[Duration of splint therapy in patients with temporomandibular joint disorders]. / Prodolzhitel'nost' splint-terapii u patsientov s sindromom bolevoi disfunktsii visochno-nizhnechelyustnogo sustava.

AIM: Studying the duration of treatment in patients with temporomandibular joint pain dysfunction syndrome, and the relationship of the duration of treatment with the age of the patient at the beginning of therapy. MATERIALS AND METHODS: The study was carried out using information from medical records of dental patients, information from additional examinations of patients who were treated at the National Medical Research Centre for Dentistry and Maxillofacial Surgery of the Ministry of Health of Russia from 2016 to 2022. Statistical research methods: to evaluate the normality of the distribution, graphical methods were used, as well as the Shapiro-Wilk criterion. RESULTS: The duration of splint therapy in patients with temporomandibular joint pain dysfunction syndrome varied from 4 to 27 months. The average duration of treatment of patients using occlusive splints was 10.5±5.3 months. Without abnormal observations, the average duration of splint therapy in patients with TMJ pain syndrome was 9.6±4.1 months. The obtained data allow stating the absence of a correlation between the age of patients and the duration of splint-therapy. CONCLUSION: The majority of patients (68.4%) complete the splint therapy stage within 1 year, and a very small part (1.8%) are treated for more than 1.5 years. The duration of treatment of patients with temporomandibular joint pain dysfunction syndrome does not depend on age or gender.

[Clinical efficiency of occlusive splints in the treatment of patients with temporomandibular joint dysfunction complicated by bruxism]. / Klinicheskaya effektivnost' okklyuzionnykh shin v lechenii patsientov s disfunktsiei visochno-nizhnechelyustnogo sustava, oslozhnennoi bruksizmom.

OBJECTIVE: Improving the effectiveness of treatment of patients with temporomandibular joint (TMJ) dysfunction complicated by bruxism. MATERIAL AND METHODS: 70 patients with signs of parafunction of the masticatory muscles were selected for the clinical study. The patients were divided into 2 groups of 35 people. Splints were made for patients from the groups using 2 different 3D printing methods. The treatment was monitored using clinical and instrumental studies, electromyography of the muscles themselves and computed tomography of the TMJ after 3, 6 and 12 months. RESULTS: The severity of hypertonicity of the masticatory muscles decreased by the end of 3 months of treatment with the help of repositioning occlusal splints. After 6 months of treatment, the mean BEA decreased in both study groups, but to a lesser extent than in the first 3 months. After wearing a splint after 12 months, the decrease in muscle tone was insignificant. CONCLUSION: The clinical use of positioning splints plays a crucial role in the stabilization of occlusion and is a mandatory stage of complex treatment of patients with pathology of the occlusal-musculoskeletal complex.

Repouso eletromiográfico dos músculos mastigatórios de pacientes com disfunção temporomandibular antes e após intervenção fonoaudiológica com e sem bandagem elástica / Electromyographic rest of the masticatory muscles of patients with temporomandibular disorders before and after speech therapy with and without elastic bandage / Resto electromiográfico de los músculos masticatorios de pacientes con trastornos temporomandibulares antes y después de logopedia con y sin venda elástica

Objetivo: A pesquisa tem por objetivo verificar os limiares de repouso eletromiográfico dos músculos masseter e temporal em pacientes com disfunção temporomandibular (DTM) antes e após intervenção fonoaudiológica com e sem a utilização de bandagem elástica terapêutica. Métodos: A coleta contou com 14 participantes do sexo feminino, com idade entre 18 e 40 anos, com diagnóstico de DTM muscular ou mista. As pacientes foram divididas entre dois grupos classificados em: pacientes com bandagem associada à terapia tradicional (CB) e grupo de terapia tradicional (SB). As pacientes inicialmente foram avaliadas pelo exame de eletromiografia de superfície nas situações de contração voluntária máxima e repouso, e após quatro semanas de intervenção, foi realizada nova avaliação com os mesmos instrumentos. A análise dos dados ocorreu de forma quantitativa e qualitativa. Resultados:No grupo SB o músculo masseter direito apresentou aumento dos valores de repouso com significância, foi observado que o mesmo ocorreu para todos os músculos deste grupo, influenciando no equilíbrio da musculatura ipsilateral e contralateral, no entanto sem evidência estatística. O grupo CB não demonstrou valores estatísticos significativos, porém qualitativamente os valores de repouso muscular diminuíram e equilibraram-se de forma contralateral. Conclusão: Não foram observadas mudanças estatisticamente significantes nos limiares eletromiográficos durante repouso dos músculos masseter e temporal em ambos os grupos. Qualitativamente houve aumento dos valores eletromiográficos após terapia manual tradicional em todos os músculos do grupo SB. Com relação ao grupo CB, houve diminuição dos valores do repouso eletromiográfico após terapia, embora sem evidências estatísticas. (AU)

Purpose: Objective: The research aims to verify the electromyographic rest thresholds of the masseter and temporal muscles in patients with temporomandibular disorders (TMD) before and after speech therapy intervention with and without the use of therapeutic elastic bandage. Methods: The collection included 14 female participants, aged between 18 and 40 years, who had a diagnosis of muscular or mixed TMD. The patients were divided into two groups: with traditional therapy (CB) bandage and traditional therapy (SB) only group. The patients underwent initial evaluation, as well as surface electromyography in situations of maximum voluntary contraction and rest and at the end of the four weeks of intervention, a new evaluation was performed with the same instruments. Data analysis occurred quantitatively and qualitatively. Results: In the SB group, the right masseter muscle showed a significant increase in resting values. It was observed that the same occurred for all muscles in this group, influencing the balance of the ipsilateral and contralateral muscles, although without statistical evidence. The CB group did not show statistically significant values, but qualitatively the muscle rest values decreased and balanced in a contralateral way. Conclusion: No statistically significant changes were observed in the resting electromyographic thresholds of the masseter and temporalis muscles in both groups. Qualitatively, there was an increase in electromyographic values after traditional manual therapy in all muscles in the SB group. Regarding the CB group, there was a decrease in electromyographic resting values after therapy, although without statistical evidence. (AU)

Objetivo: La investigación tiene como objetivo verificar los umbrales electromiográficos de reposo de los músculos masetero y temporal en pacientes con trastornos temporomandibulares (TMD) antes y después de la terapia del habla con y sin el uso de venda elástica terapéutica. Métodos: La colección incluyó a 14 participantes mujeres, con edades entre 18 y 40 años, diagnosticadas con TTM muscular o mixta. Los pacientes fueron divididos en dos grupos clasificados en: pacientes con vendaje asociado a terapia tradicional (CB) y grupo de terapia tradicional (SB). Los pacientes fueron inicialmente evaluados mediante electromiografía de superficie en situaciones de máxima contracción voluntaria y reposo, luego de cuatro semanas de intervención se realizó una nueva evaluación con los mismos instrumentos. El análisis de datos se llevó a cabo cuantitativa y cualitativamente. Resultados: En el grupo SB, el músculo masetero derecho presentó un aumento significativo en los valores de reposo, se observó que lo mismo ocurrió para todos los músculos de este grupo, influyendo en el equilibrio de los músculos ipsilaterales y contralaterales, sin embargo, sin evidencia estadística. El grupo CB no mostró valores estadísticamente significativos, pero cualitativamente los valores de descanso muscular disminuyeron y se equilibraron contralateralmente. Conclusión: No se observaron cambios estadísticamente significativos en los umbrales electromiográficos en reposo de los músculos masetero y temporal en ambos grupos. Cualitativamente, hubo un aumento de los valores electromiográficos después de la terapia manual tradicional en todos los músculos del grupo SB. En cuanto al grupo CB, hubo una disminución de los valores electromiográficos de reposo después de la terapia, aunque sin evidencia estadística. (AU)

Effects of a program consisting of strain/counterstrain technique, phonophoresis, heat therapy, and stretching in patients with temporomandibular joint dysfunction: A pilot study.

BACKGROUND: The present study was conceptualized as a pilot study to examine the effects of a 3-week program consisting of strain/counterstrain technique (SCST), phonophoresis, heat therapy, and stretching exercises on pain and functions in patients with temporomandibular dysfunction (TMD). METHODS: Seven participants (mean age 25.85 years) diagnosed with TMD having pain in the temporomandibular joint (TMJ) area with decreased jaw opening were recruited for the study. Treatment interventions consisting of SCST, phonophoresis (ultrasound gel mixed with diclofenac gel), heat therapy, and stretching (mouth-opening) exercises were performed 3 days a week for 3 weeks. SCST was performed on the masseter, medial, and lateral pterygoid muscles. No control group was present in the study. RESULTS: Paired samples t test revealed a significant difference in numerical pain rating scale (NPRS) (decreased by 50%, P < .001) and jaw functional limitation scale (JFLS) (reduced by 59.58%, P < .001) scores after 3 weeks of intervention. A large effect size (Cohen d = -3.00 for NPRS and -3.16 for JFLS) was observed for both variables. No correlation (R = 0) was found between the baseline values of NPRS and JFLS. CONCLUSION: A 3-week program consisting of SCST, phonophoresis, heat therapy, and stretching exercises was effective in reducing the pain and improving the functions related to TMJ in patients suffering from TMD. However, a randomized controlled trial is needed to reach a definite conclusion.

Carboxytherapy for the elimination of pain symptoms (or arthralgia) among the elderly persons with the pathology of the temporomandibular joint.

Temporomandibular arthralgia is difficult to treat, painful and often relapses. 48 patients (19 men and 29 women) aged 61-72 years, suffering from the syndrome of pain dysfunction of the temporomandibular joint, were under observation. In 1st (control) group of patients (18 people), NSAIDs indomethacin in tablet form of 25 mg 3 times a day were used for 9 days. In patients of the 2nd (main) group (30 people), the method of invasive carboxytherapy was used, consisting in subcutaneous injection of carbon dioxide with a volume of 3 ml of 5 procedures every other day. On the 3rd, 9th and 15th days of follow-up, invasive carboxytherapy was more effective than the use of a nonsteroidal anti-inflammatory agent by 8.9; 36,5 and 37%, respectively. The high efficiency of the method of invasive carboxytherapy for the elimination of pain symptoms in pain dysfunction was shown, which was 22,86% on day 3; 64,29% on day 9 and 68,16% on day 15 of observation. The method of invasive carboxytherapy can be used in the complex treatment of patients with pain dysfunction of the temporomandibular joint.

Isotonic exercises and relaxing techniques in individuals with temporomandibular dysfunction.

Objective: The present study aimed to compare the clinical characteristics of volunteers with temporomandibular dysfunction before and after performing exercises with those of volunteers who only followed self-care guidelines.Methods: A parallel randomized controlled trial was performed. Individuals included underwent the intervention twice a week for one month, while the control group only followed self-care guidelines.Results: Twenty-three volunteers participated; however, during the study, four dropped out. At the end of the study, the degree of depression decreased in the volunteers in the intervention group.Conclusion: The level of pain decreased, but the improvement was not statistically significant and, therefore, could not be attributed to the intervention. It can be concluded that the strategies used to reduce pain in this study were not sufficient for clinical improvement in volunteers with temporomandibular dysfunction.

Estratégias para o treino da mastigação e deglutição em indivíduos com disfunção temporomandibular e dor orofacial: uma revisão de escopo / Strategies to train mastication and swallowing in individuals with temporomandibular disorder and orofacial pain: a scoping review

RESUMO Objetivo identificar e sintetizar evidências sobre estratégias utilizadas no treino da mastigação e deglutição em indivíduos com disfunção temporomandibular e dor orofacial. Estratégia de pesquisa revisão de escopo desenvolvida com consulta nas bases de dados MEDLINE, LILACS, BBO, IBECS, BINACIS, CUMED, SOF, DeCS, Index Psi, LIPECS e ColecionaSUS (via BVS), Scopus, CINAHL, Embase, Web of Science, Cochrane e na literatura cinzenta: Biblioteca Digital Brasileira de Teses e Dissertações (BDTD), OpenGrey e Google Acadêmico. Critérios de seleção estudos quantitativos ou qualitativos, sem limite temporal e sem restrição de idioma, que continham os seguintes descritores ou palavras-chave: Articulação Temporomandibular, Síndrome da Disfunção da Articulação Temporomandibular, Transtornos da Articulação Temporomandibular, Dor Facial, Mastigação, Deglutição, Terapêutica, Terapia Miofuncional e Fonoaudiologia. Na primeira etapa, dois revisores fizeram a triagem independente dos estudos, por meio da leitura dos títulos e resumos. Na segunda etapa, os revisores leram, independentemente, os documentos pré-selecionados na íntegra. Em caso de divergência, um terceiro pesquisador foi consultado. Resultados as 11 publicações incluídas foram publicadas entre 2000 e 2018. As estratégias mais utilizadas foram o treino da mastigação bilateral simultânea, seguido da mastigação bilateral alternada. Na deglutição, foi proposto aumento do tempo mastigatório para reduzir o alimento em partículas menores e lubrificar melhor o bolo alimentar e treinos com apoio superior de língua. Conclusão o treinamento funcional demonstrou efetividade na reabilitação dos pacientes, embora não siga uma padronização e não seja realizado de forma isolada. Os estudos encontrados apresentam baixo nível de evidência. Considera-se fundamental a realização de estudos mais abrangentes e padronizados, como ensaios clínicos randomizados.

ABSTRACT Purpose To identify and synthesize evidence on strategies used to train chewing and swallowing in individuals with temporomandibular disorder and orofacial pain. Research strategy Scoping review conducted by search in MEDLINE, LILACS, BBO, IBECS, BINACIS, CUMED, SOF, DeCS, Index Psi, LIPECS, and ColecionaSUS (via VHL), Scopus, CINAHL, Embase, Web of Science, Cochrane, and the grey literature: Brazilian Digital Theses and Dissertations Library (BDTD), OpenGrey, and Google Scholar. Selection criteria Quantitative or qualitative studies, with no restriction on time or language of publication, with the following descriptors or keywords: Temporomandibular Joint; Temporomandibular Joint Dysfunction Syndrome; Temporomandibular Joint Disorders; Facial Pain; chewing (Mastication); swallowing (Deglutition); Therapeutics; Myofunctional Therapy; Speech, Language and Hearing Sciences. In the first stage, two reviewers independently screened the studies by title and abstract reading. In the second stage, the reviewers independently read the preselected documents in full text. In case of divergences, a third researcher was consulted. Results The 11 documents included in the review were published between 2000 and 2018. The mostly used training strategies were simultaneous bilateral mastication/chewing, followed by alternating bilateral mastication. In swallowing, increased mastication time was proposed to break food into smaller bits and better lubricate the bolus; training with upper tongue support was also indicated. Conclusion Functional training proved to be effective in rehabilitation, although it was not standardized or performed alone. The studies had low levels of evidence. It is essential to conduct more encompassing and standardized studies, such as randomized clinical trials.

O uso da bandagem elástica adesiva para alívio da dor no tratamento das disfunções temporomandibulares: revisão sistemática com metanálise / Use of kinesiology tape for pain relief in the treatment of temporomandibular disorders: a systematic review with meta-analysis

RESUMO Objetivos Verificar o efeito da aplicação da bandagem elástica sobre músculos mastigatórios no alívio da dor, em comparação com outras intervenções, em indivíduos com disfunções temporomandibulares. Estratégia de pesquisa Busca nas bases de dados LILACS, IBECS, CINAHL, Scopus, Web of Science, Cochrane, Embase e MEDLINE. A pergunta norteadora, utilizando-se os elementos da estratégia PICOT (população, intervenção, comparador, outcome/desfecho, tipo de estudo) foi: "A bandagem elástica promove alívio da dor em indivíduos com disfunção temporomandibular?". Critérios de seleção Foram incluídos ensaios clínicos que fizeram uso da bandagem elástica em músculos mastigatórios de indivíduos com disfunção temporomandibular, publicados em português, inglês ou espanhol. Foram excluídos os artigos que não abordavam o método de aplicação e o desfecho "intensidade da dor". A avaliação da elegibilidade foi realizada pela leitura dos títulos e resumos, bem como pela leitura dos estudos na íntegra. Foram extraídas informações sobre ano de publicação, país de condução do estudo, idade e condição clínica da amostra, tratamento e resultados da avaliação da dor. Na metanálise, realizada por meio do método do inverso da variância, a média do valor indicado na escala visual analógica foi considerada como medida de efeito da intervenção. Resultados Foram localizadas, inicialmente, 344 referências, das quais, 3 foram selecionadas. Foram identificados resultados significativamente superiores na redução da dor, em uma semana de uso da bandagem, na comparação com outras abordagens conservadoras analisadas. Conclusão Considerando os artigos incluídos, a bandagem elástica apresentou resultados significativos para maior redução da dor na primeira semana. Porém, o número reduzido de estudos e a presença de vieses limitam os achados.

ABSTRACT Purpose To verify the effects on pain relief by applying kinesiology tape on the masticatory muscles, in comparison with other interventions, in people with temporomandibular disorders. Research strategy Search in LILACS, IBECS, CINAHL, Scopus, Web of Science, Cochrane, EMBASE, and MEDLINE. The research question, based on the PICOT components, was: "Does kinesiology tape applied on to masticatory muscles relieve the pain in people with temporomandibular disorders?". Selection criteria The included articles were clinical trials using kinesiology tape on masticatory muscles in people with temporomandibular disorders, published in Portuguese, English, or Spanish. Articles whose authors had not adopted this application method and pain intensity as an outcome were excluded. Eligibility was assessed by reading their titles, abstracts, and full texts. The following information was extracted: year of publication, the country where the study was conducted, age and clinical condition of the sample, treatment, and pain assessment results. The meta-analysis, using the inverse variance method, considered the mean value indicated in the visual analog scale as the intervention effect measure. Results Initially, 344 references were retrieved, of which three were selected. Significantly better pain relief results were identified after 1 week of using the tape, in comparison with the other conservative approaches analyzed. Conclusion Considering the included articles, the kinesiology tape had significant results with greater pain relief in the first week. However, small number of studies and their biases limit the findings.

Comparison of the Effects of Myotherapy in Patients with Myofascial Pain with and without Self-Reported Sleep Bruxism Using The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I Questionnaire.

BACKGROUND This study aimed to compare the effects of myotherapy using sublingual relaxation splints and stretching exercises in 110 patients with myofascial pain with and without self-reported sleep bruxism using The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I Questionnaire. MATERIAL AND METHODS The study involved 110 patients with myofascial pain. The diagnosis was based on the RDC/TMD questionnaire. The number of painful muscle sites (PMS) and the range of maximum mouth opening (MMO) were assessed 2 times - at the first visit and after 3 months. Then, the influence of possible bruxism on the treatment was assessed. RESULTS The mean age of the patients was 26.8 years (SD 5.4); 89% of the subjects were women; and 60.9% of the patients reported bruxism. Each patient was instructed to perform muscle stretching at the first visit and after 1 week all patients received a sublingual relaxation splint. The number of PMS decreased and the range of MMO increased in both groups after a period of 3 months of treatment (P<0.05). Significant differences were observed in the obtained treatment effects between the patients with and without possible bruxism. CONCLUSIONS This study evaluated the effectiveness of the sublingual relaxation splint and stretching exercises in patients with myofascial pain. Patients at a single center in Poland who reported myofascial pain that was not associated with self-reported sleep bruxism had a significantly better response to myotherapy when compared to patients with self-reported sleep bruxism.

Terapia fonoaudiológica nas disfunÒ«ões temporomandibulares (DTM): uma revisão de literatura / Speech therapy in temporomandibular joint (TMJ) dysfunction: a literature review / Terapia fonoaudiológica en trastornos temporomandibulares (TTM): una revisión de la literatura

Introdução: A Disfunção Temporomandibular (DTM) é reconhecida como um grupo de condições musculoesqueléticas e neuromusculares alteradas que abrangem as articulações temporomandibula­res (ATMs), os músculos mastigatórios e todos os tecidos associados, com etio­logias múltiplas e tratamentos específicos. Objetivo: O objetivo deste trabalho é revisar a literatura sobre as propostas terapêuticas das disfunções temporomandibulares (DTM's) e verificar quais são os procedimentos terapêuticos utilizados na terapia fonoaudiológica. Métodos: Foram incluídos artigos que agregaram aos seus objetivos a descrição de propostas de intervenção fonoaudiológica, publicados em português e inglês, com os resumos disponíveis nas bases de dados LILACS, PUBMED e SCIELO e publicados entre 2008 e 2018. Os descritores utilizados foram: "síndrome da disfunção da articulação temporomandibular", "tratamento", "fonoaudiologia", "transtornos da articulação temporomandibular'', "temporomandibular joint dysfunction syndrome", "treatment", "speech therapy". Resultados: Dos 83 artigos selecionados, 10 foram considerados para análise do estudo por atenderem aos critérios de inclusão. Destes, 3 se encontravam sem acesso disponível e 2 estavam repetidos, restando, assim 5 artigos para a análise. Foram encontrados artigos que abordaram técnicas com laser de baixa intensidade, terapia miofuncional orofacial tradicional e bandagem terapêutica. Conclusão: Conclui-se que nos estudos na área da Fonoaudiologia, os tratamentos trazem, além da diminuição da dor, a necessidade da reabilitação das funções orofaciais. Os estudos ainda são escassos dentro dessa patologia, sendo de muita importância novas pesquisas sobre a DTM, pois a fonoaudiologia pode trazer uma variação benéfica de tratamentos, visando o restabelecimento das funções estomatognáticas.

Introduction: Temporomandibular joint (TMJ) dysfunction is recognized as a group of altered musculoskeletal and neuromuscular conditions that encompass temporomandibular joints (TMJ), masticatory muscles and all associated tissues, with multiple etiologies and specific treatments. Objective: The objective of this paper is to review the literature on the therapeutic proposals of temporomandibular joint (TMJ) dysfunctions and to verify what therapeutic procedures are used in speech therapy. Methods: Articles were included that added to their objectives the description of proposals for speech therapy intervention, published in Portuguese and English, with the abstracts available in the LILACS, PUBMED and SCIELO databases and published between 2008 and 2018. The descriptors used were: "síndrome da disfunção da articulação temporomandibular", "tratamento", "fonoaudiologia", "transtornos da articulação temporomandibular'', "temporomandibular joint dysfunction syndrome", "treatment", "speech therapy". Results: Of the 83 selected articles, 10 were considered for study analysis because they met the inclusion criteria. Of these, 3 were without available access and 2 were repeated, thus remaining 5 articles for analysis. Articles were found that addressed techniques with low-intensity laser, traditional orofacial myofunctional therapy, and therapeutic bandage. Conclusion: It is concluded that in studies in the field of speech therapy, treatments bring, in addition to the reduction of pain, the need for rehabilitation of orofacial functions. Studies are still scarce within this pathology, and new research on TMJ dysfunction is very important because speech therapy can bring a beneficial variation of treatments, aiming at the restoration of stomatognathic functions.

Introducción: El Trastorno Temporomandibular (TTM) se reconoce como un grupo de afecciones musculoesqueléticas y neuromusculares alteradas que abarcan las articulaciones temporomandibulares (ATM), los músculos masticatorios y todos los tejidos asociados, con múltiples etiologías y tratamientos específicos. Objetivo: El objetivo de este trabajo es revisar la literatura sobre las propuestas terapéuticas de los trastornos temporomandibulares (TTM) y verificar los procedimientos terapéuticos utilizados en la terapia fonoaudiológica. Métodos: Se incluyeron artículos que añadieron a sus objetivos la descripción de las propuestas de intervención fonoaudiológica, publicadas en portugués e inglés, con los resúmenes disponibles en las bases de datos LILACS, PUBMED y SCIELO y publicadas entre 2008 y 2018. Los descriptores utilizados fueron: "síndrome da disfunção da articulação temporomandibular", "tratamento", "fonoaudiologia", "transtornos da articulação temporomandibular'', "temporomandibular joint dysfunction syndrome", "treatment", "speech therapy". Resultados: De los 83 artículos seleccionados, 10 fueron considerados para el análisis del estudio porque cumplían los criterios de inclusión. De ellos, 3 no tenían acceso disponible y 2 se repitieron, dejando 5 artículos para el análisis. Se encontraron artículos que abordaban técnicas con láser de baja intensidad, terapia miofuncional orofacial tradicional y vendaje terapéutico. Conclusión: se concluye que en los estudios en el campo de la Fonoaudiología, los tratamientos traen, además de la reducción del dolor, la necesidad de rehabilitación de las funciones orofaciales. Los estudios son todavía escasos dentro de esta patología, y nuevas investigaciones sobre TTM son muy importantes, porque la terapia fonoaudiológica puede traer una variación beneficiosa de los tratamientos, con el objetivo de restaurar las funciones estomatognáticas.

Tuina therapy for temporomandibular joint disorder syndrome: A protocol for systematic review and meta-analysis.

BACKGROUND: Temporomandibular joint disorders (TMD) is common in clinic at present, which seriously affects the mental health and quality of life of patients. With the development of society, the incidence of TMD is gradually increasing. At present, there are many treatment methods, Tuina as a characteristic traditional Chinese medicine therapy, clinical treatment of TMD has a significant effect. In recent years, there are many clinical studies on Tuina in the treatment of TMD, but the clinical efficacy of Tuina in the treatment of TMD has not been systematically evaluated. In this study, we systematically evaluated the relevant literature of Tuina in the treatment of TMD by using the method of evidence-based medicine, in order to provide reference for clinical research in this direction in the future. METHODS: VIP Chinese database, China knowledge Network, Wanfang, China Biomedical Database, PubMed, Embase, Cochrane Library and Web of Science were searched for clinical randomized controlled trials of Tuina in the treatment of TMD from the establishment of the database to December 2020. The 2 researchers independently screened the literature and carried out quality assessment and data extraction for the included study, and used RevMan5.3 software for risk assessment and Meta analysis. RESULTS: In this study, the efficacy and safety of Tuina in the treatment of TMD were evaluated by effective rate, visual analog score (VAS) of temporomandibular joint pain, dysfunction index ((DI), palpation index (PI), craniomandibular index (CMI), maximum mouth opening (MMO), incidence of adverse reactions and so on. CONCLUSION: This protocol can provide evidence-based basis for the treatment of TMD, with Tuina to significantly improve the symptoms and function of patients with TMD. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/J75A8.

Microtornillos como método de control vertical en desprogramación muscular / Vertical control with miniscrews in muscular deprogramming treatment

Una de las consecuencias de la desprogramación neuromuscular es la rotación mandibular en sentido horario, evidenciando el punto prematuro de contacto y aumentando la dimensión vertical del paciente. En pacientes clase II con componente vertical, es un problema realizar este tipo de tratamiento, ya que por lo general este efecto de posterorrotación mandibular hace el perfil más convexo, y en algunos casos genera mordida abierta anterior, la cual se debe corregir posteriormente con el tratamiento de ortodoncia, cirugía o prótesis, lo que alarga el tiempo total de tratamiento por la necesidad de control vertical. El presente caso se trata de una mujer de 45 años de edad, dolicofacial, con tendencia a mordida abierta, mordida dual, sobremordida vertical y horizontal disminuidas, motivo de consulta dolor articular, el cual no le permite continuar con sus labores diarias, el tratamiento realizado fue desprogramación neuromuscular con un guarda oclusal inferior con el propósito de aliviar sintomatología articular y control vertical con microtornillos palatinos previo a tratamiento ortodóncico (AU)

One of the effects of the neuromuscular deprogramming treatment is the mandibular clockwise rotation, making the light premature occlusal contact more evident and increasing the patient vertical dimension. In Class II patients with vertical component is difficult to treat them due to profile worsening as an effect of the clockwise rotation creating in some patient's anterior open bite, this has to be corrected later in treatment with orthodontic intrusion, surgery or prosthodontic treatment, increasing the total time of treatment with the vertical control necessity. This case report is a 45 years old patient, dolichofacial, with anterior open bite tendency, dual bite, decreased overjet and overbite, her chief complaint was temporomandibular joint dysfunction which dont allow her to do her daily duties, the treatment for her was neuromuscular deprogramming splint for the temporomandibular joint pain, and vertical control with temporary anchorage devices (miniscrews) before the orthodontic treatment (AU)

The effectiveness of stabilization appliance therapy among patients with myalgia.

BACKGROUND: The efficacy of stabilization appliance therapy for masticatory muscle pain is debated. Therefore, there are currently no clear usage standards. We analyzed patient factors influencing its efficacy and characterized masticatory muscle pain subtypes to determine appropriate therapy candidates. METHODS: This case series study recruited patients diagnosed with local myalgia or myofascial pain and used variables related to temporomandibular disorders in the analysis. We used temporary appliance to screen patients for sleep bruxism for 2 weeks. Afterwards, we initiated therapy with stabilization appliances. Efficacy was evaluated via tenderness intensity during muscle palpation and the treatment satisfaction score after 2 months of treatment. RESULTS: We analyzed 62 (91%) patients. Tenderness upon muscle palpation was mitigated in 27 patients. Mitigated tenderness odds ratios were 0.035 for myofascial pain, 0.804 for 15-item Patient Health Questionnaire scores, and 1.915 for facet length. Thirty-nine patients expressed satisfaction; satisfaction odds ratios were 0.855 for 9-item Patient Health Questionnaire scores, 1.606 for facet length, and 4.023 for awake bruxism awareness. CONCLUSIONS: Stabilization appliance therapy is most effective for patients with awake bruxism awareness, local myalgia, long facets, and no psychosocial risk factors.

Efeito da terapia manual sobre os níveis de cortisol, intensidade de dor, qualidade de vida e aspectos psicológicos em pacientes portadores da disfunção temporomandibular. Série de casos / Effect of manual therapy on cortisol levels, pain intensity, quality of life and psychological aspects in patients with temporomandibular disorder. Case series

Objetivo: Avaliar o efeito da terapia manual (TM) sobre os níveis de cortisol, intensidade de dor, qualidade de vida e aspectos psicológicos em pacientes portadores de disfunção temporomandibular ( DTM ). Metodologia: Foi realizado a série de casos com 5 pacientes portadores de DTM, diagnosticados pelo Critério de Diagnóstico em pesquisa em pacientes com Disfunção Temporomandibular (RDC/TMD). Os pacientes receberam sessões de TM 2 vezes por semana com duração de 30 minutos por um período de 1 mês, perfazendo um total de 8 sessões. Verificou-se o nível de cortisol salivar, intensidade de dor pela escala visual numérica (EVN), grau de sintomas de ansiedade pelos questionários: Escala Hospitalar de Ansiedade e Depressão (HADS ), Inventário de Ansiedade de Beck( BAI ) e Índice de Ansiedade Traço-Estado ( IDATE), grau de sintomas de depressão pelo questionário Escala Hospitalar de Ansiedade e Depressão (HADS ) e qualidade de vida pelo questionário World Health Organization Quality of Life (WHOQUOL bref ). Foram avaliados antes e após a aplicação da terapia. Resultados: Observou-se que após a TM todos os pacientes apresentaram-se sem dor (EVN =0), com diminuição no nível de cortisol salivar (1,98 µg/dl para 1,31 µg/dl), menos ansiosos (ansiedade média) e menos depressivos (depressão leve) e com melhora na qualidade de vida. Conclusão: Os resultados deste estudo demonstraram que a terapia manual apresentou efeitos satisfatórios no tratamento de pacientes com DTM na intensidade de dor, nível de cortisol salivar, ansiedade em relação ao questionário BAI , depressão e qualidade de vida (AU).

Objective: To evaluate the effect of manual therapy (TM) on cortisol levels, pain intensity, quality of life and psychological aspects in patients with temporomandibular disorders .Methodology: A series of cases was carried out with 5 patients with TMD, diagnosed by the Diagnostic Criterion in research in patients with Temporomandibular Disorders (RDC / TMD). Patients received TM sessions twice a week for 30 minutes for a period of 1 month, for a total of 8 sessions. The level of salivary cortisol, intensity of pain was verified on the numerical visual scale (EVN), degree of symptoms of anxiety by the questionnaires: Hospital Anxiety and Depression Scale (HADS), Beck Anxiety Inventory (BAI) and Anxiety Index State trait (STAI), degree of symptoms of depression using the Hospital Anxiety and Depression Scale questionnaire (HADS) and quality of life using the World Health Organization Quality of Life questionnaire (WHOQUOL bref). They were evaluated before and after the application of the therapy. Results: It was observed that after TM all patients were pain free (EVN = 0), with a decrease in the level of salivary cortisol (1.98 µg / dl to 1.31 µg / dl), less anxious (medium anxiety) and less depressive (mild depression) and with improved quality of life. Conclusion: The results of this study demonstrated that manual therapy had satisfactory effects in the treatment of patients with TMD on pain intensity, salivary cortisol level, anxiety in relation to the BAI questionnaire, depression and quality of life (AU).

[Diagnostic criteria for the transition from occlusal splints to non-removable orthopedic appliances in patients with TMJ dysfunction with disc disorders]. / Kriterii perekhoda ot okkliuzionnoi shiny k vremennym nes''emnym ortopedicheskim konstruktsiiam pri lechenii patsientov s sindromom bolevoi disfunktsii visochno-nizhnecheliustnogo sustava s diskovymi narusheniiami.

The aim of the study was to elaborate Diagnostic criteria for the transition from occlusal splints to non-removable orthopedic appliances in patients with TMJ dysfunction with disc disorders. The study involved 95 patients with the clinics of TMJ dysfunction. An examination included electrovibrography and computerized electromyography in order to assess diagnostic value of the methods. Electrovibrography is a method based on arthrophonography, which makes it possible to obtain data on intraarticular noise in the TMJ. Computerized electromyography provides an objective assessment of the bioelectrical activity of the masticatory muscles in occlusive disorders, changes in the height of the lower facial area, and their relationship with the development of musculo-articular dysfunction of the TMJ and allows monitoring the effectiveness of orthopedic treatment. Within the normal function of the jaws the graphic trajectories of mandibular movements are within the limits of norm, and in the case of a violation of the TMP function, the graphic and linear indices are significantly different from the normal values.

Terapia combinada de láser diódico y plano desprogramador neuromuscular en pacientes con disfunción temporomandibular / Combined therapy of diode laser and neuromuscular deprogrammer splint in patients with temporomandibular disorder

La desprogramación neuromuscular juega un papel importante en el tratamiento de la disfunción temporomandibular, uno de los principales inconvenientes es el periodo prolongado del tratamiento, lo cual influye en la aceptación del paciente o el abandono del tratamiento. El diagnóstico es crucial para planificar el tratamiento ya que cubre una amplia gama de variables para tratarlo, por lo que en este caso es un paciente dolicofacial, con problemas de disfunción temporomandibular de origen muscular, por lo cual se optó por utilizar laserterapia de bajo nivel como coadyuvante de tratamiento, dando como resultado una mejor aceptación y colaboración de la desprogramación del paciente en un periodo de tiempo más corto (AU)

Neuromuscular deprogramming plays an important role in the treatment of temporomandibular dysfunction, one of the main drawbacks is the prolonged period of treatment, which influences the acceptance of the patient or the abandonment of treatment. The diagnosis is crucial to plan the treatment since it covers a wide range of variables to treat it, so in this case it is a dolichofacial patient, with problems of temporomandibular dysfunction of muscular origin, which is why we chose to use low-level laser therapy, level as a coadjutant of treatment, resulting in a better acceptance and collaboration of the deprogramming of the patient in a shorter period of time (AU)

Avaliação da efetividade de tratamentos conservadores para disfunções temporomandibulares miogênicas: revisão integrativa da literatura / Evaluation of the effectiveness of conservative treatments for miogenic temporomandibular dysfunctions: integrating review of the literature

Objetivo: revisão integrativa sobre os principais métodos de tratamento conservador para disfunção temporomandibular, sendo eles: placa oclusal, aconselhamento e farmacoterapia. Materiais e método: a busca foi feita nas bases de dados PubMed, SciELO, Lilacs e Google Acadêmico, utilizando os seguintes descritores: "counseling and temporomandibular joint"; "counseling and facial pain"; "counseling and temporomandibular joint dysfunction syndrome"; "counseling and temporomandibular joint and drug therapy"; e "counseling and drug therapy and facial pain". Resultados: no total, foram encontrados 314 estudos nesta pesquisa, porém, somente 8 foram incluídos no estudo. Esses comprovam a eficácia desses métodos de tratamento, fazendo com que o paciente obtenha diminuição da sintomatologia dolorosa, melhora das funções mastigatórias, além de proporcionar um alívio na tensão muscular, devido ao relaxamento das estruturas relacionadas. A placa oclusal tende a diminuir as forças oclusais aplicadas, redistribuindo a carga mastigatória sobre as superfícies oclusais. Alguns fármacos (anti-inflamatórios, antidepressivos e relaxantes musculares) são capazes de minimizar a sintomatologia dolorosa, proporcionando uma melhora na qualidade do sono e a redução de episódios de dor intensa. Por sua vez, o aconselhamento orienta os pacientes para que possam evitar atitudes que piorem sua doença, educando-os e conscientizando-os sobre seus hábitos parafuncionais, além de reduzir os fatores causadores de sintomatologia dolorosa. Conclusão: conseguimos observar que esses tratamentos apresentam índices de sucesso relevantes, quando se referem à diminuição dos sintomas, especialmente o aconselhamento, que ainda é uma terapia conservadora pouco explorada. Faz-se necessária a realização de mais estudos neste campo, para que sejam obtidos resultados cada vez mais concretos e conclusivos. (AU)

Objective: integrative review on the main methods of conservative treatment for Temporomandibular Dysfunction, being occlusal plaque, counseling and pharmacotherapy. Materials and method: the search was done in the databases PubMed, SciELO, Lilacs and Google Scholar using the descriptors: "counseling" and "temporomandibular joint", "counseling" and "facial pain", "counseling" and "temporomandibular joint dysfunction syndrome", "counseling" and "temporomandibular joint" and "drug therapy" and "counseling" and "drug therapy" and "facial pain". Results: in total were found 314 studies in this work, but only 8 were included. These tests prove the efficacy of these treatment methods, causing to the patient a decrease in painful symptoms, an increase in masticatory functions, and also providing a relief in muscle tension due to the relaxation of related structures. The occlusal plaque tends to decrease the forces applied in the occlusion, preventing the muscles from exerting excessive force. Some drugs (anti-inflammatories, antidepressants and muscle relaxants) are able to minimize the painful symptomatology, providing an improvement in the quality of sleep and reduction of episodes of intense pain. In turn, counseling guides patients to avoid attitudes that worsen their illness, educating them and making them aware of their parafunctional habits, as well as reducing the factors that cause painful symptoms. Conclusion: we could observe that these treatments present relevant success indexes when it refers to the decrease of the symptoms, especially the counseling, which is still a little explored conservative therapy. It is still necessary to carry out further studies in this field in order to obtain increasingly concrete and conclusive results. (AU)

Eficacia de la acupuntura en el tratamiento del síndrome de dolor miofascial de la musculatura masticatoria / Efficacy of acupuncture for the treatment of myofascial pain síndrome of the masticatory musculature

Objetivos: El síndrome de dolor miofascial (SDM) de la musculatura masticatoria (MM) constituye la patología más frecuente dentro de los trastornos temporomandibulares (TTM). En cuanto al tratamiento del SDM de la MM, no existen protocolos estandarizados. Hay evidencia de que la acupuntura es eficaz en el tratamiento del dolor miofascial. El objetivo del presente estudio es analizar la eficacia de la acupuntura en el tratamiento del SDM de la MM en términos de reducción de la intensidad del dolor y la duración de la reducción del dolor en el tiempo. Material y métodos: Se realizó un estudio observacional prospectivo en 30 pacientes diagnosticados de SDM de la MM que fueron tratados mediante 15 sesiones de acupuntura. Las variables del estudio fueron: 1) Porcentaje de pacientes que alcanzan una respuesta clínica relevante a lo largo del seguimiento (disminución del dolor de, al menos, un 50 % en la escala visual analógica con respecto al inicial o bien una reducción total del dolor a < 30 mm en la misma escala). 2) Reducción del dolor muscular orofacial después del tratamiento, expresado en milímetros (mm), dentro de la escala visual analógica (EVA). 3) Máxima apertura oral (MAO) expresada en mm. 4) Estabilidad del efecto terapéutico. Las variables fueron evaluadas antes del tratamiento, a los 3, 6, 9 y 12 meses. Resultados: La mediana de edad fue de 42 años (33-53). Con respecto al sexo, 28 de los 30 pacientes (93 %) fueron mujeres. El seguimiento fue completo para los 30 pacientes. Al final del seguimiento, 20 de los 30 pacientes (67 %, IC 95% 49-81) mantuvieron una reducción del dolor a la categoría leve (EVA < 30 %) o bien una reducción > 50 % del basal. A lo largo del estudio, el porcentaje de pacientes que alcanzó el criterio de respuesta clínica relevante preestablecido se mantuvo estable (67-80 %), no variando significativamente a lo largo del tiempo. Conclusiones: Los resultados del estudio demuestran que la acupuntura es eficaz en el control del dolor del SDM de la MM. Los efectos terapéuticos de la acupuntura son de inicio temprano (< 3 meses), estables y se mantienen hasta el final del seguimiento de un año

Objectives: Myofascial Pain Syndrome (MPS) of the Masticatory Muscles (MM) is one of the most prevalent diseases included in the Temporomandibular Joint Dysfunction Syndrome. Regarding its treatment, there are not standarized protocols. There is some evidence that acupuncture is effective in MPS of the MM treatment. The objective of the present study is to analyze the efficacy of acupuncture for the treatment of MPS of the MM, in terms of pain intensity reduction and duration of the pain reduction along time. Patients and methods: This is an observational prospective study. Thirty patients diagnosed of MPS of the MM were treated with 15 sessions of acupuncture. The variables of the study included were: 1) Percentage of patients that achieved a relevant clinical response (pain reduction of at least 50 % from the initial value, in a visual analogue scale, or a visual analogue scale pain value less than 30 milimeters). 2) Pain reduction after treatment, measured in milimeters in a visual analogue scale (VAS). 3) Maximal mouth opening measured in milimeters. 4) Stability of the pain reduction. The variables were evaluated before treatment and 3, 6, 9 and 12 months after. Results: The median of age was 42 years (33-53). Twenty eight patients were female (93 %). The follow up period lasted one year and all the patients completed it. At the end of the follow up period, 20 of the 30 patients (67 %, IC 95 % 49-81) maintained a pain reduction in a mild category (VAS < 30 %) or a total reduction of > 50 % from de initial pain value. Along the follow-up period, the percentage of patients that achieved a relevant clinical response maintained stable (67-80 %). Conclusions: The results of the study show that acupuncture is effective in the treatment of MPS of the MM. Treatment effects appear early (< 3 months) and maintain stable within the first year

Platelet-Rich Plasma in Treatment of Temporomandibular Joint Dysfunctions: Narrative Review.

BACKGROUND: The aims of this narrative review were to examine up-to-date literature in order to evaluate the effectiveness of arthrocentesis or injections with platelet-rich plasma in temporomandibular affections and to compare them to arthrocentesis alone or with hyaluronic acid (HA) or to hyaluronic acid injections. METHODS: The search of international literature was made on the PMC, PubMed and Cochrane databases, including all full-length text of studies on humans focused on osteoarthritis and disc displacements and their treatment with platelet-rich plasma arthrocentesis or injections. All design studies were included in the review and they were examined for three different outcomes: pain, joint sound and mandibular motion. English papers were only selected. RESULTS: Even though the low number of studies in this field, arthrocentesis with platelet-rich plasma and platelet-rich plasma injections in temporomandibular disorders' management were found to be effective in reducing pain and joint sound as well as in improving mandibular motion in a maximum follow-up of 24 months. CONCLUSION: Comparison to arthrocentesis alone or to HA use in arthrocentesis or by injections provided encouraging results in terms of the effectiveness of platelet-rich plasma use.

A efetividade de dois tratamentos para disfunção temporomandibular muscular: estudo piloto / The effectiveness of two treatments for muscle temporomandibular dysfunction: pilot study

Objetivo: comparar a eficácia de dois protocolos de tratamento para disfunção temporomandibular (DTM) de origem muscular. Sujeitos e método: Estudantes da Faculdade Especializada na Área de Saúde do Rio Grande do Sul foram selecionados por meio de questionário, para avaliar a presença de sinais e sintomas de DTM e diagnóstico de DTM muscular pelos Critérios de Diagnóstico para Transtornos da Pesquisa Temporomandibular. Dez estudantes compuseram a amostra, divididos em dois grupos, de acordo com o protocolo de tratamento: G1 ­ hipertermia induzida, exercícios mandibulares e massagem; e G2 ­ agulhamento seco, hipertermia induzida, exercícios mandibulares e massagem. Os alunos foram instruídos a realizar o protocolo do tratamento G1 todos os dias em casa e na instituição de ensino por três sessões, que ocorreram a cada cinquenta dias. O agulhamento seco foi realizado no G2 apenas nas segunda e terceira sessões de tratamento. Para avaliar a efetividade dos dois tratamentos antes e após cada sessão, avaliaram-se: abertura bucal (AB), por meio de régua milimetrada; dor, pela escala visual analógica; força de mordida (FM), usando um medidor de força digital; e qualidade de vida, avaliada imediatamente antes do início do tratamento e depois do término do tratamento. Resultados: a dor mostrou diferença estatística significativa no G2 após a segunda sessão (p=0,020) e a terceira sessão (p=0,047). Os demais resultados mostram que não houve diferença estatisticamente significativa entre os grupos (p>0,05). Conclusão: considera-se que neste estudo piloto ambos os tratamentos foram eficazes para DTM muscular, uma vez que todos os pacientes apresentaram melhora dos sintomas. Não houve diferença estatisticamente significativa entre os tratamentos, exceto a dor pós-procedimento, causada pela técnica do agulhamento seco. (AU)

Objective: the present study aims to compare the efficacy of two treatment protocols for temporomandibular dysfunction (TMD) of muscular origin. Subjects and method: students of the Faculdade Especializada na área de Saúde do Rio Grande do Sul, that were selected through the questionnaire to evaluate the presence of TMD signs and symptoms and diagnosis of muscular TMD from the Diagnostic Criteria for Temporomandibular Research Disorders. Ten students composed the sample, divided into two groups according to the treatment protocol: hyperthermia induced by G1, mandibular exercises and massage; G2 ‒ dry needling, induced hyperthermia, mandibular and massage exercises. Students were instructed to complete the G1 treatment protocol every day at home and at the educational institution for three sessions that occurred every fifty days. Dry needling was performed in G2 only in the second and third treatment sessions. To evaluate the effectiveness of the two treatments before and after each session, we evaluated: mouth opening (AB), through a millimeter ruler; visual analogue scale; bite force (FM) using a digital force gauge and quality of life was assessed immediately prior to initiation of treatment and after termination of treatment. Results: pain obtained a statistically significant difference in G2 after the second session (p=0.020) and the third session (p=0.047). The other results show that there was no statistically significant difference between the groups (p>0.05). Conclusion: it is considered that in this pilot study both treatments were effective for muscular TMD, since all the patients presented improvement of the symptoms. There was no statistically significant difference between treatments, except for post- -procedure pain, caused by the dry needling technique. (AU)