The Effectiveness of Pharmacology in Disorders of the Manducatory System

Summary: The wide variety of disorders and abnormalities affecting the manducatory apparatus has led to a multitude of therapies of various kinds including orthopedic, kinesiological as well as pharmacological treatments. Several studies have highlighted the effectiveness of orthopedic therapies using occlusal splints as well as kinesiological treatments. However, pharmacological treatments, by their multitude and their diversity remain little documented regarding clinical efficiency, with the absence of a global conclusive study. The aim of this work is to conduct a systematic review evaluating the clinical efficacy of the drugs used in the treatment of temporomandibular dysfunction. Materials and Methods: This is a systematic review questioning the Pubmed database. The research was conducted using the following key words: "Craniomandibular disorders"; "Drug therapy"; "Relaxing Muscle, Central". Articles published between January 2012 and end of August 2017 and meeting the eligibility criteria were identified after reading their titles then summarized by 2 readers. The critical analysis of the methodology was conducted based on the PICO criteria and the JADAD scoring analysis (strengths and weaknesses of each study). The effectiveness of drugs was evaluated based on their action on the following three parameters: Dyskinesia, pain and noise. Results: Of the 420 references originally found on Pubmed, 23 articles were selected. After full reading of the 24 articles selected and application of the JADAD score: • 3 articles treated botulinum toxin including 1 high rank and 2 low ranks for a conclusion in favor of the toxin. • 7 articles discussed hyaluronic acid, 5 of which ranked high and 2 of low rank all agreeing on the efficacy of this therapy. 5 articles on corticosteroids, including 1 high and 4 low, however, no consensus has been reached on its effectiveness. Only 1 item of high rank proved the beneficial effect of anesthetics on muscle pain. 1 high-ranked study and 1 low-ranked trial for nonsteroidal anti- inflammatory drugs that have not been conclusive about its effectiveness. • 3 low-grade items treating PRP were able to demonstrate efficacy as an adjunct to arthrocentesis. 1 low ranking article on painkillers has proven its value as an adjunct to arthrocentesis.