CDA Essentials 2017 • Volume 4 • Issue 6

S upporting Y our P ractice 25 Issue 8 | 2017 | The following is based on a research article originally published in the “Literature Review” section of JCDA.ca —CDA’s online, open access scholarly publication that features articles indexed in Medline, Journal Citation Reports and Science Citation Index. Research Summary Pharmacotherapy in Temporomandibular Disorders: A Review Temporomandibular disorder (TMD) is a collective term that includes disorders of the temporomandibular joint (TMJ) and of the masticatory muscles and their associated structures. Signs and symptoms 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 along with headaches and sleep disturbances. 2 There is some evidence that anxiety, stress and other emotional disturbances exacerbate TMD. 4 Most symptoms resolve over a year or more. 3 In the meantime, treatment aims at reducing pain and improving function. In this article, we review the research supporting the use of pharmacologic agents and the adverse reactions and drug interactions associated with their use. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) NSAIDs are indicated for mild to moderate acute inflammation in the TMJ, including acute inflammation resulting from disc displacement without reduction or trauma. 3 Patients will often use a single finger to point to the joint when describing the origin of pain. Manual palpation of the joint and palpation through the external auditory meatus will elicit a painful response. If pain and crepitus are noted, further radiographic investigation for degenerative joint disease is indicated. Efficacy and dosage To achieve an anti-inflammatory effect in TMD, NSAIDs should be taken for a minimum of 2 weeks. 3 No NSAID has been shown to be superior to all others 8 ; if satisfactory pain relief is not achieved with a given NSAID, a different one would not be of benefit. 3,8,9 At most, a 2-month regimen may be considered in consultation with the patient’s physician. Naproxen (500 mg twice a day) significantly reduces pain associated with TMJ disc displacement, while celecoxib (100 mg twice a day) only shows slight TMJ pain reduction and no significant effectiveness for TMD pain. 15 Studies comparing ibuprofen and piroxicam with placebo failed to demonstrate a decrease in chronic myogenous pain. 16,17 Meloxicam may be prescribed at the rate of 7.5–15 mg/day for up to 4 weeks. A repeat may be considered if pain recurs when the drug is discontinued. Adverse effects and drug interactions ❘  The most important adverse effect of NSAIDs is their effect on the gastrointestinal (GI) tract. They cause gastric erosion that can lead to ulcers and gastric bleeding; this tends Aviv Ouanounou MSc,DDS,FICO Michael Goldberg MSc,DDS,Dip Perio Daniel A. Haas DDS,PhD,FRCD(C) aviv.ouanounou@ dentistry.utoronto.ca Full article and references available at jcda.ca/h7 More Online