Guidelines in the management of orofacial pain/TMD: An evidence-based approach
Pain and dysfunction related to the jaw joint and jaw muscles are conditions dentists face regularly in their dental practice. It is essential that the individual patient is examined from both a dental and a psychosocial perspective since co-morbidities between temporomandibular disorders (TMD) and other conditions, such as widespread pain, systemic inflammatory disorders, and depression as well as impaired general health is common. The Swedish government initiated a scrutiny review of the scientific literature in dentistry for the purpose of developing national guidelines in dentistry. One policy area was orofacial pain and TMD. The review included systematic reviews, randomized clinical trials, clinical trials, and observational studies of high quality published between 1965 and 2014. The scrutiny review is unique since it also included health economic analyses and the directive to arrive at a statement for every possible condition that may be encountered in the dental clinic, even when the scientific evidence was insufficient for an evidence-based statement. Counselling and a behavioural approach, which aim to change maladaptive behaviours, are considered first-line interventions. Evidence of effect and analysis of cost effectiveness support the use of occlusal appliances and jaw exercises, which for limited periods, may be combined with non-steroidal anti-inflammatory drugs.