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Temporomandibular disorders. Part 3: pain and pharmacological therapy Peter Clarke Funmi Oluwajana Martin James Charles Crawford Emma Foster-Thomas Rigel Allan Dental Update 2024 49:6, 707-709.
Authors
PeterClarke
DCT in Restorative Dentistry, Liverpool University School of Dentistry, Pembroke Place, Liverpool L3 5PS, UK (pete.t.clarke@gmail.com)
Temporomandibular disorders (TMD) comprise a variety of diagnoses with multifactorial aetiologies. The treatment of these conditions is often multimodal, reflecting the complex nature of their pathogenesis. Pharmacology has long been used for the control of inflammation and pain in various acute and chronic conditions. Although not the mainstay of treatment in TMD, pharmacology frequently plays a supportive role, and numerous drugs are available that act on several potential targets. This article, the third in a series of six, summarizes the pathogenesis of pain relevant to TMD, before reviewing the current medications available, their efficacy and their potential indications.
CPD/Clinical Relevance: Understanding the potential medications available can help clinicians select an appropriate drug to complement other treatment for TMD.
Article
Reversible treatments are recommended as first-line management for temporomandibular disorders (TMD).1 Pharmacological therapy is predominantly encompassed in reversible treatment; however, medications with considerable side effects are not deemed conservative options. Furthermore, many of the drugs used in the management of TMDs are off-license, with notable adverse reactions, leading them to be considered second-line treatments.1
Although varying by locality, medication is used relatively infrequently in the management of TMD.2 This can mainly be explained by inconclusive evidence, clinicians' self-reported lack of knowledge and the tendency for practitioners to use familiar therapies.2,3 Additionally, many of the recommended medications are not available in the UK's Dental Practitioners Formulary.4
The aim of this article is to explore the theories and indications behind pharmacological management relating to TMD. Prior to exploring the medications available, it is important to understand the pathophysiology of pain; first, to identify an appropriate therapeutic target, and secondly, to ensure congruity with the drug's mode of action, otherwise limited benefit can be anticipated.
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