Key points for good clinical practice in the field of temporomandibular disorders

Nederlands Tijdschrift voor Tandheelkunde · 2025-06-10

'Temporomandibular disorders' is an umbrella term for disorders of the temporomandibular joints, the masticatory muscles, and the adjacent anatomical structures. On behalf of the International Network for Orofacial Pain and Related Disorders Methodology, this article gives an overview of key points for good clinical practice in the field of temporomandibular disorders. During an annual conference in March 2024, members of the aforementioned network drew up a list of 10 core principles. These core principles include knowledge about the causes, diagnosis and treatment of temporomandibular disorders. They summarize the current standard of care for the treatment of such conditions and are in keeping with the need to help increase the expertise of dentists working in general practice and to prevent incorrect treatment. The core principles can be regarded as a starting point for other national and international organisations to use to develop guidelines and recommendations for the treatment of temporomandibular disorders.

Use of low-dose naltrexone in the management of posttraumatic trigeminal neuropathic pain: a retrospective case series.

PubMed · 2025-09-18

OBJECTIVE: Dental practitioners provide treatment of anatomical structures innervated by the trigeminal system, such as the teeth and gingiva, which can be subject to injury even following routine and well-performed dental procedures. As a result, the dental clinician is often presented with patients with neuropathic pain or unusual sensory distortions. In addition, the dental clinician treats patients following facial and oral trauma which may result in chronic pain. Therefore, recognition of posttraumatic trigeminal neuropathic pain (PTTNP) and its management must be considered essential for the dental clinician. Painful neuropathies, including PTTNP, can present as a debilitating form of neuropathic pain that often defies treatment normally effective for other types of somatic pain disorders. Treatment of PTTNP typically involves the use of various classes of medications including antiseizure medications and tricyclic antidepressants. Many patients suffering with PTTNP may have contraindications for these medications due to comorbidities, occupational responsibilities, or medication side effects. An alternative to antiseizure medications and tricyclic antidepressants is the use of low-dose naltrexone. METHOD AND MATERIALS: This study is a retrospective extended case series of patients with PTTNP. The records of 21 patients diagnosed with painful PTTNP at the Center for Temporomandibular Disorders and Orofacial Pain of the Rutgers School of Dental Medicine were analyzed. They met the criteria of PTTNP according to the International Classification of Orofacial Pain and were prescribed low-dose naltrexone. Though a total of 21 patients were included, 12 with all the data present were included in the final analysis. The sex distribution was equal, with six women and six men, with a combined average age of 59.33 ± 13.96 years. RESULTS: Low-dose naltrexone significantly reduced the patients' report of pain using visual analog scale (VAS) 0 to 10 subjective pain ratings at the follow-up visits compared to the initial VAS. Interestingly, the small group of patients who used low-dose naltrexone in combination with serotonin norepinephrine reuptake inhibitors, demonstrated a lower average VAS score at the first follow-up visit, compared to those who took low-dose naltrexone with other medications. There were no significant side effects reported by the patients. No adverse effects of low-dose naltrexone therapy were reported. Side effects of the medication are rare and, as reported the literature, include mild abdominal distress or vivid dreams. None were reported among this group of subjects. CONCLUSION: Based on this retrospective extended case series, low-dose naltrexone appears to be a safe and effective medication for use in chronic PTTNP. These results highlight the need for future studies to elucidate low-dose naltrexone's analgesic mechanism of action and to decisively demonstrate the analgesic effect of low-dose naltrexone in larger cohorts using randomized, double blinded, placebo-controlled clinical studies. (Quintessence Int 2025;56:682-690; doi: 10.3290/j.qi.b6335903).

Review for "Referred pain is associated with greater odontogenic spontaneous pain and a heightened pain sensitivity in patients with symptomatic irreversible pulpitis"

2024-04-24

Temporomandibular disorders: INfORM/IADR key points for good clinical practice based on standard of care

CRANIO® · 2024-10-03 · 144 citations

OBJECTIVE: To present a list of key points for good Temporomandibular Disorders (TMDs) clinical practice on behalf of the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) group of the International Association for Dental, Oral and Craniofacial Research (IADR). METHODS: An open working group discussion was held at the IADR General Session in New Orleans (March 2024), where members of the INfORM group finalized the proposal of a list of 10 key points. RESULTS: The key points covered knowledge on the etiology, diagnosis, and treatment. They represent a summary of the current standard of care for management of TMD patients. They are in line with the current need to assist general dental practitioners advance their understanding and prevent inappropriate treatment. CONCLUSIONS: The key points can be viewed as a guiding template for other national and international associations to prepare guidelines and recommendations on management of TMDs adapted to the different cultural, social, educational, and healthcare requirements.

Access to care

The Journal of the American Dental Association · 2024-05-06 · 8 citations

Comparison of three methods for treatment of temporomandibular disorders

http://isrctn.com/ · 2024-11-13

Temporal artery ultrasonography for the diagnosis of giant cell arteritis: a case report.

PubMed · 2024-04-25 · 1 citations

Orofacial pain is a worldwide pain problem, with many patients unable to find appropriate diagnosis and treatment. Orofacial pain includes pain arising from the odontogenic and nonodontogenic structures in the head and neck region. Dental clinicians need to have a thorough knowledge and skill to diagnose, manage, and treat patients with odontogenic pain or refer patients for treatment of nonodontogenic pain to specialists such as orofacial pain specialists, neurologists, otolaryngologists, and rheumatologists. More often, dental practitioners diagnose patients with a temporomandibular disorder (TMD), and when treatment is ineffective, term it "atypical facial pain." The first requirement for effective treatment is an accurate diagnosis. Dental clinicians must be aware of giant cell arteritis (GCA), a chronic large-vessel vasculitis, primarily affecting adults over the age of 50 years, as it frequently mimics and is misdiagnosed as TMD. GCA is associated with loss of vision, and stroke and can be a life-threatening disorder. Therefore, diagnostic testing for GCA and differential diagnosis should be common knowledge in the armamentarium of all dental clinicians. Historically, temporal artery biopsy was considered the definitive diagnostic test for GCA. Temporal artery ultrasound (TAUSG), a safe and noninvasive imaging modality, has replaced the previous diagnostic gold standard for GCA, the temporal artery biopsy, owing to its enhanced diagnostic capabilities and safety profile. The present case report describes a patient with GCA, and the role TAUSG played in the diagnosis. Case report: A 72-year-old woman presented with left-sided facial pain, jaw claudication, dysesthesia of the tongue, and episodic loss of vision of 2 years' duration. She was diagnosed with and treated for a myriad of dental conditions including endodontia and temporomandibular joint therapy with no benefit. A thorough history and physical examination, combined with serologic analysis, led to the diagnosis of GCA and TAUSG, which confirmed the diagnosis. Conclusion: This report underscores the responsibility of differential diagnosis and early recognition of GCA facilitated by TAUSG in optimizing treatment outcomes as a viable, noninvasive diagnostic tool. (Quintessence Int 2024;55:336-343; doi: 10.3290/j.qi.b4938419).

Review for "Identifying phenotypes in persons with temporomandibular disorders using latent class analyses"

2023-10-16

Review for "Attention‐deficit hyperactivity disorder and psychostimulant use in patients seeking dental care—Associations with common orofacial pain complaints"

2023-08-13

New curriculum standards for teaching temporomandibular disorders in dental schools

The Journal of the American Dental Association · 2022-02-17 · 10 citations