A comparative approach to treatment methods for myofacial pain and internal derangement of the temporomandibular joint

Abstract

The temporomandibular joint (TMJ) is the site of articulation between the mandibular fossa of the temporal bone and condylar head of the mandible. The TMJ is a synovial joint that has a cartilaginous disc between two articular surfaces. It can perform rotation and translation. A group of muscles (primarily masseter, temporalis and pterygoids) and ligaments are involved in jaw movement. The group of disorders that encompasses dysfunction of these structures is called “temporomandibular disorders (TMD)”. This research primarily focuses on myofacial pain, dysfunction and internal derangement of the TMJ (anterior disc displacement (ADD) with and without reduction). Treatments include conservative and invasive interventions. Conservative treatment consists of behavioural/psychosocial therapy, physiotherapy, pain management, occlusal splint therapy, low-level laser therapy and transcutaneous electric nerve stimulation therapy. Conservative treatment provides very effective results for pain relief and signifi cant improvement of jaw function, however follow-up periods in studies were short-term (not more than three months). Continuous improvement was observed in occlusal splint therapy as it leads to sustained behavioural change, helpful in alleviating pain by reducing stress put on the masticatory muscles and correcting jaw function. Exercise and physiotherapy have also resulted in considerable pain reduction and restoration of jaw function. Evidence showed that botulinum-toxin type A provided an immediate alleviation of pain effective for 3 months, however decreased maximal incisal opening as its mechanism of action is inhibiting muscle activity.