Effectiveness of electrotherapy for the treatment of orofacial pain: A systematic review and meta-analysis.

OBJECTIVE: Summarize the evidence from randomized controlled trials and controlled trials that examined the effectiveness of electrotherapy in the treatment of patients with orofacial pain. DATA SOURCE: Medline, Embase, CINAHL PLUS with Full text, Cochrane Library Trials, Web of Science, and Scopus. REVIEW METHODS: A data search (last update, July 1, 2022) and a manual search were performed (October 5, 2022). Trials involving adults with orofacial pain receiving electrotherapy compared with any other type of treatment were included. The main outcome was pain intensity; secondary outcomes were mouth opening and tenderness. The reporting was based on the new PRISMA Guidelines. RESULTS: From the electronics databases and manual search 43 studies were included. Although this study was open to including any type of orofacial pain, only studies that investigated temporomandibular disorders were found. The overall quality of the evidence for pain intensity was very low. Although the results should be carefully used, transcutaneous electric nerve stimulation therapy showed to be clinically superior to placebo for reducing pain after treatment (2.63 [-0.48; 5.74]) and at follow-up (0.96 [-0.02; 1.95]) and reduce tenderness after treatment (1.99 [-0.33; 4.32]) and at follow-up (2.43 [-0.24; 5.10]) in subjects with mixed temporomandibular disorders. CONCLUSION: The results of this systematic review support the use of transcutaneous electric nerve stimulation therapy for patients with mixed temporomandibular disorders to improve pain intensity, and tenderness demonstrating that transcutaneous electric nerve stimulation is superior to placebo. There is inconsistent evidence supporting the superiority of transcutaneous electric nerve stimulation against other therapies.

Comparison of the pattern of activation of the masticatory muscles among individuals with and without TMD: A systematic review.

OBJECTIVE: To verify the characteristics of the electromyographic signal of masticatory muscles in individuals with TMD and asymptomatic individuals. METHODS: A systematic review was carried out, selecting cross-sectional studies with at least one electromyographic parameter (FM; iEMG; RMS) of the masticatory muscles (anterior temporal, bilateral masseter, and suprahyoid muscles) of individuals with TMD compared to asymptomatic individuals. RESULTS: This review identified 1656 titles, of which 30 articles were included in the final analysis. It was observed that the data referring to the pattern of activation of masticatory muscles in the rest, isometry, and isotonic conditions of individuals with TMD are heterogeneous. This fact may be related to variability in the methods and analyses applied in the studies. CONCLUSION: Data referring to the pattern of activation of masticatory muscles in the rest and isometry conditions and in the mastication cycle of individuals with TMD and asymptomatic individuals are diverse.

Normalization of the electromyographic signals of masticatory muscles during non-habitual chewing activity

There is no consensus on the most appropriate method for normalizing electromyography (EMG) signals from masticatory muscles during isotonic activity. Aim: To analyze the best method for data processing of the EMG signal of the masticatory muscles during isotonic activity (non-habitual chewing), comparing raw data and different types of normalization. Methods: This is a cross-sectional study. Women aged between 18 and 45 years were selected. Anthropometric data were collected (age, height, body mass index ­ BMI, masticatory preference) as well as EMG signal (root mean square ­ RMS) data for the anterior temporal and masseter bilaterally, and for the suprahyoid muscles, during isotonic (non-habitual chewing) and isometric tasks. EMG data were processed offline using Matlab® Software. The normalization of the EMG signal was carried out using the 2nd masticatory cycle, chosen at random, of the 20 cycles collected, the maximum RMS value, and the maximum voluntary contraction (MVC). To analyze the best method of data processing for the isotonic data, the coefficient of variation (CV) was calculated. Descriptive data analysis was adopted, using the mean and standard deviation. ANOVA with repeated measures was used to detect significant differences between the methods of normalization. Statistical significance was set at 5% (α<0.05). Results: The final sample of this research was composed of 86 women. The volunteers presented an average age of 27.83±7.71 years and a mean BMI of 22.85±1.91 Kg/m2. Regarding masticatory preference, 73.25% reported the right side, and 26.75% the left side. Considering the comparison between the methods, the %CV measure of the 2nd cycle showed the lowest variation coefficient during biting for all the muscles from the raw data, RMS Max, and MVC (p=0.001, p=0.003, and p=0.001 respectively). Conclusion: In conclusion, for non-habitual chewing activity, the results of this study recommend data processing using normalization with the second cycle during chewing

Strength of scapular elevation in women with TMD and asymptomatic women - a cross-sectional study

Temporomandibular disorder (TMD) is recognized for its high prevalence, presenting characteristic signs and symptoms. Cervical spine pain is present in 70% of diagnosed TMD cases. Aim To verify if women with TMD present changes in isometric muscle strength in the scapula elevation. Methods This is an observational, cross-sectional study. Thirty-five women, aged 22.89±2.04 years, were divided into the TMD group (TMDG), diagnosed with TMD according to the DC/TMD, and control group (CG), with asymptomatic individuals. The volunteers accessed a online link by the smartphone in order to answer questions on personal data, the Fonseca Anamnestic Index (FAI), Neck Disability Index (NDI), and Masticatory preference. In all participants, evaluation of the force of the scapula elevation muscles was performed, using a load cell model MM-100 (Kratos® SP, Brazil). Data were analyzed descriptively using the maximum, mean, and standard deviation and a two-way ANCOVA test was applied for all variables. A significance level of 5% was considered. Results There were no statistically significant differences between the TMDG and CG for the maximal and mean muscle strength of scapular elevation. There were statistically significant differences in FAI (p <0.001*) between the CG and the TMDG. Conclusion Based on the results, it was not possible to confirm the hypothesis that women diagnosed with TMD present lower isometric strength during scapular elevation (right/left).

Smartphone addiction and the relationship with head and neck pain and electromiographic activity of masticatory muscles.

BACKGROUND: Excessive use of smartphones may be associated with behavioral and physical health changes and might cause musculoskeletal alterations in the head and neck region. OBJECTIVE: To evaluate the prevalence of smartphone addiction in college students and its correlation with symptoms of head and neck pain and masticatory and trapezius muscle activity while resting, before and after smartphone use. METHODS: Twenty university students participated in the study. They answered the Smartphone Addiction Scale and the Fonseca Anamnestic Index. Next, the participants were seated and prepared for electromyography through the placement of surface electrodes on the masseter, temporal, and trapezius muscles. Rest condition data were collected for 10 seconds before and after 30 minutes of smartphone use. RESULTS: The results showed that 35% of the evaluated individuals were classified as smartphone addicted and 35% reported no head or neck pain in the previous 30 days. There was no association between smartphone use and head and neck pain. In the electromyography, there was an increase in RMS values after smartphone use in the right and left masseter muscles and the left trapezius. CONCLUSION: College students presented a high prevalence of smartphone addiction and head and neck pain, but these were not statistically associated. There was a change in muscle activity only in the right trapezius muscles before and after 30 minutes of smartphone use. These findings are contrary to the current belief that the use of smartphones correlates with pain in the neck region and changes in the electrical muscle activity, leading to fatigue in the cervical muscles.

Evaluation of integral electromyographic values and median power frequency values in women with myogenous temporomandibular disorder and asymptomatic controls.

BACKGROUND: Surface electromyography (EMG) has been used as a reliable tool for the evaluation of electrical muscle activity. OBJECTIVE: The purpose of this study was to evaluate the EMG indices of the masticatory muscles (masseter, anterior temporalis and suprahyoid) in women with temporomandibular disorder (TMD) and asymptomatic controls in the time domain, by the integrated EMG signal (IEMG) and in the frequency domain, using the median power frequency (MPF). METHODS: An observational, cross-sectional study was conducted involving 30 asymptomatic women as the control (mean age: 25.85 ± 2.57 years) and 74 women with myogenous TMD (mean age: 26.54 ± 2.45 years) diagnosed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Three EMG readings were taken during maximum voluntary clenching (MVC) of the molars on parafilm for five seconds with a three-minute rest interval between readings. The mixed-model analysis of variance test followed by the Bonferroni correction or the Student-t test was used for the analyses, with the level of significance set to 5% (p < 0.05). RESULTS: IEMG values were significantly higher in the masseter muscles than the anterior temporalis muscles in the control group (p < 0.01). IEMG values were significantly higher in the masseter muscles of the control group than the group with myogenous TMD (p < 0.05). MPF values of the suprahyoid muscles were significantly higher in the myogenous TMD group than the control group. CONCLUSIONS: These significant findings show that women with myogenous TMD have reduction of electrical activity of their masseter muscles and increased firing rate of the motor units of the suprahyoid muscles. These findings may help the treatment of myogenous TMD in women.

Analysis of the accuracy and reliability of the Short-Form Fonseca Anamnestic Index in the diagnosis of myogenous temporomandibular disorder in women.

BACKGROUND: The Fonseca Anamnestic Index is a questionnaire used to classify individuals with temporomandibular disorders. Previous studies have shown that the Fonseca Anamnestic Index provides a multidimensional measurement of the temporomandibular disorders construct and that the main dimension presents a good fit to the model according to the item response theory. OBJECTIVE: To evaluate the between-day reliability, accuracy, and best cut-off score of the Short-Form Fonseca Anamnestic Index for the diagnosis of myogenous temporomandibular disorders. METHODS: The sample consisted of 123 women (57 with myogenous temporomandibular disorders and 66 asymptomatic), evaluated by the Research Diagnostic Criteria for Temporomandibular Disorders. The participants answered the Short-Form Fonseca Anamnestic Index on two occasions with a seven-day interval between tests. For the analysis of between-day reliability, the intraclass correlation coefficient, the standard error of measurement and the minimum detectable change were used. The Receiver Operating Characteristic curve was used to determine the diagnostic accuracy and the best cut-off point. RESULTS: The Short-Form Fonseca Anamnestic Index demonstrated excellent reliability (intraclass correlation coefficient≥0.95) for all items and for the total Short-Form Fonseca Anamnestic Index score (intraclass correlation coefficient=0.98; standard error of measurement=3.28; minimum detectable change=9.09). The level of accuracy of the Short-Form Fonseca Anamnestic Index for the diagnosis of myogenous temporomandibular disorders was high (area under the curve of 0.97), with a better cut-off score of 17.5 points. CONCLUSION: The Fonseca Anamnestic Index should be used in its short form to classify the absence of myogenous temporomandibular disorders (scores between 0 and 15 points) or presence of myogenous temporomandibular disorders (scores between 20 and 50 points) in women.

Factor and Rasch analysis of the Fonseca anamnestic index for the diagnosis of myogenous temporomandibular disorder.

BACKGROUND: Rasch analysis has been used in recent studies to test the psychometric properties of a questionnaire. The conditions for use of the Rasch model are one-dimensionality (assessed via prior factor analysis) and local independence (the probability of getting a particular item right or wrong should not be conditioned upon success or failure in another). OBJECTIVE: To evaluate the dimensionality and the psychometric properties of the Fonseca anamnestic index (FAI), such as the fit of the data to the model, the degree of difficulty of the items, and the ability to respond in patients with myogenous temporomandibular disorder (TMD). METHODS: The sample consisted of 94 women with myogenous TMD, diagnosed by the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), who answered the FAI. For the factor analysis, we applied the Kaiser-Meyer-Olkin test, Bartlett's sphericity, Spearman's correlation, and the determinant of the correlation matrix. For extraction of the factors/dimensions, an eigenvalue >1.0 was used, followed by oblique oblimin rotation. The Rasch analysis was conducted on the dimension that showed the highest proportion of variance explained. RESULTS: Adequate sample "n" and FAI multidimensionality were observed. Dimension 1 (primary) consisted of items 1, 2, 3, 6, and 7. All items of dimension 1 showed adequate fit to the model, being observed according to the degree of difficulty (from most difficult to easiest), respectively, items 2, 1, 3, 6, and 7. CONCLUSION: The FAI presented multidimensionality with its main dimension consisting of five reliable items with adequate fit to the composition of its structure.

Efeitos da manipulação cervical alta sobre a atividade eletromiográfica dos músculos mastigatórios e amplitude de movimento de abertura da boca em mulheres com disfunção temporomandibular: ensaio clínico randomizado e cego / Los efectos de la manipulación cervical en la actividad electromiográfica de los músculos masticatorios y la amplitud del movimiento de apertura de la boca en mujeres con trastorno temporomandibular: un ensayo clínico aleatorizado y ciego / Effects of upper cervical manipulation on the electromyographic activity of the masticatory muscles and the opening range of motion of the mouth in women with temporomandibular disorder: randomized and blind clinical trial

RESUMO Avaliou-se os efeitos da manipulação cervical alta sobre a atividade eletromiográfica de superfície (sEMG) dos músculos mastigatórios e amplitude do movimento de abertura da boca em mulheres com disfunção temporomandibular (DTM). Foram avaliadas 10 mulheres com diagnóstico de DTM miogênica, segundo o Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD), divididas, aleatoriamente, em grupo experimental (GE) n=5, que recebeu manipulação cervical alta e grupo placebo (GP) n=5, que recebeu manobra sem efeito terapêutico. Cinco intervenções foram aplicadas para ambos os grupos uma vez por semana, e avaliações de pré-intervenção, pós-imediato (após a 1ª intervenção) e pós-tardio (48 horas após a 5ª intervenção) foram realizadas. A atividade sEMG foi processada via raiz quadrada da média e normalizada pelo valor de pico (RMS EMGn). Utilizou-se para comparação os testes t de Student e ANOVA two-way (medidas repetidas), adotando-se como significância o valor de 5%, e o Cohen's d para tamanho de efeito de tratamento. Constatou-se a interação significativa grupo × tempo (p<0,05) no RMS EMGn dos músculos temporal direito e esquerdo, na condição de repouso, assim como para todos os músculos mastigatórios durante contração isométrica máxima de elevação e depressão da mandíbula. Os tamanhos de efeito de tratamento moderado a alto foram observados no GE, destacando-se na avaliação pós-tardia. Foi observado também um aumento significativo (p<0,05) e um alto efeito de tratamento na abertura da boca para o GE. A manipulação cervical alta demonstrou equilibrar o RMS EMGn dos músculos mastigatórios e aumentar a amplitude de movimento de abertura da boca em mulheres com DTM miogênica.

RESUMEN En este estudio se evaluaron los efectos de la manipulación cervical alta sobre la actividad electromiográfica de superficie (SEMG) de los músculos masticatorios y de amplitud del movimiento de apertura de la boca en mujeres con trastorno temporomandibular (TTM). Se evaluaron 10 mujeres con diagnóstico de TTM miogénico, con base en el Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD), las que fueron aleatoriamente divididas en grupo experimental (GE) n=5, que recibió manipulación cervical alta, y grupo placebo (GP) n=5, que recibió maniobra sin efecto terapéutico. Se aplicaron cinco intervenciones para ambos grupos una vez por semana, y se realizaron evaluaciones preintervención, posintervención inmediata (después de la 1a. intervención) y posintervención tardía (48 horas después de la 5a. intervención). La actividad SEMG fue calculada mediante raíz cuadrada de la media y normalizada por el valor de pico (RMS EMGn). Se empleó para comparación los test t de Student y ANOVA two-way (medidas repetidas), y el nivel de significancia de 5%, y para el efecto del tratamiento el Cohen's d. Se encontró la interacción significativa grupo × tiempo (p<0,05) en el RMS EMGn de los músculos temporales derecho e izquierdo, en reposo, así como para todos los músculos masticatorios durante la contracción isométrica máxima de elevación y depresión de la mandíbula. Se observaron efectos de tratamiento moderado a alto en el GE, destacando en la etapa posevaluación tardía. También se observó un aumento significativo (p<0,05) y un alto resultado del tratamiento en la apertura de la boca en el GE. La manipulación cervical alta demostró equilibrar el RMS EMGn de los músculos masticatorios y aumentar la amplitud del movimiento de la apertura de la boca en mujeres con TTM miogénica.

ABSTRACT We evaluated the effects of upper cervical manipulation on the surface electromyographic activity (sEMG) of masticatory muscles and range of motion of the opening movement of the mouth in women with temporomandibular disorders (TMD). We evaluated 10 women with myogenic a TMD diagnosis, according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and divided randomly into an experimental group (EG) n=5, which received upper cervical manipulation, and a placebo group (PG) n=5, which received maneuvers without therapeutic effects. Five interventions were performed in both groups, once a week, with performance of pre-intervention assessments, post-immediate assessments (after 1st intervention) and post-delayed assessments (48 hours after the 5th intervention). The sEMG activity was processed using the root mean square and normalized by the peak value (RMS EMGn). We used for comparison the Student's t-test and ANOVA two-way repeated measures, adopting as significance the amount of 5%, and the Cohen d for treatment effect size. We found a significant interaction of group vs time (p<0.05) in the RMS EMGn of the left and right temporal muscles at rest, as well as for all masticatory muscles during maximal isometric contraction during jaw-elevation and jaw-depression. Treatment effect size, high to moderate, was observed in the EG, especially in the post-delayed assessment. We also observed a significant increase (p<0.05) and a high treatment effect during mouth opening in the EG. The upper cervical manipulation demonstrated a balance of the RMS EMGn of the masticatory muscles and increase the opening range of motion of the mouth in women with myogenic TMD.

Immediate and Short-Term Effects of Upper Thoracic Manipulation on Myoelectric Activity of Sternocleidomastoid Muscles in Young Women With Chronic Neck Pain: A Randomized Blind Clinical Trial.

OBJECTIVE: The aim of this study was to assess the immediate and short-term effects of upper thoracic spine manipulation on pain intensity and myoelectric activity of the sternocleidomastoid muscles in young women with chronic neck pain. METHODS: A randomized clinical trial was carried out involving 32 women with chronic neck pain (mean age, 24.8 ± 5.4 years) allocated to an experimental group and a placebo group. Three evaluations were carried out: baseline, immediate postintervention, and short-term postintervention (48-72 hours after intervention). Myoelectric activity of the right and left sternocleidomastoid muscles was assessed at rest and during isometric contractions for cervical flexion and elevation of the shoulder girdle. Neck pain intensity was assessed at rest using a visual analog scale. Comparisons of the data were performed using 2-way repeated-measures analysis of variance with the Bonferroni correction. The level of significance was set at P < .05. RESULTS: A moderate treatment effect on myoelectric activity of the right and left sternocleidomastoid muscles during isometric elevation of the shoulder girdle was found in the experimental group only on the short-term postintervention evaluation (d > 0.40). No statistically significant differences were found for any of the variables analyzed in the intergroup comparisons at the different evaluation times (P > .05). CONCLUSION: No statistically significant differences were found in the intragroup or intergroup analyses of the experimental and placebo groups regarding myoelectric activity of the cervical muscles or the intensity of neck pain at rest in the immediate or short-term postintervention evaluations.

Accuracy of the Fonseca anamnestic index in the identification of myogenous temporomandibular disorder in female community cases.

The aim of the present study was to evaluate the accuracy of the Fonseca anamnestic index (FAI) in the identification of myogenous temporomandibular disorder (TMD). Two hundred and three female volunteers participated in this study, 117 with myogenous TMD and 86 without TMD. The Research Diagnostic Criteria for Temporomandibular Disorders were first applied as the gold standard for the diagnosis. The volunteers then answered the 10 items on the FAI, which furnished a score ranging from 0 to 100 points. The receiver operating characteristic (ROC) was used to determine the accuracy of the diagnosis (area under the curve) and the best cutoff point of the tool. Thus, FAI demonstrated a high degree of accuracy for the diagnosis of myogenous TMD (area under the ROC curve of 0.940). The best cutoff point was a score of 47.50. Thus, a score ranging from 0 to 45 points corresponds to the absence of myogenous TMD and scores ranging from 50 to 100 points identifies individuals with the disorder. In conclusion, the high degree of diagnostic accuracy demonstrates that the FAI can be employed for the identification of myogenous TMD in female community cases.

Accuracy of the surface electromyography RMS processing for the diagnosis of myogenous temporomandibular disorder.

Due to the multifactor etiology of temporomandibular disorder (TMD), the precise diagnosis remains a matter of debate and validated diagnostic tools are needed. The aim was to determine the accuracy of surface electromyography (sEMG) activity, assessed in the amplitude domain by the root mean square (RMS), in the diagnosis of TMD. One hundred twenty-three volunteers were evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders and distributed into two groups: women with myogenous TMD (n=80) and women without TMD (n=43). The volunteers were then submitted to sEMG evaluation of the anterior temporalis, masseter and suprahyoid muscles at rest and during maximum voluntary teeth clenching (MVC) on parafilm. The accuracy, sensitivity and specificity of the muscle activity were analyzed. Differences between groups were found in all muscles analyzed at rest as well as in the masseter and suprahyoid muscles during MVC on parafilm. Moderate accuracy (AUC: 0.74-0.84) of the RMS sEMG was found in all muscles regarding the diagnosis of TMD at rest and in the suprahyoid muscles during MVC on parafilm. Moreover, sensitivity ranging from 71.3% to 80% and specificity from 60.5% to 76.6%. In contrast, RMS sEMG did not exhibit acceptable degrees of accuracy in the other masticatory muscles during MVC on parafilm. It was concluded that the RMS sEMG is a complementary tool for clinical diagnosis of the myogenous TMD.

Effect of upper thoracic manipulation on mouth opening and electromyographic activity of masticatory muscles in women with temporomandibular disorder: a randomized clinical trial.

OBJECTIVE: The purpose of this study was to assess the effect of upper thoracic manipulation on vertical mouth opening (VMO) and electromyographic activity of the masticatory muscles in women with temporomandibular disorder (TMD). METHODS: A randomized, controlled, blinded study involving 32 women (mean age of 24.78 ± 5.41 years) diagnosed with TMD was performed. Subjects were randomly allocated to an experimental group (n = 16) or a sham manipulation (placebo) group (n = 16). A single session of manipulation was administered to the T1 vertebral area. Electromyography was used to determine activity of masticatory muscles with the mandible at rest and during isometric contraction. Vertical mouth opening was measured using a ruler. Measurements were made before manipulation, immediately after manipulation, and at the short-term follow-up (2 to 4 days after manipulation). RESULTS: No significant differences were found in any of the comparisons of mandibular VMO or electromyographic activity of the masticatory muscles at rest or during isometric contraction of mandibular elevator muscles (P > .05). Regarding isometric contraction of the mandibular depressors, an immediate increase in muscle activity was found in the suprahyoid (P = .014) and left masseter (P = .005) muscles. CONCLUSION: In the present study, no significant differences were found regarding VMO between the experimental and placebo groups or among the different evaluations times in each group. Moreover, Cohen d test revealed no clinical effect of the technique. Therefore, based upon the findings of this study, manipulation administered to the T1 vertebral area appears to have no effect on VMO and electromyographic activity of the masticatory muscles in women with TMD.

Immediate effects of upper thoracic manipulation on the skin surface temperature of the vertebral region in healthy women / Efeitos imediatos da manipulação torácica alta sobre a temperatura superficial cutânea da região vertebral em mulheres saudáveis / Los efectos inmediatos de la alta manipulación torácica de la temperatura superficial de la piel en la región vertebral en mujeres sanas

Manipulation of the spinal column is a manual therapeutic resource characterized by passive thrust of a given joint at a high velocity and low amplitude within the limits of anatomic integrity. The objective of the present study was to assess the immediate effects of upper thoracic manipulation on skin temperature in the vertebral region in healthy women. Thus, a randomized controlled blind trial was realized in the university community. Twenty-six healthy women were randomly allocated into an experimental group (n=13) and a placebo group (n=13). A single session of upper thoracic spine manipulation (segment T3) was performed. Infrared thermography was used to determine changes in skin temperature in the vertebral region. Images were taken prior to, immediately after and both five and 10 minutes after manipulation. Two-way repeated measures analysis of variance with post hoc Bonferroni test was used for inter and intragroup comparisons. The level of significance was set to 5%. No significant differences were found between the different evaluation times in either group (p>0.05). In the intergroup analysis, no statistically significant differences were found in any of the comparisons (p>0.05). Based on the method employed, thoracic spine manipulation of the T3 vertebral segment does not promote changes in skin surface temperature in the region manipulated in asymptomatic individuals.

A manipulação da coluna vertebral é um recurso da terapia manual caracterizado por um impulso passivo de alta velocidade e baixa amplitude dentro dos limites de integridade anatômica de uma articulação (thrust). O objetivo do presente estudo foi avaliar os efeitos imediatos da manipulação torácica alta sobre a temperatura superficial cutânea da região vertebral em mulheres saudáveis. Para tal, foi realizado um estudo clínico randomizado cego na comunidade universitária. Vinte e seis voluntárias saudáveis foram alocadas de forma randomizada em um grupo experimental (n=13) e um grupo placebo (n=13). Uma sessão de manipulação torácica alta (segmento T3) foi realizada. Foi empregada a termografia infravermelha para determinar alterações na temperatura cutânea na região vertebral. Imagens foram capturadas antes, imediatamente após, cinco e dez minutos após a manipulação. Foi usada análise de variância com medidas repetidas (dois critérios) seguida do teste de Bonferroni para as comparações inter e intragrupos. Adotou-se um nível de significância de 5%. Não foi encontrada diferença significativa nas diferentes avaliações ao longo do tempo (p>0,05). Na análise intergrupos, não foi constatada diferença significativa nas comparações realizadas (p>0,05). Com base na metodologia empregada, a manipulação torácica do segmento vertebral T3 não promoveu alterações na temperatura superficial cutânea na região manipulada.

La manipulación de la espina dorsal es un recurso de terapia manual que se caracteriza por un impulso pasivo de alta velocidad y baja amplitud de los límites de integridad anatómica de una articulación (thrust). Esta investigación tuvo por objetivo evaluar los efectos inmediatos de la alta manipulación torácica de la temperatura superficial de la piel en la región vertebral en mujeres sanas. Para eso, se ha realizado un estudio clínico aleatorizado ciego en la comunidad universitaria. Veintiséis voluntarias han sido puestas de forma aleatorizada en un grupo experimental (n=13) y un grupo placebo (n=13). Ha sido realizada una sesión de manipulación torácica alta (segmento T3). Se ha empleado el término infrarrojo para determinar alteraciones en la temperatura de la piel en la región vertebral. Se han capturado imágenes antes, inmediatamente después, cinco y diez minutos tras la manipulación. Se ha hecho un análisis de los cambios con medidas repetidas (dos criterios) seguido de la prueba de Bonferroni para las comparaciones inter e intragrupal. Se ha adoptado un nivel de significancia de 5%. No ha sido encontrado diferencias significativas en las diferentes evaluaciones al largo del tiempo (p>0,05). En el análisis intergrupal, no ha sido constatado diferencias significativas en las comparaciones realizadas (p>0,05). Basándose en la metodología empleada, la manipulación torácica del segmento vertebral T3 no cambió la temperatura superficial de la piel en la región estudiada.

Women with more severe degrees of temporomandibular disorder exhibit an increase in temperature over the temporomandibular joint.

AIM: The purpose of the present study was to correlate the degree of temporomandibular disorder (TMD) severity and skin temperatures over the temporomandibular joint (TMJ) and masseter and anterior temporalis muscles. MATERIALS AND METHODS: This blind cross-sectional study involved 60 women aged 18-40 years. The volunteers were allocated to groups based on Fonseca anamnestic index (FAI) score: no TMD, mild TMD, moderate TMD, and severe TMD (n = 15 each). All volunteers underwent infrared thermography for the determination of skin temperatures over the TMJ, masseter and anterior temporalis muscles. The Shapiro-Wilk test was used to determine the normality of the data. The Kruskal-Wallis test, followed by Dunn's test, was used for comparisons among groups according to TMD severity. Spearman's correlation coefficients were calculated to determine the strength of associations among variables. RESULTS: Weak, positive, significant associations were found between FAI score and skin temperatures over the left TMJ (rs = 0.195, p = 0.009) and right TMJ (rs = 0.238, p = 0.001). Temperatures over the right and left TMJ were significantly higher in groups with more severe TMD (p < 0.05). CONCLUSION: FAI score was associated with skin temperature over the TMJ, as determined by infrared thermography, in this sample. Women with more severe TMD demonstrated a bilateral increase in skin temperature.

Relationship between neck disability and mandibular range of motion.

BACKGROUND AND OBJECTIVE: There is a close interaction between the mandibular and cervical systems due to the existing neurological and biomechanical communications. This study aimed to evaluate the relationship between neck disability and mandibular range of motion (ROM). MATERIALS AND METHODS: Fifty-two women aged between 18 and 40 years were recruited and allocated to four groups using two outcome measures: the Neck Disability Index (NDI) and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD): Group I (n=13), healthy volunteers; Group II (n=13), volunteers with TMD and neck disability; Group III (n=13), volunteers with TMD and without neck disability; and Group IV (n=13), volunteers with neck disability and without TMD. Mandibular ROM was evaluated as part of the RDC/TMD clinical examination. Statistical analysis involved one-way ANOVA followed by Tukey's test for comparisons between groups. Spearman's correlation coefficients were calculated to determined correlations among the variables. RESULTS: Significant differences were found in the mandibular ROM of functional opening in the comparisons between Groups I and III (p=0.009) and between Groups III and IV (p=0.024). No significant association was found between mandibular ROM and the NDI score (p > 0.05). CONCLUSION: Based on the methodology employed, there is no association between mandibular ROM and neck disability in university women. In this sense, clinical interventions focusing on the flexibility of the temporomandibular joint does not have repercussions on the neck disability and vice versa.

Accuracy of two forms of infrared image analysis of the masticatory muscles in the diagnosis of myogenous temporomandibular disorder.

The aim of the present study was to assess the accuracy of two forms of infrared image analysis (area and extension) of the masseter and anterior temporalis muscles in the diagnosis of myogenous temporomandibular disorder (TMD). A cross-sectional study was carried out involving 104 female volunteers from the university community. Following the application of the Research Diagnostic Criteria for Temporomandibular Disorders, the volunteers were divided into a TMD group (n = 52) and control group (n = 52), and evaluated using infrared thermography. The area and extension of the masseter and anterior temporalis muscles were measured on the images. The receiver operating characteristic (ROC) curve was used to determine diagnostic accuracy (area under the curve), best cutoff point, sensitivity and specificity. A significant difference in skin temperature between groups was only found in the measurement of the area of the left anterior temporalis muscle (p = 0.011). The area under the ROC curve was less than the reference values for all muscles evaluated in the analyses of area and extension. Thus, neither method of infrared thermography tested for the quantification of the masseter and anterior temporalis muscles (analysis of area and extension) is consistent with the RDC/TMD for the diagnosis of myogenous TMD in women.

Effects of upper thoracic manipulation on pressure pain sensitivity in women with temporomandibular disorder: a randomized, double-blind, clinical trial.

OBJECTIVE: The aim of the present study was to evaluate the effects of upper thoracic manipulation on pain in subjects with temporomandibular disorder. DESIGN: Thirty-two women with a diagnosis of temporomandibular disorder were randomly allocated to an experimental group (n = 16), submitted to upper thoracic manipulation, and a placebo group (n = 16), submitted to a procedure in the thoracic region with no therapeutic effect. All volunteers underwent an evaluation of pain in the masticatory muscles and the temporomandibular joint using an algometer and the visual analog scale before and immediately after the procedure as well as after 48-72 hrs. Two-way repeated-measures analysis of variance was used for the intragroup and intergroup analyses, with the level of significance set to 5% (P < 0.05). Cohen d was calculated for the determination of the effect size. RESULTS: No significant group-by-time interaction was found (P > 0.05) for algometry in any analysis, and Cohen d revealed no significant effect of the treatment. Moreover, no significant group-by-time interaction was found for facial pain intensity determined using the visual analog scale (P > 0.05), and Cohen d also revealed no significant effect of the treatment regarding this variable. CONCLUSIONS: On the basis of the present findings, upper thoracic spinal manipulation does not lead to a reduction in pain in women with temporomandibular disorder.

Correlation between skin surface temperature over masticatory muscles and pain intensity in women with myogenous temporomandibular disorder.

BACKGROUND AND OBJECTIVE: Pain is a common clinical manifestation in individuals with temporomandibular disorder (TMD). The literature report changes in microcirculation in this condition. The aim of the present study was to correlate skin surface temperature at the central point of the masticatory muscles with pain intensity in women with myogenous TMD. MATERIALS AND METHODS: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and the visual analogue scale (VAS) were used to divide 40 female university students into four groups: control group (n=10), mild pain group (n=10), moderate pain group (n=10) and severe pain group (n=10). Infrared thermography was used to assess the masticatory muscles. RESULTS: No significant correlations were found between pain intensity and skin surface temperature over the left masseter (p=0.368), right masseter (p=0.618), left anterior temporalis (p=0.293) and right anterior temporalis (p=0.922) muscles. No correlations were found between pain intensity and asymmetry of the masseter (p=0.375) and anterior temporalis (p=0.090) muscles. Moreover, no significant difference in skin surface temperature (p> 0.05) was found among the different groups. CONCLUSION: Pain intensity in women with myogenous TMD was not associated with skin surface temperature at the central point of the masseter and anterior temporalis muscles.

Accuracy and reliability of infrared thermography in the diagnosis of arthralgia in women with temporomandibular disorder.

OBJECTIVE: The purpose of this study was to determine the accuracy and reliability of infrared thermography in the diagnosis of arthralgia in women with temporomandibular disorder. METHODS: Thirty women aged between 18 and 40 years were recruited for the study. The Research Diagnostic Criteria for Temporomandibular Disorders was used to allocate the volunteers to the control group (n = 15) and arthralgia group (n = 15). Both groups were submitted to infrared thermography of the temporomandibular joint (TMJ), followed by a punctual analysis of the images. The Mann-Whitney U test was used for the comparison of skin surface temperature between groups. The intraclass correlation coefficient was calculated to determine the reliability of the infrared image analysis. The receiver operating characteristic curve was used to determine the accuracy of the diagnosis. RESULTS: Skin temperature was significantly greater over the left (P = .004) and right (P = .012) TMJ in the arthralgia group. The intraclass correlation coefficient ranged from 0.841 to 0.874. The area under the receiver operating characteristic curve ranged from 0.598 to 0.675. CONCLUSION: Excellent intrarater and interrater reliability was found in the analysis of the infrared images of the TMJ. However, infrared thermography demonstrated a low accuracy in the diagnosis of arthralgia in women with temporomandibular disorder.