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Weden A, Haig H. Current thinking in physiotherapy for the management of idiopathic and postsurgical temporomandibular disorders: a narrative review. Br J Oral Maxillofac Surg 2024; 62:588-593. [PMID: 38906764 DOI: 10.1016/j.bjoms.2024.05.008] [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: 02/21/2024] [Revised: 05/14/2024] [Accepted: 05/30/2024] [Indexed: 06/23/2024]
Abstract
Temporomandibular disorders (TMDs) are the second most common form of orofacial pain after an odontogenic source. Despite their complex aetiopathology they are considered a musculoskeletal disorder. They can have a significant impact on the quality of life of those suffering from TMDs, but can be treated and managed through a mixture of conservative and surgical approaches. Physiotherapists specialising in musculoskeletal therapy and pain management can offer a variety of techniques to help in the treatment and management of TMDs. In this narrative review the evolution of physiotherapy practice in the United Kingdom will be outlined, along with a discussion about physiotherapeutic theoretical frameworks in the management of musculoskeletal disorders and idiopathic TMDs. Finally, a narrative review will be presented, outlining the literature exploring the use of physiotherapy post TMJ surgery, underpinned by a systematic literature search on the topic. After screening for inclusion in the narrative review, eight articles were included for narrative synthesis. The main findings were that there is a relative paucity of studies looking at the value of physiotherapy post TMJ surgery compared with the treatment of idiopathic TMDs, and there is heterogeneity in the physiotherapy programmes described in the literature, but the addition of physiotherapy post TMJ surgery seems to augment the patient's response to surgery. The article concludes by describing the domestic challenges and opportunities of integrating physiotherapy into TMD management pathways.
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Affiliation(s)
- Alexander Weden
- Clinical Specialist Physiotherapist in Craniomandibular Disorders, Department of Maxillofacial, Queens Medical Centre, Nottingham University Hospitals, Derby Road, Nottingham NG7 2UH, United Kingdom.
| | - Harriette Haig
- Therapy Services, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom.
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Taqi M, Zaidi SJA, Siddiqui SU, Zia B, Khadija Siddiqui M. Dental practitioners' knowledge, management practices, and attitudes toward collaboration in the treatment of temporomandibular joint disorders: a mixed-methods study. BMC PRIMARY CARE 2024; 25:137. [PMID: 38671353 PMCID: PMC11046804 DOI: 10.1186/s12875-024-02398-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Temporomandibular joint disorders (TMDs) are a variety of conditions that affect different parts of the temporomandibular joints (TMJ) and can cause orofacial pain and functional impairment. This study aims to investigate dental practitioners' knowledge and management of Temporomandibular Joint Disorders (TMDs), particularly their knowledge of the role physical therapy plays in TMD treatment. METHODS A mixed-methods approach was adopted to provide a comprehensive view of current knowledge, management practices, and attitudes toward collaboration among dental practitioners in treating TMD. Data were collected from a convenience sample of 335 dentists in Karachi using a detailed questionnaire to assess their knowledge of the role of physical therapy in the treatment of TMD. Twenty dentists were chosen for face-to-face, in-depth interviews to explore their experiences and challenges in managing TMDs based on their responses to the administered questionnaire. RESULTS The cumulative quantitative and qualitative findings of the study revealed a landscape marked by individualized approaches to referral practices and significant gaps in interdisciplinary collaboration. Most practitioners holding a bachelor's degree predominantly used medication (65.2%) and cause-specific treatment (65.3%) for TMD treatment. Thematic analysis of clinical efficacy and practitioner challenges in managing TMD revealed significant issues faced by dental professionals. CONCLUSIONS The study successfully validated a questionnaire to understand dental practitioners' knowledge regarding physical therapy in TMD treatment. The study identified significant gaps in knowledge and a lack of collaboration between dentists and physiotherapists. The limited referral practices highlighted in the study, along with insights from dentist interviews, emphasize the need for improved interdisciplinary approaches to managing TMDs within dental practice.
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Affiliation(s)
- Muhammad Taqi
- Department of Community Dentistry, Dow Dental College, Dow University of Health Sciences, Karachi, Sindh, Pakistan.
| | - Syed Jaffar Abbas Zaidi
- Department of Oral Biology, Dow Dental College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Saad Uddin Siddiqui
- Department of Oral Medicine, Dow Dental College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Babar Zia
- Department of Community Dentistry, Dow Dental College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Maria Khadija Siddiqui
- Department of Community Dentistry, Jinnah Medical & Dental College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
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Arikan H, Citaker S, Ucok C, Ucok O. Effect of high voltage electrical stimulation in temporomandibular disorders: a randomized controlled trial. Physiother Theory Pract 2024:1-14. [PMID: 38407175 DOI: 10.1080/09593985.2024.2321215] [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: 08/11/2023] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To examine the effects of high voltage electrical stimulation (HVES) on pain intensity, maximum mouth opening (MMO), cervical mobility, head position, pressure pain thresholds (PPTs), bite force, joint sounds, and jaw muscle strength in individuals with temporomandibular disorders (TMDs). METHODS Thirty-four individuals with TMDs were randomly divided into the exercise group (EG) (n = 17) and the HVES group (HG) (n = 17). For 4 weeks, EG received exercise therapy alone, while HG received HVES (12 sessions in total, 3 days a week to anterior temporalis and masseter) in conjunction with exercise. RESULTS After the treatment, in both groups, pain intensity significantly decreased (p < .001); MMO (7.27 mm in HG and 3.61 mm in EG), cervical mobility, head position, PPTs, bite force, and jaw muscle strength significantly increased (p = .043 to < .001). Joint sounds significantly decreased in the HG (p = .008). Left bite force (p = .040) and left medial pterygoid PPT (p = .013) increased more in EG. The change in left bite force in EG over time was significant (p = .040; ηp2 = .126). The effect sizes of treatments were medium to large (from .527 to 1.602) for the evaluated parameters. CONCLUSION Although exercise alone was effective in many parameters evaluated, additional application of HVES provided further improvement for pain, MMO, cervical mobility, PPTs, jaw muscle strength and joint sounds. HVES can be routinely used in clinics for individuals with TMDs.
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Affiliation(s)
- Halime Arikan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Seyit Citaker
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Cankaya/Ankara, Turkey
| | - Cahit Ucok
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Yenimahalle/Ankara, Turkey
| | - Ozlem Ucok
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Gazi University, Cankaya/Ankara, Turkey
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Riley JLI, Rindal DB, Velly AM, Anderson GC, Johnson KS, Gilbert GH, Schiffman EL. Practitioner/Practice- and Patient-Based Factors Contributing to Dental Practitioner Treatment Recommendations for Patients with Pain-Related TMDs: Findings from the National Dental PBRN. J Oral Facial Pain Headache 2023; 37:195-206. [PMID: 37975783 PMCID: PMC10664701 DOI: 10.11607/ofph.3263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 04/16/2023] [Indexed: 11/19/2023]
Abstract
AIMS To document National Dental Practice-Based Research Network (PBRN) practitioner treatment recommendations for patients with painful temporomandibular disorders (TMDs) and to identify practitioner/practice- and patient-related factors contributing to treatment recommendations made at the initial clinical visit. METHODS This prospective single-sample cohort study formed groups based on treatment recommendations made by 185 dental practitioners who treated 1,901 patients with painful TMDs. At the baseline visit, which this article describes, practitioners provided patients with their diagnoses and a treatment plan and then completed a comprehensive questionnaire. RESULTS Self-care, an intraoral appliance, medication, and practitioner-recommended jaw exercises were the most frequently recommended treatments. Practitioners recommended multiple treatments to most patients. TMD signs, symptoms, and diagnoses were primary considerations in treatment planning, but the practitioner's expectations for improvement were only significant for intraoral appliances and self-care. Female practitioners and those with expertise in TMDs more frequently recommended patient-directed and multidisciplinary treatments compared to their counterparts. CONCLUSIONS Practitioners used a wide range of treatments for patients with few consistent patterns. The propensity to use TMD signs, symptoms, and diagnoses when making treatment recommendations suggests a tendency to conceptualize patients using the biomedical model. Infrequent referral to nondental providers suggests a lack of availability of these providers, a misunderstanding of the complexity of TMDs, and/or discomfort with assessment of psychosocial factors. Implications include the need for comprehensive training in the assessment and management of TMD patients during dental school and participation in TMD continuing education courses following evidence-based guidelines.
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Romero-Reyes M, Klasser G, Akerman S. An Update on Temporomandibular Disorders (TMDs) and Headache. Curr Neurol Neurosci Rep 2023; 23:561-570. [PMID: 37581857 DOI: 10.1007/s11910-023-01291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE OF REVIEW To provide an overview and highlight recent updates in temporomandibular disorders (TMDs) and their comorbidity with headache disorders regarding pathophysiology and management. RECENT FINDINGS In the last decade, there have been great advancements in the understanding of TMDs and their relationship with neurovascular pains such as headaches. Understanding of TMDs is necessary for the context of its comorbidity with primary headache disorders. The literature regarding management of these comorbidities is scarce but points to combination therapy including pharmacological and non-pharmacological approaches to optimize management. The use of CGRP receptor-targeted monoclonal antibodies or CGRP receptor antagonists should be explored for the management of chronic TMDs. It could also be used as a novel monotherapy or in combination with non-pharmacological approaches for TMDs' comorbidity with headache, particularly migraine. Research is needed to support evidence-based management protocols. A team involving neurology (headache medicine) and dentistry (orofacial pain) is critical for optimal management.
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Affiliation(s)
- Marcela Romero-Reyes
- Brotman Facial Pain Clinic, School of Dentistry, University of Maryland, Baltimore, MD, USA.
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th floor, Baltimore, MD, 21201, USA.
| | - Gary Klasser
- Department of Diagnostic Sciences, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, LA, USA
| | - Simon Akerman
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th floor, Baltimore, MD, 21201, USA
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Wang X, Yang Y, Lin L, Yao Q, Zhang J. Obesity and temporomandibular joint disorders: a systematic review and meta-analysis. BMC Oral Health 2023; 23:607. [PMID: 37644424 PMCID: PMC10466750 DOI: 10.1186/s12903-023-03322-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Temporomandibular joint disorders (TMD) is the most common non-dental pain complaint in the maxillofacial region, which presents a variety of symptoms and signs, including temporomandibular joints (TMJ) and masticatory muscle pain, joint noise, tinnitus, headaches, irregular or restricted mandibular function, masticatory difficulty, and restricted mouth opening. When comes to the relationship between obesity and TMD, it has remained controversial and inconsistent, therefore, we first conducted this meta-analysis to estimate the unclear relationship between obesity and TMD. METHODS Searches were conducted in PubMed, Web of Science, Embase, and Cochrane Library. Subjects were divided into five groups according to BMI level in this study, including the normal weight group: 18.5 ≤ BMI < 25, overweight group: 25 ≤ BMI < 30, obesity group: BMI ≥ 30, control group: BMI < 25, and overweight and obesity group: BMI ≥ 25. Statistics analyses were conducted using Stata (15.0). The number of PROSPERO was CRD42022368315. RESULTS Eight studies were included in this study, and six articles with a total of 74,056 participants were synthesized for meta-analysis. Compared to normal weight individuals, overweight and obesity together decreased the risk of TMD (OR = 0.66, 95% CI = 0.46-0.95), and it was significantly decreased by obesity alone (OR = 0.58). Moreover, it was lower in obesity compared with control subjects (OR = 0.83, 95% CI = 0.73-0.94). Furthermore, in overweight and obese individuals, it was much lower in obesity than in overweight (OR = 0.82, 95% CI = 0.71-0.94). CONCLUSIONS Obesity is not a risk factor for TMD, and maybe a protective factor for TMD, of which patients with larger BMI are less likely to suffer from TMD pain. Therefore, the value of BMI should be taken into consideration in the assessment of TMD.
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Affiliation(s)
- Xia Wang
- Center of Stomatology, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, China
| | - Yan Yang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Linni Lin
- Center of Stomatology, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, China
| | - Qianqian Yao
- Center of Stomatology, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, China.
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Shaffer SM, Naze GS. Evaluation and management of temporomandibular disorders. Part 2: an orthopaedic physical therapy update on examination and clinical reasoning. J Man Manip Ther 2023; 31:143-152. [PMID: 36171740 PMCID: PMC10288906 DOI: 10.1080/10669817.2022.2124617] [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] [Indexed: 10/14/2022] Open
Abstract
Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.
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Affiliation(s)
- Stephen M. Shaffer
- Department of Rehabilitation Sciences, College of Education, Nursing, and Health Professions, University of Hartford, West Hartford, CT, USA
| | - Garrett S. Naze
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
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Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review. Int J Mol Sci 2022; 23:ijms232012164. [PMID: 36293017 PMCID: PMC9602546 DOI: 10.3390/ijms232012164] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
Temporomandibular disorders (TMD) are a group of musculoskeletal diseases affecting masticatory muscles and temporomandibular joints (TMJ). In this context, the chronic TMD could be considered as a condition with chronic primary orofacial pain, presenting as myofascial TMD pain or TMJ arthralgia. In this context, myogenous TMD may present overlapping features with other disorders, such as fibromyalgia and primary headaches, characterized by chronic primary pain related to dysfunction of the central nervous system (CNS), probably through the central sensitization. This phenomenon could be defined as an amplified response of the CNS to sensory stimuli and peripheral nociceptive, characterized by hyperexcitability in the dorsal horn neurons in the spinal cord, which ascend through the spinothalamic tract. The main objectives of the management of TMD patients are: decreasing pain, increasing TMJ function, and reducing the reflex masticatory muscle spasm/pain. The first-line treatments are physical therapy, pharmacological drugs, occlusal splints, laser therapy, extracorporeal shockwave therapy, transcutaneous electrical nerve stimulation, and oxygen–ozone therapy. Although all these therapeutic approaches were shown to have a positive impact on the central sensitization of TMD pain, there is still no agreement on this topic in the scientific literature. Thus, in this comprehensive review, we aimed at evaluating the evidence on pain management and rehabilitation for the central sensitization in TMD patients.
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The Quantification of Salivary Flow and pH and Stomatognathic System Rehabilitation Interference in Patients with Oral Diseases, Post-Radiotherapy. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12083708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Xerostomia is a common complication post-radiotherapy in patients with oral cancer. The acute and long-term side effects can considerably reduce the patient’s quality of life. The aim of our study was to perform analysis of salivary flow and pH in patients after radiotherapy. Methodology: Clinical and laboratory evaluations were conducted in the 2014–2019 period; out of a total 58 subjects aged between 45 and 84, 28 individuals with oral cancer were selected from St. Spiridon Hospital, Clinic of Maxillo-facial Surgery and Oncology Hospital, Iasi post-radiotherapy. Results: Significant downsized mean values of the hydrogen ion concentration (pH) in saliva (p < 0.001) were recorded in patients after radiotherapy, pH value = 4.580 (±1.051). The mean value of resting salivary flow (MRSF) was significantly lower for the group of patients with radiotherapy (MRSF) = 0.145 mL/min. In 89.29% of cases (25 post-radiotherapy cases), in order to perform oral complex rehabilitation treatment, several endodontic and periodontal treatments were performed. A total of 78.57% of the cases received complex oral rehabilitation as mobile or hybrid prostheses or fixed solutions. Conclusion: Understanding post-radiotherapy salivary biochemic modifications in patients with oral cancer could be of critical importance, in view of related oral disorder prevention.
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BATISTA JFDOL, VILA-NOVA TEL, MORAES SLD, PELLIZZER EP, VASCONCELOS BCDE, GOMES JMDL, LEMOS CAA, HEIMER MV. Are exercises with or without occlusal splints more effective in the reduction of pain in patients with temporomandibular disorders of myogenic origin? A systematic review. J Appl Oral Sci 2022. [DOI: 10.1590/1678-7757-2022-0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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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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Liu GF, Gao Z, Liu ZN, Yang M, Zhang S, Tan TP. Effects of Warm Needle Acupuncture on Temporomandibular Joint Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:6868625. [PMID: 34873409 PMCID: PMC8643238 DOI: 10.1155/2021/6868625] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/13/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Temporomandibular joint disorders (TMDs) are a common and prevalent disease with main symptoms of pain, joint sounds, and mandibular movement disorders, which seriously affects the mental health and quality of life of the sufferers. In recent years, there have been an increasing number of studies utilizing warm needle acupuncture (WNA) for the treatment of TMD, and the quality of the studies has gradually improved. However, evidence from evidence-based medicine is lacking. This study aims to use a systematic review and meta-analysis method to understand the efficacy of WNA for the treatment of TMD. Methods and Analysis. We searched randomized controlled trials (RCTs) of WNA for the treatment of TMD from 9 electronic databases, including 5 English databases (PubMed, EMBASE, Cochrane Library, Web of Science, and MEDLINE) and 4 Chinese databases (Chinese National Knowledge Infrastructure (CNKI), Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database (CBM)) from their inception to May 2021. The included RCTs compared WNA with acupuncture, electroacupuncture, pharmacological therapy, or other therapies. And outcome indicators such as total effective rate and cure rate were assessed. All analyses were conducted using RevMan software V5.3 and Stata16. Measurement count data used the relative risk (RR) as the efficacy statistic, and each effect size was given its point estimate value and 95% confidence interval (CI). RESULTS The meta-analysis included 10 studies with a total of 670 patients, which included 340 patients in the experimental group and 330 patients in the control group. The data in this review showed that WNA is superior to treatments such as acupuncture alone, acupuncture therapy combined with TDP, drug therapy, and ultrasonic therapy in terms of effective rate (RR = 1.20; 95% CI, 1.06 to 1.35; and P = 0.003) and cure rate (RR = 1.82; 95% CI, 1.46 to 2.28; and P < 0.00001) for the treatment of TMD. CONCLUSIONS This systematic review and meta-analysis provides new evidence for the effectiveness of WNA for the treatment of TMD. However, the above conclusions need to be further verified by multicenter prospective studies of larger samples and higher-quality RCTs. Protocol registration number: INPLASY202160030.
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Affiliation(s)
- Gao-Feng Liu
- Graduate Faculty, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Zhen Gao
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu 6100752, China
| | - Zheng-Nan Liu
- The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510405, China
| | - Min Yang
- Dermatology Department, Qujiang District Hospital of Traditional Chinese Medicine, Quzhou 324022, China
| | - Sheng Zhang
- Neurology Department, Qujiang District Hospital of Traditional Chinese Medicine, Quzhou 324022, China
| | - Tai-Peng Tan
- Acupuncture Department, Heilongjiang Provincial Academy of Traditional Chinese Medicine Sciences, Harbin 150036, China
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Wu J, Huang Z, Chen Y, Chen Y, Pan Z, Gu Y. Temporomandibular disorders among medical students in China: prevalence, biological and psychological risk factors. BMC Oral Health 2021; 21:549. [PMID: 34702237 PMCID: PMC8549286 DOI: 10.1186/s12903-021-01916-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/12/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of the present study is to evaluate the prevalence of temporomandibular disorders (TMD) and their associated biological and psychological factors in Chinese university students. METHODS A total of 754 students were included from Zunyi Medical University, each participant completed questionnaires and clinical examinations according to the Diagnostic Criteria for Temporomandibular Disorders. RESULTS The overall prevalence of TMD was 31.7% among medical students. Subjects with TMD had a high prevalence of bruxism, empty chewing, unilateral chewing, chewing gum, anterior teeth overbite, anterior teeth overjet, depression, anxiety, and sleep disturbance. Moreover, sleep bruxism, empty chewing, unilateral chewing, anterior teeth overbite, depression, and anxiety were the strongest risk factors for TMD. CONCLUSIONS Individuals with TMD have a high prevalence of psychological distress and oral parafunctional habits. Except for the psychological factors associated with TMD, bruxism, abnormal chewing, and malocclusion also shared similar risks for TMD.
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Affiliation(s)
- Jing Wu
- Department of Stomatology, Huzhou Traditional Chinese Medicine Hospital, Zhejiang Chinese Medicinal University, Huzhou, Zhejiang, China
| | - Zelun Huang
- Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yong Chen
- Department of Stomatology, Stomatological Hospital of Honghuagang, Zunyi, Guizhou, China
| | - Yifan Chen
- Department of Stomatology, Huzhou Traditional Chinese Medicine Hospital, Zhejiang Chinese Medicinal University, Huzhou, Zhejiang, China
| | - Zhongqiang Pan
- Department of Acupuncture, Huzhou Traditional Chinese Medicine Hospital, Zhejiang Chinese Medicinal University, Huzhou, Zhejiang, China
| | - Yu Gu
- Department of Stomatology, Zhuhai Campus of Zunyi Medical University, 368 Jinwan Road, Zhuhai, 519041, Guangdong Province, China.
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Validity and Reliability of the Helkimo Clinical Dysfunction Index for the Diagnosis of Temporomandibular Disorders. Diagnostics (Basel) 2021; 11:diagnostics11030472. [PMID: 33800185 PMCID: PMC8000811 DOI: 10.3390/diagnostics11030472] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 01/12/2023] Open
Abstract
The Helkimo Clinical Dysfunction Index (HCDI) is a simple and quick test used to evaluate subjects affected by temporomandibular disorders (TMDs), and its psychometric properties have not been tested. The test evaluates movement, joint function, pain and musculature, providing a quick general overview that could be very useful at different levels of care. For this reason, the aim of this study was to validate the use of the HCDI in a sample of patients with TMD. Methods: The sample consisted of 107 subjects, 60 TMD patients and 47 healthy controls. The study evaluated concurrent validity, inter-rater concordance and predictive values. Results: The HCDI showed moderate to substantial inter-rater concordance among the items and excellent concordance for the total scores. The correlation with other TMD assessment tests was high, the correlation with dizziness was moderate and the correlation with neck pain, headache and overall quality of life was poor. The prediction of TMD showed a sensitivity of 86.67%, a specificity of 68.09% and an area under the curve (AUC) of 0.841. Conclusions: The HCDI is a valid and reliable assessment instrument; its clinimetric properties are adequate, and it has a good ability to discriminate between TMD-affected and TMD-unaffected subjects.
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