Outcomes of management of early temporomandibular joint disorders: How effective is nonsurgical therapy in the long-term?

Keywords: Bruxism, clicking, interocclusal splint, pain, TMD, temporomandibular disorder, TMJ, temporomandibular joint ,head pain, IOS, splint therapy, Maxillofacial Surgery, skull, ear, and lower jaw

Many people throughout Arizona and the United States suffer from a Temporomandibular Disorder (TMD) in various forms and stages.  Most people suffering from TMD refer to this condition by another name, which is TMJ.  The name TMJ is derived from the temporomandibular joint (TMJ), which is a small joint located in front of the ear where the skull and lower jaw meet.  This joint permits the lower (mandible) to move and function.  Recently, the National Journal of Maxillofacial Surgery published an article about the long-term effects of a noninvasive procedure in the treatment of TMD.  The treatment included the use of an Interocclusal Splint (IOS).  An IOS or “splint therapy” is one of several methods Dr. Stan Farrell has at his disposal to address and treat those who suffer from TMD and other head pain.  Furthermore, this article goes on to conclude that greater than 80% of the patients who suffered from TMD in this study were effectively and moderately helped through the use of an IOS.  Dr. Farrell, who is a Diplomate of the American Board of Orofacial Pain, prides himself on his ability to treat Temporomandibular Disorders (TMD) through “splint therapy” or other noninvasive methods.  His ability to properly diagnose the cause and recommend a treatment plan that is specifically designed to alleviate your pain over the long term sets him apart from his peers. Schedule an appointment for a consultation with Dr. Farrell at 480-945-3629.   www.headpaininstitute.com

Seyed Hossein Mortazavi, Mohammad Hosein Kalantar Motamedi, Fina Navi, Majid Pourshahab, Seyed Masoud Bayanzadeh, Habib Hajmiragha, and Mona Isapour

Aim:  The first step in the management of Temporomandibular Disorders (TMD) is usually noninvasive, especially if the disorder is in the early stages. Clinically, pain and clicking are early signs and symptoms of TMD. The management of TMD usually includes “splint therapy” and analgesics. In this study, we report our long-term outcomes in the treatment of patients suffering from early TMD.

Materials and Methods:  We assessed the records of 138 patients who were referred for management of TMD. Selection was based on pain and/or clicking of the Temporomandibular Joint (TMJ), no pathologic lesions of the TMJ, no anterior disc displacement without reduction (closed lock), no Degenerative Joint Disease, no history of migraine, trauma, osteoarthritis, metabolic disease, or malocclusion (deep bite, cross bite, jaw deformity, etc). The patients were treated with an acrylic maxillary Interocclusal Splint (IOS) cuspid-rise type and were told to refrain from biting, yawning and chewing hard food. The outcome of the treatment, potential etiologic factors (Bruxism), signs and symptoms and patient demographics (such as age, sex, treatment duration, etc.) were assessed. The data were analyzed using the Chi-square test to correlate significance.

Results:  One hundred thirty-eight patients (26 males and 112 females) with early signs and symptoms of TMD (pain and/or click of the TMJ) were treated from 2001 to 2010; 81% were females and 19% were males. All the 138 patients used the IOS at night only. The patients were followed-up for 1–9 years. Data analysis showed that 64% of the patients were completely relieved of signs and symptoms; 22% were moderately relieved (decreased severity of signs and symptoms) and 14% had no noticeable post-treatment changes in clicking or pain (P = 0.001). Patients with bruxism and those presenting with both pain and clicking showed a better response to IOS treatment (P = 0.046 and P = 0.001, respectively). The results also showed that age, sex, severity of symptoms and duration of the treatment did not influence treatment results in this group of patients with early TMD.

Conclusion:  In this population, TMD was significantly higher in females. Treatment of early TMD with IOS was effective and moderately effective in long-term in over 80% of the patients during the follow-up period of 1–9 years. Bruxism had a significant etiologic role in TMD; occlusal attrition of the dentition, pain of all the teeth, early morning pain of the masticatory muscles and the TMJ are signs and symptoms to suspect nocturnal bruxism. Use of an IOS is recommended to prevent potential damage to the dentition, periodontium and the TMJ in early TMD. (Natl J Maxillofac Surg. 2010 Jul-Dec; 1(2): 108–111)