ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title TMD Education And Self-Management Instruction Is The First Choice For Patients With Myofascial Pain
Clinical Question Would TMD education and self-management instructions or an occlusal splint be more effective in reducing the spontaneous muscle pain for my TMD patient with a primary diagnosis of myofascial pain?
Clinical Bottom Line For patients with myofascial pain, TMD education and self-management instructions are equal or more effective than the occlusal splint in reducing the spontaneous muscle pain based on 3 randomized clinical trials. Such conservative strategies are likely to be accepted by the average patient and should be the first treatment for the myofascial pain.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22207667Michelotti/2012Patients with myofascial pain (Type Ia and Ib in the RDC/TMD)Randomized Controlled Trial
Key resultsAfter three months, education was slightly more effective than an occlusal splint in reducing spontaneous muscle pain in patients with TMD. Pain-free mouth opening, headache and pain during chewing were not significantly different between the two groups.
#2) 18976268Alencar/2009Patients with myofascial pain in the orofacial regionRandomized Controlled Trial
Key resultsAfter 90-day follow up, all the three different appliances (hard, soft, or non-occluding occlusal splints) associated with counseling were able to equally reduce the symptoms and digital palpation pain.
#3) 11889647Carlson/2001Patients with myofascial pain (Type Ia and Ib in the RDC/TMD)Randomized Controlled Trial
Key resultsBoth physical self-regulation (PSR) and standard dental care (SDC, including a flat-plane intraoral splint) reduced pain severity and life interference from pain after initial treatment. However, at the 26-week follow-up, the PSR group reported less severe pain and greater incisal opening than the SDC group.
Evidence Search self care AND occlusal splint AND myofascial pain
Comments on
The Evidence
The Alencar article did not have TMD counseling only as a research or placebo group, the result was indicated by the non-occluding occlusal splints. Overall the sample size may not be sufficient (Michelotti:41, Alencar:42, Carlson:44).
Applicability TMD education and self-management instructions are within the capability of the average general dental practice. The self-care procedure is easy and acceptable by the average patient, in the most cost effective manner.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Orthodontics) (Prosthodontics)
Keywords temporomandibular joints (TMJ), temporomandibular disorders (TMD), myofascial pain, management, education, occlusal splint, self-care
ID# 2199
Date of submission: 04/12/2012spacer
E-mail Liux4@livemail.uthscsa.edu
Author Xingkun Liu
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward F. Wright, DDS, MS
Faculty mentor/Co-author e-mail WrightE2@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Barret Davidson Nestor Olague (San Antonio, Tx) on 11/28/2017
The PubMed database was searched for "TMD AND myofascial pain AND self management." A systematic review of the effectiveness of TMD noninvasive treatments was found (Randhawa et. al, 2016, PMID 25924094). The review looked at many treatments including splints, education, self management, and professional intraoral messages. It came to the same conclusion as the CAT: that TMD education and self-management instruction are effective and patient-friendly in regard to cost, comfort of treatment, and ease of treatment.
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