Choosing Wisely:

Avoid routinely using irreversible surgical procedures such as braces, occlusal equilibration, and restorations as the first treatment of choice in the management of temporomandibular joint disorders.

Rationale and Comments: There is a lack of evidence that temporomandibular joint disorders (defined as musculoskeletal disorders, not the lesion of traumatic occlusion) are always progressive, and evidence exists that in many instances, patients with temporomandibular joint disorder have spontaneous remissions without treatment. Therefore, management is generally conservative and includes reversible strategies such as patient education, medications, physical therapy, and/or the use of occlusal appliances that do not alter the shape or position of the teeth or the alignment of the jaws.
Sponsoring Organizations:
  • American Dental Association
  • Sources:
  • Cochrane Database of Systematic Reviews
  • Disciplines:
  • Orthopedic
  • Neurologic
  • References: • Aggarwal VR, Lovell K, Peters S, Javidi H, Joughin A, Goldthorpe J. Psychosocial interventions for the management of chronic orofacial pain. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD008456.
    • Al-Ani MZ, Davies SJ, Gray RJM, Sloan P, Glenny A-M. Stabilisation splint therapy for temporomandibular pain dysfunction syndrome. Cochrane Database Syst Rev. 2004;(1):CD002778.
    • Treatment for Temporomandibular Joint Dysfunction: guidelines. Ottowa (ON): Canadian Agency for Drugs and Technologies in Health (CA); 2010 May 17. 6 p.
    • De Boever JA, Nilner M, Orthlieb JD, Steenks MH; Educational Committee of the European Academy of Craniomandibular Disorders. Recommendations by the EACD for examination, diagnosis, and management of patients with temporomandibular disorders and orofacial pain by the general dental practitioner. J Orofac Pain. 2008 Summer;22(3):268-78.
    • de Souza RF, Lovato da Silva CH, Nasser M, Fedorowicz Z, Al-Muharraqi MA. Interventions for the management of temporomandibular joint osteoarthritis. Cochrane Database Syst Rev. 2012 Apr 18;4:CD007261.
    • Guidelines: diagnosis & management of temporomandibular disorders & related musculoskeletal disorders. Toronto (ON): Royal College of Dental Surgeons of Ontario (CA); 11 p.
    • Ernst E, White AR. Acupuncture as a treatment for temporomandibular joint dysfunction: a systematic review of randomized trials. Arch Otolaryngol Head Neck Surg. 1999 Mar;125(3):269-72.
    • Forssell H, Kalso EJ. Application of principles of evidence-based medicine to occlusal treatment for temporomandibular disorders: are there lessons to be learned? J Orofac Pain. 2004 Winter;18(1):9-22; discussion 23-32.
    • de Souza RF, Lovato da Silva CH, Nasser M, Fedorowicz Z, Al-Muharraqi MA. Interventions for the management of temporomandibular joint osteoarthritis. Cochrane Database Syst Rev. 2012 Apr 18;4:CD007261.
    • Koh H, Robinson PG. Occlusal adjustment for treating and preventing temporomandibular joint disorders. Cochrane Database Syst Rev. 2003;(1):CD003812.
    • Luther F, Layton S, McDonald F. Orthodontics for treating temporomandibular joint (TMJ) disorders. Cochrane Database Syst Rev. 2010 Jul 7;(7):CD006541.
    • de Leeuw R, Klasser GD. Orofacial pain: guidelines for assessment, diagnosis, and management. 5th Ed. Hanover Park: Quintessence Books; 2013. 312 p.

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