Pharmacotherapy in Temporomandibular Disorders: A Review.

Abstract

Temporomandibular disorder (TMD) is a collective term that includes disorders of the temporomandibular joint (TMJ) and of the masticatory muscles and their associated structures. TMDs are characterized by pain, joint sounds and restricted mandibular movement, and drugs are widely used in the management of that pain. Pharmacological agents commonly used for the treatment of TMDs include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, muscle relaxants, antidepressants, anticonvulsants and benzodiazepines. In this paper, we discuss these agents and the potential adverse drug reactions and interactions associated with their use. Temporomandibular disorder (TMD) is a collective term used for a number of clinical problems that involve the masticatory muscle complex, the temporomandibular joint (TMJ) and associated structures. TMD is one of the most common disorders in the maxillofacial region. Signs and symptoms of TMD may include pain, impaired jaw function, malocclusion, deviation from the midline on opening or closing the jaw, limited range of motion, joint noises and locking.1 Among other signs and symptoms, headaches and sleep disturbances can appear concomitantly.2 This disorder is most prevalent in people aged 20-40 years.3 Approximately 33% of the population have at least 1 TMD symptom, and 3.6-7.0% of the population have TMD with sufficient severity to seek treatment.3 There is some evidence to suggest that anxiety, stress and other emotional disturbances exacerbate TMD.4 As many as 75% of patients with TMD have a significant psychological abnormality.5 Most TMD symptoms resolve over time, but, for a significant number of patients, this may take a year or more.3 Treatment is directed toward reducing pain and improving function. Many non-invasive therapies, such as self-care, physical therapy and appliance therapy, are commonly used for the treatment of TMD.3 Pharmacological intervention has been used for many years, and the most effective pharmacological agents for the treatment of TMD include analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, anxiolytics, muscle relaxants, antidepressants, anticonvulsants and benzodiazepines. However, we found only 1 relevant Cochrane study, which included 11 randomized controlled trials of pharmacotherapy for TMD.6 In this article, we review the pharmacology and research supporting the use of a host of pharmacologic agents that have been prescribed for patients who have TMD. The decision to select any of these agents depends on a full understanding of the drug's risks and benefits.