Electrical physical therapy in treating TMJ patients

Physical medicine modalities and trigger point injections in the management of temporomandibular disorders and assessing treatment outcome

Temporomandibular disorders (TMDs) are principally musculoskeletal, orthopedic, and neurologic in nature. The use of trigger point injections and physical medicine modalities has become commonplace in the management of TMDs. These modalities have a long and successful history in the management of similar disorders in other areas of the body, and it is only natural that they would be included in the management of TMD as well.

Outcome of 6-week treatment with transcutaneous electric nerve stimulation compared with splint on symptomatic temporomandibular joint disk displacement without reduction

The aim of the present study was to compare the effect of transcutaneous electric nerve stimulation (TENS) with the flat occlusal splint in the treatment of temporomandibular joint (TMJ) disk displacement without reduction. Thirty-one patients were included and randomly selected to be treated 6 weeks with either TENS (90 Hz, 30 min, three times/day) or with a flat occlusal splint (24 h/day. Those selected for the TENS group had one electrode placed over the painful TMJ and another electrode over the anterior temporal muscle. The splint group used a conventional flat occlusal splint with cuspid guidance. Both treatment groups visited the clinic once a week. Symptoms and signs were registered before and after treatment. The intensity of pain was recorded with a visual analogue scale (VAS) and with an electronic pocket-sized recorder (Pain-Track) carried 1 week before and also the last week of treatment for continuous registration of pain. Measured with the VAS, half of the patients treated with splints became pain-free or their TMJ pain improved at least 50% both at rest and with jaw function compared with only 6% in the TENS-treated group. With regard to strictly chewing pain, the VAS-registered pain improved in two-thirds of the splint group, compared with 50% of the TENS group. With the Pain-Track device it was found that in most individuals pain was aggrevated at mealtimes. The conclusion was that flat occlusal splints in several respects are better than TENS in the treatment of symptoms associated with TMJ disk displacement without reduction.

Physical therapy techniques in the treatment of the head and neck patient

Limited jaw openings, which may develop following surgery and radiation therapy is a significant clinical problem. Some patients develop restricted oral opening because of extensive fibrosis and scarring of the affected tissues. The aid of the physical therapist is invaluable in the treatment of these patients.

The effect of physical therapy intervention on incisal opening after temporomandibular joint surgery

A retrospective study of 58 postoperative patients who underwent temporomandibular joint surgery was done to determine the effect of a physical therapy treatment program of ultrasound, superficial heat, and exercise on incisal opening 6 to 12 months after surgery. Twenty-nine of the subjects had surgery and physical therapy intervention, while 29 had surgery only. Patients referred for physical therapy had more complaints of pain and significantly less incisal opening after surgery than those not referred for physical therapy. Both groups, however, had achieved a comparable amount of incisal opening 6 to 12 months after surgery. Chi square analysis indicated that patients with an incisal opening of less than 30 mm postoperatively were more likely to have an incisal opening of 40 mm 6 to 12 months after surgery if they received physical therapy treatments. Patients having more than 30 mm of incisal opening a month after surgery showed a greater tendency to achieve more than 40 mm of opening if physical therapy was included in the postoperative management.

Masseter muscle nodule due to bruxism. A case in point

A 16-year-old white boy had a soft subcutaneous mass in the right masseter muscle. The pediatrician and two surgeons the patient had previously consulted had disagreed as to the origin of the mass and its treatment; their recommendations had ranged from leaving it alone to surgical excision. Treatment involved an orthopedic oral appliance restoring vertical dimension to its genetic norm and galvanic muscle stimulation. After 1 year the mass was eliminated.

Factors influencing the outcome of treatment in patients referred to a temporomandibular joint clinic

A retrospective review was performed in 350 consecutive patients referred for functional disturbances of the masticatory system. Two and one-half years after the first visit, the records of all patients were examined for clinical findings, diagnosis, and observations related to treatment. Number of visits, length of the treatment period, and evaluation of signs and symptoms at last visit (factors which showed a wide variation) were analyzed for correlation with signs and symptoms at first visit and some background factors. A total of 50 variables were considered. The number of visits and length of treatment indicated the severity of signs and symptoms at the first visit. Multiple regression analysis showed that tenderness on muscle palpation at first visit was the most important of the independent variables. About one-fourth of the variance of number of visits and length of treatment could be explained (R2 = 0.28 and 0.27, respectively), while the corresponding value for the variance of the evaluation at last visit was 15% (R2 = 0.15). The results tend to emphasize the heterogeneity of patients with functional disturbances of the masticatory system and the difficulty of prognosticating the outcome of treatment in such patients, even when attempts are made to divide them into subgroups.