Thanks to Joan Wilentz, The TMJ Association's editor for this summary.
A recent article that appeared in Current Rheumatology Reviews by a Spanish and a Scandinavian author* underscores the complexity of temporomandibular disorders (TMD). The authors note that these painful conditions have been discussed for over 70 years without reaching consensus on either their causes or treatment. As a service to the research field they have reviewed the most recent studies for which there is valid scientific evidence relating to the epidemiology, symptoms, diagnosis, pathophysiology, management of myofascial TMD, and making suggestions for future research. "Myofascial" refers to the fibrous tissue that sheathes the chewing muscles and other tissues associated with the TM joint. It is the more common form of TMD, as opposed to conditions confined to the joint itself, such as disc displacement.
The investigators conclude that TMD represents a complex and multifaceted pain disorder that may involve genetics, nervous system peripheral or central sensitization, and a range of psychological, behavioral and other variables. Most importantly, they emphasize that proper management of patients with myofascial TMD must be multimodal, including health care professionals besides dentists. Also, "Proper therapeutic interventions should see things from a personalized patient's point of view," they say, "including active listening, empathy, and addressing psycho-social issues," adding that "Patient-centered care involves shared decision making with mutual respect between clinicians and individuals."
Included in the management section of the paper is a table evaluating a range of treatment options, such as manual and physical therapies, psychological approaches, acupuncture and orthodontics, rating the strength or weakness of evidence for their effectiveness. While the article is lengthy and not written for the general reader, we believe that it will help those who live with TMD or care for a TMD patient in validating that the pain is real, that it is associated with a multitude of risk factors, that symptoms can vary and that patients deserve treatment that takes into consideration their unique set of clinical findings and history.
* Fernandez-de-Las-Penas C1, Svensson P., Myofascial Temporomandibular Disorder. Curr Rheumatol Rev. 2016;12(1):40-54.