Massage therapy in the management of myogenic TMD: a pilot study

Evaluation of the single and combined therapeutic effects of individually manufactured earplug therapy in patients with myogenous temporomandibular disorders: A randomized controlled clinical trial

OBJECTIVE

To evaluate the effect of individually manufactured earplug therapy on pain intensity (PI), symptom severity (SS), and maximum mouth opening (MMO), in patients with myogenous temporomandibular disorders (TMD).

METHODS

One-hundred-twenty patients were randomly allocated to six groups: Groups EP (earplug), OS (occlusal splint), EX (exercise), EPO (earplug with occlusal splint), EPE (earplug with exercise), and C (control). Outcomes were PI (assessed with a visual analog scale (VAS)), SS (assessed with the modified Symptom Severity Index Questionnaire (mSSI)), and MMO (evaluated with a digital caliper). Measurements were performed at T0 (before the therapy), T1 (1-month follow-up), and T2 (3-month follow-up). Data were analyzed using one-way analysis of variance (ANOVA), Tukey's HSD, and chi-square tests (alpha = 0.05).

RESULTS

At T1 and T2, the greatest VAS and mSSI reduction was detected for the groups EPE (VAS = 5.3 ± 1.05, 3.3 ± 0.7; mSSI = 38.2 ± 2.27, 43.6 ± 3.94) and EPO (VAS = 5.2 ± 0.91, 3.2 ± 0.78; mSSI = 36.3 ± 3.97, 42.2 ± 3.19), respectively (p < 0.05). At T1, occlusal splint groups (groups OS (34.8 ± 2.97 mm) and EPO (33.8 ± 3.49 mm)) gave the highest MMO values, while T2 values did not constitute a significant difference with T1 (p > 0.05).

CONCLUSIONS

The short-term use of combined earplug therapy resulted in a decrease in both PI and SS. Improvement in MMO in participants using occlusal splints was observed in the 1st month and was maintained through the 3rd month.

CLINICAL RELEVANCE

Earplug therapy can be applied as a complementary therapy to occlusal splint and exercise treatments to decrease PI and SS in patients with myogenous TMD. To achieve functional recovery such as MMO, its combined use with splints should be taken into consideration by clinicians.

The Relationships Between Psychosocial Factors and Short-Term Treatment Outcomes of Massage Therapy in Patients with Myogenic Temporomandibular Disorders: A Single-Arm Preliminary Study

Background

Massage therapy is included as part of a comprehensive treatment plan for patients with temporomandibular disorders (TMDs). However, it displayed varying degrees of success. Preexisting psychosocial impairments may be one of the possible factors affecting the treatment response. This preliminary study aimed to investigate the relationships between psychological factors and treatment outcomes of massage therapy in myogenous TMD patients.

Methods

Twenty-two myogenous TMD patients were enrolled in this single-arm preliminary study. Baseline psychosocial assessment was done using self-report measures associated with chronic pain severity, depression, anxiety, and non-specific physical symptoms. Massage therapy including the intraoral and extraoral massage of the face and neck muscles was performed twice a week for 4 weeks. Pain intensity and quality of life related to oral health were evaluated as treatment outcomes before and immediately after eight sessions of massage therapy.

Results

Regression analyses showed a significant effect of depression on changes in the quality of life after massage (β = 0.35, p-value = 0.026). In addition, results showed a significant effect of chronic pain severity on changes in the pain intensity following massage (β = 1.50, p-value = 0.027).

Conclusion

Our findings suggested that psychosocial characteristics of myogenous TMD patients should be considered as important factors that may adversely affect pain intensity reduction and quality-of-life improvement after short-term massage therapy.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

DISCUSSION

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

Thermal ultrasound, manipulation and exercise on pain and mouth opening in Chronic temporomandibular joint disorder

BACKGROUND

A 60-year-old female patient reported with a chief complaint of pain in bilateral temporomandibular joints (TMJ) region since 1_1/2  years. The pain was initially reported to be insidious in onset, moderate in intensity, aggravated on chewing food and during excessive mouth opening. On examination her mouth opening was found to be less than 8 mm and standard head and neck examination showed grade 2 tenderness with swelling on bilateral TMJ and forward neck posture with rounded shoulders. The patient reported her pain to be 6 at rest in NPRS (with 0 being no pain and 10 being maximum) and 8 out of 10 on mouth opening.

METHODOLOGY/MANAGEMENT

A 4-week Physiotherapy Intervention program, which consisted of Ultrasound Therapy at varying intensity, TMJ manipulation, Cervical Range of Motion Exercises and Manual Cervical traction was administered. Repeated evaluation of pain and other functional outcomes were done on a weekly basis.

RESULTS

There was significant improvement in her mouth opening (41 mm), restoration of masticatory functions, complete resolution of pain and overall improvement in quality of life after the 4 weeks intervention program.

CONCLUSION

A structured Physiotherapy intervention program consisting of Non-thermal Ultrasound, Manipulation and exercise targeting TMJ and Upper quarter, proved to be highly effective in increasing functions and reducing signs and symptoms in Chronic TMJ Dysfunction which can be highly disabling. The recovery observed in this patient, who was not on any standard treatment for almost 18 months, hence the severe limitations she encountered, is a testament to the need of designing individualized treatment protocols addressing the many facets of impairment in TMJ Disorders.

Evaluation of Soft Tissue Mobilization in Patients with Temporomandibular Disorder-Myofascial Pain with Referral

The aim of the study was functional evaluation of soft tissue mobilization in patients with temporomandibular disorder-myofascial pain with referral. The study group consisted of 50 individuals-37 females and 13 males. The average age was 23.36 ± 2.14 years. All subjects were diagnosed with myofascial pain with referral (diagnostic criteria for temporomandibular disorders). Soft tissue mobilization was applied three times. Electromyography of selected masticatory muscles was performed six times-before and after the treatment. After each mobilization, a decreasing tendency of muscular activity was observed in the entire study group. The Friedman test indicated that mobilization altered the activity of the right temporal muscle (p = 0.00010), both masseters (p = 0.0000), right sternocleidomastoid (p = 0.00251), left sternocleidomastoid (p = 0.00033), and right and left digastric muscles (p = 0.00045 and p = 0.00000, respectively). With respect to symmetry a statistically significant difference was noted in the case of the sternocleidomastoid muscles (p = 0.00729). In conclusion, soft tissue mobilization seems to be effective in the relaxation of masticatory muscles in patients with temporomandibular disorders. Our findings proved that soft tissue mobilization does not improve the symmetry and synergy of the masticatory muscles limited by dental occlusion.

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

Background

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

Results

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

Conclusion

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

Assessment of the Short-Term Effectiveness of Kinesiotaping and Trigger Points Release Used in Functional Disorders of the Masticatory Muscles

Chronic face pain syndrome is a diagnostic and therapeutic problem for many specialists, and this proves the interdisciplinary and complex nature of this ailment. Physiotherapy is of particular importance in the treatment of pain syndrome in the course of temporomandibular joint functional disorders. In patients with long-term dysfunction of masticatory muscles, the palpation examination can localize trigger points, that is, thickening in the form of nodules in the size of rice grains or peas. Latent trigger points located in the muscles can interfere with muscular movement patterns, cause cramps, and reduce muscle strength. Because hidden trigger points can spontaneously activate, they should be found and released to prevent further escalation of the discomfort. Kinesiotaping (KT) is considered as an intervention that can be used to release latent myofascial trigger points. It is a method that involves applying specific tapes to the patient's skin in order to take advantage of the natural self-healing processes of the body. The aim of the study was to evaluate the effect of the kinesiotaping method and trigger points inactivation on the nonpharmacological elimination of pain in patients with temporomandibular disorders. The study was conducted in 60 patients (18 to 35 years old). The subjects were randomly divided into two subgroups of 30 people each. Group KT (15 women and 15 men) were subjected to active kinesiotaping application. Group TrP, composed of 16 women and 14 men, was subjected to physiotherapy with the release of trigger points by the ischemic compression method. The results show that the KT method and TrP inactivation brought significant therapeutic analgesic effects in the course of pain-related functional disorders of the muscles of mastication. The more beneficial outcomes of the therapy were observed after using the KT method, which increased the analgesic effect in dysfunctional patients.

Short-duration therapeutic massage reduces postural upper trapezius muscle activity

Massage therapy has historically been used as a therapeutic treatment to help reduce pain and promote relaxation. The aim of this study was to investigate the effect of therapeutic massage on the upper trapezius muscles, which are commonly associated with increased muscle tension. This was a randomized crossover study. Seventeen healthy individuals (nine women; 24.5±4.0 years) participated in the study. All individuals participated in two sessions that were held 24 h apart. In one of the sessions, the participants received a moderate pressure massage applied to the shoulders and neck. In the other session, participants sat quietly. The order of the sessions was counterbalanced across participants. Muscle activity, as measured by surface electromyography, of the upper trapezius muscles was recorded. The amount of muscle activity change following massage was compared with the change in muscle activity following quiet sitting. Muscle activity of the upper trapezius reduced significantly (19.3%; P=0.004) following massage compared with muscle activity following quiet sitting (1.0%). Our findings suggest that short-duration moderate pressure massage leads to a reduction in upper trapezius muscle activity. This result has potential implications for clinical populations such as those with chronic neck pain.

Temporomandibular disorders. Part 2: conservative management

Appropriate management of temporomandibular disorders (TMD) requires an understanding of the underlying dysfunction associated with the temporomandibular joint (TMJ) and surrounding structures. A comprehensive examination process, as described in part 1 of this series, can reveal underlying clinical findings that assist in the delivery of comprehensive physical therapy services for patients with TMD. Part 2 of this series focuses on management strategies for TMD. Physical therapy is the preferred conservative management approach for TMD. Physical therapists are professionally well-positioned to step into the void and provide clinical services for patients with TMD. Clinicians should utilize examination findings to design rehabilitation programs that focus on addressing patient-specific impairments. Potentially appropriate plan of care components include joint and soft tissue mobilization, trigger point dry needling, friction massage, therapeutic exercise, patient education, modalities, and outside referral. Management options should address both symptom reduction and oral function. Satisfactory results can often be achieved when management focuses on patient-specific clinical variables.

Effectiveness of two physical therapy interventions, relative to dental treatment in individuals with bruxism: study protocol of a randomized clinical trial

Background

Bruxism is a parafunctional habit characterized by grinding and/or clenching of the teeth. It may happen while awake (awake bruxism) or while sleeping (sleep bruxism). In adults, the prevalence is 20% for the awake bruxism and 8% for the sleep bruxism. Peripheral, central, and psychosocial factors influence the disorder, which may predispose to pain in the masticatory muscles and neck, headache, decreased pain thresholds in the masticatory and cervical muscles, limitation mandibular range of motion, sleep disorders, stress, anxiety, depression, and overall impairment of oral health. The aim of this study is to compare two distinct physical therapy interventions with dental treatment in pain, mandibular range of motion, sleep quality, anxiety, stress, depression, and oral health in individuals with bruxism.

Methods/Design

Participants will be randomized into one of three groups: Group 1 (n = 24) intervention will consist of massage and stretching exercises; Group 2 (n = 24) will consist of relaxation and imagination therapies; and Group 3 (n = 24) will receive dental treatment. The evaluations will be performed at baseline, immediately after treatment, and at 2-month follow-up. Pain intensity will be assessed using the visual analogical scale, while pain thresholds will be determined using dolorimetry. Mandibular range of motion will be assessed using digital pachymeter. Sleep quality will be assessed by the Pittsburgh Sleep Quality Index, anxiety by the State-Trait Anxiety Inventory, stress by the Perceived Stress Scale-10, depression by the Beck Depression Inventory, and oral health will be assessed using the Oral Health Impact Profile - 14. Significance level will be determined at the 5% level.

Discussion

This project describes the randomization method that will be used to compare two physical therapy interventions with dental treatment in the management of pain, mandibular range of motion, sleep quality, anxiety, stress, depression, and oral health in individuals with bruxism. The study will support the practice of evidence-based physical therapy for individuals with bruxism. Data will be published after study is completed.

Trial registration

ClinicalTrials.gov, NCT01778881

Effect of facial massage on static balance in individuals with temporomandibular disorder - a pilot study

Introduction

The influence of the neuromuscular system on the cervical region and mastication is directly associated with mandibular movements and neck posture. Normal occlusal homeostasis depends on complex sensory feedback mechanisms of the periodontal ligament, temporomandibular joint and other structures of the stomatognathic system. This feedback serves as a regulatory mechanism that helps determine the force and nature of muscle contractions. Alterations in the muscles of mastication, neck muscles, and occlusal characteristics constitute causal factors of imbalances in the postural muscle chains, leading to alterations in the center of pressure (CoP) of the feet. Thus, therapies that seek occlusal reestablishment, such as muscle relaxation techniques, may lead to a restructuring of the global equilibrium of the neuromuscular system and an improvement in body posture.

Purpose

The aim of the present pilot study was to investigate the immediate effect of facial massage on the CoP in the anteroposterior (CoP_AP) and mediolateral (CoP_ML) directions in individuals with temporomandibular disorder (TMD).

Methods

Twenty individuals with a diagnosis of TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were submitted to a facial massage technique. CoP_AP and CoP_ML were evaluated using a force plate. Evaluations were performed under two visual conditions (eyes open and eyes closed) prior to resting in dorsal decubitus (baseline), after 10 minutes of rest (premassage) and after the administration of the massage technique (postmassage).

Results

No significant differences were found regarding CoP_AP velocity with eyes open or the following aspects under either visual condition (eyes open or closed): CoP_ML velocity, RMS of CoP_AP, RMS of CoP_ML, and sway area. The only significant difference was found for mean CoP_AP velocity with eyes closed.

Conclusions

While the results of the present study demonstrate the reliability of the reproduction of the data, facial massage had no immediate influence on postural control in individuals with TMD.

Effect of mandibular mobilization on electromyographic signals in muscles of mastication and static balance in individuals with temporomandibular disorder: study protocol for a randomized controlled trial

BACKGROUND

The stomatognathic system and dysfunction in this system may be related to postural control. The proposal of the present study is to assess the effect of mandibular mobilization in individuals with temporomandibular disorder using surface electromyography of the muscles of mastication and stabilometric variables.

METHODS/DESIGN

A randomized, controlled, blind, clinical trial will be carried out, with the participants divided into three groups: 1) facial massage therapy (control group), 2) nonspecific mandibular mobilization and 3) specific mandibular mobilization. All groups will be assessed before and after treatment using the Research Diagnostic Criteria for Temporomandibular Disorders, surface electromyography of the masseter and temporal muscles and stabilometry. This study is registered with the Brazilian Registry of Clinical Trials (RBR9x8ssz).

DISCUSSION

A large number of studies have employed surface electromyography to investigate the function/dysfunction of the muscles of mastication and associations with signs and symptoms of temporomandibular disorders. However, it has not yet been determined whether stabilometric variables offer adequate reliability in patients with this disorder. The results of the proposed study will help determine whether specific and/or nonspecific mandibular mobilization exerts an effect on the muscles of mastication and postural control. Moreover, if an effect is detected, the methodology defined in the proposed study will allow identifying whether the effect is local (found only in the muscles of mastication), global (found only in postural control) or generalized.

Intra-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomised, clinical trial

BACKGROUND

Myogenous temporomandibular disorders (TMD) are considered to be a common musculoskeletal condition. No studies exist comparing intra-oral myofascial therapies to education, self-care and exercise (ESC) for TMD. This study evaluated short-term differences in pain and mouth opening range between intra-oral myofascial therapy (IMT) and an ESC program.

METHODS

Forty-six participants with chronic myogenous TMD (as assessed according to the Research Diagnostic Criteria Axis 1 procedure) were consecutively block randomised into either an IMT group or an ESC group. Each group received two sessions per week (for five weeks) of either IMT or short talks on the anatomy, physiology and biomechanics of the jaw plus instruction and supervision of self-care exercises. The sessions were conducted at the first author's jaw pain and chiropractic clinic in Sydney, Australia. Primary outcome measures included pain at rest, upon opening and clenching, using an eleven point ordinal self reported pain scale. A secondary outcome measure consisted of maximum voluntary opening range in millimetres. Data were analysed using linear models for means and logistic regression for responder analysis.

RESULTS

After adjusting for baseline, the IMT group had significantly lower average pain for all primary outcomes at 6 weeks compared to the ESC group (p < 0.001). These differences were not clinically significant but the IMT group had significantly higher odds of a clinically significant change (p < 0.045). There was no significant difference in opening range between the IMT and ESC groups. Both groups achieved statistically significant decreases in all three pain measures at six weeks (p ≤ 0.05), but only the IMT group achieved clinically significant changes of 2 or more points.

CONCLUSION

This study showed evidence of superiority of IMT compared to ESC over the short-term but not at clinically significant levels. Positive changes over time for both IMT and ESC protocols were noted. A longer term, multi-centre study is warranted.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12610000508077.

Path generator control system and virtual compliance calculator for maxillofacial massage robots

PURPOSE

Oral disorders such as temporomandibular joint disorders (TMD) and dry mouth are common and often require treatment. Maxillofacial massage is used as a complementary and alternative therapy for these disorders. We developed an oral rehabilitation robot that massages the maxillofacial tissues for this purpose. In this paper, we propose a control system for oral rehabilitation robots.

METHOD

The control system consists of a massage path generator, virtual compliance calculator, and inverse kinematics calculator. The massage path generator computes a target massage path based on a human head model obtained from a reference MRI image of an adult male. The head model includes the shape and elastic modulus of each component, all of which were obtained experimentally. Virtual compliance control is used to control manipulators with position servo actuators. The manipulators, which have a force sensor at their end-effectors, move actively in the direction of the external force applied to their sensors via virtual compliance control. We implemented this control in WAO-1, our first prototype oral rehabilitation robot.

RESULTS

WAO-1 provided massage to three adult male subjects with and without virtual compliance control. One of the subjects was the adult male whose MRI image was used to synthesize the head model in the massage path generator. Without virtual compliance control, the actual massage force was greater than the target massage force, while that with virtual compliance control was less than the target massage force. Furthermore, with virtual compliance control, the massage paths conformed to the head shape of each patient.

CONCLUSION

Implementation of virtual compliance control in the WAO-1 massage robot is feasible and useful for implementation of safe and potentially effective maxillofacial massage therapy.