Evidence-Based TMD Treatment

March 31, 2024

Progress in Evidence-Based TMD Treatments

Efficient early intervention helps deter TMD’s development; and today, new studies support a comprehensive TMD pain management approach involving evidence-based treatment.

Experienced, certified Orofacial Pain Experts treating Temporomandibular disorders (TMD) have long relied on their proven TMD treatment capabilities. Thankfully, many individuals suffering from painful TMD have gained significant pain relief. At the same time, it is universally acknowledged that improving the evidence base for TMD treatments and patient care is needed.

Caring for Individuals with a TMD

Communicating complex medical knowledge, research findings, and practice discoveries to practitioners and patients in a clear, accessible, and meaningful way is challenging for many. However, it’s an important part of translating evidence to improve access to a guideline and TMD health outcomes.

Historically, treating individuals with temporomandibular disorders, especially chronic and painful TMD cases, has been challenging if seeking scientific evidence. Future effective care for individuals with TMDs will improve with national alignment on high-quality evidence about which treatments are appropriate and for which patients. [1]

The National Institute of Health (NIH) recognizes the benefits of an established, evidence-based TMD treatment guideline and is funding a new collaborative effort. [2] Together, participants will conduct new clinical trials, build a TMD patient registry, and develop US clinical practice guidelines. This will include additional provider education, narrowing the medical–dental, and increasing access to specialty care.

NIH and The Minnesota TMD IMPACT Collaborative

The Minnesota Collaborative participates in an NIH initiative, called the TMD Collaborative for Improving Patient-Centered Translational Research (TMD IMPACT). A key goal is to improve the diagnosis and treatment of TMD pain patients through a patient registry that collects data for clinical, translational, analysis, and basic research.

The principal investigator is Julie K. Olson at the University of Minnesota (U of M), who works with many TMD pain specialists. The Minnesota Head & Neck Pain Clinic has many participating U of M experts, chiefly Dr. Herman and Dr. Fricton

Cory Herman, DDS, MS, is an Adjunct Associate Professor at the University of Minnesota School of Dentistry TMD, Orofacial Pain and Dental Sleep Medicine clinic. Regarded as a lead speaker and trainer, he has also developed a TMD Education Course.

James R. Fricton, UMN Department of Diagnostic and Biological Sciences, has over 79 research works with 3301 citations and 16082 reads. This includes The New Specialties of Orofacial Pain and Oral Medicine: Practical Strategies to Improve Access to Care for Orofacial Disorders, Transformative Care for Chronic Pain and Addiction, and TMJ and Craniofacial Pain: Diagnosis and Management.

Brief Recap on TMD Treatment

When an orofacial pain specialist is diagnosing a pain disorder, your pain history is key in order to identify a specific type of TMD.

The Two Types of TMDs:

  1. Muscular – caused by tension or spasms in the muscles used to move a person’s jaw.
  2. Articular – caused by a person’s actual jawbone joint failing to function normally.

Let’s look more closely at the facial areas related to TMD versus the muscles involved. TMD involves jaw muscles, temporomandibular joints (bone), and the nerves associated with chronic facial pain.

Bone: Your temporomandibular joint (TMJ) is a hinge that connects your jaw to your skull’s temporal bones. They are located in front of each ear.

Muscles: Your muscles that function to close your jaw are masseter, temporal, lateral, or external pterygoid. The muscles that open your jaw are medial or internal pterygoid, geniohyoideus, mylohyoideus; digastric.

Nerves: The TMJ is mainly innervated by the following nerves:

  • Auriculotemporal nerve: Posteriorly
  • Masseteric nerve: Anteriorly
  • Posterior deep temporal nerve: Anteromedially
  • TMJ branch: Originating directly from the mandibular nerve medially

Both types listed [3] above are best with initial TMJ conservative treatment, without the need for surgery.

Determining the Most Effective Interventions for Chronic TMD Pain

Dr. Friction encourages an inclusive approach to diagnosis and management of TMD that reflects both conceptual models of human systems in understanding chronic illnesses as well as systematic reviews of treatment for successful management. He is widely published and recognized as a leader in contextualized guidance based on the current body of evidence.

Your designated pain specialist will review your TMD pain severity levels with you.

Combining years of professional experience with moderate certainty evidence, Dr. Friction and our staff have successfully provided TMD cognitive behavioral therapy augmented with biofeedback, relaxation therapy, therapist-assisted jaw mobilization, and manual trigger point therapy. Other effective interventions for pain relief have also been gained by some patients.

Published 2 March 2024, Accuracy of temporomandibular disorders diagnosis evaluated through the diagnostic criteria for temporomandibular disorder (DC/TDM) Axis II compared to the Axis I evaluations came to the following consensus. “DC/TMD is an effective tool for the diagnosis of TMD. It improves the accuracy of TMD diagnosis, allows for the classification of subtypes, and assesses psychosocial factors that may impact the development or maintenance of TMD symptoms.” [4]

Eric Schiffman, DDS MS, a Minnesota Head & Neck Pain Provider, was the main author of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. The 2014 article discusses how a valid screener can detect any pain-related TMD and provide valid diagnostic criteria for differentiating the most common pain-related TMD.

Multifactorial TMD Etiology

It is widely agreed that the etiology of TMD is considered multifactorial. Dr. Fricton, Cory Herman DDS, Thiago Nascimento, DDS, MMedSc, MS, Saranya Varun BDS, MS, MS, and other clinic orofacial pain specialists have long been involved in the study of what may predispose, precipitate, or prolong pain during TMD.

Specific risk factors that may contribute to TMD’s development:

Joanna Warzocha published a 29 February 2024 article on MDPI that further explains this disorder’s multifactorial complexities.

“The pathophysiological causes of this condition may arise from alterations in the structure and function of the TMJ joints themselves, or the surrounding muscles and/or other tissues.

Rather than a single cause, TMD arises from a multifactorial interplay of various factors, including biochemical changes, such as structural abnormalities, muscle dysfunction, trauma, genetic mutations, hormonal changes, systematic diseases, and other factors.” – Etiologic Factors of Temporomandibular Disorders: A Systematic Review of Literature Containing Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) from 2018 to 2022

Questionnaires, a Bruxism Parafunction Risk Assessment, or other diagnostic tools may be used during the diagnosis of the disease. They assist in the analysis of the factors involved in your facial pain. This may include jaw locking, head, neck, or other types of facial pain.

Our goal is to ensure that TMD patients have a precise diagnosis and treatment plan when they leave our office. We focus on integrative care that helps patients understand their medical condition and how TMD may be managed. The most rewarding part for our providers is seeing patients improve and return to enjoying life.

SUMMARY: Science-based TMJ & TMD Treatment

If you, or someone you know, suffers from this disorder, the Minnesota Head & Neck Pain Clinic can diagnose and treat the underlying causes of head and neck pain for long-term relief. We have been a trusted source of information and TMD care for over 38 years.

Resources:

[1] National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Board on Health Sciences Policy; Committee on Temporomandibular Disorders (TMDs), “Temporomandibular Disorders: Priorities for Research and Care,” March 2020, https://www.ncbi.nlm.nih.gov/books/NBK557986/

[2] National Institute of Dental and Craniofacial Research, “TMD Collaborative for Improving Patient-Centered Translational Research (TMD IMPACT),” Nov 2023, https://www.nidcr.nih.gov/grants-funding/research-funded-by-nidcr-extramural/tmd-impact

[3] University of Oklahoma, “OU College of Dentistry Surgeon Wins ‘Best Paper’ for Research on Jaw Joint Disorder,” Feb 2024, https://www.ou.edu/news/articles/2024/february/ou-college-of-dentistry-surgeon-wins-best-paper-for-research-on-jaw-joint-disorder

[4] Giuseppe Minervini, et al, “Accuracy of temporomandibular disorders diagnosis evaluated through the diagnostic criteria for temporomandibular disorder (DC/TDM) Axis II compared to the Axis I evaluations: a systematic review and meta-analysis,” March 2024, https://pubmed.ncbi.nlm.nih.gov/38431574/

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