Letters Dental occlusion and headache

Education is better than splints in temperomandibular pain

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e7447 (Published 06 November 2012) Cite this as: BMJ 2012;345:e7447
  1. Joanna M Zakrzewska, consultant pain medicine1
  1. 1UCLH NHS Foundation Trust, London WC1X 8LD, UK
  1. j.zakrzewska{at}ucl.ac.uk

It is disappointing that the notion that occlusion causes temperomandibular pain (TMD; persistent orofacial muscle pain) persists.1 2 Some headaches are related to TMD,3 and systematic reviews of the management of TMD with various splints show that these can be effective in the short term, but that some have serious irreversible adverse effects.4 Studies also show that another drug-free approach—education about these disorders—can have a longer lasting effect than splints.5

The baseline data from the large American study, OPPERA, are now published and show that TMD has complex and multidimensional causes, and that it is significantly associated with psychosocial factors and other chronic pains.6 Patients with TMD and headaches need a biopsychosocial approach to management that includes being listened to and given explanations about their symptoms. Our multidisciplinary facial pain unit, which sees more than 600 new patients with facial pain each year, does not use splints, provides education in physiotherapy and psychological management, and rarely uses drugs.


Cite this as: BMJ 2012;345:e7447


  • Competing interests: None declared.


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