Home » Supporting Your Practice » Dental Specialties » Oral Medicine » ‘Usual treatment’ vs. ‘psychosocial interventions’ in the treatment of TMD: What’s the difference? A systematic review

‘Usual treatment’ vs. ‘psychosocial interventions’ in the treatment of TMD: What’s the difference? A systematic review

Dramatic Black and White Shot of a Man in Pain holding his Jaw. Toothache!This summary is based on the article published in the Journal of Oral & Facial Pain and Headache: A systematic review and meta-analysis of usual treatment versus psychosocial interventions in the treatment of myofacial temporomandibular disorder pain (summer 2014)

Carolina Roldán-Barraza, DDS/Steffani Janko, DDS, PhD/Julio Villanueva, DDS, MBA/Ignacio Araya, DDS, MSc/Hans-Christoph Lauer, DDS, PhD

 

 

Context

  • Temporomandibular disorders (TMD) represent a complex set of conditions reflecting different symptoms that affect the Temporomandibular joint and surrounding structures.
  • Epidemiologic studies have shown that the majority of TMD patients are diagnosed with myofacial pain. (1)
  • The different approaches to treatment as well as the varying types of diagnoses exemplify the lack of consensus and understanding of TMD.
  • Although multiple possibilities have been proposed for the treatment of TMD, most recognized standards prioritize reversible interventions over invasive ones.

Purpose of the Review

To compare the effects of occlusal splint therapy (usual treatment) and psychosocial interventions for the treatment of myofacial TMD pain in adult patients.

Key Findings

  • The outcomes “long-term self-reported pain” and “long-term depression” were significantly different for the comparisons of “usual treatment” and “psychosocial interventions”, and they favoured the latter.
  • A tendency toward greater improvements of psychosocial outcomes was observed for psychosocial interventions, while physical functioning was slightly more responsive to “usual treatment.”
  • No evidence was found to distinguish the clinical effectiveness between “usual treatment” and “psychosocial interventions” for myofacial TMD pain.

References

  1. Winocur E., Steinkeller-Dekel M., Reiter S., Eli I. A retrospective analysis of temporomandibular findings among Israeli-born patients based on the RDC/TMD. J Oral Rehabil 2009: 36:11-17.

 

Do you have any particular question on this topic? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca

You are invited to comment on this post and provide further insights by posting in the comment box which you will find by clicking on “Post a reply” below. You are welcome to remain anonymous and your email address will not be posted.

4 comments

  1. I will say that the type of appliance, how the orthopedic position of the mandible is determined, how the occlusion is engineered and adjusted, and whether, or not, the appliance is worn 24/7 are all critical factors in the success of the treatment. This study seems to be based on something called “usual treatment” with an appliance vs. psychosocial. It should be based on “exceptional, science-based treatment” with an appliance vs. psychosocial. That would likely result in a definitive functional benefit to the patient over a psychosocial approach.

  2. Well stated Dr. Hill. As presented, this summary is of little value.

  3. TMJ “usual” treatment is the weakness in this study. Most academic teachings and thus most dental care use a variety of “lab” based plastic care. They do not have physiological or functional appliances in place (because they are not obtaining data on these parameters). Placing a “custom” splint just means it fits the teeth and not any of the anatomy that has an effect on cranialmandibular cervical health. Very poor use of term to associate the entire field to “usual” which is the same as inadequate and outdated care.

    What is needed are studies using the latest in imaging, neuromuscular, and other current modalities for diagnosis and treatment.

  4. “Usual” TMJ splint treatment typically is a very parochial care approach. It is acquired from academic settings that have not kept up with current technology or technique. 3D imaging, functional appliances, neuromuscular instrumentation, and more have changed the landscape of cranialmandibular cervical disorders (CMCD). Even the term has become more anatomically encompassing as we have learned more of the connectiveness of these dysfunctions from other medical specialties. The idea that myofacial pain is the goal dismisses the need to diagnose anatomical causes and remedy those endpoints.

    With a reference of eight years ago we need to show care as it is being provided in up to date clinical settings by those that have the experience, case histories, and success in not just allowing pallative techniques perpeturate pathology. Adaptation with overt symptoms and signs or subclinical damage often lead to more pain and dysfunction later in life; often not associated with etiology that current science shows to be related.

Leave a Reply

Your email address will not be published.

%d bloggers like this: