Editing Temporomandibular joint dysfunction (section)

===Medication===
Medication is the main method of managing pain in TMD, mostly because there is little if any evidence of the effectiveness of surgical or dental interventions.<!-- <ref name="Mujakperuo 2010" /> --> Many drugs have been used to treat TMD pain, such as [[analgesic]]s (pain killers), [[benzodiazepine]]s (e.g. [[clonazepam]], [[prazepam]], [[diazepam]]), [[anticonvulsant]]s (e.g. [[gabapentin]]), [[muscle relaxant]]s (e.g. [[cyclobenzaprine]]), and others. Analgesics that have been studied in TMD include [[non-steroidal anti-inflammatory drug]]s (e.g. [[piroxicam]], [[diclofenac]], [[naproxen]], [[celecoxib]]).<!-- <ref name="Mujakperuo 2010" /> -->

[[Topical medication|Topical]] [[methyl salicylate]] and topical [[capsaicin]] have also been used.<!-- <ref name="Mujakperuo 2010" /> -->

Other drugs that have been described for use in TMD include [[glucosamine hydrochloride]]/[[chondroitin sulphate]] and [[propranolol]].<!-- <ref name="Mujakperuo 2010" /> --> Low-doses of [[anti-muscarinic]] [[tricyclic antidepressant]]s such as [[amitriptyline]],<ref name="Marbach 1996">{{cite journal | vauthors = Marbach JJ | title = Temporomandibular pain and dysfunction syndrome. History, physical examination, and treatment | journal = Rheumatic Disease Clinics of North America | volume = 22 | issue = 3 | pages = 477–98 | date = August 1996 | pmid = 8844909 | doi = 10.1016/S0889-857X(05)70283-0 }}</ref> or [[nortriptyline]] have also been described.<ref name="pmid9007937">{{cite journal | vauthors = Dionne RA | title = Pharmacologic treatments for temporomandibular disorders | journal = Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics | volume = 83 | issue = 1 | pages = 134–42 | date = January 1997 | pmid = 9007937 | doi = 10.1016/S1079-2104(97)90104-9 | url = https://zenodo.org/record/1260198 }}</ref>

Despite many [[randomized control trial]]s being conducted on these commonly used medications for TMD a [[systematic review]] carried out in 2010 concluded that there was insufficient evidence to support or not to support the use of these drugs in TMD.<ref name="Mujakperuo 2010" />

In a subset of people with TMD who are not helped by either noninvasive and invasive treatments, long term use of [[opiate]] analgesics has been suggested, although these drugs carry a risk of [[drug dependence]] and other side effects.<ref name="Bouloux 2011">{{cite journal | vauthors = Bouloux GF | title = Use of opioids in long-term management of temporomandibular joint dysfunction | journal = Journal of Oral and Maxillofacial Surgery | volume = 69 | issue = 7 | pages = 1885–91 | date = July 2011 | pmid = 21419546 | doi = 10.1016/j.joms.2010.12.014 }}</ref> Examples include [[morphine]], [[fentanyl]], [[oxycodone]], [[tramadol]], [[hydrocodone]], and [[methadone]].<ref name="Bouloux 2011" />

Injections of [[local anesthetic]], sometimes combined with [[steroid]]s, into the muscles (e.g. the temoralis muscle or its tendon) are also sometimes used. Local anesthetics may provide temporary pain relief, and steroids inhibit pro-inflammatory [[cytokine]]s.<ref name="Hupp 2008" /> Steroids and other medications are sometimes injected directly into the joint (See [[#Intra-articular injections|Intra-articular injections]]). Platelet-rich fibrin injection, alone or associated with arthrocentesis, can be considered a very suitable.<ref name="Treatments for painful temporomandi">{{cite journal | vauthors = Al-Moraissi, EA et al.| title = Treatments for painful temporomandibular disc displacement with reduction: a network meta-analysis of randomized clinical trials | journal = International Journal of Oral and Maxillofacial Surgery| volume = 53 | issue = 1 | pages = 45–56 | date = January 2024| pmid = 37802670 | doi = 10.1016/j.ijom.2023.09.006}}</ref>

[[Botulinum toxin]] solution ("Botox") is sometimes used to treat TMD.<ref name="Schwartz 2002">{{cite journal | vauthors = Schwartz M, Freund B | s2cid = 37480726 | title = Treatment of temporomandibular disorders with botulinum toxin | journal = The Clinical Journal of Pain | volume = 18 | issue = 6 Suppl | pages = S198-203 | date = Nov–Dec 2002 | pmid = 12569969 | doi = 10.1097/00002508-200211001-00013 }}</ref> Injection of botox into the lateral pterygoid muscle has been investigated in multiple randomized control trials, and there is evidence that it is of benefit in TMD.<ref name="Persaud 2013">{{cite journal | vauthors = Persaud R, Garas G, Silva S, Stamatoglou C, Chatrath P, Patel K | title = An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions | journal = JRSM Short Reports | volume = 4 | issue = 2 | date = February 2013 | page = 10 | pmid = 23476731 | pmc = 3591685 | doi = 10.1177/2042533312472115 }}</ref> It is theorized that spasm of lateral pterygoid causes anterior disc displacement. Botulinum toxin causes temporary muscular paralysis by inhibiting [[acetylcholine]] release at the neuromuscular junction.<ref name="Glick 2003" /> The effects usually last for a period of months before they wear off. Complications include the creation of a "fixed" expression due to diffusion of the solution and subsequent involvement of the [[muscles of facial expression]],<ref name="Persaud 2013" /> which lasts until the effects of the botox wear off.