Wieckiewicz Mieszko, Boening Klaus, Wiland Piotr, Shiau Yuh-Yuan, Paradowska-Stolarz Anna
Department of Prosthetic Dentistry, Faculty of Dentistry, Wroclaw Medical University, 26 Krakowska St., 50425, Wroclaw, Poland.
Department of Prosthetic Dentistry, Faculty of Medicine, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany.
J Headache Pain. 2015;16:106. doi: 10.1186/s10194-015-0586-5. Epub 2015 Dec 7.
Pain related to temporomandibular disorders (TMD) is a common problem in modern societies. The aim of the article is to present the concepts of TMD pain clinical management.
A survey was performed using the PubMed, SCOPUS and CINAHL databases for documents published between 1994 and 2014. The following search keywords were selected using MeSH terms of the National Library of Medicine in combination: TMD pain, TMD, TMJ, TMJ disorders, occlusal splint, TMD physiotherapy, TMJ rheumatoid disorders and TMJ surgery. Original articles and review papers which presented the clinical relevance and practical validity regarding the possibility of application in TMD management have been included. Authors have excluded articles without outstanding practical aspect and evidence-based background. A first selection was carried out by reviewing titles and abstracts of all articles found according to the criteria. After that the full texts of potentially suitable articles were assessed. In line with these criteria, among 11467 results the writers have included 66 papers.
The most commonly reported conservative treatments are massage therapy and individually fabricated occlusal splints. In addition to massage, other popular methods include manual therapy and taping, warming/cooling of aching joints, and light and laser therapy. Drugs are also commonly used. In the most severe cases of the temporomandibular joint degeneration, surgical restoration of the joint is sometimes applied.
The authors concluded that conservative treatment including counselling, exercises, occlusal splint therapy, massage, manual therapy and others should be considered as a first choice therapy for TMD pain because of their low risk of side effects. In the case of severe acute pain or chronic pain resulting from serious disorders, inflammation and/or degeneration pharmacotherapy, minimally invasive and invasive procedures should be considered.
与颞下颌关节紊乱症（TMD）相关的疼痛是现代社会中的常见问题。本文旨在介绍TMD疼痛的临床管理概念。
使用PubMed、SCOPUS和CINAHL数据库对1994年至2014年发表的文献进行调查。结合美国国立医学图书馆的医学主题词选择了以下搜索关键词：TMD疼痛、TMD、颞下颌关节、颞下颌关节紊乱症、咬合板、TMD物理治疗、颞下颌关节类风湿性疾病和颞下颌关节手术。纳入了具有临床相关性和关于在TMD管理中应用可能性的实际有效性的原创文章和综述论文。作者排除了没有突出实际方面和循证背景的文章。首先根据标准审查所有找到的文章的标题和摘要进行筛选。之后评估潜在合适文章的全文。根据这些标准，在11467个结果中，作者纳入了66篇论文。
最常报道的保守治疗方法是按摩疗法和个体化制作的咬合板。除按摩外，其他常用方法包括手法治疗和贴扎、对疼痛关节进行温热/冷敷以及光疗和激光治疗。药物也常用。在颞下颌关节退变最严重的情况下，有时会进行关节的手术修复。
作者得出结论，包括咨询、锻炼、咬合板治疗、按摩、手法治疗等在内的保守治疗应被视为TMD疼痛的首选治疗方法，因为它们的副作用风险低。对于由严重疾病、炎症和/或退变引起的严重急性疼痛或慢性疼痛，应考虑药物治疗、微创和有创手术。
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