Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis

Management of Functional Somatic Syndromes and Bodily Distress

Functional somatic syndromes (FSS), like irritable bowel syndrome or fibromyalgia and other symptoms reflecting bodily distress, are common in practically all areas of medicine worldwide. Diagnostic and therapeutic approaches to these symptoms and syndromes vary substantially across and within medical specialties from biomedicine to psychiatry. Patients may become frustrated with the lack of effective treatment, doctors may experience these disorders as difficult to treat, and this type of health problem forms an important component of the global burden of disease. This review intends to develop a unifying perspective on the understanding and management of FSS and bodily distress. Firstly, we present the clinical problem and review current concepts for classification. Secondly, we propose an integrated etiological model which encompasses a wide range of biopsychosocial vulnerability and triggering factors and considers consecutive aggravating and maintaining factors. Thirdly, we systematically scrutinize the current evidence base in terms of an umbrella review of systematic reviews from 2007 to 2017 and give recommendations for treatment for all levels of care, concentrating on developments over the last 10 years. We conclude that activating, patient-involving, and centrally acting therapies appear to be more effective than passive ones that primarily act on peripheral physiology, and we recommend stepped care approaches that translate a truly biopsychosocial approach into actual management of the patient.

[The nose, an orthodontic-surgical marker]

INTRODUCTION

Inthe quest for a universal marker to describe the physiological function of facialmechanics, the author has found nasal ventilation at rest to be a major factor to beborne in mind.

MATERIALS AND METHODS

Factors related to embryology, anatomyand respiratory physiology, along with analysis of the literature in the relevantareas, now enable us to view the nose in a different light.

CONCLUSION

The authorconcludes that nasal ventilation at rest constitutes a mandatory objective in theperformance of all types of therapy.

Scoping review of systematic review abstracts about temporomandibular disorders: Comparison of search years 2004 and 2017

INTRODUCTION

The purposes of this study were to determine how many systematic reviews and meta-analyses relating to temporomandibular disorders (TMDs) had been published as of 2017 compared with those published as of 2004 and then to summarize the findings, based on an analysis of the abstracts from those studies.

METHODS

A PubMed search was initiated on May 1, 2017. There were 2 separate searches. The first search was for the topic, "temporomandibular disorders." The second search was for "temporomandibular disorders and published in the Cochrane database." The number and the topic category of reviews for 2017 were compared with those published as of 2004.

RESULTS

There were 120 relevant TMD systematic reviews found in search year 2017: 110 from the PubMed and 10 from the Cochrane searches. By comparison, there were only 8 TMD systematic reviews published in 2004. The abstracts for all 120 reviews indicated increased roles of genetics and psychosocial factors in the etiology of TMD. The future of TMD diagnoses appears to be toward various psychosocial and cellular tests, along with brain neuroimaging. The reviews on the topic of "treatment" supported conservative, noninvasive, reversible therapies, with a trend toward more targeted individual strategies.

CONCLUSIONS

There were only 8 TMD systematic reviews published in 2004 compared with 110 in 2017. Overall, the trend has been in the direction of better diagnostic procedures, more scientific concepts of etiology, and more conservative treatments for TMD.

Common symptoms of temporomandibular disorders do not mean same treatment plans: A case series

INTRODUCTION

Temporomandibular disorders (TMDs) present several risks and different contributing factors with consequently diverse treatment approaches. It is important to recognize what patients' characteristics may benefit from orthodontics, from physiotherapy, from other treatment modalities or even from a combined approach.

CASES PRESENTATION

We present three cases of patients with common TMDs signs and/or symptoms and different treatment approaches and outcomes, and our aim is to understand what might explain the different outcomes observed and also provide a rationale about the skeletal, muscular, facial and occlusal characteristics that may be indicative of a particular intervention benefit.

CONCLUSION

It has been shown that orthodontics plays an important role solving occlusal problems as well as changes in the vertical dimension. On the other hand, physiotherapy was effective in pain management and range improvement, when musculoskeletal changes were clearly found. Finally, it has also been shown that a multidisciplinary approach may be crucial, and the clinician should be aware of a comprehensive assessment, valuing all the contributing factors, namely the psychological ones.

Changes in cervical movement impairment and pain following orofacial treatment in patients with chronic arthralgic temporomandibular disorder with pain: A prospective case series

The purpose of this study was to investigate the influence of isolated temporomandibular joint (TMJ) manual therapy on pain and range of motion (ROM) of the TMJ and cervical spine including flexion-rotation test (FRT) in people suffering chronic pain arising from chronic arthralgic temporomandibular disorder (TMD). An experienced clinician managed a case series of 12 patients with TMD (mean duration 28.6 months +/- 26.9). The intervention comprised four-weekly sessions of transverse medial accessory TMJ mobilization and advice. Patients were examined prior to and one-week following the intervention period. Outcome measures included jaw disability (JFLS-20), jaw pain measured by Visual Analogue Scale (VAS), maximal mouth opening ROM, cervical ROM including FRT, and pain during cervical movement. A paired t-test revealed significant improvement following the intervention in disability (p < 0.001), VAS pain score at rest (p < 0.001) and at maximum mouth opening (p < 0.001), jaw opening ROM (p < 0.001), FRT ROM to the left (p = 0.024) and right (p = 0.001). In contrast, no significant change was identified for total cervical ROM (p = 0.905). After the intervention, five patients (41.66%) had no pain at rest or at maximal mouth opening, and all had a negative FRT. The effect sizes indicate a moderate to strong, clinically significant effect for all variables apart from total cervical ROM. While a case series cannot identify a cause and effect relationship, these results provide preliminary evidence for the influence of TMJ manual therapy on measures of TMD including pain, as well as upper but not whole cervical movement and associated pain in patients with a diagnosis of TMJ arthralgia.