An Evidence-Based Pharmacological Management of Temporomandibular Joint Disorders and Trigeminal Neuralgia: A Narrative Review

Chronic orofacial pain (OFP), particularly temporomandibular disorders (TMDs) and trigeminal neuralgia (TN), poses significant diagnostic and therapeutic challenges in dental practice. This narrative review explores current pharmacological strategies, highlighting the efficacy of first-line medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, and anticonvulsants, as well as emerging therapies including palmitoylethanolamide and botulinum toxin A. The review highlights the limitations of opioid use and encourages combination therapy for mitigation of untoward effects and enhancing treatment response. The lack of high-quality randomized trials remains a significant challenge to final clinical guidelines. Multimodal treatment with pharmacologic and non-pharmacologic interventions including cognitive behavioral therapy and transcranial magnetic stimulation holds promising possibilities for long-term treatment of OFP management. This critique highlights the significance of personalised treatment programs and requires further clinical studies to support novel therapeutic agents.