Treatment of Temporomandibular Disorders of Arthrogeneous Origin. Controlled double-blind studies of a non-steroidal anti-inflammatory drug and a stabilisation appliance

Abstract: The aim of this thesis was to prospectively evaluate the short-term effect of a non-steroidal anti-inflammatory drug (diclofenac sodium, Voltaren) and stabilisation appliance in controlled trials of patients with temporomandibular disorders (TMD) of arthrogeneous origin. The active treatments were compared to placebo in the study of diclofenac and to a control appliance in the other study. Thirty-two patients in the first study and 60 patients in the second study were randomly assigned into two equally large groups. In the second study two different techniques regarding assessment of changes in condylar position on radiographs with and without an occlusal appliance was evaluated. Changes in condyle-fossa relationship was compared in the two patient groups, and the changes in condyle-fossa relationship was compared with the treatment outcome between the two treatment groups. The influence of possible background variables on outcome of treatment with occlusal appliances were tested. The group treated with diclofenac did not seem to have recovered better from TMD than placebo. However, in the other study the group treated with a stabilisation appliance showed a better treatment outcome, with respect to both symptoms and signs, than the group treated with a control appliance. The group treated with a stabilisation appliance more often showed a changed condylar position in the transcranial radiographs of the TMJ than the group treated with a control appliance. It was also shown that the patients treated with a stabilisation appliance more often experienced relief of TMD symptoms when the stabilisation appliance had achieved a changed condyle-fossa relationship. Treatment with a stabilisation appliance was still a strong explanatory factor when testing possible background variables for a positive treatment outcome, but also male sex (positive) and severe or very severe TMJ pain (negative) influenced the treatment outcome. It was concluded that there was no evidence to suggest that diclofenac sodium (Voltaren) should be used as a primary treatment for TMJ pain in patients with TMD. However, the stabilisation appliance is recommended for the treatment of patients with TMD suffering from TMJ pain.