Facial pain is a fairly common complaint and may present in a myriad of symptoms. These patients present to both dentists and general practitioners and could end up referred to a number of specialists. Temporomandibular disorders (TMD) may originate from either the joint or adjoining muscles or a mixture of both. Myofascial pain disorder is another common complaint in that region but in temporomandibular joint disorders, there will be internal derangement of the joint as well as muscle spasm. The aetiology is multifactorial and could have a number of contributing factors. A detailed history and examination are of paramount value in leading to the diagnosis. Associated habits and investigations such as MRI are also of value. Initial treatment is almost always conservative with a soft diet and prescribed limitation of jaw movement. Additionally, local anti-inflammatories, gels and warm compresses may help in pain relief. Initial intervention is usually an occlusal splint of a sort on either jaw and, if particular trigger points are identified, these could be injected for immediate relief or until the occlusal splint offloads the muscles. If these fail then surgical interventions, especially in joints identified to have internal derangement, will go on to have arthrocentesis. This is a retrospective study from one institution in Turkey of 56 patients from 2009-2015 that met their particular inclusion criteria. Following treatment, the patients were reviewed. There is a good discussion with excellent paper citations of TMD treatments in the discussion. The treatment options are discussed to various degrees and are useful. This is a small cohort of patients and refreshes the practitioner's treatment options for temporomandibular joint and myofascial pain syndrome treatment options. The authors conclude with the accepted treatment options as the three treatments being useful depend on the patient's signs and symptoms. I found this an easy paper to understand and review TMD treatments.

Evaluation of the effects of occlusal splint, trigger point injection and arthrocentesis in the treatment of the internal derangement patients with myofascial pain disorders.
Bilici I S, Emes Y, Aybar B, Yalcin S.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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