Towards an Optimal Therapy Strategy, Pharmacologic Treatment for Temporomandibular Disorders
Lecture Description
Temporomandibular disorders (TMD) is a common form of orofacial pain which involves the temporomandibular joints, masticatory muscles, and associated structures. It is known to affect approximately 33% of the adult population when considering at least one related symptom as the criteria, while 3.6-7% seek treatment due the severity of their TMD symptoms. It is generally more common in women with a peak prevalence around the age of 20-40 years which somewhat overlaps with the major patient group seeking orthodontic treatment. It is second only to toothache as the cause of orofacial pain. While symptoms are mild and self-limiting in most patients, a chronic type of TMD with persistent pain and a higher level of comorbidities such as psychological, autonomic, and sleep disturbances may develop. The etiology of TMD is known to be multifactorial including biologic, behavioral, and psychological factors however, the underlying mechanism is yet to be fully elucidated. Due to the lack of full understanding involving its pathophysiology the current diagnostic and treatment process for TMD is centered on verifying symptoms through patient interviews, palpation of surrounding muscle and joint, and imaging of associated structures leading to symptomatic treatment rather than pathophysiology-driven therapy. Conventional treatment includes controlling of contributing factors based on cognitive behavioral therapy, physical therapy such as thermal, electric, and laser stimulation, and also oral appliance therapy. Invasive treatment should not be considered as first line approaches in most cases since non-invasive treatment results in sufficient symptom relief in the majority of patients in the long-term experiencing improvement in both pain and function.
Pharmacological treatment is a well-accepted approach for TMD patients that has been applied for many years. Commonly used and also effective agents include analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants, anticonvulsants, muscle relaxants, benzodiazepine, and corticosteroids. Such medication influences TMD symptoms by directly reducing pain and in some cases by controlling comorbid symptoms such as mood disorders and sleep disturbance. Recently, chronic systemic inflammation has been proposed as the underlying mechanism of pain chronicity in several pain conditions and a few studies have also suggested the possibility of immune disturbance in TMD patients. The control of systemic inflammation could be another mechanism in affecting TMD symptoms through medication.
TMD is a complex disorder accompanied by various comorbidities and multiple factors may influence its long-term prognosis and treatment response. Based on such characteristics, individual aspects of the disease should be considered when selecting pharmacologic treatment for TMD which will lead to personalized treatment with increased efficiency. Orthodontic treatment related issues could be one of such factors to be included in the treatment planning process for TMD patients.
Therefore, in this lecture general points to consider in the pharmacologic treatment of TMD patients will be handled in a comprehensive manner, later moving on to more detailed description on individual factors to consider when selecting specific agents and also special thoughts on issues related to orthodontic treatment.
October 28-30, 2022 กค COEX, Seoul, Korea