Effects of Therapeutic and Aerobic Exercise Programs on Pain, Neuromuscular Activation, and Bite Force in Patients with Temporomandibular Disorders

The effectiveness of aerobic exercise compared to other types of treatment on pain and disability in patients with orofacial pain: A systematic review

PURPOSE

To compile and synthesise the evidence regarding the effectiveness of aerobic exercise (AE) compared with other treatments to reduce pain and disability of individuals with orofacial pain (OFP).

METHODS

Electronic searches were conducted on five databases (MEDLINE, Embase, CINAHL, Cochrane Library, and Scopus). Randomised controlled trials (RCT) or controlled trials including adults of both sexes with painful OFP diagnoses were targeted. The intervention of interest was AE (e.g., walking, cycling, running, among others), compared to any other conservative and non-conservative therapy. The primary outcome was pain intensity. The risk of bias (RoB) was determined using a compiled set of items and the Cochrane RoB-2 tools. The overall certainty of the evidence was evaluated with the GRADE approach.

RESULTS

Out of 4.669 records screened, four manuscripts were included. However, three of them used the same population but presented different outcomes. These studies included subjects with headache associated with temporomandibular disorders (TMD) and general TMD. Both studies used aerobic exercise (AE) as the intervention of interest. Manual therapy (MT) plus exercise (Ex) (strengthening exercise (Str ex) or general exercises) were used as a comparison group. The combined treatment, including a multimodal therapy (AE + MT + Str ex), was superior to MT + Ex (MD: -8.65 points [95% CI -13.73, -3.57]) on pain intensity (orofacial pain [OFP] and headache intensity) at the end of the treatment and also after 12-week follow-up (MD: -9.43 points [95% CI -14.97, -3.89]). Also, the combination of three treatment modalities (AE + MT + Ex) was better on quality of life than AE alone (MD: -14.60 points [95% CI -16.74, -12.46]) and MT + Ex (MD: -12.30 point [95% CI -14.50, -10.10]) at the end of the treatment.

CONCLUSIONS

Aerobic exercise plus MT and general exercises achieved the greatest positive effects on pain and other outcomes in the short/medium term in patients with OFP. However, the scientific evidence supporting the isolated effects of AE for OFP is limited, indicating the need for more studies. Further studies are also needed to elaborate guidelines when using AE for individuals with OFP.

Comparative effects of post isometric relaxation technique and Bowen's therapy on pain, range of motion and function in patients with temporomandibular joint disorder

BACKGROUND

The most common cause of mouth and facial pain is a temporomandibular joint disorder, which affects the patient's quality of life and interferes with their ability to perform daily tasks.

OBJECTIVE

The purpose was to compare the effects of the Post-Isometric Relaxation Technique and Bowen's Therapy on pain, range of motion and functional activity in patients with temporomandibular joint disorders.

METHODS

This study was a randomized clinical trial. A total of 24 participants were randomly allocated into two groups using the lottery method. Baseline treatment was the same (ultrasound and tapping) in both groups. Group 1 (12 participants) was treated with a post-isometric relaxation technique, and Group 2 (12 participants) with Bowen's therapy for two sessions per week (total duration of 4 weeks). Outcome measures were the Numeric Pain Rating Scale, Maximal mouth opening inter-incisal rural and jaw functional limitation scale-20. SPSS version 25 was used for statistical analysis.

RESULTS

A significant improvement in pain, range of motions and functional activities in the post-isometric group showed significant results (p < 0.05) as compared to Bowen's group (independent t-test). However, within-group comparison (paired t-test), both groups showed significant results (p < 0.05).

CONCLUSION

This study concluded that post-isometric relaxation was more effective in terms of pain, range of motions for mouth opening, lateral deviations and functional activity of temporomandibular joint disorder patients. However, both groups showed clinical results according to minimal clinical difference values.

TRIAL REGISTRY NUMBER

The trial is registered under ClinicalTrials.govt with reference no. ID: NCT05392049 registered on 26/05/2022.

Craniofacial disorders and headaches. A narrative review

OBJECTIVES

Craniofacial- and headache disorders are common co-morbid disorders. The aim of this review is to provide an overview of the research discussing craniofacial pain, especially temporomandibular disorders, and its relationship and impact on headaches, as well as suggestions for diagnostic assessment tools and physical therapeutic management strategies.

METHOD

A narrative structured review was performed. A search was conducted in MEDLINE using terms related to craniofacial pain and headaches. Additionally, papers regarding this topic were also extracted from the authors' personal libraries. Any study design (i.e., RCT, observational studies, systematic review, narrative review) that reported the concepts of interest was included, using Covidence. Results were narratively synthesized and described.

RESULTS

From an epidemiological perspective, craniofacial pain and headaches are strongly related and often co-existing. This may be due to the neuroanatomical connection with the trigeminal cervical complex, or due to shared predisposing factors such as age, gender, and psychosocial factors. Pain drawings, questionnaires, and physical tests can be used to determine the cause of pain, as well as other perpetuating factors in patients with headaches and craniofacial pain. The evidence supports different forms of exercise and a combination of hands-on and hands-off strategies aimed at both the craniofacial pain as well as the headache.

CONCLUSION

Headaches may be caused or aggravated by different disorders in the craniofacial region. Proper use of terminology and classification may help in understanding these complaints. Future research should look into the specific craniofacial areas and how headaches may arise from problems from those regions. (249 words).

Association of Non-carious Cervical Lesions with Oral Hygiene Aspects and Occlusal Force

AIM

The purpose of this case-control (CT) study was to investigate the association between the presence of non-carious cervical lesions (NCCLs) with occlusal force and other potential risk factors.

MATERIALS AND METHODS

Thirty-nine participants with NCCLs [cases (CS)] and 39 with no NCCLs [control (CT)] attending the dental clinic of the Faculdades Integradas São Pedro (FAESA), located in Brazil, were enrolled in this study. Information was collected through anamnesis, clinical examination, and a questionnaire addressing aspects related to tooth brushing, dentifrice, and mouthwash use. In clinical examination, patients were submitted to four measurements of occlusal force in the maxillary first premolars and maxillary first molars, using a strain gauge sensor of medium intensity, the Flexiforce (Tekscan, South Boston, Massachusetts, United States of America). The sensor was calibrated for the unit of measurement in Newtons (N). Data were analyzed using a student's t-test and multiple logistic regression, e with a significance level of 5%.

RESULTS

There was no statistically significant difference between the case and CT groups regarding the bite force in the four measured regions. Logistic regression identified sex as a factor significantly associated with NCCLs (p = 0.020). The odds ratio showed the female sex had more chance (OR = 6.082; CI = 1.332-27.765) of having NCCLs.

CONCLUSION

It is concluded that females presented a higher risk factor for NCCLs than men. In contrast, there was no association of occlusal force, as well as aspects related to brushing and deleterious habits.

CLINICAL SIGNIFICANCE

Females have a higher risk factor for non-carious lesions than men.

Silencing of TRPV4-expressing sensory neurons attenuates temporomandibular disorders pain

Identification of potential therapeutic targets is needed for temporomandibular disorders (TMD) pain, the most common form of orofacial pain, because current treatments lack efficacy. Considering TMD pain is critically mediated by the trigeminal ganglion (TG) sensory neurons, functional blockade of nociceptive neurons in the TG may provide an effective approach for mitigating pain associated with TMD. We have previously shown that TRPV4, a polymodally-activated ion channel, is expressed in TG nociceptive neurons. Yet, it remains unexplored whether functional silencing of TRPV4-expressing TG neurons attenuates TMD pain. In this study, we demonstrated that co-application of a positively charged, membrane-impermeable lidocaine derivative QX-314 with the TRPV4 selective agonist GSK101 suppressed the excitability of TG neurons. Moreover, co-administration of QX-314 and GSK101 into the TG significantly attenuated pain in mouse models of temporomandibular joint (TMJ) inflammation and masseter muscle injury. Collectively, these results suggest TRPV4-expressing TG neurons represent a potential target for TMD pain.

Personalized Care and Treatment Compliance in Chronic Conditions

Chronic diseases are commonly defined as conditions that last one year or more and require ongoing medical attention, limit activities of daily living, or both [...].