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van der Meer HA, van der Wal AC, van Hinte G, Speksnijder CM. Counselling for patients with a temporomandibular disorder: A scoping review and concept analysis. J Oral Rehabil 2024. [PMID: 39225165 DOI: 10.1111/joor.13827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND An integral component of comprehensive temporomandibular disorder (TMD) treatment involves what is commonly referred to in literature as patient counselling or patient education. Despite its importance, a clear definition of the concept is lacking. OBJECTIVES To describe the concept of counselling (i.e. what is it, what should it consist of, and when should it be given) through a concept analysis of the literature. ELIGIBILITY CRITERIA All papers that include a description of counselling or education for TMD are included. SOURCES OF EVIDENCE Literature searches were performed in the electronic databases PubMed, Cinahl, and PsycInfo. CHARTING METHODS A qualitative analysis was done using the principle-based concept analysis approach, where descriptions of counselling from the included papers were analysed by the researchers. RESULTS A total of 71 articles were included. Based on the qualitative analysis of the included articles and descriptions of counselling, the following content themes were identified: (1) general information on TMD; (2) overuse of the masticatory system; (3) posture education; (4) lifestyle and psychosocial factors; (5) exercise- and thermotherapy; and (6) additional information and therapies. CONCLUSIONS A definition and framework of counselling for TMD has been provided, which can be used in the clinic, research, and educational programs.
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Affiliation(s)
- Hedwig A van der Meer
- SOMT University of Physiotherapy, Softwareweg, Amersfoort, The Netherlands
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
- Department of Oral-Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Annemarie C van der Wal
- SOMT University of Physiotherapy, Softwareweg, Amersfoort, The Netherlands
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Gerben van Hinte
- SOMT University of Physiotherapy, Softwareweg, Amersfoort, The Netherlands
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Caroline M Speksnijder
- SOMT University of Physiotherapy, Softwareweg, Amersfoort, The Netherlands
- Department of Oral-Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Romeo A, Incorvati C, Vanti C, Turolla A, Marinelli F, Defila L, Gulotta C, Marchetti C, Pillastrini P. Physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: A randomised controlled trial. J Oral Rehabil 2024; 51:1566-1578. [PMID: 38757854 DOI: 10.1111/joor.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/17/2024] [Accepted: 04/26/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Myogenic temporomandibular disorders (M-TMD) commonly involve occlusal splint (OS) therapy and musculoskeletal physiotherapy (MPT). OBJECTIVES To compare the effects of combining OS with MPT and education (EG) against OS and education (CG), in chronic M-TMD patients. METHODS In this double-blind randomised controlled trial, 62 participants were assigned to either EG or CG. The primary outcomes, pain levels at rest (VAS rest), maximum oral opening (VAS open) and during chewing (VAS chew), were measured by Visual Analogue Scale (VAS) in cm. The secondary outcome was the range of motion (ROM) for maximum oral opening. Both interventions lasted 3 months, with outcomes assessed at baseline (T0), post-treatment (T1) and 3 months post-treatment (T2). RESULTS Intention-to-treat analysis revealed significant improvements favouring EG (VAS rest = -1.50 cm [CI95%: -2.67, -0.32], p = .04; VAS open = -2.00 cm [CI95%: -3.23, -0.75], p < .01; VAS chew = -1.71 cm [CI95%: -2.90, -0.52], p = .01; ROM = 4.61 [CI95%: 0.93, 8.30], p = .04). Additionally, VAS measures were influenced by follow-up times (VAS rest = -0.73 cm [CI95%: -1.30, -0.17], p = 0.03; VAS open = -0.97 cm [CI95%: -1.57, -0.37], p < .01; VAS chew = -1.15 cm [CI95%: -1.73, -0.58], p < .01). At T1, EG demonstrated higher number of responders compared to CG for VAS open (χ2(1) = 4.39, p = .04) and VAS chew (χ2(1) = 11.58, p < .01). CONCLUSION Adding MPT to education and OS yields better outcomes in terms of pain reduction and ROM improvement, in chronic M-TMD. TRIAL REGISTRATION NUMBER NCT03726060.
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Affiliation(s)
- Antonio Romeo
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna, Italy
| | - Cristina Incorvati
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna, Italy
| | - Carla Vanti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Marinelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Defila
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna, Italy
| | - Chiara Gulotta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna, Italy
| | - Claudio Marchetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Menéndez-Torre Á, Pintado-Zugasti AM, Zaldivar JNC, García-Bermejo P, Gómez-Costa D, Molina-Álvarez M, Arribas-Romano A, Fernández-Carnero J. Effectiveness of deep dry needling versus manual therapy in the treatment of myofascial temporomandibular disorders: a systematic review and network meta-analysis. Chiropr Man Therap 2023; 31:46. [PMID: 37924127 PMCID: PMC10625247 DOI: 10.1186/s12998-023-00489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/01/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Temporomandibular disorders (TMDs) are the most common cause of orofacial pain of non-dental origin, with approximately 42% of diagnoses corresponding to myofascial pain. Manual therapy and dry needling are commonly used interventions for the treatment of myofascial temporomandibular disorders. However, it is unclear whether one of them could be superior to the other. OBJECTIVES The aim of the present systematic review and network meta-analysis was to compare the effectiveness of manual therapy and dry needling in patients with myofascial TMD. METHODS This is a systematic review and network meta-analysis. Randomized clinical trials were searched in the databases of Pubmed, PEDro, CINAHL, Web of Science, Scopus, Cochrane, Google Academic and EMBASE. The methodological quality of studies included in this review was judged using the Physiotherapy Evidence Database (PEDro) scale. A frequentist network meta-analysis was carried out, assuming random effects, to estimate the effects of interventions for temporomandibular joint pain measured on a 10-point visual analogue scale. RESULTS Out of 3190 records identified, 17 met the inclusion criteria for qualitative analysis and eight were included in the network meta-analysis. Indirect comparisons between dry needling and manual therapy showed no significant differences in their effects on pain reduction (Odds Ratio [95%CI]; - 0.263 [- 1.517, 0.992]). The ranking of treatments shows that manual therapy (SUCRA = 0.932) followed by deep dry needling (SUCRA = 0.775) present the highest values of estimation and can be considered the most likely to reduce pain. CONCLUSIONS The results of the network meta-analysis should be considered with caution due to the low quality of the evidence available and the high variability of the study protocols in terms of the method of application of dry needling and manual therapy interventions. PROSPERO under identifier: (CRD42020186470).
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Affiliation(s)
- Ángela Menéndez-Torre
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933, Alcorcón, Spain
- Servicio de Fisioterapia, Centro Médico Gava, 28600, Navalcarnero, Madrid, Spain
| | - Aitor Martín Pintado-Zugasti
- Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, 28008, Madrid, Spain
| | - Juan Nicolás Cuenca Zaldivar
- Rehabilitation Service, Guadarrama Hospital, Madrid, Spain.
- Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute - Segovia de Arana (IDIPHISA), Madrid, Spain.
| | - Paula García-Bermejo
- DINAMIA Clinic. Alfonso VI, 28806, Alcalá de Henares, Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - Diego Gómez-Costa
- Department of Nursing and Estomatology, Faculty of Health Sciences, Rey Juan Carlos University, Avenida de Atemas s/n, Alcorcón, 28922, Madrid, Spain
| | - Miguel Molina-Álvarez
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Universidad Rey Juan Carlos, Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, Madrid, Spain
| | - Alberto Arribas-Romano
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933, Alcorcón, Spain
- Department of Physical and Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922, Madrid, Spain
| | - Josué Fernández-Carnero
- Department of Physical and Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922, Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, 28046, Madrid, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora, Universidad Rey Juan Carlos-Banco de Santander, 28922, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023, Madrid, Spain
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B H S, G D, Sawal A, Balwir TP. Anatomical Basis of Obstructive Sleep Apnoea: A Review of Randomized Controlled Trials. Cureus 2023; 15:e44525. [PMID: 37789996 PMCID: PMC10544646 DOI: 10.7759/cureus.44525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Repeated obstruction and closure of the upper airway, sporadic hypoxic episodes, and sympathetic activity are symptoms of obstructive sleep apnea (OSA). Obstructive sleep apnoea is due to a combination of altered upper airway structure and muscular function, a low arousal threshold and increased loop gain. Although recurrent upper airway (UA) collapse during sleep is the most frequent clinical hallmark of OSA, the exact cause of this collapse is unknown. Furthermore, while continuous positive airway pressure aids in the management of OSA, many patients find it intolerable. As a result, a better knowledge of the causes of OSA may result in more effective treatments. We did a review of randomized controlled trials that were done in this regard in the last 10 years and whose full-text version is available on the PubMed database. A total of 20 articles were finalized for review after applying our criteria. The articles have proposed different theories regarding the anatomical basis responsible for obstructive sleep apnoea. The theories proposed by different studies in the last decade include reduced genioglossus and hypoglossal nerve activity, the pharyngeal muscles' failure to keep the airway open or tighten it, tonsils and adenoid hypertrophy, an oversensitive ventilatory control system and low respiratory arousal threshold, mandibular position, pharyngeal muscles' high sympathetic drive, cephalometric alterations such as mandibular and hyoid bone position and the length of the soft palate, obesity, and neck fat and fluid re-distribution in the body, from the lower to the upper parts while reclining. Given the diverse etiological characteristics of OSA patients and to increase our knowledge of the condition, additional study into this group is required. Filling any knowledge gaps that may exist in the anatomical basis of the onset of OSA is the main objective of this review paper.
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Affiliation(s)
- Shrikrishna B H
- Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Deepa G
- Anatomy, Datta Meghe Medical College, Nagpur, IND
| | - Anupama Sawal
- Anatomy, Jawaharlal Nehru Medical College, Sawangi, IND
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Asquini G, Devecchi V, Edoardo Bianchi A, Borromeo G, Tessera P, Falla D. External validation of a clinical prediction tool for the use of manual therapy for patients with temporomandibular disorders: a protocol for a prospective observational study. BMJ Open 2023; 13:e069327. [PMID: 37451727 PMCID: PMC10351239 DOI: 10.1136/bmjopen-2022-069327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Clinical guidelines recommend conservative treatment for the management of temporomandibular disorders (TMD), and manual therapy directed to temporomandibular structures is commonly applied to reduce pain and improve function. In a recent prospective study, we developed a clinical prediction tool based on an array of predictors to identify people with TMD who are likely to experience significant pain relief and functional improvements following a programme of manual therapies (MTP) applied to temporomandibular structures. The purpose of this study is to externally validate in a different sample (temporal validation) the prediction model obtained in the initial study. METHODS/ANALYSIS This observational prospective study will recruit a cohort of 120 adults with TMD from a Dental Hospital in Italy. The intervention will be an MTP consisting of four sessions (once per week) of manual therapy applied to temporomandibular structures. Candidate predictors included in the predictive model will be pain intensity during mouth opening, treatment expectations, number of pain locations, central sensitisation, TMD pain duration and maximal mouth opening. Outcome measures (i.e., pain intensity, functional improvement) will be collected before starting the MTP, after the last session and after 1 month (2 months from baseline). A reduction of pain intensity by at least 30% will be considered a good outcome. External validity of the prediction model will be evaluated after the last session by measuring its calibration, discrimination and overall fit. Additionally, the performance of the model will be evaluated considering the clinical outcomes collected 1 month after the last MTP session. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Committee of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy. The results will be submitted for publication in a peer-reviewed journal, and the prediction model will be implemented in a web-based calculator to facilitate its use by clinicians. TRIAL REGISTRATION NUMBER NCT03990662.
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Affiliation(s)
- Giacomo Asquini
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Craniomandibular Physiotherapy Service, Istituto Stomatologico Italiano, Milano, Italy
| | - Valter Devecchi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Andrea Edoardo Bianchi
- Craniomandibular Physiotherapy Service, Istituto Stomatologico Italiano, Milano, Italy
- Saint Camillus International University of Health Sciences, UniCamillus, Via di Sant'Alessandro 8, 00131 Rome, Italy, Italy
| | - Giulia Borromeo
- Craniomandibular Physiotherapy Service, Istituto Stomatologico Italiano, Milano, Italy
| | - Paola Tessera
- Craniomandibular Physiotherapy Service, Istituto Stomatologico Italiano, Milano, Italy
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Idáñez-Robles AM, Obrero-Gaitán E, Lomas-Vega R, Osuna-Pérez MC, Cortés-Pérez I, Zagalaz-Anula N. Exercise therapy improves pain and mouth opening in temporomandibular disorders: A systematic review with meta-analysis. Clin Rehabil 2023; 37:443-461. [PMID: 36263523 DOI: 10.1177/02692155221133523] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyse the effectiveness of exercise therapy in improving pain and active or passive maximum mouth opening in patients with temporomandibular disorders. DATA SOURCES PubMed Medline, Web of Science, Scopus, CINAHL Complete and Physiotherapy Evidence Database, until April 2022, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. REVIEW METHODS We included randomized controlled trials evaluating the effect of exercise therapy on pain and on active and passive maximum mouth opening in patients with temporomandibular disorders. Effect size was calculated using Cohen's standardized mean difference (SMD) and their 95% confidence interval (95% CI) in a random-effects model. RESULTS A total of 16 studies with 812 participants were included. Exercise therapy is effective in reducing pain (SMD: -0.58; 95% CI: -1.01 to -0.12) and increasing the pain pressure threshold (SMD: 0.45; 95% CI: 0.14-0.76), active and passive maximum mouth opening (SMD: 0.43; 95% CI: 0.14-0.71 and SMD: 0.4; 95% CI: 0.06-0.75, respectively). Subgroup analyses showed more effect of exercise therapy more splints versus splints on pain (SMD: -0.5; 95% CI: -0.73 to -0.26), active and passive maximum mouth opening (SMD: 1.14; 95% CI: 0.22-2.07 and SMD: 0.56; 95% CI: 0.06-1.06, respectively). On pain pressure threshold, exercise therapy was better than physiotherapy approach (manual therapy and electrotherapy) (SMD: 0.48; 95% CI: 0.09-0.87). CONCLUSIONS Therapeutic exercise is an effective therapy to reduce pain and increase pain pressure threshold and active and passive maximum mouth opening in patients with temporomandibular disorders.
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Affiliation(s)
- Ana M Idáñez-Robles
- Servicio de Fisioterapia, Residencia de Mayores "Fuente de la Peña", Dean de la Fuente González, Jaén, Spain
| | - Esteban Obrero-Gaitán
- Physiotherapy Area, 536192Department of Health Sciences, 553090Faculty of Health Sciences, 16747University of Jaén, 16747Campus Las Lagunillas s/n, Jaén, Spain
| | - Rafael Lomas-Vega
- Physiotherapy Area, 536192Department of Health Sciences, 553090Faculty of Health Sciences, 16747University of Jaén, 16747Campus Las Lagunillas s/n, Jaén, Spain
| | - María C Osuna-Pérez
- Physiotherapy Area, 536192Department of Health Sciences, 553090Faculty of Health Sciences, 16747University of Jaén, 16747Campus Las Lagunillas s/n, Jaén, Spain
| | - Irene Cortés-Pérez
- Physiotherapy Area, 536192Department of Health Sciences, 553090Faculty of Health Sciences, 16747University of Jaén, 16747Campus Las Lagunillas s/n, Jaén, Spain
| | - Noelia Zagalaz-Anula
- Physiotherapy Area, 536192Department of Health Sciences, 553090Faculty of Health Sciences, 16747University of Jaén, 16747Campus Las Lagunillas s/n, Jaén, Spain
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Lee IS, Kim SY. Effectiveness of manual therapy and cervical spine stretching exercises on pain and disability in myofascial temporomandibular disorders accompanied by headaches: a single-center cohort study. BMC Sports Sci Med Rehabil 2023; 15:39. [PMID: 36959659 PMCID: PMC10035158 DOI: 10.1186/s13102-023-00644-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/11/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Previous studies have demonstrated a relationship between headaches and temporomandibular disorders (TMDs). Moreover, recent studies have shown functional, anatomical, and neurological associations between the temporomandibular joint (TMJ) and upper cervical spine. This study aimed to investigate the effectiveness of manual therapy and cervical spine stretching exercises for pain and disability in patients with myofascial TMDs accompanied by headaches. METHODS Thirty-four patients recruited from Gyeryong Hospital with headaches and diagnosed with TMDs were randomly assigned to the experimental (n = 17) and control (n = 17) groups. Headache impact was assessed using the Korean Headache Impact Test-6. Masseter myofascial pain was measured using the visual analog scale, and TMJ pressure pain threshold levels were evaluated using an algometer. Neck pain intensity was assessed using the numerical rating scale. Once per week for 10 weeks, the experimental group received cervical spine-focused manual therapy and stretching exercises alongside conservative physical therapy, and the control group received conservative physical therapy alone. Patients were evaluated at baseline and 5 and 10 weeks post-intervention. RESULTS After the intervention, the experimental group exhibited significant reductions in the cervical kyphotic angle, Korean Headache Impact Assessment score, neck pain intensity, TMJ pain pressure threshold, Neck Disability Index score, and Jaw Functional Limitation Scale level compared with the control group (p < 0.01). CONCLUSION Manual therapy and stretching exercises could help resolve TMDs accompanied by headaches through biomechanical changes in the cervical spine. These findings may guide protocols and clinical trials involving manual therapy that align morphological structures.
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Affiliation(s)
- In-Su Lee
- Department of Physical Therapy, Graduate School, Daejeon University, Daejeon, Republic of Korea
| | - Suhn-Yeop Kim
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, 62 Daehak-ro, Dong-gu, Daejeon, 34520, Republic of Korea.
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Rathi S, Gilani R, Kamble R, Bhandwalkar S. Temporomandibular Joint Disorder and Airway in Class II Malocclusion: A Review. Cureus 2022; 14:e30515. [DOI: 10.7759/cureus.30515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
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Osteopathic Manipulation of the Sphenopalatine Ganglia Versus Sham Manipulation, in Obstructive Sleep Apnoea Syndrom: A Randomised Controlled Trial. J Clin Med 2021; 11:jcm11010099. [PMID: 35011840 PMCID: PMC8745154 DOI: 10.3390/jcm11010099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: osteopathic manipulation of the sphenopalatine ganglia (SPG) blocks the action of postganglionic sensory fibres. This neuromodulation can reduce nasal obstruction and enhance upper airway stability. We investigated the manipulation of the SPG in 31 patients with obstructive sleep apnoea syndrome (OSAS); (2) Methods: Randomised, controlled, double-blind, crossover study. Participants received active (AM), then sham manipulation (SM), or vice versa. The primary endpoint was apnoea-hypopnoea index (AHI). Secondary endpoints were variation of nasal obstruction evaluated by peak nasal inspiratory flow (PNIF) and upper airways stability evaluated by awake critical closing pressure [awake Pcrit]), at 30 min and 24 h. Schirmer’s test and pain were assessed immediately post-manipulation. Tactile/gustatory/olfactory/auditory/nociceptive/visual sensations were recorded. Adverse events were collected throughout. (3) Results: SPG manipulation did not reduce AHI (p = 0.670). PNIF increased post-AM but not post-SM at 30 min (AM-SM: 18 [10; 38] L/min, p = 0.0001) and 24 h (23 [10; 30] L/min, p = 0.001). There was no significant difference on awake Pcrit (AM-SM) at 30 min or 24 h). Sensations were more commonly reported post-AM (100% of patients) than post-SM (37%). Few adverse events and no serious adverse events were reported. (4) Conclusions: SPG manipulation is not supported as a treatment for OSAS but reduced nasal obstruction. This effect remains to be confirmed in a larger sample before using this approach to reduce nasal congestion in CPAP-treated patients or in mild OSAS.
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Asquini G, Pitance L, Michelotti A, Falla D. The effectiveness of manual therapy applied to craniomandibular structures in temporomandibular disorders: a systematic review. J Oral Rehabil 2021; 49:442-455. [PMID: 34931336 DOI: 10.1111/joor.13299] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Giacomo Asquini
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Laurent Pitance
- Institute of Experimental and Clinical Research, Health Sciences division, Neuro-Musculo-Skeletal-Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium
| | - Ambra Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples 'Federico II'
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
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Olivencia O, Kaplan K, Dreger M, Veloz M, Kais A, Marlowe K. Postrehabilitation Considerations for Individuals With Temporomandibular Disorders. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Al-Moraissi EA, Conti PCR, Alyahya A, Alkebsi K, Elsharkawy A, Christidis N. The hierarchy of different treatments for myogenous temporomandibular disorders: a systematic review and network meta-analysis of randomized clinical trials. Oral Maxillofac Surg 2021; 26:519-533. [PMID: 34674093 DOI: 10.1007/s10006-021-01009-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/23/2021] [Indexed: 02/08/2023]
Abstract
The best treatment modality for the management of painful temporomandibular disorders of muscular origin (M-TMD) with predictable outcomes based on solid evidence is still not well defined. Thus, the aim of this network meta-analysis (NMA) was to identify the best treatment for adult patients with M-TMD. An electronic search was undertaken from the inception of each database to August 2018, to identify randomized clinical trials (RCTs), which are comparing two or more of the following treatment modalities in patients with M-TMD: counseling therapy; occlusal appliances; manual therapy; laser therapy; dry needling; intramuscular injection of local anesthesia (LA) or botulinum toxin-A (BTX-A); muscle relaxants; hypnosis/relaxation therapy; oxidative ozone therapy; and placebo or no treatment. Primary outcome variables were the reduction of pain and mechanical sensitivity. The secondary outcome was the maximal mouth opening (MMO). The quality of evidence was rated according to Cochrane's tool for assessing risk of bias. Standardized mean difference was used to analyze via frequentist network meta-analysis (NMA), using STATA software. 52 RCTs were included in this NMA. At the most follow up moments, manual therapy, counseling therapy, occlusal splints therapy, and needling using BTX-A or LA as well as dry needling significantly decreased post-treatment pain intensity in M-TMDs, when compared to placebo. At short term (≤5 months), the four highest-ranked treatments for post-treatment pain reduction were manual therapy (83.5%, low quality evidence), ozone therapy (75.7%, very low quality evidence),counseling therapy (71.2%, moderate quality), and occlusal appliances (71.7%,moderate quality evidence). When intermediate term (≥6 months)was considered, BTX-A (85.8%, very low quality evidence) , counseling therapy(80%, low quality evidence), occlusal appliances (62.8%, low quality evidence) and hypnosis (50.6%, very low quality evidence) were the four highest-ranked treatments. This NMA reveals that manual therapy can be considered the most effective treatment for M-TMD, followed by counseling treatment, intramuscular injection of LA, and occlusal appliances . However, considering the limitations of the studies included, and the scarce of strong evidence, the present findings should be interpreted cautiously.
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Affiliation(s)
- Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
| | | | - Abdulmalik Alyahya
- Oral and Maxillofacial Surgery Department, King Abdulaziz Medical City - National Guard, Riyadh, Saudi Arabia
| | - Khaled Alkebsi
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ahmed Elsharkawy
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences, SE-141 04, Huddinge, Sweden
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13
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Moleirinho-Alves PMM, Almeida AMCSD, Exposto FG, Oliveira RANDS, Pezarat-Correia PLCD. Effects of therapeutic exercise and aerobic exercise programmes on pain, anxiety and oral health-related quality of life in patients with temporomandibular disorders. J Oral Rehabil 2021; 48:1201-1209. [PMID: 34370327 DOI: 10.1111/joor.13239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/18/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pain and anxiety contribute to decreasing quality of life related to oral health in patients with temporomandibular disorders (TMD). Evidence-based practice has shown that therapeutic and aerobic exercise programmes are adequate strategies for modifying these factors. OBJECTIVE To assess the effects of aerobic exercise on pain, anxiety and quality of life related to oral health in patients with TMD. METHODS Forty-five patients diagnosed with TMD were divided into three groups of 15 participants: a therapeutic exercise programme (G1, mean 26.9 ± 5.5 years), a therapeutic and aerobic exercise programme (G2, mean 26 ± 4.4 years) and an aerobic exercise programme (G3, mean 24.9 ± 3.4 years). Pain intensity was assessed using a numerical rating scale (NRS), anxiety level and quality of life related to oral health through GAD-7 and OHIP-14, respectively. These parameters were evaluated twice at baseline (T0a/T0b), ending 8-week intervention period (T1) and 8-12 weeks after ending intervention (T2). RESULTS NRS significantly decreased in G1 (mean difference T0a/T1 = 5.2, p ˂ .001), G2 (mean difference T0a/T1 = 6.0, p ˂ .001) and G3 (mean difference T0a/T1 = 2.2, p = 0.001). OHIP-14 significantly decreased in G1 (mean difference T0a/T1 = 13.5, p ˂ .001) and G2 (mean difference T0a/T1 = 15.8, p ˂ 0.001) but not in G3 (mean difference T0a/T1 = 1.2, p = 0.55). There were no significant differences between groups regarding GAD-7. Between T1 and T2, there were no significant differences in variables. CONCLUSION Therapeutic exercises and therapeutic excercises combined with aerobic exercise groups had a significant decrease in pain and oral health-related quality of life at 8 and 12 weeks. These decreases were not seen for the aerobic exercise group.
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Affiliation(s)
- Paula Manuela Mendes Moleirinho-Alves
- CIPER Neuromuscular Research Lab, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.,Center of Interdisciplinary Research Egas Moniz (CiiEM), Egas Moniz Higher School of Health, Monte de Caparica, Portugal.,Cuf Infante Santo Hospital, Lisbon, Portugal
| | - André Mariz Coelho Santos de Almeida
- Cuf Infante Santo Hospital, Lisbon, Portugal.,Center of Interdisciplinary Research Egas Moniz (CiiEM), Egas Moniz Higher Institute of Health Science, Monte de Caparica, Portugal
| | - Fernado Gustavo Exposto
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON, Aarhus, Denmark
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14
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Facial Pain and Temporomandibular Joint Dysfunction Secondary to Acromegaly: Treatment with Manual Therapy, Neuromuscular Re-education - A Case Report. REHABILITATION ONCOLOGY 2021; 38:127-133. [PMID: 33447472 DOI: 10.1097/01.reo.0000000000000190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background and Purpose Acromegaly is a disorder typically caused by a benign pituitary adenoma resulting in hypersecretion of growth hormone. Common sequelae, including musculoskeletal changes and arthropathies can result in facial pain and temporomandibular disorder (TMD) that persist beyond primary treatment. Due to the unique etiology of facial pain and TMD in cases of acromegaly, the generalizability of established physical therapy (PT) literature for treatment of TMD cannot be assumed. The purpose of this case report was to illustrate an example of multimodal PT as a treatment strategy for facial pain and TMD secondary to acromegaly following treatment for benign pituitary macroadenoma. Case Description 48-year-old male patient with history significant for benign pituitary macroadenoma, presented with facial pain and TMD secondary to acromegaly. Patient-reported outcomes of pain, function, and quality of life were assessed utilizing the Gothenburg Trismus Questionnaire (GTQ) at baseline, eighth PT visit, and eight weeks following course of PT. Quantity and quality of jaw mobility were assessed at baseline and post-intervention using standard goniometric measurements and observation. A total of nine PT sessions were delivered over three months consisting of manual therapy, relaxation techniques, neuromuscular re-education, and therapeutic exercise. Outcomes After eight PT visits, patient's GTQ score improved from 81% to 67.6%, with a corresponding decrease in pain and improved symmetry of jaw mobility. Eight weeks following last PT visit, patient's GTQ score further decreased from 67.6% to 61.3%. Discussion Conservative management through multimodal PT may be effective in managing facial pain and TMD secondary to acromegaly following treatment for benign pituitary macroadenoma.
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Potential of Using Shear Wave Elastography in the Clinical Evaluation and Monitoring of Changes in Masseter Muscle Stiffness. Pain Res Manag 2020; 2020:4184268. [PMID: 33273992 PMCID: PMC7676944 DOI: 10.1155/2020/4184268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 12/30/2022]
Abstract
The study aimed to evaluate masseter muscle stiffness in adult healthy volunteers referred to a massage treatment and also to investigate whether shear-wave elastography can be used to monitor the effect of massage on the masseter muscle. The study included 21 healthy volunteers, who were subjected to a 30-minute massage of the masseter muscle. Muscle stiffness was measured by shear-wave elastography before and directly after the massage. Pain during the massage was assessed using the visual analogue scale (VAS). The data of 20 patients (one excluded due to severe pain) with a median age of 34.5 years were analysed. The stiffness values were 11.46 ± 1.55 kPa before and 8.97 ± 0.96 kPa after the massage (p < 0.0001). The mean drop was 2.49 ± 1.09 kPa. The greatest decrease was observed in people with higher elasticity values before the massage (r = 0.79; p < 0.0001). The median intensity of pain was 7.2 (range: 6–9.5). We concluded that shear-wave elastography is a sensitive tool to monitor changes in the stiffness of the masseter muscle.
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Effectiveness of Cervical Spine High-Velocity, Low-Amplitude Thrust Added to Behavioral Education, Soft Tissue Mobilization, and Exercise for People With Temporomandibular Disorder With Myalgia: A Randomized Clinical Trial. J Orthop Sports Phys Ther 2020; 50:455-465. [PMID: 31905097 DOI: 10.2519/jospt.2020.9175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the immediate and short-term effects of adding cervical spine high-velocity, low-amplitude thrust (HVLAT) to behavioral education, soft tissue mobilization, and a home exercise program on pain and dysfunction for people with a primary complaint of temporomandibular disorder (TMD) with myalgia. DESIGN Randomized clinical trial. METHODS Fifty individuals with TMD were randomly assigned to receive cervical HVLAT or sham manipulation for 4 visits over 4 weeks. Participants in both groups received other treatments, including standardized behavioral education, soft tissue mobilization, and a home exercise program. Primary outcomes included maximal mouth opening, the numeric pain-rating scale, the Jaw Functional Limitation Scale (JFLS), the Tampa Scale of Kinesiophobia for TMD (TSK-TMD), and a global rating of change (GROC). Self-report and objective measurements were taken at baseline, immediately after initial treatment, and follow-ups of 1 week and 4 weeks. A 2-by-4 mixed-model analysis of variance was used, with intervention group as the between-subjects factor and time as the within-subject factor. Separate analyses of variance were performed for dependent variables, and the hypothesis of interest was the group-by-time interaction. RESULTS There was no significant interaction for maximal mouth opening, the numeric pain-rating scale, or secondary measures. There were significant 2-way interactions for the JFLS (d = 0.60) and TSK-TMD (d = 0.80). The HVLAT group had lower fear at 4 weeks and improved jaw function earlier (1 week). The GROC favored the HVLAT group, with significant differences in successful outcomes noted immediately after baseline treatment (thrust, 6/25; sham, 0/25) and at 4 weeks (thrust, 17/25; sham, 10/25). CONCLUSION Both groups improved over time; however, differences between groups were small. There were significant differences between groups for the JFLS, TSK-TMD, and GROC. The additive clinical effect of cervical HVLAT to standard care remains unclear for treating TMD. J Orthop Sports Phys Ther 2020;50(8):455-465. Epub 6 Jan 2020. doi:10.2519/jospt.2020.9175.
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Espí-López GV, Arnal-Gómez A, Cuerda del Pino A, Benavent-Corai J, Serra-Añó P, Inglés M. Effect of Manual Therapy and Splint Therapy in People with Temporomandibular Disorders: A Preliminary Study. J Clin Med 2020; 9:jcm9082411. [PMID: 32731453 PMCID: PMC7463644 DOI: 10.3390/jcm9082411] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Gemma Victoria Espí-López
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street nº 5, 46010 Valencia, Spain; (G.V.E.-L.); (A.C.d.P.); (P.S.-A.); (M.I.)
- Research Unit in Clinical Biomechanics (UBIC), University of Valencia, 46010 Valencia, Spain
| | - Anna Arnal-Gómez
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street nº 5, 46010 Valencia, Spain; (G.V.E.-L.); (A.C.d.P.); (P.S.-A.); (M.I.)
- Research Unit in Clinical Biomechanics (UBIC), University of Valencia, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-963983853 (ext. 51227)
| | - Alba Cuerda del Pino
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street nº 5, 46010 Valencia, Spain; (G.V.E.-L.); (A.C.d.P.); (P.S.-A.); (M.I.)
| | - José Benavent-Corai
- Cavanilles Institute for Biodiversity and Evolutionary Biology, University of Valencia, 46980 Paterna, Spain;
| | - Pilar Serra-Añó
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street nº 5, 46010 Valencia, Spain; (G.V.E.-L.); (A.C.d.P.); (P.S.-A.); (M.I.)
- Research Unit in Clinical Biomechanics (UBIC), University of Valencia, 46010 Valencia, Spain
| | - Marta Inglés
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street nº 5, 46010 Valencia, Spain; (G.V.E.-L.); (A.C.d.P.); (P.S.-A.); (M.I.)
- Research Unit in Clinical Biomechanics (UBIC), University of Valencia, 46010 Valencia, Spain
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18
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Brandão RDAFS, Mendes CMC, Brandão Filho RA, De Sena EP. Isotonic exercises and relaxing techniques in individuals with temporomandibular dysfunction. Cranio 2020; 40:199-206. [PMID: 31900091 DOI: 10.1080/08869634.2019.1708607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The present study aimed to compare the clinical characteristics of volunteers with temporomandibular dysfunction before and after performing exercises with those of volunteers who only followed self-care guidelines.Methods: A parallel randomized controlled trial was performed. Individuals included underwent the intervention twice a week for one month, while the control group only followed self-care guidelines.Results: Twenty-three volunteers participated; however, during the study, four dropped out. At the end of the study, the degree of depression decreased in the volunteers in the intervention group.Conclusion: The level of pain decreased, but the improvement was not statistically significant and, therefore, could not be attributed to the intervention. It can be concluded that the strategies used to reduce pain in this study were not sufficient for clinical improvement in volunteers with temporomandibular dysfunction.
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Affiliation(s)
- Renata De Assis Fonseca Santos Brandão
- Postgraduate Studies in Interactive Processes of Organs and Systems, Health Science Institute, Federal University of Bahia, Salvador, Bahia, Brazil.,Life Science Department, State University of Bahia, Salvador, Bahia, Brazil
| | - Carlos Maurício Cardeal Mendes
- Postgraduate Studies in Interactive Processes of Organs and Systems, Health Science Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Eduardo Pondé De Sena
- Postgraduate Studies in Interactive Processes of Organs and Systems, Health Science Institute, Federal University of Bahia, Salvador, Bahia, Brazil.,Department of Pharmacology and Physiology, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
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Asquini G, Bianchi AE, Heneghan NR, Rushton AB, Borromeo G, Locatelli M, Falla D. Predictors of pain reduction following manual therapy in patients with temporomandibular disorders: a protocol for a prospective observational study. BMJ Open 2019; 9:e032113. [PMID: 31722951 PMCID: PMC6858120 DOI: 10.1136/bmjopen-2019-032113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Giacomo Asquini
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Department of Craniomandibular Disorders, Italian Stomatologic Institute, Milan, Italy
| | | | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Alison B Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Giulia Borromeo
- Department of Craniomandibular Disorders, Italian Stomatologic Institute, Milan, Italy
| | - Matteo Locatelli
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Abstract
BACKGROUND Numerous treatment modalities have been attempted for masticatory muscle pain in patients with temporomandibular disorders (TMD). To compare the treatment efficacy of more than 2 competing treatments, a network meta-analysis (NMA) was conducted. METHODS This study was reported with reference to the extended Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting of systematic reviews incorporating network meta-analyses. Medline via Pubmed, Embase via OVID, and Cochrane Library Central were searched (up to February 11, 2019). Axis I protocol of Diagnostic Criteria or Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD, RDC/TMD) were chosen as diagnostic standards. The PICOS (Problem/patient, Intervention, Comparison, Outcome, Study design) method was used to screen trials under eligibility criteria. And the NMA was performed with mvmeta commands in Stata (StataCorp, Tex). RESULTS Of 766 studies searched, 12 randomized clinical trials (RCTs) were finally included. Nineteen different therapies were found and further categorized into 9 treatment modalities. The general heterogeneity was not found among included trials. But predictive intervals (PrIs) were conspicuously wider than confidential intervals (CIs) of all pairwise comparisons, indicating that heterogeneity may exist between studies. Complementary therapy showed the greatest probability (42.7%) to be the best intervention. It also had the highest mean rank (2.3) in the rankogram and the biggest value of surface under the cumulative ranking (SUCRA, 84.1%). CONCLUSIONS Based on the limited evidence of available trials, complementary therapy seemed to be slightly more effective than remaining treatment modalities for pain reduction in TMD patients with masticatory muscle pain. High-quality randomized controlled trials are expected to validate the findings.
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21
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Herpich CM, Leal-Junior ECP, Politti F, de Paula Gomes CAF, Dos Santos Glória IP, de Souza Amaral MDFR, Herpich G, de Azevedo LMA, de Oliveira Gonzalez T, Biasotto-Gonzalez DA. Intraoral photobiomodulation diminishes pain and improves functioning in women with temporomandibular disorder: a randomized, sham-controlled, double-blind clinical trial : Intraoral photobiomodulation diminishes pain in women with temporomandibular disorder. Lasers Med Sci 2019; 35:439-445. [PMID: 31325122 DOI: 10.1007/s10103-019-02841-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/02/2019] [Indexed: 12/26/2022]
Abstract
The aim of the present study was to evaluate the effect of intraoral photobiomodulation involving super-pulsed laser (905 nm) combined with red (640 nm) and infrared (875 nm) light-emitting diodes on pain, mandibular range of motion, and functioning in women with myogenous temporomandibular disorder. A randomized, sham-controlled, double-blind clinical trial was conducted involving 30 women with myogenous temporomandibular disorder diagnosed using the Research Diagnostic Criteria for Temporomandibular Disorders. The participants were randomly allocated to two groups (active and sham photobiomodulation). The evaluations involved this use of the visual analog scale, digital calipers, and a functional scale. Photobiomodulation was administered intraorally in the region of the pterygoid muscles, bilaterally, in all participants for a total of six sessions. Evaluations were performed on five occasions: prior to the intervention, immediately after the first session, 24 h and 48 h after the first session, and after the six sessions. Significant differences between groups were found regarding pain (p ≤ 0.01) and functioning (p ≤ 0.04). However, no statistically significant difference was found regarding range of mandibular motion. The findings demonstrate that intraoral photobiomodulation involving super-pulsed laser (905 nm) combined with red (640 nm) and infrared (875 nm) light-emitting diodes diminishes pain and improves functioning but does not exert an influence on mandibular range of motion in women with temporomandibular disorder.Trial registration: NCT02839967.
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Affiliation(s)
| | | | - Fabiano Politti
- Department of Postgraduate Program in Rehabilitation Sciences, University Nove de Julho, São Paulo, Brazil
| | | | | | | | - Graciela Herpich
- Department of Postgraduate Program in Rehabilitation Sciences, University Nove de Julho, São Paulo, Brazil
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22
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Eliassen M, Hjortsjö C, Olsen-Bergem H, Bjørnland T. Self-exercise programmes and occlusal splints in the treatment of TMD-related myalgia-Evidence-based medicine? J Oral Rehabil 2019; 46:1088-1094. [PMID: 31286551 DOI: 10.1111/joor.12856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/22/2019] [Accepted: 07/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The low-cost and reversible treatments concerning disorders of the masticatory muscles represent a vast array of regimens. Common treatments include information, stretching exercises, manual therapy, acrylic splints and cognitive behavioural therapy. OBJECTIVE The aim of this study was to evaluate the evidence behind the use of self-exercising programmes and occlusal splints in the treatment of myofascial pain. METHODS We conducted a thorough search of five databases, using four cardinal search terms in combination with twelve supporting terms. We also assessed the evidence quality, using GRADEpro software. RESULTS The search resulted in 4967 individual studies. 18 studies met the inclusion criteria and were re-evaluated. CONCLUSION The selected studies were in favour of a self-care or an occlusal splint treatment of myalgia. However, a GRADE assessment showed that 14 of the 18 selected studies had low or very low evidence quality. Studies also showed weaknesses with regard to nomenclature and reproducibility. Hence, it is our professional opinion that the evidence level for prescribing self-exercises and occlusal splints in the treatment of myalgia is low.
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Affiliation(s)
- Morten Eliassen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Carl Hjortsjö
- Department of Prosthetic Dentistry and Oral Function, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Heming Olsen-Bergem
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tore Bjørnland
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Denneny D, Frawley HC, Petersen K, McLoughlin R, Brook S, Hassan S, Williams AC. Trigger Point Manual Therapy for the Treatment of Chronic Noncancer Pain in Adults: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2019; 100:562-577. [DOI: 10.1016/j.apmr.2018.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
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Shimada A, Ishigaki S, Matsuka Y, Komiyama O, Torisu T, Oono Y, Sato H, Naganawa T, Mine A, Yamazaki Y, Okura K, Sakuma Y, Sasaki K. Effects of exercise therapy on painful temporomandibular disorders. J Oral Rehabil 2019; 46:475-481. [DOI: 10.1111/joor.12770] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 12/30/2018] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Akiko Shimada
- Department of Oral Rehabilitation Osaka Dental University Hospital Osaka Japan
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Faculty of Health Aarhus University Aarhus Denmark
- Scandinavian Center for Orofacial Neurosciences Aarhus Denmark
| | - Shoichi Ishigaki
- Department of Fixed Prosthodontics Osaka University Graduate School of Dentistry Suita Japan
| | - Yoshizo Matsuka
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences Tokushima University Tokushima Japan
| | - Osamu Komiyama
- Department of Oral Function and Rehabilitation Nihon University School of Dentistry at Matsudo Chiba Japan
| | - Tetsurou Torisu
- Department of Prosthetic Dentistry, Graduate School of Biomedical Sciences Nagasaki University Nagasaki Japan
| | - Yuka Oono
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences Meikai University School of Dentistry Saitama Japan
| | - Hitoshi Sato
- Department of Oral and Maxillofacial Surgery, School of Dentistry Showa University Tokyo Japan
| | - Takuya Naganawa
- Department of Oral and Maxillofacial Surgery, School of Medicine Tokyo Women's Medical University Tokyo Japan
| | - Atsushi Mine
- Department of Fixed Prosthodontics Osaka University Graduate School of Dentistry Suita Japan
| | - Yoko Yamazaki
- Orofacial Pain Clinic, Tokyo Medical and Dental University Hospital of Dentistry Tokyo Japan
| | - Kazuo Okura
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences Tokushima University Tokushima Japan
| | - Yasushi Sakuma
- Department of Anesthesiology Osaka Dental University Graduate School Osaka Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry Tohoku University Graduate School of Dentistry Sendai Japan
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Kim KW, Ha IH, Lee YJ, Kim MR, Shin BC, Song MY, Cho JH. A clinical practice guideline for temporomandibular disorders in traditional Korean medicine: An evidence-based approach. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Agha-Hosseini F, Sheykhbahaei N, Mirzaii-Dizgah I, Fatehi F. The efficacy of oral habit modification on headache. J Korean Assoc Oral Maxillofac Surg 2017; 43:401-406. [PMID: 29333370 PMCID: PMC5756797 DOI: 10.5125/jkaoms.2017.43.6.401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/26/2017] [Accepted: 08/06/2017] [Indexed: 12/29/2022] Open
Abstract
Objectives Headache is the most common complaint of patients suffering from temporomandibular joint disorders (TMDs). Thus, temporomandibular joint (TMJ) examinations maybe necessary in patients with headache. Considering the high prevalence of bruxism and TMDs in patients with headache the effects of conservative TMD treatment on headache should be assessed. Materials and Methods Patients were questioned about headaches in the past three months. Those responding affirmatively to this question were examined for TMD and bruxism. After the examinations, 219 patients remained in the study and received self-management instructions. Patients were requested to modify oral habits except when eating or sleeping. The degree of pain (visual analogue scale), headache disability index (HDI), frequency of headaches (FH) per month and TMD intensity were evaluated. Results The median levels of pain, HDI, FH, and TMD intensity were 8, 44, 8, and 7, respectively, before modifying oral habits and decreased to 4, 24, 2, and 3, respectively, after intervention. These decreases were statistically significant. Conclusion Having patients maintain free space between the teeth and relax muscles can be an efficient method to treat headache and TMD, especially when repeated frequently.
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Affiliation(s)
- Farzaneh Agha-Hosseini
- Dental Research Center, Dental Research Institute, Tehran University of Medical Sciences and Department of Oral and Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Sciences & The Academy of Medical Sciences, Tehran, Iran
| | - Nafiseh Sheykhbahaei
- Dental Research Center, Dental Research Institute, Tehran University of Medical Sciences and Department of Oral and Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Sciences & The Academy of Medical Sciences, Tehran, Iran
| | - Iraj Mirzaii-Dizgah
- Department of Physiology, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Jacq O, Arnulf I, Similowski T, Attali V. Upper airway stabilization by osteopathic manipulation of the sphenopalatine ganglion versus sham manipulation in OSAS patients: a proof-of-concept, randomized, crossover, double-blind, controlled study. Altern Ther Health Med 2017; 17:546. [PMID: 29262824 PMCID: PMC5738827 DOI: 10.1186/s12906-017-2053-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 12/07/2017] [Indexed: 11/10/2022]
Abstract
Background Osteopathic manipulative treatment (OMT) of the sphenopalatine ganglion (SPG) is used empirically for the treatment of rhinitis and snoring and is thought to increase pharyngeal stability. This trial was designed to study the effects of this treatment on pharyngeal stability evaluated by critical closing pressure in obstructive sleep apnoea syndrome. Methods This single-centre, randomized, crossover, double-blind study compared active manipulation and sham manipulation of the SPG. Randomization was computer-generated. Patients each received one active manipulation and one sham manipulation at an interval of 21 days and were evaluated 30 min and 48 h after each session administered by a qualified osteopath. Neither the patients, nor the investigator performing the evaluations were informed about the order of the two techniques (double-blind). The primary endpoint was the percentage of responding patients presenting increased pharyngeal stability defined by a variation of critical closing pressure (Pcrit) of at least −4 cmH2O at 30 min. Secondary endpoints were the variation of Pcrit in absolute values, sleepiness and snoring. Others endpoints were lacrimation (Schirmer’s test), induced pain, sensations experienced during OMT. Results Ten patients were included and nine (57 [50; 58] years, comprising 7 men, with an apnoea-hypopnoea index of 31.0 [25.5; 33.2]/h; (values are median [quartiles])) were analysed. Seven patients were analysed for the primary endpoint and nine patients were analysed for secondary endpoints. Five patients responded after active manipulation versus no patients after sham manipulation (p = 0.0209). Active manipulation induced more intense pain (p = 0.0089), increased lacrimation (ns) and more tactile, nociceptive and gustatory sensations (13 versus 1) compared to sham manipulation. No significant difference was observed for the other endpoints. Conclusions Osteopathic manipulative treatment of the SPG may improve pharyngeal stability in obstructive sleep apnoea syndrome. This trial validates the feasibility of the randomized, controlled, double-blind methodology for evaluation of this osteopathic treatment. Studies on a larger sample size must specify the efficacy on the apnoea-hypopnoea index. Trial registration The study was retrospectively registered in the clinicaltrial.gov registry under reference NCT01193738 on 1st September 2010 (first inclusion May 19, 2010). Electronic supplementary material The online version of this article (doi: 10.1186/s12906-017-2053-0) contains supplementary material, which is available to authorized users.
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Giro G, Policastro VB, Scavassin PM, Leite ARP, Mendoza Marin DO, Gonçalves DADG, Compagnoni MA, Pero AC. Mandibular kinesiographic pattern of women with chronic TMD after management with educational and self-care therapies: A double-blind, randomized clinical trial. J Prosthet Dent 2016; 116:749-755. [PMID: 27236596 DOI: 10.1016/j.prosdent.2016.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Abstract
STATEMENT OF PROBLEM Limited mandibular movements are one of the most important signs of temporomandibular disorders (TMDs) and may cause functional difficulties. PURPOSE The purpose of this double-blind, randomized clinical trial was to evaluate the effect of treatment with only educational or education associated with self-care therapies on the pattern of mandibular movements of women with chronic painful TMDs. MATERIAL AND METHODS Forty-two women were selected and randomly divided into 3 groups, control group (CG, n=13), education group (EG, n=16), and education and self-care group (ESG, n=13), according to the sequence of treatment they received. A kinesiograph device recorded mandibular movements during maximum mouth opening and mastication at baseline (T0) and at 30-day (T1) and 60-day (T2) follow-up. Kinesiographic data were statistically analyzed using 1-way ANOVA, followed by the Bonferroni test for multiple comparisons of means (α=.05). RESULTS The ESG group demonstrated an improvement in the maximum vertical opening (MVO= 5.1 ±3.4 mm; P=.012) and anteroposterior mandibular movement (MAM) during maximum opening (7.4 ±9.5; P=.019), significantly higher than that of the EG (MVO=1.8 ±3.5 mm; MAM=0.8 ±5.0 mm) and the CG (MVO=0.9 ±3.8 mm; MAM=0.8 ±4.4 mm) after 30 days of follow-up. Moreover, at T1, vertical mandibular movement during mastication was significantly higher in the ESG group (17.4 ±1.7 mm) than in the EG group (15.0 ±2.8, P=.027). No significant differences were found between the women who received treatment with educational and self-care therapies for 60 days and the women who received this treatment for 30 days. CONCLUSIONS In the short-term, education and self-care treatment positively influenced the mandibular movement pattern of women with chronic painful TMDs.
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Affiliation(s)
- Gabriela Giro
- Doctoral student, Department of Dental Materials and Prosthodontics, São Paulo State University, Araraquara Dental School, São Paulo, Brazil
| | - Vivian Barnabé Policastro
- Graduate student, Department of Dental Materials and Prosthodontics, São Paulo State University, Araraquara Dental School, São Paulo, Brazil
| | - Priscila Mattos Scavassin
- Graduate student, Department of Dental Materials and Prosthodontics, São Paulo State University, Araraquara Dental School, São Paulo, Brazil
| | - Andressa Rosa Perin Leite
- Doctoral student, Department of Dental Materials and Prosthodontics, São Paulo State University, Araraquara Dental School, São Paulo, Brazil
| | - Danny Omar Mendoza Marin
- Doctoral student, Department of Dental Materials and Prosthodontics, São Paulo State University, Araraquara Dental School, São Paulo, Brazil
| | | | - Marco Antonio Compagnoni
- Full Professor, Department of Dental Materials and Prosthodontics, São Paulo State University, Araraquara Dental School, São Paulo, Brazil
| | - Ana Carolina Pero
- Assistant Professor, Department of Dental Materials and Prosthodontics, São Paulo State University, Araraquara Dental School, São Paulo, Brazil.
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Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A. Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis. Phys Ther 2016; 96:9-25. [PMID: 26294683 PMCID: PMC4706597 DOI: 10.2522/ptj.20140548] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 08/01/2015] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Susan Armijo-Olivo
- S. Armijo-Olivo, PT, BScPT, MScPT, PhD, Department of Physical Therapy, Faculty of Rehabilitation Medicine, 3-48 Corbett Hall, University of Alberta, Edmonton, Alberta, Canada T6G 2G4.
| | - Laurent Pitance
- L. Pitance, PT, MT, PhD, Université Catholique de Louvain-Institute of Neuroscience, Brussels, Belgium, and Stomatology and Maxillofacial Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Vandana Singh
- V. Singh, DDS, MS, MSc, Department of Dentistry, Faculty of Medicine, TMD/Orofacial Pain Clinic, Kaye Edmonton Clinic, Edmonton, Alberta, Canada
| | - Francisco Neto
- F. Neto, PT, FisioNeto-Terapia Manual Ortopédica and Pilates Clínico, Póvoa de Varzim, Portugal
| | - Norman Thie
- N. Thie, BSc, MSc, MMSc, DDS, School of Dentistry, Faculty of Medicine and Dentistry, TMD/Orofacial Pain Graduate Program, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Ambra Michelotti
- A. Michelotti, BSc, DDS, Orthodontic Post-Graduate Program and TMD/Orofacial Pain Master Program, School of Medicine Federico II-Dental School, Naples, Italy
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Sanches ML, Juliano Y, Novo NF, Guimarães AS, Rodrigues Conti PC, Alonso LG. Correlation between pressure pain threshold and pain intensity in patients with temporomandibular disorders who are compliant or non-compliant with conservative treatment. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:459-68. [DOI: 10.1016/j.oooo.2015.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/13/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
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Rodriguez-Blanco C, Cocera-Morata FM, Heredia-Rizo AM, Ricard F, Almazán-Campos G, Oliva-Pascual-Vaca Á. Immediate Effects of Combining Local Techniques in the Craniomandibular Area and Hamstring Muscle Stretching in Subjects with Temporomandibular Disorders: A Randomized Controlled Study. J Altern Complement Med 2015. [PMID: 26218883 DOI: 10.1089/acm.2014.0332] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To assess the immediate effects on vertical mouth opening, orofacial mechanosensitivity, and lumbar and suboccipital mobility after adding a myofascial induction technique to a multimodal protocol in subjects with temporomandibular disorders (TMD). DESIGN A randomized and double-blind controlled trial was carried out. SETTINGS/LOCATION University-based physical therapy research clinic. SUBJECTS Sixty subjects (35±11.22 years) with TMD, and restricted mobility of the mandibular condyles and the first cervical vertebrae, were recruited and randomized to either a control group (CG) (n=30) or an experimental group (EG) (n=30). INTERVENTIONS The CG underwent a neuromuscular technique over the masseter muscles and passive hamstring muscle stretching. A suboccipital muscle inhibition technique was added to this protocol in the EG. OUTCOME MEASURES Primary measurements were made of vertical mouth opening and pressure pain threshold of the masseter muscles. Secondary outcome measures included pressure algometry of the trigeminal nerve, suboccipital range of motion, and lumbar spine mobility, assessed with the sit-and-reach (SAR) test and lumbar forward bending. All evaluations were collected at baseline and immediately after intervention. RESULTS In the intragroup comparison, the EG observed an increase in suboccipital flexion (p<0.001; F1,29=14.47; R(2)=0.33) and the SAR test (p=0.009; F1,29=7.89; R(2)=0.21). No significant differences were found in the between-group comparison for any variable (p>0.05). CONCLUSION The inclusion of a myofascial induction maneuver in a protocol combining local (neuromuscular treatment) and distal techniques (hamstring stretching) in subjects with TMD has no impact on improving mouth opening, suboccipital and lumbar mobility, and orofacial sensitivity to mechanical pressure.
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Affiliation(s)
- Cleofás Rodriguez-Blanco
- 1 Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla , Sevilla, Spain
| | | | - Alberto Marcos Heredia-Rizo
- 1 Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla , Sevilla, Spain
| | | | | | - Ángel Oliva-Pascual-Vaca
- 1 Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla , Sevilla, Spain
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Gomes CAFDP, El Hage Y, Amaral AP, Politti F, Biasotto-Gonzalez DA. 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. Chiropr Man Therap 2014; 22:43. [PMID: 25512839 PMCID: PMC4266206 DOI: 10.1186/s12998-014-0043-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/03/2014] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Cid André Fidelis de Paula Gomes
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil ; Department of Physical Therapy, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil
| | - Yasmin El Hage
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil ; Department of Physical Therapy, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil
| | - Ana Paula Amaral
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil
| | - Fabiano Politti
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil ; Department of Physical Therapy, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil
| | - Daniela Aparecida Biasotto-Gonzalez
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil ; Department of Physical Therapy, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil
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Muir B, Brown C, Brown T, Tatlow D, Buhay J. Immediate changes in temporomandibular joint opening and pain following vibration therapy: a feasibility pilot study. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2014; 58:467-480. [PMID: 25550672 PMCID: PMC4262808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The purpose of this pilot study was to determine the scientific and process feasibility in an effort to direct future larger trials. METHODS Scientific Feasibility: Twelve subjects were randomly allocated to an intervention and a control group. The intervention protocol consisted of intraoral vibration therapy on the muscles of mastication bilaterally for a period of 1 minute per muscle. Process Feasibility: Several feasibility outcomes were examined including recruitment and retention rates and consent. RESULTS Scientific Feasibility: Large effect sizes were generated for both mouth opening and VAS in favour of the intervention group. Process Feasibility: a recruitment ratio of 2.3 respondents to 1 participant was determined, along with a retention to loss ratio of 13:1 and a consent to loss ratio of 12:0. CONCLUSION Scientific Feasibility: The scientific results should be interpreted with caution due to the small sample sizes employed. The study seems to support the scientific feasibility of a future larger single treatment trial. Process Feasibility: Recruitment and retention rates and ratios seem to support future studies. Utilizing the feasibility results of the current study to direct a future larger multiple treatment trial consistent with other comparable TMD studies however is limited.
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Affiliation(s)
- Brad Muir
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Canada
- Associate Professor, Faculty of Clinical Education, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Canada
| | - Courtney Brown
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Canada
- Sports Sciences Resident, Department of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Canada
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