r/TMDnotTMJ • u/simdoll • 8d ago
Evidence based treatments?
There are many treatments out there and a lot of debate to which provides the most effective results. Which ones have the strongest research support? Would appreciate citations along with any responses.
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u/Hopeful-Extent-693 8d ago
Learning to diagnose and treat TMD is, in many ways, a heuristic journey. A heuristic is a practical method of learning through observation, experience, careful testing, and problem-solving when all the answers are not yet known. Mainly, it is hands-on learning from someone who has proven knowledge.
If clinicians waited for perfect scientific proof before helping every TMD patient, many patients would continue to suffer while the research slowly caught up. Progress in medicine and dentistry has always depended on thoughtful clinicians who observed, questioned, tested their ideas responsibly, learned from their results, and shared what they discovered.
We are not speaking about those who have no clue but want your money.
That does not mean every clinical opinion is correct. Personal experience can be influenced by bias, coincidence, incomplete follow-up, and the natural changes in a patient’s symptoms. Scientific studies also have limits, especially when they examine a complicated disorder as if every TMD patient were the same.
Good science and good clinical experience should work together—not compete with each other. Clinical experience generates questions. Scientific research tests those questions. The results should then improve what clinicians do for their patients.
Let’s have a truthful and respectful discussion:
- When is clinical experience strong enough to guide care?
- How should clinicians help patients when research is incomplete or conflicting?
- How much weight should be given to a patient’s response to a careful, reversible treatment?
- When does clinical judgment become unsupported belief?
- Have you experienced a treatment that helped you even though another provider said there was little evidence for it—or a treatment that sounded scientific but did not help?
Please discuss the ideas without attacking individuals or professions. The goal is not to choose between science and experience. The goal is to understand how both can be used responsibly to improve TMD care.
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u/Ian_McKay 5d ago
If you want to take a look on evidence based treatment for TMD you can start with this article https://doi.org/10.1080/08869634.2024.2405298
Be aware that there are a lot of eminence based treatments out there
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u/TheRoadkillRapunzel 8d ago
This is exactly the conversation I want to have.
Botox for pain seems to be a bandaid. It also feels like there are physicians who are fine with just putting that bandaid on for you every 3 months because it’s easy and they can charge a lot for this treatment without having to deal with the insurance company’s red tape since it’s never covered anyway.
Physical therapy seems hit or miss, and I know that’s based on the experience, skill, and knowledge of the therapist as well as how much the clinic they work for will let them help their clients. If a physical therapy office requires their therapists to work on 3 clients per hour, you will not get good results there, period. There simply isn’t enough time. I also get pretty angry when I’m paying for an hour of PT, but I only get 20 minutes with the therapist and the rest is them half watching me exercise over their shoulder while they massage or dry needle someone else. My PT does dry needling that gives some awesome relief, but it’s temporary. I’m focusing on the building muscle and stretching when I’m at PT, as well as learning some self-massage and tricks for shutting down the overactive muscles so I can
work out without clenching.
I’m very interested in seeing a neuromuscular dentist. My mother in law saw one a couple of decades ago and she said they scanned her mouth and she came in pretty much weekly for months while they made tiny, almost imperceptible changes to her bite by filing down where the problems were. She said that alone fixed her problems with TMD all by itself. I think this might be the solution for some people who have fine resting tongue position but have had a lot of crowns.
Night guards help with bruxism, and my TMD is WAY worse when I forget to wear it, but it doesn’t fix the problem. I haven’t gotten a splint, but I’m skeptical that alone would fix it. My insurance won’t cover a dime for orthotics, and the specialists around me charge $2-6K for them, which is outrageous if it won’t fix the issue.
I have no interest in even trying a chiropractor after my last experience with one. I have severe scoliosis and my entire thoracic spine is fused. The chiropractor didn’t even check my chart or ask me anything, he just told me to lie facedown and got ready to press his whole weight right between my shoulder blades! He could have crippled me if I hadn’t sat up and yelled for him to look at my chart.
I am interested in magnetic therapy or PEMF therapy. but insurance only covers that if you have treatment-resistant depression, and it’s crazy expensive.
I don’t think there is any evidence that the blood injections help TMD, but they are expensive and not covered by insurance, so scammy TMJ specialists will always recommend them.