Dr. Mariam Tahir Siddiqui

Temporomandibular disorders (TMD) and orofacial pain persisting beyond three months are classified as chronic and require a comprehensive, layered management strategy. We propose an “onion peel” approach that systematically addresses the multiple contributors to chronic pain, including musculoskeletal dysfunction, joint pathology, neuropathic and neuralgic components, psychosocial factors, stress, and sleep disturbances.While pharmacologic therapy is often first-line, we advocate for an initial integrative, non-pharmacologic approach. This includes trigger point injections, acupuncture, cupping, targeted nerve blocks (e.g., occipital and sphenopalatine ganglion), and the use of compounded topical therapies. Equally important are cognitive behavioral therapy and comprehensive sleep evaluation to identify and treat conditions such as obstructive sleep apnea, insomnia, and circadian rhythm disorders.Restoration of autonomic balance—specifically promoting parasympathetic (“rest and digest”) activity—plays a central role. Interventions such as structured breathing techniques, temperature-based therapies, sleep optimization, and reduction of external stimulants may support this shift.We further propose that integrating preventive education into community and school-based programs could significantly reduce the burden of chronic orofacial pain. Early awareness and adoption of these strategies have the potential to improve population-level quality of life while decreasing long-term healthcare utilization