Effects on temporomandibular disorder in the treatment of tension-type headache with acupuncture and therapeutic exercises. A secondary analysis from a randomized controlled trial.

OBJECTIVES: To examine the effects of acupuncture and therapeutic exercise alone and in combination on temporomandibular joint symptoms in tension-type headache and to evaluate the potential interaction of existing temporomandibular dysfunction on the success of headache treatment. DESIGN: Pre-planned secondary analysis of a randomized controlled, non-blinded trial. SETTING: Outpatient clinic of a German university hospital. SUBJECTS: Ninety-six Participants with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups. INTERVENTIONS: Six weeks of acupuncture or therapeutic exercise either as monotherapies or in combination, or usual care. Follow-up at 3 and 6 months. MAIN MEASURES: Subjective temporomandibular dysfunction symptoms were measured using the Functional Questionnaire Masticatory Organ, and the influence of this sum score and objective initial dental examination on the efficacy of headache treatment interventions was analyzed. RESULTS: Temporomandibular dysfunction score improved in all intervention groups at 3-month follow-up (usual care: 0.05 [SD 1.435]; acupuncture: -5 [SD 1.436]; therapeutic exercise: -4 [SD 1.798]; combination: -3 [SD 1.504]; P = 0.03). After 6 months, only acupuncture (-6 [SD 1.736]) showed a significant improvement compared to the usual care group (P < 0.01). Subjective temporomandibular dysfunction symptoms had no overall influence on headache treatment. CONCLUSIONS: Only acupuncture had long-lasting positive effects on the symptoms of temporomandibular dysfunction. Significant dental findings seem to inhibit the efficacy of acupuncture for tension-type headache.

Efficacy of acupuncture and laser acupuncture in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The aim of this study is to perform a qualitative and quantitative analysis of the scientific literature regarding the use of acupuncture and laser acupuncture in the treatment of pain associated with temporomandibular disorders (TMDs). The aim of this article was to assess the clinical evidence for acupuncture and laser acupuncture therapies as treatment for temporomandibular joint disorder (TMD). MATERIALS AND METHODS: This systematic review includes randomized clinical trials (RCTs) of acupuncture and laser acupuncture as a treatment for TMD compared to other treatments. Systematic searches were conducted in 3 electronic databases up to July 2023; PubMed, EMBASE, and SCOPUS databases. All RCTs of acupuncture for TMD were searched without language restrictions. Studies in which no clinical data and complex interventions were excluded. The Cochrane risk of bias tool (RoB 2) tool was employed to analyze randomized controlled trials. A Meta-analysis was performed in order to investigate a quantitative analysis comparing acupuncture and laser acupuncture to placebo. RESULTS: A total of 11 RCTs met our inclusion criteria. The findings show that acupuncture is short-term helpful for reducing the severity of TMD pain with muscle origin. Meta-analysis revealed that the Acupuncture group and Laser Acupuncture group had a higher efficacy rate than the Placebo control group, showing a high efficacy of Acupuncture and Laser Acupuncture group in the treatment of temporomandibular. CONCLUSIONS: In conclusion, our systematic review demonstrate that the evidence for acupuncture as a symptomatic treatment of TMD is limited. Further rigorous studies are, however, required to establish beyond doubt whether acupuncture has therapeutic value for this indication. However high efficacy of Laser Acupuncture in the treatment of temporomandibular disorders was reported.

Debilitating lower back pain during menses unexpectedly resolved after treatment of subclinical temporomandibular disorder: a case report.

This case report describes a patient in whom debilitating lower back pain that always occurred during menses resolved when she received treatment for subclinical temporomandibular disorder (TMD). The patient was diagnosed with subclinical TMD and facial myalgia based on the results of clinical and radiographic examinations. She was treated with maxillary (nighttime) and mandibular (daytime) dental orthotics to provide stabilization and decompression of the temporomandibular joints. After 12 weeks of appliance therapy, which resulted in resolution of the TMD symptoms, the patient reported that the debilitating lower back pain she experienced during menses had ceased. Her back pain did not return after the use of the mandibular appliance was discontinued. The authors discuss how neurologic, postural, inflammatory, and qi flow changes attributed to the patient's TMD treatment may have contributed to the cessation of the patient's menses-related lower back pain.

Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline.

CLINICAL QUESTION: What is the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD)? CURRENT PRACTICE: TMD are the second most common musculoskeletal chronic pain disorder after low back pain, affecting 6-9% of adults globally. TMD are associated with pain affecting the jaw and associated structures and may present with headaches, earache, clicking, popping, or crackling sounds in the temporomandibular joint, and impaired mandibular function. Current clinical practice guidelines are largely consensus-based and provide inconsistent recommendations. RECOMMENDATIONS: For patients living with chronic pain (≥3 months) associated with TMD, and compared with placebo or sham procedures, the guideline panel issued: (1) strong recommendations in favour of cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care (such as home exercises, stretching, reassurance, and education); (2) conditional recommendations in favour of manipulation, supervised jaw exercise with mobilisation, CBT with non-steroidal anti-inflammatory drugs (NSAIDS), manipulation with postural exercise, and acupuncture; (3) conditional recommendations against reversible occlusal splints (alone or in combination with other interventions), arthrocentesis (alone or in combination with other interventions), cartilage supplement with or without hyaluronic acid injection, low level laser therapy (alone or in combination with other interventions), transcutaneous electrical nerve stimulation, gabapentin, botulinum toxin injection, hyaluronic acid injection, relaxation therapy, trigger point injection, acetaminophen (with or without muscle relaxants or NSAIDS), topical capsaicin, biofeedback, corticosteroid injection (with or without NSAIDS), benzodiazepines, and ß blockers; and (4) strong recommendations against irreversible oral splints, discectomy, and NSAIDS with opioids. HOW THIS GUIDELINE WAS CREATED: An international guideline development panel including patients, clinicians with content expertise, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. The panel approached the formulation of recommendations from the perspective of patients, rather than a population or health system perspective. THE EVIDENCE: Recommendations are informed by a linked systematic review and network meta-analysis summarising the current body of evidence for benefits and harms of conservative, pharmacologic, and invasive interventions for chronic pain secondary to TMD. UNDERSTANDING THE RECOMMENDATION: These recommendations apply to patients living with chronic pain (≥3 months duration) associated with TMD as a group of conditions, and do not apply to the management of acute TMD pain. When considering management options, clinicians and patients should first consider strongly recommended interventions, then those conditionally recommended in favour, then conditionally against. In doing so, shared decision making is essential to ensure patients make choices that reflect their values and preference, availability of interventions, and what they may have already tried. Further research is warranted and may alter recommendations in the future.

Effectiveness of deep dry needling versus manual therapy in the treatment of myofascial temporomandibular disorders: a systematic review and network meta-analysis.

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).

Is acupuncture an effective treatment for temporomandibular disorder?: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Acupuncture is used for treating various disorders, but its effects on temporomandibular disorder (TMD) remain unclear. This study aimed to assess the effectiveness and safety of acupuncture for TMD via a systematic review of randomized clinical trials. METHODS: A total of 11 Korean and worldwide databases were searched to identify acupuncture studies in adults with TMD. A Cochrane risk of bias assessment was performed on all articles; a meta-analysis, which involved the categorization according to the type of control used (inactive control, active control, or add-on), was subsequently performed. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation methodology. RESULTS: The qualitative analysis of randomized clinical trials with acupuncture as the intervention included 32 articles, 22 of which were included in the quantitative analysis (471 participants). Acupuncture significantly improved outcomes (effect rate, relative risk [RR]: 7.00, 95% confidence interval [CI]: 1.91, 25, 62; visual analog scale, standardized mean difference: 0.49, 95% CI: 0.24, 0.73) versus active controls (effect rate, RR: 1.19; 95% CI: 1.12, 1.27). In the analysis of add-ons, acupuncture significantly improved the effect rate and pain intensity (effect rate, RR: 1.36; 95% CI: 1.04, 1.77; visual analog scale, mean difference: -1.23; 95% CI -1.79, -0.67). However, the quality of evidence was determined to range from low to very low. CONCLUSION: Acupuncture in TMD significantly improved outcomes versus active controls and when add-on treatments were applied. However, as the quality of evidence was determined to be low, well-designed clinical trials should be conducted in the future.

Trigger point dry needling increases masseter muscle oxygenation in patients with temporomandibular disorder.

BACKGROUND: Temporomandibular disorder (TMD) is an umbrella term encompassing various clinical complaints involving the temporomandibular joints, masticatory muscles, and/or associated orofacial structures. Myogenous TMDs are the most frequent cause of chronic orofacial pain. Musculoskeletal pain is commonly associated with myofascial trigger points (MTPs), for which dry needling (DN) is a routine treatment. OBJECTIVE: To investigate muscle oxygenation and pain immediately after DN application on an MTP in the masseter muscle of patients with myogenous TMDs. METHODOLOGY: Masseter muscle oxygen tissue saturation indices (TSI%) were assessed by near-infrared spectroscopy (NIRS) pre- and post-interventions by a randomized, controlled, double-blind, crossover DN/Sham clinical trial (primary outcome). Pain was investigated by the visual analog scale (VAS). In total, 32 individuals aged from 18 to 37 years who were diagnosed with myogenous TMD and myofascial trigger points in their masseter muscles participated in this study. Relative deltas for the studied variables were calculated. Data normality was tested using the Shapiro-Wilk test. According to their distribution, data were analyzed by two-way ANOVA and the Student's t-, and Mann-Whitney tests. Statistical analyses were performed using Prism® 5.0 (GraphPad, USA). RESULTS: We found a significant difference (2,108% vs. 0,142%) between masseter muscle TSI% deltas after the DN and Sham interventions, respectively (n=24). We only evaluated women since men refused to follow NIRS procedures. Pain increased immediately after DN (n=32, 8 men), in comparison to Sham delta VAS. CONCLUSION: These findings show an increase in tissue oxygen saturation in the evaluated sample immediately after the DN intervention on the MTP of patients' masseter muscle. Pain may have increased immediately after DN due to the needling procedure.

Manejo das disfunções temporomandibulares. Parte I: tratamento conservador / Management of temporomandibular joint disorders. Part I: conservative treatment

Objetivo: Apresentar as modalidades de tratamentos conservadoras e minimamente invasivas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTM). Revisão da literatura: Os objetivos do tratamento invariavelmente incluem redução da dor, diminuição das atividades parafuncionais e restauração da função. Dentre as alternativas conservadoras e minimamente invasivas, podemos citar os dispositivos interoclusais, exercícios terapêuticos, eletrofototermoterapia, agulhamento seco e infiltração de anestésicos locais em pontos gatilho, injeção de sangue autógeno para controle da luxação mandibular, terapia cognitivo comportamental, toxina botulínica, viscossuplementação, controle farmacológico da dor aguda e crônica. As DTMs afetam uma proporção significativa da população. Somente após o fracasso das opções não invasivas é que devem ser iniciados tratamentos mais invasivos e irreversíveis. No entanto, algumas condições, como a anquilose e neoplasias, por exemplo, são essencialmente tratadas cirurgicamente e tentativas de tratamentos conservadores podem trazer piora na qualidade de vida ou risco de morte. Considerações finais: Uma abordagem de equipe multidisciplinar para o manejo é essencial no cuidado fundamental de todos os pacientes com DTM, para que o tratamento possa ser especificamente adaptado às necessidades individuais do paciente.

Aim: To present the most widely used conservative and minimally invasive treatment modalities available in the therapeutic arsenal for temporomandibular disorders (TMD). Literature review: Treatment goals invariably include pain reduction, reduction of parafunctional activities and restoration of function. Among the conservative and minimally invasive alternatives, we can mention interocclusal devices, therapeutic exercises, electrophototherapy, dry needling and infiltration of local anesthetics in trigger points, autogenous blood injection to control mandibular dislocation, cognitive behavioral therapy, botulinum toxin, viscosupplementation, pharmacological control of acute and chronic pain. TMD affects a considerable proportion of the population. Only after non-invasive options have failed should more invasive and irreversible treatments be initiated. However, some conditions, such as ankylosis and neoplasms, for example, are treated surgically and attempts at conservative treatments can lead to worsening quality of life or risk of death. Conclusions: A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients, so that treatment can be specifically tailored to the patient's individual needs.

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.

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.

Manual Therapy Applied to the Cervial Joint Reduces Pain and Improves Jaw Function in Individuals with Temporomandibular Disorders: A Systematic Review on Manual Therapy for Orofacial Disorders.

AIMS: To examine the effect of manual therapy applied to the cervical joint for reducing pain and improving mouth opening and jaw function in people with TMDs. METHODS: A systematic review of randomized controlled trials was performed. Participants were adults diagnosed with TMDs. The experimental intervention was manual therapy applied to the cervical joint compared to no intervention/placebo. Outcome data relating to orofacial pain intensity, pressure pain threshold (PPT), maximum mouth opening, and jaw function were extracted and combined in meta-analyses. RESULTS: The review included five trials involving 213 participants, of which 90% were women. Manual therapy applied to the cervical joint decreased orofacial pain (mean difference: -1.8 cm; 95% CI: -2.8 to -0.9) and improved PPT (mean difference: 0.64 kg/cm2; 95% CI: 0.02 to 1.26) and jaw function (standardized mean difference: 0.65; 95% CI: 0.3 to 1.0). CONCLUSION: Manual therapy applied to the cervical joint had short-term benefits for reducing pain intensity and improving jaw function in women with TMDs. Further studies are needed to improve the quality of the evidence and to investigate the maintenance of benefits beyond the intervention period.

Knowledge, Attitudes, and Practices on New Treatment Modalities for Temporomandibular Dysfunctions and Orofacial Pain / Conocimientos, Actitudes y Prácticas sobre Nuevas Nodalidades de Tratamiento de las Disfunciones Tempomanibulares y el Dolor Orofacial

The present study proposed to describe, through a literature review, the use of new therapeutic management which allows for offering a better quality of life to individuals affected by these pathologies. A bibliographic search was conducted in the main health databases PUBMED (www.pubmed.gov) and Scholar Google (www.scholar.google.com.br), in which studies published from 1987 to 2023 were collected. In the first stage, the list of retrieved articles was examined by reading the titles and abstracts. In the second stage, the studies were selected by reading the full contents. Two authors (JDMM and DAQ) performed stages 1 and 2. Experimental, clinical, case-control, randomized controlled, and laboratory cohort studies, case reports, systematic reviews, and literature reviews, which were developed in living individuals, were included. Therefore, articles that did not deal with the subject in question, letters to the editor, opinion articles, duplicated literature in databases, and literature that did not address the variables under study, we re excluded. Contemporary dentistry uses alternative treatments capable of improving the patient's condition since a cure is not always possible. Therefore, the possibility of improving the quality of life becomes an important point to be reached. Evidence-based healthcare has made great advances in recent decades, especially in the areas of orofacial pain, TMD, and occlusion, especially related to orthodontic, prosthetic, and restorative care.

En el presente estudio se propuso describir, a través de una revisión bibliográfica, el uso de nuevos manejos terapéuticos que permitan brindar una mejor calidad de vida a los individuos afectados por estas patologías. Se realizó una búsqueda bibliográfica en las principales bases de datos de salud PUBMED (www.pubmed.gov) y Scholar Google (www.scholar.google.com.br), en las que se recopilaron estudios publicados entre 1987 y 2023. En la primera etapa, se examinó la lista de artículos recuperados mediante la lectura de los títulos y resúmenes. En la segunda etapa, los estudios fueron seleccionados mediante la lectura del contenido completo. Dos autores (JDMM y DAQ) realizaron las etapas 1 y 2. Se incluyeron estudios de cohortes experimentales, clínicos, de casos y controles, controlados aleatorios y de laboratorio, informes de casos, revisiones sistemáticas y revisiones de la literatura, que se desarrollaron en individuos vivos. Por lo tanto, se excluyeron artículos que no trataran el tema en cuestión, cartas al editor, artículos de opinión, literatura duplicada en bases de datos y literatura que no abordara las variables en estudio. La odontología contemporánea utiliza tratamientos alternativos capaces de mejorar el estado del paciente, ya que no siempre es posible la curación. Por lo tanto, la posibilidad de mejorar la calidad de vida se convierte en un objetivo importante. La atención médica basada en la evidencia ha logrado grandes avances en las últimas décadas, especialmente en las áreas de dolor orofacial, TMD y oclusión, especialmente en relación con la atención de ortodoncia, prótesis y restauración.

Does dental rehabilitation under general anaesthetic contribute to the development of temporomandibular disorders in children and adolescents? A scoping review.

BACKGROUND: Temporomandibular disorders (TMDs) have multiple aetiological factors. Although some evidence suggests invasive and lengthy dental procedures may contribute towards TMD development, there is a relative paucity in the literature regarding an association between elements of paediatric dental general anaesthesia (pDGA) and TMDs. This review aims to consider the impact of dental rehabilitation (and its constituent elements) performed under general anaesthesia on the development of TMDs in childhood and adolescence and identify theories and/or gaps in knowledge which may benefit from future research. METHODS: Due to the need to preliminarily examine the nature and extent of the current evidence base, a scoping review approach was chosen. The review was conducted based on the framework provided by the methodological working group of the Joanna Briggs Institute (JBI) for conducting systematic scoping reviews. Electronic databases MEDLINE, Embase, Scopus, Web of Science and Cochrane Library were searched as well as the grey literature using OpenGrey, Nexis, Ethos, Google Scholar and ProQuest, with eligible studies uploaded onto Zotero (Mac Version 5.0.96.2). RESULTS: A total of 810 records were identified. After removing duplicates and those not available in English, 260 were identified for title and abstract screening. Seventy-six records underwent full-text review of which only one met the broad inclusion criteria. The most common reasons for exclusion were no specific relation to general anaesthesia, not specifically relating to dental treatment and only being concerned with TMD management. The included study found that while development of TMDs following dental rehabilitation under GA did occur in children, whether the problems caused by treatment were exacerbated by other elements of the pDGA process remains unknown. CONCLUSION: This review has confirmed a distinct paucity of research in this field. While there is no current tangible scientific evidence that common and routine dental procedures lead to TMD, the literature shows that alterations to any one or a combination of critical factors can contribute to TMD development, which may be collectively exacerbated by iatrogenic macrotrauma during the pDGA process. We have highlighted elements of pre-, peri- and post-operative pDGA, alongside biopsychosocial factors, which may contribute to TMD development in childhood and adolescence and may benefit from future research.

Abdominal Acupuncture for Non-Responding TMD Patients: a Retrospective Observational Study in General Practice.

Background: Pain related to Temporomandibular Disorders (TMD) is severe, negatively affecting patients' quality of life, and often resistant to conventional treatments. Abdominal Acupuncture (AA) is known to be particularly effective for pain, especially chronic and musculoskeletal pain, but it is still poorly studied and never investigated in TMD patients. Objectives: To analyze the efficacy of AA for the treatment of patients with subacute and chronic pain related to TMD and non-responding to previous conventional therapies (occlusal splint, medications, physical therapy). Methods: Twenty-eight patients, 24 F and four M (mean age 49.36 years), were recruited from January 2019-February 2021. All patients underwent AA treatment: two sessions per week for four weeks, for a total of eight sessions. At the beginning of therapy (T0) and at the end of the cycle (T1) the following data were evaluated: maximum mouth opening (MMO); cranio-facial pain related to TMD (verbal numeric scale, VNS); pain interference with normal activities and quality of life of patients (Brief Pain Inventory, BPI); oral functioning (Oral Behavior Checklist, OBC); impression of treatment effectiveness (Patients' Global Impression of Improvement, PGI-I Scale). Statistical comparison of data before and after the AA treatment was performed by Wilcoxon's signed-rank test (significance level p < 0.05). Results: The MMO values were significantly improved after one cycle of AA (p = 0.0002). In addition, TMD-related pain had a statistically significant decline following AA treatment (all p < 0.001). Patients' general activity and quality of life (BPI) were described as improved following a course of AA, with statistically significant values for all aspects considered (all p < 0.05). Conclusion: Abdominal acupuncture resulted in effective treatment of subacute/chronic-resistant pain related to TMD, capable of improving mandibular function and facial pain, and reduced the interference of pain affecting patients' quality of life.

Effects of an Interdisciplinary Approach in the Management of Temporomandibular Disorders: A Scoping Review.

Temporomandibular disorders (TMD) is an umbrella term that encompasses many musculoskeletal problems that include the masticatory muscles, the temporomandibular joint, and other associated structures. TMD can be divided into two large groups: those that affect the musculature and those that affect the joint. The treatment of TMD requires the combined skills of physiotherapists and dentists, as well as sometimes psychologists and other medical specialists. This study aims to examine the effectiveness of the interdisciplinary approach using physiotherapy and dental techniques on pain in patients with temporomandibular disorders (TMDs). This is a Scoping Review of studies investigating the effects of combined therapy on patients with TMD. PRISMA guidelines were followed during this review's design, search, and reporting stages. The search was carried out in the MEDLINE, CINHAL, and EMBASE databases. A total of 1031 studies were detected and analyzed by performing the proposed searches in the detailed databases. After removing duplicates and analyzing the titles and abstracts of the remaining articles, six studies were ultimately selected for this review. All the included studies showed a positive effect on pain decreasing after a combined intervention. The interdisciplinary approach characterized by the combination of manual therapy and splint or electrotherapy can positively influence the perceived symptoms; positively decrease pain; and reduce disability, occlusal impairments, and perception of change.

Effectiveness of Different Electrical Stimulation Modalities for Pain and Masticatory Function in Temporomandibular Disorders: A Systematic Review and Meta-Analysis.

Temporomandibular disorders comprise a set of conditions that include alterations of the temporomandibular joint and masticatory muscles. Although different modalities of electric currents are widely used for treating temporomandibular disorders, previous reviews have suggested these are ineffective. This systematic review and meta-analysis aimed to determine the effectiveness of different electrical stimulation modalities in patients with temporomandibular disorders for reducing musculoskeletal pain, increasing the range of movement, and improving muscle activity. An electronic search was conducted of randomized controlled trials published until March of 2022 that compared the application of an electrical stimulation therapy versus a sham or control group. The main outcome measure was pain intensity. Seven studies were included in the qualitative analysis and in the quantitative analysis (n = 184 subjects). The overall effect of electrical stimulation on pain reduction was statistically superior to sham/control (MD = -1.12 cm; CI 95%: -1.5 to -0.8), showing moderate heterogeneity of results (I2 = 57%, P = .04). The overall effect on range of movement of the joint (MD = 0.97 mm; CI 95%: -0.3 to 2.2) and muscle activity (SMD = -2.9; CI 95%: -8.1 to 2.3) were not significant. Transcutaneous electrical nerve stimulation (TENS) and high-voltage current stimulation reduces pain intensity clinically in people with temporomandibular disorders with a moderate quality of evidence. On the other hand, there is no evidence of the effect of different electrical stimulation modalities on range of movement and muscle activity in people with temporomandibular disorders with a moderate and low quality of evidence respectively. PERSPECTIVE: TENS and high voltage currents are valid options for the control of pain intensity in patients suffering from temporomandibular disorder. Data suggest clinically relevant changes compared to sham. Healthcare professionals should take this into account as it is inexpensive therapy, has no adverse effects and can be self-administered by patients.

The reliability of using light therapy compared with LASER in pain reduction of temporomandibular disorders: a randomized controlled trial.

BACKGROUND: Temporomandibular Disorders (TMD) refer to a group of symptoms where pain is the most leading cause to demand a treatment by the patient. Light therapies are of great importance at current times due to its biosafety and non-invasive quality when used for the management of TMD symptoms. This study aimed to evaluate the efficacy of red LED light with low-level LASER in treating TMD patients. MATERIALS AND METHODS: A double-blind randomized clinical study was conducted and included 60 patients along 3 groups (20 for each group) presented with myofascial pain related to TMD. Patients were randomly divided into 3 groups. Group A were managed by applying the LED light device into the trigger points without switching the device on. A red LED light was given to group B for 5 min at the tender muscles. Group C were treated by using low-level LASER therapy for 30 s. Patients were evaluated for any improvements regarding the pain score, presence of trigger points, and trismus along 4 visits (1 week interval between each visit). Any side effects related to the 2 devices were also assessed. RESULTS: Both group B and C patients showed a statistically significant improvement in the pain value (P < 0.05) at the 3rd and 4th visits when compared to group A. Regarding tenderness, there was a reduction in the number of trigger points in both study groups; however, the results were insignificant in group B. Statistics showed insignificant differences between group B & C patients regarding pain and number of trigger points at all visits (P > 0.05). CONCLUSION: Both LED light and LASER therapies could effectively relieve pain associated with myogenic TMD as there were no important differences between their outcomes. However, the biosafety and lower cost of the LED light device compared to the LASER should also be considered. Trial Registration This clinical trial was prospectively registered (TCTR ID: TCTR20190507002) on 07/05/2019. URL: http://www.thaiclinicaltrials.org/show/TCTR20190507002.

Comparison of effects of manual physical therapy and exercise therapy for patients with Temporomandibular disorders.

The term temporomandibular disorder is used for pain and dysfunction at the temporomandibular joint. Manual therapy or exercise therapy has proven to be an effective measure for pain relief. The purpose of this study was to compare the effectiveness of manual therapy and exercise therapy in temporomandibular disorders. A quasi-experimental study was conducted from June 30, 2020 to December 30, 2020 in Al-Sheikh teaching hospital, Sialkot, Pakistan. A convenient sample of 24 patients was involved in the study. Lottery method was used to randomise the patients in either the Manual Therapy Group or Exercise Therapy Group. The participants were assessed before and after the intervention through Numeric Pain Rating Scale (NPRS) for pain, Patient-Specific Functional Scale (PSFS) for function, Fonesca Amnestic Index (FAI) for the severity of condition, and Millimetre Mouth Opening (MMO) for ranges. The manual therapy group showed a statistically significant difference in pre- and post-treatment NPRS, PSFS, FAI and MMO (p< 0.0001). Manual physical therapy is more effective to improve pain, ROM, function, and severity in temporomandibular disorders.

Efficacy of stabilisation splint and low-level laser therapy for patients with chronic closed lock from non-reducible displaced temporo-mandibular joint discs: A parallel randomised clinical trial.

BACKGROUND: Stabilisation splint therapy (SST) and low-level laser therapy (LLLT) are effective-invasive treatment for temporo-mandibular disorder (TMD) patients. However, the specific efficacy of each therapy in patients with chronic closed lock (CCL) from temporo-mandibular joints (TMJ) disc displacement without reduction (DDwoR) remains unknown. OBJECTIVES: The aim of this study was to assess and compare the efficacy of SST and LLLT alone or in combination in patients with CCL from TMJ DDwoR. METHODS: This parallel randomised clinical trial included 42 patients who were diagnosed with CCL from TMJ DDwoR. Patients were allocated equally and randomly into three treatment groups: group I received combined SST and LLLT, group II received LLLT and group III received SST. Maximum mouth opening (MMO), visual analogue scale (VAS), muscle and joint palpation scores and time required to achieve normal state were evaluated at baseline, 1, 2, 4 weeks, 3 and 6 months after the intervention. Data were collected and analysed using SPSS software. RESULTS: Regarding MMO and VAS, a statistically significant improvement was found between group I versus group II and versus group III at all evaluation times. Regarding muscle and joint palpation scores, a statistically significant difference was found between group I versus group III, while non-significant difference was found between group I and group II. A statistically significant faster improvement was found in group I versus group III and versus group II. CONCLUSION: All treatment modalities can be effective in management of CCL from a TMJ DDwoR cases, but the combined SST and LLLT group seems to provide the best and quickest improvement. CLINICAL TRIAL REGISTRATION NUMBER: NCT05548894.

Education-Enhanced Conventional Care versus Conventional Care Alone for Temporomandibular Disorders: A Randomized Controlled Trial.

The objective of this study was to determine the effect of enhancing conventional care for people with chronic painful temporomandibular disorders (TMD) with an individualised contemporary pain science education (PSE) intervention. In this randomized controlled trial, a consecutive sample of 148 participants (18-55 years of age) was randomized into 2 groups: PSE-enhanced conventional care or Conventional care alone. Conventional care involved a 6-week, 12-session manual therapy and exercise program. The PSE enhancement involved 2 sessions of modern PSE, undertaken in the first 2 treatment sessions. Primary outcomes were pain intensity, assessed with a numeric pain rating scale, and disability, assessed with the craniofacial pain and disability inventory, post-treatment. Linear mixed model analyses were used to investigate between-group differences over time. There was a statistically and clinically meaningful effect of PSE enhancement on disability (Mean Difference = 6.1, 95% CI: 3.3-8.8), but not on pain intensity, post-treatment. Secondary analyses suggested clinically meaningful benefit of PSE enhancement on pain and disability ratings at 10-week and 18-week follow-ups, raising the possibility that preceding conventional care with a PSE intervention may result in long-term benefits. PERSPECTIVE: The addition of modern Pain Science Education (PSE) intervention improved disability for people with chronic TMD receiving manual therapy and exercise, but not pain. A mean difference in pain and disability favoring the PSE group at the 10- and 18-week follow-ups, respectively, suggests that PSE addition resulted in longer-lasting effects. Trial registration: NCT03926767. Registered on April 29, 2019. https://clinicaltrials.gov/ct2/show/NCT03926767.

Temporomandibular disorders and the use of traditional and laser acupuncture: a systematic review.

OBJECTIVE: To evaluate current studies to establish and compare the efficacy of traditional and laser acupuncture in reducing the signs and symptoms of temporomandibular disorders (TMD). METHODS: PubMed, Cochrane, Scopus, and Web of Science databases were searched. Clinical, controlled, and randomized trials written in English and having used traditional or laser acupuncture as therapy for TMD and RDC/TMD or DC/TMD as a diagnostic criterion for TMD were included. RESULTS: Six studies that evaluated the intensity of pain and the level of mouth opening of the patients submitted to acupuncture were selected, and all showed improvement. However, similar results were also observed in the groups treated with occlusal splint and placebo acupuncture. Only one study evaluated laser acupuncture and showed a higher proportion of patients with remission of symptoms in the experimental group. CONCLUSION: The traditional acupuncture seems to relieve the signs and symptoms of TMD, as well as laser acupuncture when associated with occlusal splint. However, more rigorous and high-quality clinical trials are needed.