Contemporary Medical Acupuncture Program

Neurofunctional Treatment of Pain with Movement Disorders

Acupuncture in the integrated treatment of Temporomandibular (TMD) disorders

By Dr. Alejandro Elorriaga Claraco
February 1, 2009

by Alejandro Elorriaga Claraco, M.D. (Spain), Director McMaster Contemporary Medical Acupuncture Program, Hamilton, Ontario
and Rodrigo Garcia-Loyer, Odontologist, Director Cranio-Cervico-Mandibular Disorders Institute, Rio de Janeiro, Brazil
Hospital News – February 2009

Temporomandibular Disorders (TMD) are a group of conditions that cause pain and dysfunction in the jaw joint and its associated muscles. Some estimates suggest that over 10 million US citizens are affected. In a 2001 article, the Journal of the Canadian Dental Association revealed that the prevalence of TMD related symptoms in the Canadian population ranged from 5% to 15%, with peak prevalence between 20-40 years of age. The condition appears to be more common in women than in men.

TMD sufferers are one of the most difficult groups of chronic pain patients to treat successfully. There is not yet a universal gold standard treatment of TMD. In the US National Institutes of Health web site, there are 18 studies reported, either completed or in progress, related to the effectiveness of different interventions on the treatment of TMD. Studied interventions include several kinds of medication, joint injections, dental appliances, biofeedback, cognitive behavioral therapy, naturopathic medicine, chiropractic care, acupuncture, and even shamanic healing.

Currently, it is accepted that chronic pain of any kind is best managed by multimodal bio-psychosocial therapy, addressing the full range of physical, psychological and social components of the chronic pain in order to change beliefs, attitudes, coping style, dysfunctional behavior patterns, and activity levels.

It is within this bio-psychosocial treatment approach of TMD that acupuncture may play a valuable role mainly in alleviating the sensory component of the condition (pain experience) and in helping recondition the muscles that have been overworked due to joint and teeth imbalances and/or excessive grinding of the teeth due to stress.

In the last few years, there have been a number of studies showing the value of acupuncture in the management of TMD. Already in 1999, a systematic review of several previously published studies concluded that acupuncture might be an effective therapy for TMD, though further investigation was suggested.

In 2003, a study measuring the effect of integrating several interventions concluded that acupuncture treatment, in combination with splint therapy and trigger point injections, appeared to be effective for managing TMD.

A recent 2006 review of seven studies published in Sweden and one in the US, found also that acupuncture appears to be a suitable complementary treatment method in the management of cranio-mandibular dysfunction.

On the basis of another 2006 published randomized control clinical trial (in Austria), acupuncture can be recommended as acute treatment of cranio-mandibular disorders.

Another 2006 publication revealed that the results of using acupuncture in the treatment of temporomandibular dysfunction in a general dental practice are comparable to those obtained in clinical studies in university settings.

Finally, in a 2008 published randomized control trial, a group of 160 women TMD sufferers treated with acupuncture and naturopathic medicine showed significantly greater reduction of pain and psychosocial interference than a comparable group of women receiving state of the art specialty dental care.

As in any other area of health care, further ongoing research continues to be needed. However, based on the best available evidence (such as the one presented above) it is fair to state that acupuncture is a simple, relatively safe and potentially efficacious and useful modality in the integrated management of TMD.

How about the future? In the last few years, new insights in the understanding of TMD have led to the expansion of this syndrome into the term Cervico-Cranio-Mandibular Disorders (CCMD), a longer but more accurate descriptor of the multiple etiology and highly complex scope of the dysfunction experienced by this group of pain sufferers. This new clinical paradigm (CCMD) opens new therapeutic avenues for a more interdisciplinary management of these complex disorders to be developed in the next few years.

In conclusion, in order to be truly effective in dealing with TMD/CCMD, dental professionals need the help of manual therapy (chiropractors, massage therapists, osteopaths), psychotherapy, physiotherapy, naturopathic medicine, and acupuncture professionals.

Only integration of modalities and interdisciplinary work can bring complex chronic pain sufferers, such as the TMD/CCDM group, the relief and restoration of function that is the mission and goal of all health care professions.

For more information on the McMaster University Contemporary Acupuncture Program, please call Valerie Cannon at 905-521-2100 x75175 or visit