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 |
|
PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
22207667 | Michelotti/2012 | Patients with myofascial pain (Type Ia and Ib in the RDC/TMD) | Randomized Controlled Trial | Key results | After 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. | 18976268 | Alencar/2009 | Patients with myofascial pain in the orofacial region | Randomized Controlled Trial | Key results | After 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. | 11889647 | Carlson/2001 | Patients with myofascial pain (Type Ia and Ib in the RDC/TMD) | Randomized Controlled Trial | Key results | Both 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 |
(Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Orthodontics) (Prosthodontics) (Behavioral Science) |
Keywords |
temporomandibular joints (TMJ), temporomandibular disorders (TMD), myofascial pain, management, education, occlusal splint, self-care
|
ID# |
2199 |
Date of submission |
04/12/2012 |
E-mail |
Liux4@livemail.uthscsa.edu |
Author |
Xingkun Liu |
Co-author(s) |
|
Co-author(s) e-mail |
|
Faculty mentor |
Edward F. Wright, DDS, MS |
Faculty mentor 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?) |
None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
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. | |