The use of pharmacologic agents in the management of temporomandibular joint disorder

Temporomandibular joint disorders (TMD) are oro-facial pain conditions that originate from either intraarticular or extraarticular related pathology. Following an accurate diagnosis, there are a variety of non-surgical and surgical management options available. The aim of this article is to review the available pharmacologic agents for the management of extraarticular and intraarticular TMD. These medical options are often first line and are combined with other non-surgical modalities. There are multiple pharmacologic options utilized to treat TMD, from non-steroidal anti-inflammatory drugs (NSAIDs) to muscle relaxants and steroids. Many of these medications are used synergistically to provide symptom improvement and prevention of persistent disease. This paper will discuss the use of the following classes of medications used to manage TMD: NSAIDs, corticosteroids, narcotics, muscle relaxants, anticonvulsants, anxiolytics, and topical therapy. Despite their extensive clinical use, there remains insufficient evidence to recommend one therapy over another. This is due to the lack of systematic reviews and meta-analyses in the current literature. For this reason, there remains a need for a randomized control trial with clear pre-pharmacotherapy diagnoses, blinding, and research objectives. NSAIDs have been recommended as first line therapy for intraarticular disorders with the addition of muscle relaxants if there is a muscle component. Several of the other medications discussed are often patient specific or given secondarily when previous therapy has failed. It is critical to recognize systemic patient factors when prescribing any of these medications to avoid side effects and drug-drug interactions.