dentists using the criteria in the Orofacial Pain Prospective Evaluation and Risk Assessment Study. Trained gastroenterologists made blinded diagnoses of GERD according to the Montreal definition and classification (at least 2 d of mild symptoms, or 1 d of moderate or severe symptoms per week). We used validated questionnaires to evaluate psychological status and sleep quality. Of the study participants, we identified 132 patients and 61 controls with GERD. Using conditional logistic regression analysis, we identified GERD as a risk factor for TMD (odds ratio 2.74, 95% confidence interval 1.88 to 3.98). Mediation analyses identified that somatization, anxiety and undermined sleep moderately mediated the relation between TMD and GERD. Our study suggests that symptomatic GERD is associated with chronic, painful TMD, and somatization, anxiety and undermined sleep mediate this association to a certain extent. Due consideration should be given to the evaluation and management of gastrointestinal symptoms and mental disorders in the combined therapy for painful TMD.

Changes in salivary oxidative status, salivary cortisol, and clinical symptoms in female patients with temporomandibular disorders during occlusal splint therapy: a 3-month follow up

BackgroundDifferences in the expression of oxidative stress (OS) markers between female patients with temporomandibular disorders (TMD) and healthy individuals indicate that OS plays a role in the pathogenesis of TMD. Because chronic exposure to stress generates oxidative damage during continuous stimulation of the hypothalamic-pituitary-adrenal axis, we expected that higher levels of cortisol might be associated with higher oxidative damage. Our aim was to test the association between OS markers, stress perception, and salivary cortisol (SC) in chronic, female TMD patients. We tracked changes in OS markers and SC during occlusal splint therapy in order to evaluate the influence of treatment on oxidative status. We hypothesized that the effects of TMD therapy would differ among individuals depending on the source and intensity of pain.MethodsSixteen female patients were recruited, and 12 finished the study. Clinical assessment and saliva sampling were performed at the baseline and follow-up appointments. Repeated measures analysis of variance and Pearson’s correlation were used for analyzing the data.ResultsAfter 3 months, a significant reduction in afternoon total antioxidant capacity (TAC) was observed (p < 0.05). A significant reduction in afternoon malondialdehyde (MDA) (p = 0.021) and a decrease in afternoon MDA to superoxide dismutase ratios (p = 0.017) were present in high-intensity pain patients. At baseline, higher levels of perceived stress were significantly associated with higher morning cortisol (ρ = 0.67). At the end of the therapy, reduced perceived stress was positively correlated with morning SC changes when considering all TMD patients, but the association between perceived stress with OS markers was present only in myofascial pain (MP) group. The effect of treatment on the self-perceived quality of life was more pronounced in female MP patients while the reduction of spontaneous pain was significantly greater in high-intensity pain patients.ConclusionOur data indicate that occlusal splint therapy in female TMD patients contributes to increasing their capacity to remove free radicals. The question remains whether or not TAC decreases in this process as a result of avoiding unnecessary processes, once the increase in antioxidants effectively compensates for OS. The intensity and the source of pain should be considered important factors in future investigations evaluating salivary OS markers and their association with perceived stress and SC in TMD patients.Trial registrationClinicalTrials.gov NCT03029494. Registered on 2017-01-19.

Nonsurgical management of temporomandibular joint autoimmune disorders.

IntroductionTemporomandibular disorders (TMD) are observed in a number of autoimmune diseases but limited studies have assessed the effect of autoimmune diseases on TMD. Therefore, the present review article was conducted to determine the effect of autoimmune diseases on TMD.MethodsInternational databases, including Web of Sciences, PubMed and Scopus, were searched in order to find related articles. The search key words were; temporomandibular joint (TMJ) autoimmune disorders, TMJ, TMD, medical therapy and non-invasive, local and systemic management. Published articles from June, 2010 to June, 2019 were included in the review.ResultsA total of 11 related articles including rheumatoid arthritis (RA), lupus erythematosus and systemic sclerosis were found. All articles noted that TMJ has unique features that distinguishes it from other human body joints. Cases of TMJ injury and TMD require specific treatments. Therefore, early diagnosis of TMD is essential. It was also mentioned in the articles that the collagen-induced arthritis (CIA) method is a suitable method for investigating TMD and its relationship with RA. Treatment methods included oral steroids, Disease-modifying antirheumatic drugs, nonsteroidal anti-inflammatory drugs, methotrexate 75 mg, and combination therapy with methotrexate.ConclusionBased on the results of this study, TMD exists in some autoimmune diseases, including RA, lupus erythematosus and systemic sclerosis. Therefore, there should be an interdisciplinary collaboration between physicians and dentists in order to choose the best conservative treatment and medication therapy for TMD to reduce the progression and pain associated with this type of disorder.

Efficacy of splint therapy for the management of temporomandibular disorders: a meta-analysis.

Temporomandibular disorders (TMD) are a group of clinical problems affecting temporomandibular joint (TMJ), myofascial muscles and other related structures. Splint therapy is the most commonly used approach to treatment of TMD, but its effectiveness is remains unclear. We therefore conducted a meta-analysis to evaluate the effectiveness of splint therapy for TMD in adults. The electronic databases PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched for reports published up to March 31, 2016. Thirteen eligible studies involving 538 patients were identified. The results indicated that splint therapy increased maximal mouth opening (MMO) for patients with a MMO <45mm and reduced pain intensity measured using the visual analogue scale (VAS) for patients with TMD without specific description (TMDSD). Splint therapy also reduced the frequency of painful episodes for patients with TMJ clicking. No publication bias was observed, as determined with Egger's test for all outcomes. On the basis of this evidence, we recommend the use of splints for the treatment and control of TMD in adults.

Treatment of temporomandibular disorders – knowledge, attitudes and clinical experience among general practising dentists in Sweden

Objective: The aim of the study was to investigate the self-perceived level of knowledge, attitudes and clinical experience in treatment of temporomandibular disorders (TMD) among general practising dentists (GPDs).Material and methods: A web-based questionnaire was sent to all GPDs in the public dental health service in the County of Uppsala in 2010 (n = 128) and 2014 (n = 113). The GPDs were asked to answer questions in the following categories: Demographic information, Quality assurance, Clinical experience and treatment, Need for specialist resources in the field of TMD and Attitudes. Between the two questionnaires, the GPDs were offered TMD education and an examination template including three TMD questions was introduced in the computer case files. The results were also compared with a previous questionnaire from 2001.Results: The response rate was 71% (2010) and 73% (2014). The majority of the GPDs were women (70% in 2010 and 72% in 2014). The reported frequency of taking a case history of facial pain and headache increased between 2010 and 2014. In 2014, the GPDs were more secure and reported higher frequency of good clinical routines in treatment with jaw exercises and pharmacological intervention compared to 2001. Interocclusal appliance was the treatment with which most dentists felt confident and reported good clinical routines.Conclusions: The GPDs felt more insecure concerning TMD diagnostics, therapy decisions and treatment in children/adolescents compared to adults. There is a high need for orofacial pain/TMD specialists and a majority of the GPDs wants the specialists to offer continuing education in TMD.

Effect of temporomandibular disorder therapy on otologic signs and symptoms: a systematic review.

The most common temporomandibular disorders (TMD) signs and symptoms are related to muscle sensitivity through palpation, restricted mouth opening, asymmetric mandibular movements, joint sounds, pain and otologic signs and symptoms. To date, counselling, occlusal splints, exercises, biofeedback and acupuncture are examples of conservative modalities proposed for TMD therapy. The aim of this systematic review was to investigate the effect of these conservative therapies for TMD on otologic signs and symptoms. The authors searched the following electronic databases published up to 1st May 2015: PubMed, LILACS, Scopus, Web of Science and Science Direct with no time or language limitations. Using a two-phase selection process, the authors identified 08 articles and used them to conduct a qualitative analysis. Methodological quality of each article was performed with the aid of 'Quality Assessment of a Cohort Study' and 'Quality Assessment of a Randomized Clinical Trial', developed by the Dutch Cochrane Centre, a centre of the Cochrane Collaboration. This systematic review showed in seven of the eight studies included that a total or partial resolution of otologic complains occurred after counselling, exercise therapies and occlusal splint therapy. Upon the limitations of the studies included in this systematic review, the present outcomes suggested that there is insufficient evidence in favour or against the conservative therapies for TMD on changes in otologic signs and symptoms. Thus, further studies with a higher level of evidence and more representative samples should be conducted to better understand the relationship of TMD therapy changes on otologic complains.