Temporomandibular disorder pain treated with behavioral therapy

Introduction: Temporomandibular disorder (TMD) pain has a multifactorial aetiology. Sleep bruxism, daytime clenching, together with psychological stress, seems to contribute to it. Only a minority of studies have tested the effectiveness of psychological interventions in TMD patients. Case description: F. is a 39-year-old woman with no history of physical or psychiatric disorders. Six months after the birth of her son, she went to the dentist because of jaw muscle tenderness, jaw opening limitations, morning headache, tooth hypersensitivity. The dentist diagnosed TMD and encouraged F. to stop clenching and reduce the daily stress. After 2 weeks symptoms were unchanged and F. asked for a psychological evaluation. At assessment, no diagnosis emerged via the MINI International Neuropsychiatric Interview while allostatic overload was diagnosed according to the clinimetric approach. The patient was informed about the negative effects of distress on her neuromuscular habit patterns, of which clenching was a consequence, and invited to take note of the daily level of distress. At second session, F. referred to be always distressed since she has to balance her job with family duties and referred to have hired a domestic worker to reduce it. The next step was to teach F. to observe her neuromuscular patterns at specific times of the day and, if this was the case, switch from muscle tension to relaxation by dynamic muscle contraction. One month later, F. was free of symptoms and maintained this condition at 2 years follow-up. Comment: Therapy for TMD should be behavioural rather than mechanical.