Conservative treatment methods in craniomandibular disorder.

Conservative methods should be a basic treatment principle in CMD. In spite of similar signs and symptoms, the etiology may vary and treatment should, if possible, be directed towards the cause, but the management may often just be mitigating. Counselling may be crucial. Occlusal appliances of different design obviously influence the muscular activity significantly but equilibration may include a strong placebo effect. While relaxation is incompletely investigated, biofeedback seem possibly effective. The application of physical medicine procedures is almost entirely empirically based. Experience from other areas also motivates pharmacotherapy in CMD while intra-articular injections seem reasonably well founded. Investigations of pain-alleviating methods like TENS and acupuncture, though sometimes promising, are often uncontrolled. Manipulation, even if effective, may not necessarily be a "disc recapturing" manoeuvre. The results of conservative treatment for joint clicking seem unpredictable and long-term results of treatment with repositioning splints are not encouraging. A need for well-controlled, randomised clinical studies in diagnostic subgroups and controls has been expressed. Although most patients with CMD can be successfully treated with different conservative methods, often with remarkably similar results, other options must be considered for some.