Temporomandibular disorder: A guide for general dental practitioners

Shah, AM; Naqvi, Ambareen

doi:10.1177/20501684221112513

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…Але клінічні особливості самого больового синдрому можуть слугувати провідними опорними пунктами диференціальної діагностики лицевих болів. Пухлина здавлює черепно мозковий нерв або його гілки, що супроводжується виникненням болю та зниженням чутливості (гіпестезія) нижче місця локалізації новоутворення [14].…”

Section: результати обговоренняunclassified

Differential Diagnosis Challenges of Facial Pain (Clinical Case)

Bezkorovaina,

Garlyauskaite,

Ponomarenko

2023

Rep. of Vinnytsia Nation. Med. Univ.

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Annotation. The diagnosis of facial pain falls within the realm of professional competence for dentists, orthopedic dentists, ophthalmologists, otolaryngologists, neurosurgeons, neurologists, and physiotherapists. The complex and highly subjective nature of clinical symptoms often poses challenges for practitioners across these specialties. Consequently, a patient with facial pain may undergo multiple consultations with different specialists before a definitive diagnosis is established and effective treatment is provided. The aim of this study is to demonstrate a developed routing protocol for a patient with atypical facial pain through a clinical case. The stages of interdisciplinary simultaneous consultation, a comprehensive approach to diagnosis and treatment of patients with facial pain, and differential diagnosis are considered using the example of a clinical case of a 15-year-old female patient K., who presented to a dental surgeon with complaints of constant facial pain and a preliminary diagnosis of “Temporomandibular joint dysfunction. Impacted wisdom teeth 38 and 28”. The pain was constant, dull, deep, and piercing. She experienced decreased sensitivity in the lower lip and the anterior half of the tongue on the left side, as well as stuffiness and ringing in the left ear. Consultations with a neurologist and an orthopedic dentist were conducted, which led to the prescription of additional diagnostic methods: needle electromyography and magnetic resonance imaging of the brain. The article assesses the relevance and effectiveness of a multidisciplinary approach to the comprehensive diagnosis of facial pain syndrome, including a thorough history-taking by a dental practitioner, conclusions of a neurologist, and the results of additional diagnostic methods. Based on the electromyographic signs, the trigeminal nerve damage was detected, and a voluminous brain tumor causing compression of the trigeminal nerve and its peripheral endings was visualized on magnetic resonance tomography. Following the consultation with the dental surgeon, the patient was referred for further treatment to the A.P. Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine. Thus, interdisciplinary consultation is recognized as the basis for the comprehensive management of patients with atypical facial pain, requiring the involvement of a primary care physician - a dentist, who develops a routing protocol for timely diagnosis and effective treatment of these kind of patients.

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Section: результати обговоренняunclassified

Differential Diagnosis Challenges of Facial Pain (Clinical Case)

Bezkorovaina,

Garlyauskaite,

Ponomarenko

2023

Rep. of Vinnytsia Nation. Med. Univ.

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“…They are classed as a primary pain condition in the new chronic pain coding system of the International Classification of Disease , 11th revision 2. The demand for clinical guidance on TMDs management is clear: there have been five recent guidelines,34567 each with some identified limitations, plus nine previous network meta-analyses, which either investigated only a subset of interventions8910111213 or specific subtypes of TMDs 10131415. With more than 50 possible interventions identified, there is an urgent need for clear, comprehensive, evidence-based guidance to ensure that people with TMDs receive timely and effective management using the current best available evidence.…”

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Chronic pain associated with temporomandibular disorders

Senaratne,

Colvin

2023

BMJ

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Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline

Busse,

Casassus,

Carrasco-Labra

et al. 2023

BMJ

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Clinical question What is the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD)? Current practice TMD are the second most common musculoskeletal chronic pain disorder after low back pain, affecting 6-9% of adults globally. TMD are associated with pain affecting the jaw and associated structures and may present with headaches, earache, clicking, popping, or crackling sounds in the temporomandibular joint, and impaired mandibular function. Current clinical practice guidelines are largely consensus-based and provide inconsistent recommendations. Recommendations For patients living with chronic pain (≥3 months) associated with TMD, and compared with placebo or sham procedures, the guideline panel issued: (1) strong recommendations in favour of cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care (such as home exercises, stretching, reassurance, and education); (2) conditional recommendations in favour of manipulation, supervised jaw exercise with mobilisation, CBT with non-steroidal anti-inflammatory drugs (NSAIDS), manipulation with postural exercise, and acupuncture; (3) conditional recommendations against reversible occlusal splints (alone or in combination with other interventions), arthrocentesis (alone or in combination with other interventions), cartilage supplement with or without hyaluronic acid injection, low level laser therapy (alone or in combination with other interventions), transcutaneous electrical nerve stimulation, gabapentin, botulinum toxin injection, hyaluronic acid injection, relaxation therapy, trigger point injection, acetaminophen (with or without muscle relaxants or NSAIDS), topical capsaicin, biofeedback, corticosteroid injection (with or without NSAIDS), benzodiazepines, and β blockers; and (4) strong recommendations against irreversible oral splints, discectomy, and NSAIDS with opioids. How this guideline was created An international guideline development panel including patients, clinicians with content expertise, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. The panel approached the formulation of recommendations from the perspective of patients, rather than a population or health system perspective. The evidence Recommendations are informed by a linked systematic review and network meta-analysis summarising the current body of evidence for benefits and harms of conservative, pharmacologic, and invasive interventions for chronic pain secondary to TMD. Understanding the recommendation These recommendations apply to patients living with chronic pain (≥3 months duration) associated with TMD as a group of conditions, and do not apply to the management of acute TMD pain. When considering management options, clinicians and patients should first consider strongly recommended interventions, then those conditionally recommended in favour, then conditionally against. In doing so, shared decision making is essential to ensure patients make choices that reflect their values and preference, availability of interventions, and what they may have already tried. Further research is warranted and may alter recommendations in the future.

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Temporomandibular disorder: A guide for general dental practitioners

Cited by 3 publications

References 22 publications

Differential Diagnosis Challenges of Facial Pain (Clinical Case)

Differential Diagnosis Challenges of Facial Pain (Clinical Case)

Chronic pain associated with temporomandibular disorders

Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline

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