Abstract
The article presents recommendations from the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) for the management of temporomandibular disorders (TMD), following the article “Temporomandibular disorders: INfORM/IADR key points for good clinical practice based on standard of care” by Manfredini et al. The document was translated by Aleksandra Nitecka-Buchta, Karolina Walczyńska-Dragon and Justyna Sędkiewicz, and reviewed by Aleksandra Nitecka-Buchta, Stefan Baron, Małgorzata Pihut, Jolanta Kostrzewa-Janicka, Edward Kijak, Mieszko Więckiewicz, Magdalena Osiewicz, Małgorzata Gałczyńska-Rusin, Aneta Wieczorek, and Daniele Manfredini.
Keywords: recommendations, pain therapy, temporomandibular disorders, orofacial pain, good clinical practice
The Polish Association for Temporomandibular Disorders (PATMD) as the only organization in Poland focused on temporomandibular disorders (TMD), which has been involved in promoting knowledge and good clinical practice in the treatment of patients with TMD for 25 years already, has prepared the Polish language version of the 10 key points for good clinical practice based on standard of care.1 The official position of the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) was prepared during the March 2024 meeting in New Orleans, LA, USA, hosted by the International Association for Dental Research (IADR). The main elements the recommendations are based on are the etiology, diagnosis and therapy of TMD, as per the latest data obtained from evidence-based medicine (EBM). The present article summarizes and indicates the promising directions in the modern approach to TMD. As a scientific society, PATMD sees it as its responsibility to introduce modern ideas to the Polish medical community, where doctors, in a conscious manner, strive to develop and follow current trends, thereby providing the highest level of medical care. The translation we are presenting has been prepared by a group of Polish TMD specialists who have been co-creating PATMD for many years. We have attempted to tailor this document to the cultural, social and healthcare system aspects of Poland.
Temporomandibular disorders have posed a challenge to clinicians worldwide for many years. The biopsychosocial factors, including the complex anatomy and physiology of the head and neck region, can contribute to the development of TMD, which is sometimes attributed to occlusion and the temporomandibular joint (TMJ) structures. These complex issues and the controversies surrounding their solutions have led to the emergence of numerous theories, not necessarily based on EBM. Currently, it is known that the biopsychosocial model provides the most probable explanation for the development of TMD. This publication compiles the most up-to-date information on diagnostic tools, including interviews, clinical examinations, psychosocial assessments, and imaging diagnostics, as well as the management of TMD patients, encompassing dental, orthopedic, neurological, psychological, and physical therapy approaches. The following key points also refer to the aspects of treatment, involving the use of neurological drugs and occlusal splints, and surgical interventions, which are reserved for selected cases. The PATMD translated and presented the current global concepts with regard to the treatment of TMD, which can prevent patients from inappropriate therapy, pain chronification and the iatrogenic effects of TMD management.
The list of the 10 key points of good clinical practice in the management of TMD, as stated in the current standards of treatment and patient needs, is presented in Figure 1.
Knowledge about TMD etiology and diagnostics is essential for dental clinicians and physicians. The standards of good clinical practice in TMD management proposed by the INfORM group are necessary to complement basic dental and medical education. The 10 key points for good clinical practice will enable the establishment of a protocol for therapy and help prevent inappropriate treatment. They can also serve as recommendations for the future development of TMD diagnostics and treatment guidelines.
List of authors of the original article
Daniele Manfredini, Birgitta Häggman-Henrikson, Ahmad Al Jaghsi, Lene Baad-Hansen, Emma Beecroft, Tessa Bijelic, Alessandro Bracci, Lisa Brinkmann, Rosaria Bucci, Anna Colonna, Malin Ernberg, Nikolaos N. Giannakopoulos, Susanna Gillborg, Charles S. Greene, Gary Heir, Michail Koutris, Axel Kutschke, Frank Lobbezoo, Anna Lövgren, Ambra Michelotti, Donald R. Nixdorf, Laura Nykänen, Juan Fernando Oyarzo, Maria Pigg, Matteo Pollis, Claudia C. Restrepo, Roberto Rongo, Marco Rossit, Ovidiu I. Saracutu, Oliver Schierz, Nikola Stanisic, Matteo Val, Merel C. Verhoeff, Corine M. Visscher, Ulle Voog-Oras, Linnéa Wrangstål, Steven D. Bender, Justin Durham; International Network for Orofacial Pain and Related Disorders Methodology.
