The use of pharmacologic agents in the management of temporomandibular joint disorder

Abstract

Temporomandibular joint disorders (TMD) are oro-facial pain conditions that originate from either intraarticular or extraarticular related pathology. Following an accurate diagnosis, there are a variety of non-surgical and surgical management options available. The aim of this article is to review the available pharmacologic agents for the management of extraarticular and intraarticular TMD. These medical options are often first line and are combined with other non-surgical modalities. There are multiple pharmacologic options utilized to treat TMD, from non-steroidal anti-inflammatory drugs (NSAIDs) to muscle relaxants and steroids. Many of these medications are used synergistically to provide symptom improvement and prevention of persistent disease. This paper will discuss the use of the following classes of medications used to manage TMD: NSAIDs, corticosteroids, narcotics, muscle relaxants, anticonvulsants, anxiolytics, and topical therapy. Despite their extensive clinical use, there remains insufficient evidence to recommend one therapy over another. This is due to the lack of systematic reviews and meta-analyses in the current literature.For this reason, there remains a need for a randomized control trial with clear pre-pharmacotherapy diagnoses, blinding, and research objectives. NSAIDs have been recommended as first line therapy for intraarticular disorders with the addition of muscle relaxants if there is a muscle component. Several of the other medications discussed are often patient specific or given secondarily when previous therapy has failed.It is critical to recognize systemic patient factors when prescribing any of these medications to avoid side effects and drug-drug interactions.

New Methods for the Acoustic-Signal Segmentation of the Temporomandibular Joint

“…Therefore, in this study, we used our own database created from the sounds recorded with an electronic stethoscope (Littmann Model 3200 Manufacturer 3M Health Care, St. Paul, MN, USA) during a clinical diagnostic trial of TMJ performed in the Dentistry Clinic of Jagiellonian University Medical College in Krakow, Poland (consent of Bioethics Committee number 1072.6120.71.2019). All patients were first diagnosed with standardised official Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) [ 21 , 22 , 23 ] and further examined by qualified staff. During auscultation, the stethoscope head was applied to the facial skin in the preauricular areas on both sides of the head, and each patient was asked to periodically open and close a jaw with non-standardised frequency, but each recording contained between five and eight repetitions.…”

Efficacy of Duloxetine With Arthrocentesis in the Management of TMJ Internal Derangement

“…5 Other supplements include different classes of oral pharmacological agents, such as non-steroidal anti-inflammatory drugs, corticosteroids, narcotics, anxiolytics, antidepressants, and anticonvulsants. 10 Duloxetine is a centrally acting analgesic and is categorized as an antidepressant, acting mainly as selective serotonin (5hydroxytryptamine) and norepinephrine reuptake inhibitor (SNRI). 5-hydroxytryptamine and norepinephrine play important roles in stimulating endogenous pain inhibitory mechanisms via descending pain inhibitory pathways in the brain and spinal cord, which is lost or decreased in chronic pain states.…”

“…These supplements include intra-articular injection of medications such as steroids and hyaluronic acid and growth factors such as platelet-rich plasma and platelet-rich fibrin 5 . Other supplements include different classes of oral pharmacological agents, such as non-steroidal anti-inflammatory drugs, corticosteroids, narcotics, anxiolytics, antidepressants, and anticonvulsants 10 …”