Effects of massage therapy and occlusal splint therapy on mandibular range of motion in individuals with temporomandibular disorder: a randomized clinical trial

Effectiveness of photobiomodulation and orofacial myofunctional therapy in orofacial pain disorders. A systematic review of randomized control trials

Orofacial pain can significantly affect physical, psychological, and overall quality of life. This study aimed to compare the effectiveness of combining photobiomodulation (PBM) with orofacial myofunctional therapy (OMT) in managing orofacial pain disorders. An electronic search of randomized controlled trials in electronic databases was performed until March 2024. Randomized controlled trials (RCTs) focusing on PBM and OMT for the management of orofacial pain were included. Risk of bias across individual studies was performed using the Cochrane risk of bias tool for interventions. A total of 10 RCTs were included, out of which 7 RCTs revealed that the combined approach of PBM and OMT had a more pronounced impact on diminishing pain and enhancing functional activity in patients with orofacial disorders. One study reported significant increases in pressure pain threshold for TMJ, masseter, and anterior temporalis muscles at both sides in the post-treatment compared with the pre-treatment in both groups. The risk of bias was low in 7, moderate in 2, and high in 1 study. The efficacy of a combined modality treatment of PBM with OMT for orofacial pain disorder shows promising results. However, further randomized controlled trials with extended follow-up periods standardized PBM and OMT parameters are warranted to obtain firm conclusions.

Accuracy of the Fonseca Anamnestic Index for identifying pain-related and/or intra-articular Temporomandibular Disorders

Objectives: This study established the diagnostic accuracy of the Fonseca Anamnestic Index (FAI) in relation to the Diagnostic Criteria for TMD (DC/TMD) standard.Methods: A total of 866 TMD patients and 57 TMD-free controls were instructed to answer the FAI and DC/TMD Symptom Questionnaire (SQ). Participants were subsequently categorized into no (NT), pain-related (PT), and/or intra-articular (IT) TMDs using the DC/TMD protocolized examination/algorithms. Receiver operating characteristics (ROC) curves, best cut-off points, and accuracy measures were determined.Results:The FAI demonstrated high accuracy for detecting all TMDs, PT, and IT (AUC = 0.96-0.98). The best cut-off points were 22.50 for all TMDs/IT and 27.50 for PT. Sensitivity of the FAI was high (94.23-98.21%), but specificity was moderate (87.72%) for all diagnostic categories.Discussion:The diagnostic accuracy of the FAI for identifying pain-related and intra-articular TMDs was high. FAI scores ≥25 points should be used to screen for TMDs.

Evaluation of the efficacy of manual soft tissue therapy and therapeutic exercises in patients with pain and limited mobility TMJ: a randomized control trial (RCT)

The limited number of randomized controlled trials (RCTs) comparing the efficacy of soft tissue manual therapy and self-therapy interventions prompted the authors to focus on the analgesic and myorelaxant use of massage, post-isometric muscle relaxation (PIR) and therapeutic exercise in TMD patients.

OBJECTIVES

To evaluate the effectiveness of soft tissue therapy and therapeutic exercises in female patients with pain, increased masseter muscle tension and limited mandibular mobility.

MATERIAL AND METHODS

The study was conducted on a group of 82 women (G1) with the Ib disorder diagnosed in DC/TMD (Ib-myofascial pain with restricted mobility). The control group (G2) consisted of 104 women without diagnosed TMDs (normal reference values for TMJ ROM and masseter muscle sEMG bioelectric activity). Diagnostic procedures were performed in both groups (sEMG of the masseter muscles at baseline and during exercise, measurement of TMJ mobility, assessment of pain intensity-NRS scale). The G1 group was randomly divided into 3 therapeutic groups in which the therapy was carried out for 10 days: therapeutic exercises (TE), manual therapy - massage and therapeutic exercises (MTM_TE), manual therapy - PIR and therapeutic exercises (MTPIR_TE). Each time after therapy, the intensity of pain and TMJ mobility were assessed. Sealed, opaque envelopes were used for randomization. After 5 and 10 days of therapy, bilateral sEMG signals of the masseter muscles were acquired.

RESULTS

Massage, PIR and self-therapy led to a decrease in sEMG at rest as well as in exercise. After day 6 of therapy, the groups obtained a significant difference (p = 0.0001). Each of the proposed forms of therapy showed a minimal clinically significant difference (MID) in the sEMG parameter at the endpoint, with the most considerable difference in the MTM_TE group. The forms of MT used were effective in reducing the patients' pain intensity; however, a significant difference between therapies occurred after 4 treatments (p = 0.0001). Analyzing the MID between methods, it was observed that self-therapy had an analgesic effect only after 8 treatments, while PIR after 3 and massage after 1 treatment. After day 7, the mean pain score in the MTM_TE group was 0.889 and in the TMPIR_TE group was 3.44 on the NRS scale. In terms of MMO, a significant difference was obtained between monotherapy and each form of TM, i.e. massage (p = 0.0001) and PIR (p = 0.0001). Analyzing mandibular lateral movements, the authors got a significant difference in the proposed MT forms, of which massage treatments exceeded the effectiveness of PIR.

CONCLUSIONS

Soft tissue manual therapy and therapeutic exercise are simple and safe interventions that can potentially benefit patients with myogenic TMDs, with massage showing better analgesic effects than PIR.

Surface electromyography evaluation of selected manual and physical therapy interventions in women with temporomandibular joint pain and limited mobility. Randomized controlled trial (RCT)

Non-invasive approach is gaining an increasing recognition in the TMD patients management. It is therefore reasonable to conduct RCTs evaluating the effectiveness of both physical and manual physiotherapy interventions. The aim of this study was to evaluate the short-term efficacy of selected physiotherapeutic interventions and their effect on the bioelectrical function of the masseter muscle in patients with pain and limited TMJ mobility. The study was conducted on a group of 186 women (T) with the Ib disorder diagnosed in DC/TMD. The control group consisted of 104 women without diagnosed TMDs. Diagnostic procedures were performed in both groups. The G1 group was randomly divided into 7 therapeutic groups in which the therapy was carried out for 10 days: magnetostimulation (T1), magnetoledotherapy (T2), magnetolaserotherapy (T3), manual therapy- positional release and therapeutic exercises (T4), manual therapy - massage and therapeutic exercises (T5), manual therapy - PIR and therapeutic exercises (T6), self therapy - therapeutic exercises (T7). In the T4 and T5 groups, the treatments led to complete resolution of pain after the 10th day of therapy and to the largest minimal clinically significant difference in the MMO and LM parameter. GEE model for PC1 values using treatment method and time point showed that T4, T5 and T6 treatments had the strongest effect on the parameters studied. Therefore, it may be concluded that SEMG testing is a helpful indicator to assess the therapeutic effectiveness of physiotherapeutic interventions.

BACKGROUND

Non-invasive approach is gaining an increasing recognition in the TMD patients management. It is therefore reasonable to conduct RCTs evaluating the effectiveness of both physical and manual physiotherapy interventions in a qualitative and quantitative manner. However, there were numerous controversies reported regarding the use of surface electromyography (SEMG) in Orofacial Pain patients. Therefore, we wanted to assess the effectiveness of physiotherapy interventions in TMD patients using SEMG.

PURPOSE

Evaluation of the short-term efficacy of selected physiotherapeutic interventions and their effect on the bioelectrical function of the masseter muscle in patients with pain and limited TMJ mobility.

MATERIAL AND METHODS

The study was conducted on a group of 186 women (T) with the Ib disorder diagnosed in DC/TMD (Ib - myofascial pain with restricted mobility). The control group consisted of 104 women without diagnosed TMDs (normal reference values for TMJ ROM and masseter muscle SEMG bioelectric activity). Diagnostic procedures were performed in both groups (SEMG of the masseter muscles at baseline and during exercise, measurement of TMJ mobility, assessment of pain intensity - NRS scale). The G1 group was randomly divided into 7 therapeutic groups in which the therapy was carried out for 10 days: magnetostimulation (T1), magnetoledotherapy (T2), magnetolaserotherapy (T3), manual therapy- positional release and therapeutic exercises (T4), manual therapy - massage and therapeutic exercises (T5), manual therapy - PIR and therapeutic exercises (T6), self-therapy - therapeutic exercises (T7). Each time after therapy, the intensity of pain and TMJ mobility were assessed. Sealed, opaque envelopes were used for randomization. After 5 and 10 days of therapy, bilateral SEMG signals of the masseter muscles were acquired. PC1 factor analysis was performed. A score of 99% in the PC1 parameter, demonstrates the clinical relevance of electromyography (MVC).

RESULTS

Synergism of physical factors will lead to a higher MID on the NRS scale. Evaluating the MID of the therapeutic interventions used showed a better therapeutic effect of manual interventions over physical and self-therapy. In the T4 and T5 groups, the treatments led to complete resolution of pain after the 10th day of therapy and to the largest minimal clinically significant difference in the MMO and LM parameter. GEE model for PC1 values using treatment method and time point showed that T4, T5 and T6 treatments had the strongest effect on the parameters studied.

CONCLUSIONS

1. Exercise SEMG testing is a helpful indicator to assess the therapeutic effectiveness of physiotherapy interventions. 2. Manual therapy treatments are superior to physical treatments in their relaxation and analgesic efficacy and should therefore be prescribed as a first line non-invasive intervention for TMD pain patients.

Einfluss von aktiven Übungsprogrammen und Aufbissschienen auf die kraniomandibuläre Dysfunktion

Hintergrund

Rund 40 % der Weltbevölkerung sind von einer kraniomandibulären Dysfunktion (CMD) betroffen. Diese äußert sich durch Schmerzen, Bewegungseinschränkungen und/oder Kiefergelenkgeräusche und wird durch die große Varianz an Symptomen meist erst spät diagnostiziert und behandelt. Nicht selten kommt es zu Einschränkungen der Lebensqualität der Betroffenen. In der Behandlung der CMD spielen Physiotherapie und Schienenversorgung eine wichtige Rolle.

Ziel

Ziel dieser Arbeit ist es, die Auswirkungen von Heimübungsprogrammen (HÜs) und Schienentherapie (ST) auf die Hauptsymptome der CMD zu klären. Es soll herausgefunden werden, ob eine Kombination der beiden Therapien einen therapeutischen Mehrwert darstellt.

Material und Methoden

Mittels Literaturrecherche in den Datenbanken PubMed, PEDro und Cochrane wurden Studien recherchiert und nach Durchsicht adäquater Abstracts die Volltexte zusammengefasst und kritisch diskutiert.

Ergebnisse

Sowohl HÜs als auch ST führen zu einer Verbesserung der beschriebenen Symptome und der Lebensqualität. Bei myogener CMD zeigen HÜs einen besseren Therapieeffekt auf die Kiefergelenkbeweglichkeit. Bei der Diagnose Diskusverlagerung mit Reposition waren im Gegensatz dazu keine deutlichen Therapieerfolge feststellbar. In keiner der analysierten Studien ergab eine Kombination der beiden Interventionen einen Mehrwert. Bei der Analyse der Lebensqualität war die Vergleichbarkeit aufgrund unterschiedlicher und nicht optimaler Fragebögen nur beschränkt möglich. Vergleicht man die Ergebnisse der durchgeführten Maßnahmen in Bezug auf die Interventionsdauer, ließ sich feststellen, dass zu Beginn der Therapien bessere Ergebnisse erzielt wurden als nach längerer Behandlungszeit. Auch die Dropout-Raten nahmen bei längeren Follow-up-Zeiten zu.

Schlussfolgerungen

Eine individuelle Anpassung der HÜs fördert die Compliance und Therapieadhärenz. Aufgrund der aktuellen Studienlage wird davon ausgegangen, dass sowohl HÜs als auch ST angemessene Methoden darstellen, um Schmerzen und Kiefergelenkgeräusche zu reduzieren und eine Verbesserung der Kiefergelenkbeweglichkeit und Lebensqualität zu erzielen. Bei myogener CMD stellen HÜs eine adäquate, kostengünstige Alternative zur ST dar. Weitere Forschung ist notwendig, um die genaue Therapiewirkung auf die verschiedenen Diagnosegruppen zu analysieren. Bezüglich der Lebensqualität sind weitere Analysen mit adäquaten Fragebögen notwendig.

A novel treatment modality for myogenous temporomandibular disorders using aromatherapy massage with lavender oil: A randomized controlled clinical trial

OBJECTIVE

To investigate the effect of aromatherapy massage on pain intensity and maximal mouth opening (MMO) in patients with myogenous TMD.

METHODS

Ninety-one patients were randomly assigned to three groups: Group L (aromatherapy massage with lavender oil, test), group P (massage with sweet almond oil, placebo), and group C (control). Participants were evaluated at T0 (before the intervention), T1 (immediately after the intervention), and T2 (2-month follow-up). Data were analyzed using one-way ANOVA, Tukey's HSD, and Kruskal-Wallis tests.

RESULTS

For T1 and T2, group L showed the greatest MMO values (48.01 ± 0.85 mm; 45.67 ± 0.84 mm), while group C exhibited the lowest values (39.13 ± 0.49 mm; 39.66 ± 0.82 mm) (p < 0.001). For VAS, group L revealed the lowest pain values at T1 (2) and T2 (2) (p < 0.001).

DISCUSSION

Aromatherapy massage with lavender oil was effective in the management of painful TMD conditions and limited mouth opening.

Occlusal Splint Therapy Combined with Cranio-Temporomandibular Kinesiotherapy in Patients with Temporomandibular Disorders-A CBCT Study

Occlusal splints are used as a non-invasive treatment for patients diagnosed with temporomandibular disorders (TMD). Another non-invasive treatment option for TMD patients is kinesiotherapy, which may be used alone or in conjunction with occlusal splint therapy. The aim of this study was to evaluate the changes in the intra-articular spaces of the temporomandibular joint (TMJ) after occlusal splint therapy combined with cranio-temporomandibular kinesiotherapy in TMD patients. Twenty-four patients (N = 24) diagnosed with TMD according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were included. Cone beam computed tomography (CBCT) images were taken before and after treatment. The anterior, superior, posterior, and medial joint spaces were measured on the CBCT images, and the condylar ratio was calculated using Pullinger and Hollender's formula. Additionally, the thickness of the glenoid fossa (GFT), condylar medio-lateral widths (MLW), and condylar height (HCo) were measured. The condylar ratio was significantly higher after treatment (p = 0.049). The changes in dimensions of the anterior, superior, posterior and medial joint spaces were not statistically significant after treatment. No statistically significant differences were found in the dimensions of the GFT, MLW, and HCo post treatment. The condylar position did not shift anteriorly in a statistically significant way after occlusal splint therapy combined with cranio-temporomandibular kinesiotherapy in TMD patients.

Craniovertebral and Craniomandibular Changes in Patients with Temporomandibular Joint Disorders after Physiotherapy Combined with Occlusal Splint Therapy: A Prospective Case Control Study

Background and Objectives: The aim of the study was to assess the craniovertebral and craniomandibular changes in patients diagnosed with temporomandibular joint disorders (TMD) after physiotherapy combined with occlusal splint therapy. Materials and Methods: There were forty patients (32 females, 80%), diagnosed with TMD, included into the study group. After the initial series of physiotherapy, patients received maxillary occlusal splints to be worn day and night. Participants continued physiotherapy simultaneously with occlusal splint therapy for 6 months. Lateral cephalograms taken in natural head position before and after the end of the therapy were used for measurements. The control group consisted of 15 healthy participants (12 females, 80%), who had taken lateral cephalograms twice, and did not receive any type of occlusal treatment nor physiotherapy in the meantime. Results: Occlusal splint therapy and physiotherapy combined together significantly affected: the vertical position of the mandible (significant increase, p < 0.0001), the sagittal position of mandible (significant decrease, p = 0.0065), as well as the width of the functional space between C1 and C2 (significant decrease, p = 0.0042). Moreover, the cervical lordosis was restored after the end of the treatment (p < 0.0001). Conclusions: Cooperation of physiotherapists with dental practitioners is necessary in the treatment of patients with TMD, including temporomandibular joint osteoarthritis.

Potential adjunct therapies for the management of temporomandibular disorders: An evidence-based review

OBJECTIVE

The aim was to review the role of adjuvant therapies that may potentially contribute toward the management of temporomandibular disorders (TMD).

METHODS

The addressed focused question was, "Are there any adjuvant therapies that may contribute toward the management of TMD?". Indexed databases were searched up to June 2021. The eligibility criteria were the following: (a) original clinical studies and (b) randomized controlled clinical trials (RCTs).

RESULTS

Adjuvant therapies were comprised of acupuncture, manual therapy, jaw exercises, dietary modifications, botulinum toxin therapy, and photobiomodulation. Short-term follow-up results from each of these RCTs showed beneficial effects in terms of pain reduction and improvements in jaw movement among patients with TMD. There are no long-term follow-up results in this regard.

CONCLUSION

The most effective adjunct treatment for managing TMD remains unknown, primarily due to a lack of sufficient scientific evidence.

The effectiveness of manual therapy applied to craniomandibular structures in temporomandibular disorders: a systematic review

Within physical therapy, manual therapy is known to be effective for managing temporomandibular disorders (TMDs). However, manual therapy is a broad term including different approaches applied to different body regions. This is the first systematic review that aims to evaluate the effectiveness of manual therapy applied specifically to the craniomandibular structures (Cranio-Mandibular Manual Therapy (CMMT)) on pain and maximum mouth opening in people with TMD. This systematic review was developed based on a pre-determined published protocol which was prospectively registered with PROSPERO (CRD42019160213). A search of MEDLINE, Embase, CINAHL, ZETOC, Web of Science, SCOPUS, PEDro, PubMed, Cochrane Library and Best Evidence, EBM reviews-Cochrane Central Register of Controlled Trials, Index to Chiropractic Literature ChiroAccess and Google Scholar databases was conducted from inception until October 2020. Randomised controlled trials comparing the effect of CMMT on pain and maximum mouth opening versus other types of treatment in TMDs were included. Two reviewers independently screened articles for inclusion, extracted data, assessed risk of bias with the revised Cochrane risk of bias tool for randomised trials and evaluated the overall quality of evidence with the Grading of Recommendations, Assessment, Development and Evaluations. A total of 2720 records were screened, of which only 6 (293 participants) satisfied the inclusion criteria. All studies showed some concerns in risk of bias, except for one, which was high risk of bias. The overall quality of evidence was very low for all outcomes because of high heterogeneity and small sample sizes. All studies showed a significant improvement in pain and maximum mouth opening for CMMT from baseline in the mid-term, but only two showed superiority compared to other interventions. Given the high heterogeneity and small sample sizes of the included studies, a quantitative synthesis was not performed. There is the need for future high methodology research investigating different manual therapy techniques applied to different regions and different populations (e.g., chronic versus acute TMD) to determine what is most effective for pain and maximum mouth opening in patients with TMDs.

Bruxism in children and adolescents with cerebral palsy

This study aims to summarize the existing evidence from primary studies in order to answer the following question: "are children and adolescents with cerebral palsy (CP) frequently affected by bruxism?". For such, databases Web of Science, Medline (via PubMed), Lilacs, SciELO, Scopus and Wiley Online Library were used, with the keywords “Cerebral Palsy” and “Bruxism” alone and in combination, without the restriction of the publication date. The search included all articles published until May 2020. A total of 229 publications were found, of which 12 were selected, after careful analysis. Retrospective data analyses, cross-sectional studies and observational case-control studies published in English and with samples composed of children and/or adolescents were included. Case reports, literature reviews and studies whose sample consisted of adults-only were excluded. In the evaluated studies, bruxism was present in all samples with cerebral palsy. However, oral signs and symptoms resulting from this parafunction were reported only in three studies, in which the presence of dental wear and pain was evaluated. Therefore, bruxism in children and adolescents with cerebral palsy is a frequent oral condition, however, knowledge about the associated and risk factors for the occurrence of this problem in these patients remains limited.

The effectiveness of manual therapy applied to craniomandibular structures in the treatment of temporomandibular disorders: protocol for a systematic review

BACKGROUND

The term temporomandibular disorder (TMD) includes disorders of the temporomandibular joints (TMJ), masticatory muscles and adjacent tissues. Several studies have examined the effectiveness of manual therapy (MT) for TMDs by evaluating changes in pain and maximum mouth opening (MMO). Nevertheless, the effectiveness of MT exclusively applied to the craniomandibular structures (craniomandibular manual therapy (CMMT)) on pain and TMJ range of motion remains unclear. This review aims to evaluate the effectiveness of CMMT on pain and TMJ range of motion in people with TMDs.

METHODS

This protocol is reported in line with the preferred reporting items for systematic reviews and meta-analysis protocols (PRISMA-P). Databases including MEDLINE, Embase, CINAHL, ZETOC, Web of Science, SCOPUS, PEDro, PubMed, Cochrane Library and Best Evidence, EBM reviews-Cochrane Central Register of Controlled Trials, Index to Chiropractic Literature ChiroAccess and Google Scholar will be searched from inception as well as key journals and grey literature. Randomised controlled trials involving adults with TMD that compare the effect of any type of CMMT (e.g. mobilisation) on pain and range of motion with a placebo intervention, controlled care intervention or other types of treatment will be included. Two reviewers will independently screen articles for inclusion, extract data, assess risk of bias (revised Cochrane risk of bias tool) for included studies and evaluate overall quality of evidence (Grading of Recommendations Assessment, Development and Evaluation). A meta-analysis will be conducted if possible. If not, a narrative synthesis will be conducted reporting the effectiveness of CMMT according to disorder type (TMJ disorders, masticatory muscle disorders and mixed disorders).

DISCUSSION

In this review, the effectiveness of MT applied to craniomandibular structures for the treatment of TMD will be evaluated. Results will be submitted for publication in a peer-reviewed journal and presented at conferences. We expect our findings will facilitate treatment planning for manual therapists managing patients with TMD and provide future clinical research implications.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019160213.

Efficacy of occlusal splints in the treatment of temporomandibular disorders: a systematic review of randomized controlled trials

OBJECTIVE

This systematic review aimed to assess the efficacy of occlusal splints in the treatment of temporomandibular disorders (TMDs).

MATERIAL AND METHODS

This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Four databases (Medline via Pubmed, Web of Science, Embase and Scopus) were searched, the last search was conducted on April 2020. Randomised controlled trials (RCTs) employing the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) or Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) as diagnostic criteria and including occlusal splint as one of the experimental groups were included in the present study. The data from the included studies were extracted and assessed for risk of bias.

RESULTS

Eleven studies were included. The sample size ranged from 12 to 96 subjects. The male to female ratio was 0 to 25%. The mean length of follow-up was 4 months. Occlusal splint had a positive effect on mandibular movements in all included studies. Seven studies showed a positive effect of occlusal splint on chronic pain reduction and pain intensity, while two others showed improvement of temporomandibular joint clicking sounds and locking of the jaws. Moreover, improvements in mouth opening, depression, and anxiety symptoms, were reported in four studies.

CONCLUSIONS

An occlusal splint can be considered as a non-invasive treatment approach for patients with TMD, especially those with signs and symptoms of restriction of mandibular movement and pain. Moreover, the present findings highlighted an urgent need of a standardised consensus regarding the prognostic evaluation of TMD.

Effcacy of Manual Therapy in TemporomandibularJoint Disorders and Its Medium-and Long-TermEffects on Pain and Maximum Mouth Opening:A Systematic Review and Meta-Analysis

The aim of this study was to conduct a systematic review of the medium- and long-term efficacy of manual therapy for temporomandibular joint disorders, alone or in combination with therapeutic exercise. Information was compiled from the PubMed, SCOPUS, Cochrane, SciELO and PEDro databases. The inclusion criteria were established: randomized controlled trials only; participants must present any kind of temporomandibular disorder; the treatments must include manual therapy in at least one of the experimental groups; a minimum of 3 months of follow-up; pain must be one of the primary or secondary outcomes; and the article must be available in English, Spanish, Italian, Portuguese or French. Six documents that fulfilled all the criteria were obtained for analysis, two of them considered low quality and four considered high quality. A significant improvement in pain and mouth opening compared to baseline was observed after manual therapy treatment. Manual therapy seems to be an effective treatment for temporomandibular disorders in the medium term, although the effect appears to decrease over time. However, when complemented with therapeutic exercise, these effects can be maintained in the long term. This review underlines the importance of manual therapy and therapeutic exercise for the medium- and long-term treatment of temporomandibular joint disorders in daily practice.

Level of awareness of dentists about the role of physiotherapy in temporomandibular disorders: a pilot study in Riyadh, Saudi Arabia

Background

Physiotherapy (PT) is a distinguished developing profession. It has a crucial role in treating temporomandibular disorders (TMD) as an effective intervention to reduce pain and improve TMD symptoms. Not all dentists are aware of the importance of collaboration with physiotherapists (PTs).Therefore, this study aimed to assess the level of dentists’ awareness about the role of PT in treating TMD, identify dentists’ willingness to collaborate with PTs, and create collaboration awareness. This cross-sectional study included Saudi dentists in Riyadh. An online survey was used to assess dentist’s awareness and their readiness to collaborate with PTs.

Results

Out of 1500 dentists, only 162 participated in the survey. About 46.9% of dentists were aware that PT can treat TMD. Generally, there was lack of awareness about the benefits of PT among dentists (61.8%), and 59.9% was not aware that the evidence suggested that PT can improve TMD symptoms. Only 29% referred patients to PT. Upon the completion of the survey, almost all dentists (97.5%) were likely to refer patients with TMD to PT, and 90.7% of them showed interest to learn more about collaborating with PTs.

Conclusion

The study concluded that, although 46.9% of the dentists are aware about the role of PT in treating TMD, there is a lack of awareness about the benefits of PT among the majority of them. The study helped to extend the awareness of surveyed dentists about the collaboration and multidisciplinary approach.

Medicare coverage patterns favor non-invasive and minimally-invasive treatments of knee osteoarthritis compared to temporomandibular joint osteoarthritis

OBJECTIVE

To compare Medicare coverage patterns for treatments of knee osteoarthritis (OA) to those of temporomandibular joint (TMJ) OA.

METHODS

The International Classification of Diseases (ICD)-10 codes were used to identify knee OA, TMJ OA, and related diagnoses. The AAPC Coder was utilized to search for Medicare insurance coverage by state/district for the indicated CPT codes. The coverage for treatments of TMJ OA and knee OA was analyzed by Fisher's exact test.

RESULTS

There was a statistically significant difference in the coverage of physical therapy, massage therapy, and arthrocentesis for TMJ OA and knee OA. The current study showed that arthrocentesis was covered 100% in all states/districts for knee OA and 0% for TMJ OA.

CONCLUSION

Medicare covers TMJ OA treatments to a lesser degree than knee treatments. Documentation of this discrepancy serves as an important first step in advocating for improvements in coverage, and subsequently, in access to care.

Effect of Manual Therapy and Splint Therapy in People with Temporomandibular Disorders: A Preliminary Study

Background: Isolated manual therapy techniques (MT) have shown beneficial effects in patients with temporomandibular disorders (TMD) but the effect of the combination of such techniques, together with the well-stablished splint therapy (ST) remains to be elucidated. Objective: This study was conducted to ascertain whether a combined program of MT techniques, including intraoral treatment, plus traditional ST improves pain and clinical dysfunction in subjects with TMD. Methods: A preliminary trial was conducted. 16 participants were assigned to either the MT plus ST-Experimental Group (EG, n = 8) or the ST alone—Control Group (CG, n = 8). Forty-five minute sessions of combined MT techniques were performed, once a week for four weeks. Three evaluations were conducted: baseline, post-treatment, and one-month follow-up. Outcome measures were pain perception, pain pressure threshold (PPT), TMD dysfunction, and perception of change after treatment. Results: EG showed significant reduction on pain, higher PPT, significant improvement of dysfunction and significantly positive perception of change after treatment (p < 0.05 all). Additionally, such positive effects were maintained at follow-up with a high treatment effect (R² explaining 26.6–33.2% of all variables). Conclusion: MT plus ST showed reduction on perceived pain (3 points decrease), higher PPT (of at least 1.0 kg/cm²), improvement of disability caused by pain (4.4 points decrease), and positive perception of change (EG: 50% felt “much improvement”), compared to ST alone.

Graded exposure and orthopedic manual physical therapy for kinesiophobia and function in chronic temporomandibular dysfunction: A case report

BACKGROUND

This case report describes the successful use of multi-modal physical therapy (PT), including orthopedic manual physical therapy (OMPT) and graded exposure, in a patient with chronic temporomandibular dysfunction (TMD).

CLINICAL PRESENTATION

A 41-yr old female presented with a five-year history of bilateral chronic myofascial TMD and comorbid neck/right arm pain. The patient was treated for 12 weeks with a focus on OMPT and graded exposure. The patient demonstrated clinically significant improvements on the Tampa Scale of Kinesiophobia-TMD, maximal mouth opening, Global Rating of Change, and Jaw Functional Limitation Scale.

CLINICAL RELEVANCE

Mechanisms underlying chronic TMD are complex. Current evidence supports PT management of physical impairments; however, neglecting central drivers or psychosocial factors may result in suboptimal outcomes. Physical therapists are able to address both peripheral and central mechanisms of pain, and future research should examine the utilization of multi-modal PT to improve kinesiophobia and function in patients with chronic TMD.

No evidence on the effectiveness of oral splints for the management of temporomandibular joint dysfunction pain in both short and long-term follow-up systematic reviews and meta-analysis studies

The aim of this study was to determine the efficacy of oral splints in reducing the intensity of pain in patients with temporomandibular joint dysfunction in both short and long-term treatment durations. Electronic databases, Cochrane Library, MEDLINE via PubMed, Web of Science, Egyptian Knowledge Bank, and EMBASE were searched for randomized controlled trials comparing different types of splints to non-occluding splints, behavioral therapy, pharmacotherapy, counseling, and no treatment. The risk of bias was assessed by using Cochrane risk of bias recommendations. Fixed and random effects were used to summarize the outcomes. The effect estimates were expressed as standardized mean differences (SMD) or risk ratios with a 95% confidence interval (CI). Subgroup analyses were carried out according to the treatment duration. Twenty-two studies met the inclusion criteria. A meta-analysis of short-term studies up to three months revealed no significant difference between the study groups. However, long-term studies exhibited a significant difference in pain reduction in favor of the control group. Total analysis revealed that the control group resulted in significant pain reduction (SMD 0.14, 95% CI 0.05-0.23, P=0.002, I²=0%). Oral splints are not effective in reducing pain intensity or improving function in patients with temporomandibular joint dysfunction.

Thoracic spine manipulation did not improve maximal mouth opening in participants with temporomandibular dysfunction

BACKGROUND AND PURPOSE

Temporomandibular joint disorders (TMD) have a prevalence of more than 5% in the general population. A positive correlation exists between temporomandibular joint mobility and cervical spine mobility. Similarly, a relationship exists between thoracic and cervical spine mobility. However, it is unknown if interventions to improve the mobility of the thoracic spine positively impact temporomandibular joint motion and pain. This study tested the hypothesis that a single thoracic thrust joint manipulation (TJM) would improve maximum mouth opening (MMO) compared with participants without TMD as well as decrease TMD symptoms.

METHODS

Forty-eight people with TMD (30.9 years old ±11.3) and 55 people without TMD (28.5 years old ±9.2) participated. Both groups received a seated upper thoracic TJM and were measured for MMO before and immediately following the TJM. The duration of TMD symptoms and pre-thrust current pain, using the 11-point Verbal Pain Rating Scale (VPRS), was recorded in the TMD group. Participants in the TMD group were contacted 2-3 days after TJM to report current VPRS and improvement utilizing the Global Rating of Change (GROC) scale.

RESULTS

No difference in MMO treatment response over time was observed between groups (p = .56). The MMO in the TMD group improved from 40 to 41.3 mm, and the non-TMD similarly improved from 44.5 to 45.4 mm. The VPRS decreased from 2.4 (±1.8) to 1.3 (±1.5) following thoracic TJM (p < .001), and the average GROC score was 1.8 (±2.25), which was statistically different than zero (no change; p < .001). The duration of TMD symptoms prior to TJM was not associated with GROC scores (r = .018, p = .90) or VPRS change scores (r = -.07, p = .64).

CONCLUSION

The observed treatment effects did not exceed previously reported standards for clinical relevance (5 mm and 2 points, respectively).

Predictors of pain reduction following manual therapy in patients with temporomandibular disorders: a protocol for a prospective observational study

INTRODUCTION

Temporomandibular disorders (TMDs) are principally characterised by pain in the craniomandibular area and probable limitations of jaw opening. Manual therapy, like other recommended conservative treatments included in clinical guidelines, is commonly used to treat patients with TMD to reduce pain and improve function. However, outcomes may be variable. The aim of this study is to identify predictors associated with pain reduction in patients with TMD following manual therapy by analysing a combination of patient-reported outcome measures and clinical tests. Such knowledge will support a more personalised management approach by facilitating clinical decision-making.

METHODS/ANALYSIS

An observational prospective design will recruit a cohort of 100 adults with a diagnosis of TMD (according to Axis I of the Diagnostic Criteria for TMD) at a Dental Hospital in Italy. Patients will be treated with four weekly sessions of manual therapy applied to craniomandibular structures. An array of predictors has been chosen based on previous research on prognostic factors for TMD and altered pain modulation in musculoskeletal disorders. Candidate predictors including demographic variables, general health variables, psychosocial features, TMD characteristics and clinical tests of the temporomandibular joint and masticatory muscles will be collected at baseline. Definition of good outcome is a clinically significant reduction of pain intensity over the last week (≥30% reduction Visual Analogue Scale) immediately following the four week intervention. Exploratory factor analysis will be applied to analyse factor loading of candidate predictors for good outcome at four weeks. Subsequently, a logistic multivariable regression model will be performed to calculate low and high risk of good outcome.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the 'Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico' and University of Birmingham Ethics Committee. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.

TRIAL REGISTRATION NUMBER

NCT03990662; Pre-results.

Effect of deprogramming splint and occlusal equilibration on condylar position of TMD patients - A CBCT assessment

Objective: Assessment of clinical symptoms and condylar position of TMD patients using CBCT imaging with deprogramming splint therapy and occlusal equilibration. The hypothesis tested was the alleviation of symptoms of TMD with possible changes in condylar position occurs with this treatment.Methods: The condylar position of 12 TMD patients was observed from CBCT images, and clinically, symptom severity score, mouth opening, and range of motion were compared pre- and post-treatment.Results: All patients reported a statistically significant decrease in the symptom severity score and increase in mouth opening and range of motion (p < .05). A significant decrease was only achieved in the left anterior joint space (p < .05).Conclusion: Deprogramming splint therapy and occlusal equilibration benefitted patients with a reduction in clinical symptoms, and minor changes in condylar position were observed.

Effects of a mouth-opening intervention with remote support on adherence, the maximum interincisal opening, and mandibular function of postoperative oral cancer patients: A randomized clinical trial

PURPOSE

The purpose of the study was to investigate the effects of a mouth-opening intervention for postoperative trismus and remote support provided via telephone following hospital discharge for intervention adherence in patients with oral cancer.

METHODS

The study is a parallel randomized trial. Patients admitted at a general hospital for oral cancer surgery were recruited and randomly assigned to either the experimental or the active control group. Both groups underwent a 12-week intervention program, including warm compress, masticatory muscle massage, and jaw exercise. Subjects in the experimental group received additional support via telephone following hospital discharge. Data on intervention adherence maximum interincisal opening and mandibular function impairment were collected at baseline, week 4, and week 12.

RESULTS

Sixty subjects (30 in each group) that completed the study were included in the analysis. At week 12, the intervention practice time in the experimental group was 299.67 min (95% CI: 223.44-357.89) more than that of the active control group. From baseline to week 12, the change in maximum interincisal opening was 10.30 mm (95% CI: 8.22-12.37) greater in the experimental than in the active control group. The change in mandibular function impairment score was -0.36 (95% CI: -0.44 to -0.28) greater in the experimental than in the active control group.

CONCLUSIONS

The study results support the effect of remote support via telephone for enhancing adherence to the intervention protocol, and the effect of the intervention program for alleviating trismus and mandibular function impairments in patients who receive curative surgery for oral cancer.

Comparative Evaluation of Salivary Cortisol Levels in Bruxism Patients Before and After Using Soft Occlusal Splint: An in vivo Study

Introduction

Bruxism is defined as a nonfunctional activity or a parafunctional habit characterized by the unconscious repetitive motion of clenching and/or grinding of the teeth. Soft occlusal splints have been considered as the first-line strategy for treating nocturnal bruxism. Cortisol is a major steroid hormone secreted by fascicular zone of the adrenal cortex, belonging to the glucocorticosteroidal group of hormones. Clinical studies have shown that when humans are placed under stress, the hypothalamic-pituitary-adrenocortical axis is activated, leading to an increase in cortical secretion. However, the effect of splint is questionable by some researchers, and best way to perceive the effect of soft splints in patients with bruxism is by evaluating the stress levels.

Materials and Methods

A total of 20 individuals suffering from bruxism were selected from the Outpatient Department of Prosthodontics and Crown and Bridge, JSS Dental College and Hospital, Mysore. Saliva samples were collected before and after using the occlusal soft splints and subjected to enzyme-linked immunosorbent assay for determining the salivary cortisol levels.

Results

The collected data were subjected to appropriate descriptive statistics, paired sample t-test, and one sample t-test. The paired sample t-test shows that intragroup comparison of the mean cortisol level in the study group shows near significant values, which means there is a decrease in the salivary cortisol levels in patients after using soft occlusal splint, but statistically nonsignificant.

Conclusion

In the present study, it has been found that 70% of individuals after using the soft occlusal splint showed decreased cortisol levels.

Magnetic resonance and sonographic imagings of masticatory muscle myalgia in temporomandibular disorder patients

This article reviews recently published studies investigating the MRI and sonographic diagnosis of masticatory muscle myalgia in temporomandibular disorder patients. The MRI and sonographic features of muscle after treatment are also discussed. Literature published within the last 15 years was obtained from the PubMed database using the following Mesh terms: magnetic resonance imaging (MRI) or sonography, masticatory muscle pain, and treatment. MRI and sonography enable accurate visualization and evaluation of the masticatory muscles, thereby increasing our understanding of pathology and cause of pain associated with these muscles. Although therapeutic efficacy is often evaluated based on clinical findings, MR and sonographic imaging studies may also be valuable.

Stretch for the treatment and prevention of contractures

BACKGROUND

Contractures are a common complication of neurological and non-neurological conditions, and are characterised by a reduction in joint mobility. Stretch is widely used for the treatment and prevention of contractures. However, it is not clear whether stretch is effective. This review is an update of the original 2010 version of this review.

OBJECTIVES

The aim of this review was to determine the effects of stretch on contractures in people with, or at risk of developing, contractures.The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions, spasticity and adverse events.

SEARCH METHODS

In November 2015 we searched CENTRAL, DARE, HTA; MEDLINE; Embase; CINAHL; SCI-EXPANDED; PEDro and trials registries.

SELECTION CRITERIA

We included randomised controlled trials and controlled clinical trials of stretch applied for the purpose of treating or preventing contractures.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials, extracted data, and assessed risk of bias. The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions and adverse events. We evaluated outcomes in the short term (up to one week after the last stretch) and in the long term (more than one week). We expressed effects as mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). We conducted meta-analyses with a random-effects model. We assessed the quality of the body of evidence for the main outcomes using GRADE.

MAIN RESULTS

Forty-nine studies with 2135 participants met the inclusion criteria. No study performed stretch for more than seven months. Just over half the studies (51%) were at low risk of selection bias; all studies were at risk of detection bias for self reported outcomes such as pain and at risk of performance bias due to difficulty of blinding the intervention. However, most studies were at low risk of detection bias for objective outcomes including range of motion, and the majority of studies were free from attrition and selective reporting biases. The effect of these biases were unlikely to be important, given that there was little benefit with treatment. There was high-quality evidence that stretch did not have clinically important short-term effects on joint mobility in people with neurological conditions (MD 2°; 95% CI 0° to 3°; 26 studies with 699 participants) or non-neurological conditions (SMD 0.2, 95% CI 0 to 0.3, 19 studies with 925 participants).In people with neurological conditions, it was uncertain whether stretch had clinically important short-term effects on pain (SMD 0.2; 95% CI -0.1 to 0.5; 5 studies with 174 participants) or activity limitations (SMD 0.2; 95% CI -0.1 to 0.5; 8 studies with 247 participants). No trials examined the short-term effects of stretch on quality of life or participation restrictions in people with neurological conditions. Five studies involving 145 participants reported eight adverse events including skin breakdown, bruising, blisters and pain but it was not possible to statistically analyse these data.In people with non-neurological conditions, there was high-quality evidence that stretch did not have clinically important short-term effects on pain (SMD -0.2, 95% CI -0.4 to 0.1; 7 studies with 422 participants) and moderate-quality evidence that stretch did not have clinically important short-term effects on quality of life (SMD 0.3, 95% CI -0.1 to 0.7; 2 studies with 97 participants). The short-term effect of stretch on activity limitations (SMD 0.1; 95% CI -0.2 to 0.3; 5 studies with 356 participants) and participation restrictions were uncertain (SMD -0.2; 95% CI -0.6 to 0.1; 2 studies with 192 participants). Nine studies involving 635 participants reported 41 adverse events including numbness, pain, Raynauds' phenomenon, venous thrombosis, need for manipulation under anaesthesia, wound infections, haematoma, flexion deficits and swelling but it was not possible to statistically analyse these data.

AUTHORS' CONCLUSIONS

There was high-quality evidence that stretch did not have clinically important effects on joint mobility in people with or without neurological conditions if performed for less than seven months. Sensitivity analyses indicate results were robust in studies at risk of selection and detection biases in comparison to studies at low risk of bias. Sub-group analyses also suggest the effect of stretch is consistent in people with different types of neurological or non-neurological conditions. The effects of stretch performed for periods longer than seven months have not been investigated. There was moderate- and high-quality evidence that stretch did not have clinically important short-term effects on quality of life or pain in people with non-neurological conditions, respectively. The short-term effects of stretch on quality of life and pain in people with neurological conditions, and the short-term effects of stretch on activity limitations and participation restrictions for people with and without neurological conditions are uncertain.

Effect of Flat-Plane Splint Vertical Thickness on Disc Displacement Without Reduction: A Retrospective Matched-Cohort Study

PURPOSE

The efficacy of occlusal splints for treating temporomandibular disorders (TMDs) remains controversial. This study aimed to evaluate and compare the effectiveness of flat-plane splints (FPSs) with a vertical thickness of 3 mm (VT3) and 5 mm (VT5) in treating disc displacement without reduction (DDWOR).

MATERIALS AND METHODS

This retrospective matched-cohort study selected the study participants from 400 TMD patients treated in the Department of Oral and Maxillofacial Surgery of Tainan Sin-Lau Hospital, Tainan, Taiwan, between August 2013 and July 2015. The thickness of occlusal splints was the predictor variable. The outcome variables included joint crepitus sound, deviation of the mandible during opening, TMD-associated headache, myofascial pain with referral, temporomandibular joint (TMJ) arthralgia, and maximum assisted opening. The case and control groups were matched 1:1 by propensity scoring to ensure that there were no statistical differences in the categorical variables and continuous variables. The analysis used χ² tests, t tests, and multiple regression analyses.

RESULTS

We allocated 162 patients into 2 groups, with 81 patients each: VT3 group and VT5 group. Both VT3 FPSs and VT5 FPSs effectively improved the DDWOR. At 12 months after treatment, the VT5 group showed remarkable improvement in joint crepitus sound and TMJ arthralgia compared with the VT3 group. No statistical differences in other TMJ-associated symptoms such as deviation of the mandible during opening, TMD-associated headache, and myofascial pain with referral were observed between the 2 groups.

CONCLUSIONS

Both VT3 and VT5 FPSs can effectively improve various clinical symptoms of DDWOR. We suggest that VT5 FPS treatment for at least 1 year is a suitable option for DDWOR patients with joint crepitus sound and TMJ arthralgia. For DDWOR patients without joint crepitus sound and TMJ arthralgia, there are no differences between the VT3 and VT5 FPSs.

Correlation between temporomandibular disorder and quality of sleep in women

Abstract Introduction: Temporomandibular Disorder (TMD) is caused by multiple factors and exhibits various symptoms. Its most common symptom is pain, a factor that can influence the quality of an individual's sleep. Objective: The aim of the present study was to assess the correlation between TMD and sleep. Methods: A cross-sectional study was conducted with 60 women, aged between 18 and 40 years, who had been diagnosed with TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Fonseca's anamnestic index (FAI) was used to classify the severity of the dysfunction. To complete the assessment, each volunteer was assessed using the visual analogue scale (VAS) for pain. They also responded to two questions related to their quality of sleep and the average hours of sleep per night. Results: The more severe the TMD, the fewer hours of sleep per night (r = -0.5663). In total, 63.33% of the volunteers reported not sleeping well. Concerning pain, the greater the VAS score, the less hours of sleep (r = -0.516) and the more severe the TMD. Conclusion: It was found that the severityof TMD was correlated with pain symptoms and the number of hours of sleep per night.

Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up

This study investigated the efficacy of combining low-level laser therapy (LLLT) with oral motor exercises (OM-exercises) for rehabilitation of patients with chronic temporomandibular disorders (TMDs). Eighty-two patients with chronic TMD and 20 healthy subjects (control group) participated in the study. Patients were randomly assigned to treatment groups: GI (LLLT + OM exercises), GII (orofacial myofunctional therapy-OMT-which contains pain relief strategies and OM-exercises), and GIII (LLLT placebo + OM-exercises) and GIV (LLLT). LLLT (AsGaAl; 780-nm wavelength; average power of 60 mW, 40 s, and 60 ± 1.0 J/cm²) was used to promote analgesia, while OM-exercises were used to reestablish the orofacial functions. Evaluations at baseline (T1), after treatment immediate (T2), and at follow-up (T3) were muscle and joint tenderness to palpation, TMD severity, and orofacial myofunctional status. There was a significant improvement in outcome measures in all treated groups with stability at follow-up (Friedman test, P < 0.05), but GIV did not show difference in orofacial functions after LLLT (P > 0.05). Intergroup comparisons showed that all treated groups had no difference in tenderness to palpation of temporal muscle compared to GC at follow-up (Kruskal-Wallis test, P < 0.01). Moreover, GI, GII, and GIII showed no difference from GC in orofacial functional condition (T2 and T3) while they differed significantly from GIV (P < 0.01). In conclusion, LLLT combined with OM-exercises was more effective in promoting TMD rehabilitation than LLLT alone was. Similar treatment results were verified with the OMT protocol.

Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis

BACKGROUND

Manual therapy (MT) and exercise have been extensively used to treat people with musculoskeletal conditions such as temporomandibular disorders (TMD). The evidence regarding their effectiveness provided by early systematic reviews is outdated.

PURPOSE

The aim of this study was to summarize evidence from and evaluate the methodological quality of randomized controlled trials that examined the effectiveness of MT and therapeutic exercise interventions compared with other active interventions or standard care for treatment of TMD.

DATA SOURCES

Electronic data searches of 6 databases were performed, in addition to a manual search.

STUDY SELECTION

Randomized controlled trials involving adults with TMD that compared any type of MT intervention (eg, mobilization, manipulation) or exercise therapy with a placebo intervention, controlled comparison intervention, or standard care were included. The main outcomes of this systematic review were pain, range of motion, and oral function. Forty-eight studies met the inclusion criteria and were analyzed.

DATA EXTRACTION

Data were extracted in duplicate on specific study characteristics.

DATA SYNTHESIS

The overall evidence for this systematic review was considered low. The trials included in this review had unclear or high risk of bias. Thus, the evidence was generally downgraded based on assessments of risk of bias. Most of the effect sizes were low to moderate, with no clear indication of superiority of exercises versus other conservative treatments for TMD. However, MT alone or in combination with exercises at the jaw or cervical level showed promising effects.

LIMITATIONS

Quality of the evidence and heterogeneity of the studies were limitations of the study.

CONCLUSIONS

No high-quality evidence was found, indicating that there is great uncertainty about the effectiveness of exercise and MT for treatment of TMD.

Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials

There is a lack of knowledge about the effectiveness of manual therapy (MT) on subjects with temporomandibular disorders (TMD). The aim of this systematic review is to synthetise evidence regarding the isolated effect of MT in improving maximum mouth opening (MMO) and pain in subjects with signs and symptoms of TMD. MEDLINE(®) , Cochrane, Web of Science, SciELO and EMBASE(™) electronic databases were consulted, searching for randomised controlled trials applying MT for TMD compared to other intervention, no intervention or placebo. Two authors independently extracted data, PEDro scale was used to assess risk of bias, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) was applied to synthetise overall quality of the body of evidence. Treatment effect size was calculated for pain, MMO and pressure pain threshold (PPT). Eight trials were included, seven of high methodological quality. Myofascial release and massage techniques applied on the masticatory muscles are more effective than control (low to moderate evidence) but as effective as toxin botulinum injections (moderate evidence). Upper cervical spine thrust manipulation or mobilisation techniques are more effective than control (low to high evidence), while thoracic manipulations are not. There is moderate-to-high evidence that MT techniques protocols are effective. The methodological heterogeneity across trials protocols frequently contributed to decrease quality of evidence. In conclusion, there is widely varying evidence that MT improves pain, MMO and PPT in subjects with TMD signs and symptoms, depending on the technique. Further studies should consider using standardised evaluations and better study designs to strengthen clinical relevance.

Correlation of stress and muscle activity of patients with different degrees of temporomandibular disorder

[Purpose] Temporomandibular disorder is one of the many different adverse health conditions that can be triggered by stress. Therefore, a biopsychosocial model has been proposed to characterize the multifactorial nature of temporomandibular disorder. The aim of the present study was investigate the correlation of salivary cortisol levels with the activities of the masseter and anterior temporal muscles of patients with different degrees of temporomandibular disorder. [Subjects and Methods] Forty-nine women between 18 and 40 years of age with a diagnosis of myogenous temporomandibular disorder based on the Research Diagnostic Criteria for temporomandibular disorders were evaluated using the Fonseca Index to determine the degree of the disorder. Salivary cortisol levels were determined and surface electromyography was used to evaluate electrical activity in the masticatory muscles. [Results] Positive correlations were found among the degree of temporomandibular disorder, electromyographic activity and salivary cortisol: as women with more severe temporomandibular disorder had greater electrical activity in the muscles analyzed, especially the anterior temporal muscle, and higher levels of cortisol. [Conclusion] Muscle activity was greater among individuals with severe temporomandibular disorder and positive correlations were found among electromyographic activity, salivary cortisol and the degree of temporomandibular disorder severity.

Effects of massage therapy and occlusal splint therapy on electromyographic activity and the intensity of signs and symptoms in individuals with temporomandibular disorder and sleep bruxism: a randomized clinical trial

Introduction

Temporomandibular disorder (TDM) is the most common source of orofacial pain of a non-dental origin. Sleep bruxism is characterized by clenching and/or grinding the teeth during sleep and is involved in the perpetuation of TMD. The aim of the present study was to investigate the effects of massage therapy, conventional occlusal splint therapy and silicone occlusal splint therapy on electromyographic activity in the masseter and anterior temporal muscles and the intensity of signs and symptoms in individuals with severe TMD and sleep bruxism.

Methods

Sixty individuals with severe TMD and sleep bruxism were randomly distributed into four treatment groups: 1) massage group, 2) conventional occlusal splint group, 3) massage + conventional occlusal splint group and 4) silicone occlusal splint group. Block randomization was employed and sealed opaque envelopes were used to conceal the allocation. Groups 2, 3 and 4 wore an occlusal splint for four weeks. Groups 1 and 3 received three weekly massage sessions for four weeks. All groups were evaluated before and after treatment through electromyographic analysis of the masseter and anterior temporal muscles and the Fonseca Patient History Index. The Wilcoxon test was used to compare the effects of the different treatments and repeated-measures ANOVA was used to determine the intensity of TMD.

Results

The inter-group analysis of variance revealed no statistically significant differences in median frequency among the groups prior to treatment. In the intra-group analysis, no statistically significant differences were found between pre-treatment and post-treatment evaluations in any of the groups. Group 3 demonstrated a greater improvement in the intensity of TMD in comparison to the other groups.

Conclusion

Massage therapy and the use of an occlusal splint had no significant influence on electromyographic activity of the masseter or anterior temporal muscles. However, the combination of therapies led to a reduction in the intensity of signs and symptoms among individuals with severe TMD and sleep bruxism.

Trial registration

This study is registered in August, 2014 in the ClinicalTrials.gov (NCT01874041).

Electronic supplementary material

The online version of this article (doi:10.1186/s12998-014-0043-6) contains supplementary material, which is available to authorized users.