Temporomandibular Disorders (TMD)

• Types:

  • Intra-articular → disc displacement, degenerative joint disease.

  • Myogenous → muscle-related pain/dysfunction.

• First-line Treatment (evidence-based):

  • Education & self-care.

  • Jaw exercises, physiotherapy.

  • Cognitive-behavioral therapy.

  • Short courses of NSAIDs.

  • Stabilization splints.
    → These are conservative, reversible, and effective in many RCTs.

• Second-line / Advanced Care:

  • Minimally invasive → arthrocentesis, intra-articular injectables (for persistent mechanical symptoms).

  • Open surgery → only for clear structural pathology.

Oral Appliance Therapy for Sleep-Disordered Breathing

• Guidelines (AASM/AADSM 2024):

  • Custom, titratable mandibular advancement devices recommended for:

    • Adults with primary snoring.

    • Adults with OSA who prefer them or cannot tolerate PAP.

  • Most effective in mild-to-moderate OSA.

  • Show better adherence than PAP in some patients.

• Best Practice:

  • Dentists must coordinate with sleep physicians for:

    • Diagnosis.

    • Appliance titration.

    • Follow-up & verification sleep testing.

• Emerging Approaches:

  • Myofunctional therapy.

  • Expansion techniques.

  • Evidence still limited but growing.