Physical self-regulation training for the management of temporomandibular disorders.

AIMS: To evaluate the long-term effectiveness of a brief skills training program for the management of chronic facial muscle pain. This program of physical self-regulation (PSR) involved primarily training in breathing, postural relaxation, and proprioceptive re-education. METHODS: Physical self-regulation training was presented by a dentist during two 50-minute sessions spaced at 3-week intervals and was compared to a standard dental care (SDC) program that included a flat-plane intraoral appliance and self-care instructions provided by a dentist. Participants (n = 44) were initially evaluated by a dentist experienced in the diagnosis and management of orofacial pain and were determined to have myofascial pain (Type 1a and 1b diagnoses per the Research Diagnostic Criteria) prior to random assignment to either the PSR or SDC conditions. Posttreatment evaluations 6 weeks and 26 weeks after treatment had begun were conducted by a dentist who was not aware of which treatment the participants received. RESULTS: Initial results indicated that pain severity and life interference from pain were reduced in both groups (P < 0.001), while perception of control was increased (P < 0.001), as was incisal opening without pain (P < 0.05). At the 26-week follow-up, the PSR group reported less pain (P < 0.04) and greater incisal opening, both with (P < 0.04) and without (P < 0.01) pain, than the SDC group. There were also significant decreases (P < 0.05) in affective distress, somatization, obsessive-compulsive symptoms, tender point sensitivity, awareness of tooth contact, and sleep dysfunction for both groups over time. CONCLUSION: The findings support the use of PSR for the short- and long-term management of muscle pain in the facial region. These results are discussed in terms of the potential mechanisms by which self-regulation treatment strategies are effective for the management of these pain disorders.

The effects of tongue position on mandibular muscle activity.

The purpose of this study was to determine the relationship between tongue position and mandibular muscle activity. Thirty-three subjects (28 women) between the ages of 18 and 34 years (mean = 22.1 years) with no prior injury to or pain in the jaw, mouth, or tongue participated in the study. Subjects were asked to rest quietly while baseline electromyographic recordings were made from the temporalis, masseter, and suprahyoid muscle regions. Afterwards, subjects were randomly assigned to conditions requiring them to position the tongue either "against the anterior palate" or "on the floor of the mouth, making sure the tip does not press against any part of the mouth." The results indicated that right temporalis activity was higher when the tongue was positioned against the roof of the mouth than when it was either at baseline or resting on the floor of the mouth (P < .03). A similar pattern of results was observed for the suprahyoid muscle group (P < .01). There were no significant differences in masseter muscle activity as a function of tongue position (Ps > .20). These findings suggest caution in labeling the "rest" position of the tongue and indicate that further study of the relationship between tongue position and orofacial pains in needed.