Education |
Durham et al.11 Durham J, Al-Baghdadi M, Baad-Hansen L, Breckons M, Goulet JP, Lobbezoo F, et al. Self-management programmes in temporomandibular disorders: results from an international Delphi process. J Oral Rehabil. 2016;43(12):929-36.
|
Diagnosis and "optimistic counseling" (reassurance that TMD is typically benign and self-limiting in the clear majority of cases). Education should also include TMD's biopsychosocial etiology; cautions against invasive and irreversible treatments; sleep practices; sensible and time-limited use of analgesia; avoidance of OTC splints bought without consultation with the dentist; caffeine usage; anatomy and usual function of TMJ complex and associated musculature. |
|
Michelotti et al.1515 Michelotti A, Iodice G, Vollaro S, Steenks MH, Farella M. Evaluation of the short-term effectiveness of education versus an occlusal splint for the treatment of myofascial pain of the jaw muscles. J Am Dent Assoc. 2012;143(1):47-53.
|
Patients that receive extensive information and considerable patient-doctor interaction present faster improvement. Therefore, the psychophysiological mechanisms associated with education and reassurance reveal positive effects. The improvement is mediated, however, by each patient's coping skills, mood and emotional state. |
|
Conti et al.1616 Conti PC, de Alencar EN, da Mota Corrêa AS, Lauris JR, Porporatti AL, Costa YM. Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation. J Oral Rehabil. 2012;39(10):754-60.
|
Education is slightly more effective than only an occlusal appliance in treating spontaneous muscle pain. |
|
Freitas et al.2020 de Freitas RF, Ferreira MÂ, Barbosa GA, Calderon PS. Counselling and self-management therapies for temporomandibular disorders: a systematic review. J Oral Rehabil. 2013;40(11):864-74.
|
Treatment modalities should include counseling and education for self-care and self-regulation, such as an explanation concerning the role of pain, possible etiological factors of the patient's TMD, the relationship between chronic pain and psychosocial distress, and its benign character. A list of recommendations can be given to patients: - Encouragement of patients to rest their masticatory muscles; - Observation and reduction in parafunctional habits; - Avoidance of excessive mandibular movements; - Maintenance of soft diet and recommendation to chew carefully; - Performance of simultaneous bilateral mastication; - Improvement of posture and sleep onset. However, education should be associated with posture training and physical therapy programmes, since counseling and self-management-based therapies provide better results when they are not used alone. Also, although it represents a conservative low-cost and beneficial treatment for the relief of signs and symptoms by improving psychological domains and potentially reducing harmful behaviors, the evidence remains unclear due to the reduced number of controlled and randomized well-designed clinical trials. |
|
Miernik and Więckiewicz2121 Miernik AM, Wieckiewicz W. The basic conservative treatment of temporomandibular joint anterior disc displacement without reduction-review. Adv Clin Exp Med. 2015;24(4):731-5.
|
As the natural course of the closed lock is self-limiting, some authors recommend just education and counseling. It is important to explain the mechanism of disc displacement and the negative effects of parafunctions on the stomatognathic system, especially the TMJ. |
|
Vernooij, Willson and Gagliardi2222 Vernooij RW, Willson M, Gagliardi AR. Characterizing patient-oriented tools that could be packaged with guidelines to promote self-management and guideline adoption: a meta-review. Implement Sci. 2015;11:52.
|
Single or multifaceted educational interventions may reinforce general information about the condition and lifestyle advice and contribute to positive outcomes. Information and evidence about the condition, prognosis, what to expect, and its management. Information and advice on how to undertake generic activities such as hygiene, dressing, preparing meals, transportation. Information and guidance on lifestyle behaviors that support disease management. |
|
Craane et al.1717 Craane B, Dijkstra PU, Stappaerts K, De Laat A. One-year evaluation of the effect of physical therapy for masticatory muscle pain: a randomized controlled trial. Eur J Pain. 2012;16(5):737-47.
|
The study showed that improvement was purely based on the education of the patients, which includes informing and explaining the presumed etiology, the good prognosis of this benign disorder and reassuring the patient regarding this problem. |
Self-exercise |
Durham et al.11 Durham J, Al-Baghdadi M, Baad-Hansen L, Breckons M, Goulet JP, Lobbezoo F, et al. Self-management programmes in temporomandibular disorders: results from an international Delphi process. J Oral Rehabil. 2016;43(12):929-36.
|
Jaw (muscle) exercises, relaxation and posture training. Can be implemented by the clinician or by referral to other health care professions, such as physical or occupational therapists. |
|
Craane et al.1717 Craane B, Dijkstra PU, Stappaerts K, De Laat A. One-year evaluation of the effect of physical therapy for masticatory muscle pain: a randomized controlled trial. Eur J Pain. 2012;16(5):737-47.
|
Exhibits significant improvement over time for pain and impairment. However, there is no evidence of the clinically important benefit of a single physical therapeutic modality, while combinations of physical therapeutic modalities seem to be more effective than a single one. |
|
Bouchard et al. 1818 Bouchard C, Goulet JP, El-Ouazzani M, Turgeon AF. Temporomandibular lavage versus nonsurgical treatments for temporomandibular disorders: a systematic review and meta-analysis. J Oral Maxillofac Surg. 2017;75(7):1352-62.
|
For the treatment of non-reducing discs, institute a home exercise program performed for jaw muscle and range of motion. |
|
Campi et al. 1919 Campi LB, Camparis CM, Jordani PC, Gonçalves DA. Influence of biopsychosocial approaches and self-care to control chronic pain and temporomandibular disorders. Rev Dor. 2013;14(3):219-22.
|
Stretching, stabilization, coordination and mobilization exercises. Although these treatments are effective to decrease pain and improve dysfunction associated with TMD, there is still a lack of studies defining effectiveness parameters. |
Thermal modalities |
Durham et al.11 Durham J, Al-Baghdadi M, Baad-Hansen L, Breckons M, Goulet JP, Lobbezoo F, et al. Self-management programmes in temporomandibular disorders: results from an international Delphi process. J Oral Rehabil. 2016;43(12):929-36.
|
Use of heat and /or ice to areas of pain. |
|
Conti, Corrêa and Lauris1010 Conti PC, Corrêa AS, Lauris JR, Stuginski-Barbosa J. Management of painful temporomandibular joint clicking with different intraoral devices and counseling: a controlled study. J Appl Oral Sci. 2015;23(5):529-35.
|
For painful temporomandibular joint clicking, hot thermotherapy. |
|
de Freitas et al.2020 de Freitas RF, Ferreira MÂ, Barbosa GA, Calderon PS. Counselling and self-management therapies for temporomandibular disorders: a systematic review. J Oral Rehabil. 2013;40(11):864-74.
|
Apply heat or cold to the most painful masticatory areas. |
|
Miernik and Więckiewicz2121 Miernik AM, Wieckiewicz W. The basic conservative treatment of temporomandibular joint anterior disc displacement without reduction-review. Adv Clin Exp Med. 2015;24(4):731-5.
|
For the closed lock, the recommended self-care protocol might include thermotherapy (cold or warm packs) in the initial period of locking. |
|
Giro et al.1313 Giro G, Policastro VB, Scavassin PM, Leite AR, Mendoza Marin DO, Gonçalves DA, et al. Mandibular kinesiographic pattern of women with chronic TMD after management with educational and self-care therapies: a double-blind, randomized clinical trial. J Prosthet Dent. 2016;116(5):749-55.
|
Thermotherapy to promote pain relief, improve muscle tone, and relax mandibular muscles. Patients should be advised to place moist heat pads on the painful muscle for 15 minutes, 3 times per day. |
Diet and nutrition |
Durham et al.11 Durham J, Al-Baghdadi M, Baad-Hansen L, Breckons M, Goulet JP, Lobbezoo F, et al. Self-management programmes in temporomandibular disorders: results from an international Delphi process. J Oral Rehabil. 2016;43(12):929-36.
|
Clinicians should implement a "pain-free diet", as opposed to a "soft diet", for a two-week period. After that, a new review determines whether the individual advances as tolerated to firmer and chewier consistency foods. |
|
Schiffman et al.88 Schiffman EL, Velly AM, Look JO, Hodges JS, Swift JQ, Decker KL, et al. Effects of four treatment strategies for temporomandibular joint closed lock. Int J Oral Maxillofac Surg. 2014;43(2):217-26.
|
To the patient minimally inconvenienced by diet, should be recommended a regular diet that, at worst, avoids tough or hard foods. |
|
Ommerborn et al.1414 Ommerborn MA, Taghavi J, Singh P, Handschel J, Depprich RA, Raab WH. Therapies most frequently used for the management of bruxism by a sample of German dentists. J Prosthet Dent. 2011;105(3):194-202.
|
Diet counseling for the patient with bruxism. |
|
Mukherjee, Sen and Sinha1212 Mukherjee S, Sen S, Sinha S. Orofacial pain: a critical appraisal in management. Indian J Pain. 2015;29(3):127-34.
|
For the management of orofacial pain, a successful home care program should emphasize a soft diet. Some patients find eating mild food helpful. |
|
Miernik and Więckiewicz2121 Miernik AM, Wieckiewicz W. The basic conservative treatment of temporomandibular joint anterior disc displacement without reduction-review. Adv Clin Exp Med. 2015;24(4):731-5.
|
For the closed lock, the recommended self-care protocol might include soft food diet in the initial period of locking. |
|
Martins et al.44 Martins AP, Aquino LM, Meloto CB, Barbosa CM. Counseling and oral splint for conservative treatment of temporomandibular dysfunction: preliminary study. Rev Odontol UNESP. 2016;45(4):207-13.
|
Avoid foods of thick consistency. |
|
de Freitas et al.2020 de Freitas RF, Ferreira MÂ, Barbosa GA, Calderon PS. Counselling and self-management therapies for temporomandibular disorders: a systematic review. J Oral Rehabil. 2013;40(11):864-74.
|
Maintenance of soft diet and recommendation to chew carefully. |
|
Craane et al.1717 Craane B, Dijkstra PU, Stappaerts K, De Laat A. One-year evaluation of the effect of physical therapy for masticatory muscle pain: a randomized controlled trial. Eur J Pain. 2012;16(5):737-47.
|
In their study, patients were advised to use a soft diet and chew bilaterally |
Self-massage |
Durham et al.11 Durham J, Al-Baghdadi M, Baad-Hansen L, Breckons M, Goulet JP, Lobbezoo F, et al. Self-management programmes in temporomandibular disorders: results from an international Delphi process. J Oral Rehabil. 2016;43(12):929-36.
|
Massage is limited to the anatomic location of the painful or tense affected masticatory muscles. The most easily accessible to palpation are masseter and temporalis. |
|
Giro et al.1313 Giro G, Policastro VB, Scavassin PM, Leite AR, Mendoza Marin DO, Gonçalves DA, et al. Mandibular kinesiographic pattern of women with chronic TMD after management with educational and self-care therapies: a double-blind, randomized clinical trial. J Prosthet Dent. 2016;116(5):749-55.
|
Self-massage promotes the improvement of local blood circulation and relieves pain and muscle tension. Patients can be instructed to bilaterally massage the masseter and temporal muscles 3 times per day with circular movements performed using the index, middle, and ring fingers. It was concluded that the improvement of blood flow in the masticatory muscles and decreased muscle tension provided by massages followed by exercises and hot pads can reduce pain, which also contributes to improvement in mandibular function. |
|
Conti et al.1616 Conti PC, de Alencar EN, da Mota Corrêa AS, Lauris JR, Porporatti AL, Costa YM. Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation. J Oral Rehabil. 2012;39(10):754-60.
|
Instruct the patients to massage painful areas. |
|
Brantingham et al.2323 Brantingham JW, Cassa TK, Bonnefin D, Pribicevic M, Robb A, Pollard H, et al. Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review. J Manipulative Physiol Ther. 2013;36(3):143-201.
|
Considered soft tissue procedures, such as trigger point therapy, transverse friction massage and therapeutic massage. A typical relaxing massage is focused on reducing muscular tension and improving circulation. |
Parafunctional behavior monitoring and avoidance |
Durham et al.11 Durham J, Al-Baghdadi M, Baad-Hansen L, Breckons M, Goulet JP, Lobbezoo F, et al. Self-management programmes in temporomandibular disorders: results from an international Delphi process. J Oral Rehabil. 2016;43(12):929-36.
|
Orient the patient to identify, monitor, and avoid any parafunctional behavior that exacerbate their pain. |
|
Mukherjee, Sen and Sinha1212 Mukherjee S, Sen S, Sinha S. Orofacial pain: a critical appraisal in management. Indian J Pain. 2015;29(3):127-34.
|
A reduction in stress/tension-related parafunctional activity can lead to immediate less pain reported by patients. A successful home care program includes parafunctional habit modification. |
|
Miernik and Więckiewicz2121 Miernik AM, Wieckiewicz W. The basic conservative treatment of temporomandibular joint anterior disc displacement without reduction-review. Adv Clin Exp Med. 2015;24(4):731-5.
|
It is important to explain the mechanism of disc displacement and the negative effects of parafunctions on the stomatognathic system, especially the TMJ. |
|
Martins et al.44 Martins AP, Aquino LM, Meloto CB, Barbosa CM. Counseling and oral splint for conservative treatment of temporomandibular dysfunction: preliminary study. Rev Odontol UNESP. 2016;45(4):207-13.
|
Their study revealed an improvement in the symptomology, which included modifications in parafunctional activities, greater awareness of the patient and the cognitive placebo effect. Counseling should include guidance on reducing parafunctional mandibular activities. |
|
Giro et al.1313 Giro G, Policastro VB, Scavassin PM, Leite AR, Mendoza Marin DO, Gonçalves DA, et al. Mandibular kinesiographic pattern of women with chronic TMD after management with educational and self-care therapies: a double-blind, randomized clinical trial. J Prosthet Dent. 2016;116(5):749-55.
|
Parafunctional habits are involved in the development and maintenance of the signs and symptoms of TMD. Behavioral therapies may help relieve musculoskeletal pain and restore mandibular function by reducing inflammation, relieving muscle tension, and improving psychological health. Counseling and self-care approaches include guidance in reducing parafunctional jaw activities. |
|
de Freitas et al.2020 de Freitas RF, Ferreira MÂ, Barbosa GA, Calderon PS. Counselling and self-management therapies for temporomandibular disorders: a systematic review. J Oral Rehabil. 2013;40(11):864-74.
|
A TMD self-management program should orient the patient towards becoming aware of parafunctional habits, such as teeth clenching. Patient must be able to monitor and reduce muscle parafunction in the head and neck region. |
|
Conti et al.1616 Conti PC, de Alencar EN, da Mota Corrêa AS, Lauris JR, Porporatti AL, Costa YM. Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation. J Oral Rehabil. 2012;39(10):754-60.
|
In their study, the improvement in pain reported after a 3-month period reflected the importance of behavioral alterations and the avoidance of deleterious and parafunctional habits in the facial pain of masticatory origin. |
|
Campi et al.1919 Campi LB, Camparis CM, Jordani PC, Gonçalves DA. Influence of biopsychosocial approaches and self-care to control chronic pain and temporomandibular disorders. Rev Dor. 2013;14(3):219-22.
|
A self-care program should include habit reversion techniques and correct jaw use. |