A Systematic Review on the Proposed Methodologies for the Treatment of TMD Patients

Abstract

The joint that joins the temporal bone to the jaw is called the temporomandibular joint (TMJ). Daily oral functions like speaking, eating, chewing, mastication, and many more are controlled by this joint. Numerous musculoskeletal conditions known as temporomandibular disorders are caused by the overloading of this joint (TMDs). This review sought to evaluate the approaches put out by various researchers in the literature for treating temporomandibular problems (TMDs). To determine the reasons behind the suggested methods for the corrections or treatments of TMDs patients, a thorough review was conducted. According to the literature, research used a significantly lower sample size to create techniques for TMDs correction, therefore therapies may not have worked for all TMDs patients. Based on the TMDs, a total of 39 related research works were found, and after applying exclusion and inclusion criteria, 8 full-text papers were included in this report. The literature's suggested treatments or approaches required a long enough time to rectify ailments, which finally caused suffering for the patient. Exclusively, a small number of researchers have put forth an efficient treatment method, however they have the drawback of only treating one specific form of TMDs. There is no proven approach described in the literature for treating all TMD types. To address the problems with this joint, a deeper comprehension of the temporomandibular joint’s biomechanics is required. This thorough investigation will pave the way for the creation of quick, efficient, and preventative TMD treatment methods.

1 Introduction

Temporomandibular disorders are the illnesses that occasionally also cause discomfort in the TMJ and its surrounding structures in addition to the TMJ being dysfunctional. TMD affects up to 15–20% of the adult population, with greater occurrences occurring in women [1]. The best strategy for treating TMDs is still up for debate. Additionally, it has been noted that there aren’t any systematic reviews or evidence-based treatment techniques for TMDs.

Therefore, a careful, systematic, and structured review is required, which is presented in this paper. This review aims to identify the reasons for the effectiveness and ineffectiveness of the proposed methodologies for the treatment of TMDs and to develop a novel, effective, and preventive approach for the treatment of TMDs (Table 1).

Table 1 Search terms

2 Methods

The present systematic review was undertaken in the following manner.

3 Sources

A search of the literature to 3 July 2022 was undertaken of the following databases: science direct, PubMed and Cochrane.

4 Study Selection

All type of studies published in literature related to the conservative treatment of TMDs have been selected including randomised controlled trials (RCT), quasi-RCTs and non-RCTs. Table 2 represents the inclusion and exclusion criteria.

Table 2 Inclusion and exclusion criteria search

5 Search Methodology

The search sequence is illustrated in Fig. 1. The studies which were excluded from the present study and the reason for their exclusion are presented in Table 3. The characteristics of included studies are presented in Table 4.

Fig. 1

Flow diagram

Table 3 Studies excluded from the present studies and the reason for their exclusion

Table 4 Features of the included studies

6 Results

Thirty nine studies were identified for review. Eight studies met the inclusion criteria and were assessed using the primary and secondary outcome measures outlined. The results of each included study are summarised as follows:

• a. Studies comparing reversible occlusal splints to irreversible occlusal splints treatments

Reversible occlusal splints and irreversible occlusal splints are available for healing the temporomandibular disorders. However, wide use of reversible occlusal splints over the irreversible splints have been reported in the literature because of not changing the bite of the patients. Studies showed that irreversible occlusal splints changes the bite of the patient, which is undesirable and dentists usually recommend less use of irreversible occlusal splint [3]. Also, one of the studies showed that using reversible splints is beneficial for the patient in healing the disorder with comfort and in less time and hence such occlusal splints are preferable over irreversible occlusal splints.

• b. Studies comparing occlusal splints of different thicknesses used for TMD correction

A recent study looked at how well various splint thicknesses worked to correct anterior disc displacement without reduction, and various researchers have suggested that the optimum vertical occlusal splint can be the best for the therapy but none of them had shown that the what should be the value of optimum thickness of occlusal splint for the correction of TMDs [2]. A recent study shows that a 2 mm vertical occlusal splint thickness was the best thickness for the therapy but the method of study used was non-randomised trials. Therefore, controlled randomised trials are need to perform to identify the optimum thickness of the occlusal splint for healing the TMDs.

• c. Studies comparing different mouth appliances used for the treatment

Contrary to occlusal splints, dentists and orthodontists are not interested in using other mouth appliances to treat TMD due to their irreversibility and discomfort when worn for an extended period of time [4].

• d. Studies comparing different mouth appliances, occlusal splints with behavioural therapy

According to reports, the best treatment option for TMD patients among the available devices was an occlusal splint with the ideal vertical thickness, which was followed by no therapy [5].

• e. Studies comparing different methodologies to pharmacological therapy

Occlusal splints are more common among patients and dentists in comparison with pharmaceutical therapy [6].

• f. Studies comparing wear patterns of different mouth appliances

The research has revealed that the frequency with which various oral appliances are worn has a substantial effect on the healing of the condition [7].

7 Discussion

The current systematic study enables comparison of suggested treatment modalities for TMDs.

Results from studies comparing the use of occlusal splints to no therapy showed that utilising occlusal splints and no treatment had statistically significant results [8]. However, doctors and orthodontists advised against using occlusal splints as often as possible. Because no statistically significant difference was identified with the use of alternative intra-oral appliances for the repair of TMDs [9], and there has unfortunately been no evidence established to support their efficacy in comparison to occlusal splints.

8 Conclusions

Based on a detailed analysis of the literature that has been published, occlusal splints with the ideal vertical thicknesses are known to be beneficial in treating TMDs. Reversible occlusal splints are actually more successful and comfortable (from the patient’s perspective) for treating TMDs than other mouth appliances and behavioural therapy.

9 Recommendations for Future Studies

The current study has brought attention to the necessity for more investigation into the precise causes and signs of TMDs. This requires a detailed and in-depth understanding of the biomechanics of both healthy and symptomatic TMJ participants. With the aid of FEM software, dentists and medical professionals will be able to better understand the biomechanics of the joint, including the positions or regions where stresses or forces appear to be at their highest or peak, as well as the critical stress areas. By assessing these points, precise causes and symptoms can be identified to a large extent, and on the basis of that patients can receive effective treatments and methodologies for the correction of TMDs.