Identifying a neurobiologic basis for drug therapy in TMDs

Article Abstract:

Medication may help treat temporomandibular disorders (TMDs). TMD is chronic pain in the mouth or face that is not caused by dental problems. TMD appears to have much in common with other types of chronic pain in which the triggering event causes long-term hypersensitivity of the nerves. The patient then experiences pain apparently without cause or out of proportion to the cause. Certain drugs may reduce or eliminate this hypersensitivity. Research is scanty but supports the following: low doses of certain antidepressants may help, but caution must be used in patients with heart disease. Benzodiazepine drugs may help when pain appears due to muscular or skeletal problems, but they can cause sedation, dependency, or worsen depression. Drugs such as aspirin, acetaminophen, or ibuprofen may help when inflammation is involved, but long-term use can cause serious gastrointestinal or kidney complications. Repeated injections of corticosteroids can damage joints. Narcotics should be reserved for cases where all other measures have failed.

Research, Cover Story, Drug therapy, Neurobiology, Temporomandibular joint disorders

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Burning mouth syndrome: an update

Article Abstract:

Burning mouth syndrome (BMS) is a common condition that is difficult to diagnose and treat. BMS is long-term orofacial pain manifested by symptoms including dry mouth, altered taste perception, oral burning, and irritability. Approximately 1,270,000 US adults had burning mouth symptoms in 1989 and the condition most often affects postmenopausal women. Patients with BMS are more likely to seek care from physicians than dentists. BMS may be caused by oral problems including irritation from ill-fitting dentures, salivary gland dysfunction, taste disturbances, and peripheral nerve damage. Systemic conditions implicated in BMS include nutritional deficiencies, diabetes, nervous system dysfunction, and psychological factors. Additional research is necessary to determine the causative factors. There is no generally effective treatment for BMS. Antidepressants or benzodiazepines may have therapeutic value, although additional scientific evidence is necessary.

Care and treatment

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Diagnosing depression in patients with chronic face pain

Article Abstract:

Dentists should screen for symptoms of depression in patients with chronic facial pain. Studies have reported depression in 41-78% of those with chronic facial pain. Depression can include feelings of sadness or emptiness, loss of interest or pleasure, changes in eating and sleeping patterns, and low energy and self-esteem. Neurotransmitters and hormones affect both mood and pain, and dysregulation in these systems can produce psychological and physical symptoms. Dentists should perform a physical exam for organic causes of pain and inquire of psychological factors that might relate.

Psychological aspects, Diagnosis, Depression, Mental, Depression (Mood disorder)

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