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Temporomandibular Joint Syndrome Medication

  • Author: Vivian Tsai, MD, MPH, FACEP; Chief Editor: Herbert S Diamond, MD  more...
 
Updated: Jul 08, 2016
 

Medication Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) and benzodiazepines are the mainstays of pharmacologic treatment for temporomandibular joint (TMJ) syndrome in the emergency deparment. Patients eventually may require tricyclics, opioids, muscle relaxants, or steroid (intra-articular) therapy for protracted pain syndromes.

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

Most commonly used for relief of mild to moderate pain. Although effects of NSAIDs in treatment of pain tend to be patient specific, ibuprofen usually is the DOC for initial therapy. Other options include naproxen, flurbiprofen, mefenamic acid, ketoprofen, indomethacin, and piroxicam.

Ibuprofen (Motrin, Advil, Ibuprin, Nuprin)

 

Usually DOC for treatment of mild to moderate pain if no contraindications exist; inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, which results in inhibition of prostaglandin synthesis.

Naproxen (Aleve, Anaprox, Naprosyn)

 

Used for relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of enzyme cyclooxygenase, which results in decrease of prostaglandin synthesis.

Flurbiprofen (Ansaid)

 

Analgesic, antipyretic, and anti-inflammatory effects; may inhibit cyclooxygenase enzyme, causing inhibition of prostaglandin biosynthesis that in turn may result in analgesic and anti-inflammatory activities.

Ketoprofen (Oruvail, Orudis, Actron)

 

Used for relief of mild to moderate pain and inflammation; administer small dosages initially to patients with small bodies, older persons, and those with renal or liver disease; doses >75 mg do not increase therapeutic effects; administer high doses with caution and closely observe patient for response.

Mefenamic acid (Ponstel)

 

Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Indomethacin (Indocin, Indochron E-R)

 

Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits prostaglandin synthesis.

Piroxicam (Feldene)

 

Decreases activity of cyclooxygenase, which, in turn, inhibits prostaglandin synthesis; effects decrease formation of inflammatory mediators.

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Benzodiazepines

Class Summary

Used for muscle relaxant properties but relatively contraindicated in pediatric patients because of sedating properties; appear to potentiate effects of GABA and facilitate inhibitory GABA neurotransmission and other inhibitory transmitters by binding to specific receptor sites.

Diazepam (Valium)

 

Depresses all levels of CNS, including limbic and reticular formation, possibly by increasing activity of GABA, a major inhibitory neurotransmitter.

Individualize dosage and increase cautiously to avoid adverse effects.

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Contributor Information and Disclosures
Author

Vivian Tsai, MD, MPH, FACEP Assistant Professor of Emergency Medicine, Mount Sinai School of Medicine, Queens Hospital Center

Vivian Tsai, MD, MPH, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Steven M Heffer, MD Consulting Staff, Department of Emergency Medicine, Greenwich Hospital

Steven M Heffer, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Jerome FX Naradzay, MD, FACEP Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina

Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Joshua Parnes, MD Resident Physician, Department of Emergency Medicine, Kings County Hospital Center

Disclosure: Nothing to disclose.

References
  1. Yule PL, Durham J, Wassell RW. Pain Part 6: Temporomandibular Disorders. Dent Update. 2016 Jan-Feb. 43 (1):39-42, 45-8. [Medline].

  2. Uyanik JM, Murphy E. Evaluation and management of TMDs, Part 1. History, epidemiology, classification, anatomy, and patient evaluation. Dent Today. 2003 Oct. 22(10):140-5. [Medline].

  3. Tallents, RH, Katzberg, RW, Murphy W, Proskin, et al. Magnetic resonance imaging findings in asymptomatic volunteers and symptomatic patients with temporomandibular disorders. J Prosthet Dent. 1996. 75:529. [Medline].

  4. Sanders AE, Maixner W, Nackley AG, Diatchenko L, By K, Miller VE, et al. Excess risk of temporomandibular disorder associated with cigarette smoking in young adults. J Pain. 2012 Jan. 13(1):21-31. [Medline]. [Full Text].

  5. Hegde V. A review of the disorders of the temporomandibular joint. J Indian Prosthodont Soc. 2005. 5:56-61.

  6. Rammelsberg P, LeResche L, Dworkin S. Longitudinal outcome of temporomandibular disorders: a 5-year epidemiologic study of muscle disorders defined by research diagnostic criteria for temporomandibular disorders. J Orofac Pain. 2003. 17(1):9-20. [Medline].

  7. Ahn SJ, Kim TW, Lee DY. Evaluation of internal derangement of the temporomandibular joint by panoramic radiographs compared with magnetic resonance imaging. Am J Orthod Dentofacial Orthop. 2006 Apr. 129(4):479-85. [Medline].

  8. American Academy of Family Physicians. Temporomandibular join (TMJ) pain. Am Fm Physician. 2007 Nov. 76(10):1483-4. [Medline].

  9. [Guideline] American Society of Temporomandibular Joint Surgeons. Guidelines for diagnosis and management of disorders involving the temporomandibular joint and related musculoskeletal structures. Cranio. 2003 Jan. 21(1):68-76. [Medline].

  10. Venezian GC, da Silva MA, Mazzetto RG, Mazzetto MO. Low level laser effects on pain to palpation and electromyographic activity in TMD patients: a double-blind, randomized, placebo-controlled study. Cranio. 2010 Apr. 28(2):84-91. [Medline].

  11. Silva PA, Lopes MT, Freire FS. A prospective study of 138 arthroscopies of the temporomandibular joint. Braz J Otorhinolaryngol. 2015 Jul-Aug. 81 (4):352-7. [Medline].

  12. Fricton JR, Look JO, Schiffman E, Swift J. Long-term study of temporomandibular joint surgery with alloplastic implants compared with nonimplant surgery and nonsurgical rehabilitation for painful temporomandibular joint disc displacement. J Oral Maxillofac Surg. 2002 Dec. 60(12):1400-11; discussion 1411-2. [Medline].

  13. Pharaboz C, Carpentier P. [MR imaging of the temporomandibular joints]. J Radiol. 2009 May. 90(5 Pt 2):642-8. [Medline].

 
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