Effects of 8 weeks of masticatory muscles focused endurance exercises on women with oro‐facial pain and temporomandibular disorders: A placebo randomised controlled trial

Evaluating the influence of sports-induced trauma on temporomandibular disorders: A systematic review and meta-analysis

OBJECTIVE

The main aim of this study was to identify the existing literature on the association between sporting activities and temporomandibular disorders and to critically appraise evidence of this association through a systematic review and meta-analysis.

DESIGN

A comprehensive search was conducted using PubMed, ScienceDirect, Dimensions, Google Scholar, Cochrane Library, and the Education Resources Information Centre (ERIC). Articles were selected using pre-specified eligibility criteria. In addition, the quality of eligible studies was assessed using the National Institutes of Health (NIH) for observational cohort and cross-sectional studies. Data were systematically extracted and analyzed.

RESULTS

Temporomandibular disorder symptoms, such as myofascial pain, clicking sounds, and musculoskeletal symptoms, were comparably prevalent among athletes and non-athletes, with some studies reporting contrasting results. However, meta-analyses of the comparisons demonstrated statistically insignificant differences between athletes and non-athletes. Additionally, there was a significant reduction in temporomandibular disorder symptoms when mouthguards were used.

CONCLUSIONS

This comprehensive analysis of existing evidence highlights the various symptoms and clinical manifestations of TMD among athletes, including myofascial pain, clicking sounds, and musculoskeletal symptoms. This study established different prevalence rates in different sports.

The Impact of an Orofacial Muscle Strengthening Program on Temporomandibular Muscles and on the Performance of Wind Instrumentalists

INTRODUCTION

Playing a wind instrument is one of the most complex tasks for the musculoskeletal system.

OBJECTIVE

Verify the effectiveness of a strengthening exercise programme on musical performance and the strength of the temporomandibular muscles.

METHODS

The sample was 60 participants (36 men; 24 women), with a mean age of 24.67 ± 13.06 years, divided into experimental group (EG) (16 brass; 15 woodwind) and control group (CG) (15 brass; 14 woodwind). The initial assessment (T0) consisted of a sociodemographic questionnaire, the EQ-5D-5L, an assessment of maximum bite force and endurance time and sound recording, before (T0) and after a musical practice of 8.5 min (T1). The EG, during 5 weeks, underwent 10 sessions of a temporomandibular muscle strengthening program, consisting of a series of 25 repetitions of isometric bite contraction, followed by a reassessment (T2) and sound recording (T2 and T3).

RESULTS

Statistically significant differences were found between groups in maximum bite force between T0 and T2, explained by the improvement in the EG (p = 0.014, bilaterally). We found no differences in endurance. In musical performance, statistically significant differences were found in the mean intensity values. There was an improvement in performance in the brass EG, with statistically significant differences in the high-piano note (p = 0.025) and in the woodwind EG all the notes were played at a significantly lower intensity (p ≤ 0.05), compared to the CG, where all the notes increased in intensity.

CONCLUSION

The isometric exercise improves the maximum bite force, accompanied by an improvement in the high note's performance in brass and greater sound stability in woodwinds.

The effectiveness of aerobic exercise compared to other types of treatment on pain and disability in patients with orofacial pain: A systematic review

PURPOSE

To compile and synthesise the evidence regarding the effectiveness of aerobic exercise (AE) compared with other treatments to reduce pain and disability of individuals with orofacial pain (OFP).

METHODS

Electronic searches were conducted on five databases (MEDLINE, Embase, CINAHL, Cochrane Library, and Scopus). Randomised controlled trials (RCT) or controlled trials including adults of both sexes with painful OFP diagnoses were targeted. The intervention of interest was AE (e.g., walking, cycling, running, among others), compared to any other conservative and non-conservative therapy. The primary outcome was pain intensity. The risk of bias (RoB) was determined using a compiled set of items and the Cochrane RoB-2 tools. The overall certainty of the evidence was evaluated with the GRADE approach.

RESULTS

Out of 4.669 records screened, four manuscripts were included. However, three of them used the same population but presented different outcomes. These studies included subjects with headache associated with temporomandibular disorders (TMD) and general TMD. Both studies used aerobic exercise (AE) as the intervention of interest. Manual therapy (MT) plus exercise (Ex) (strengthening exercise (Str ex) or general exercises) were used as a comparison group. The combined treatment, including a multimodal therapy (AE + MT + Str ex), was superior to MT + Ex (MD: -8.65 points [95% CI -13.73, -3.57]) on pain intensity (orofacial pain [OFP] and headache intensity) at the end of the treatment and also after 12-week follow-up (MD: -9.43 points [95% CI -14.97, -3.89]). Also, the combination of three treatment modalities (AE + MT + Ex) was better on quality of life than AE alone (MD: -14.60 points [95% CI -16.74, -12.46]) and MT + Ex (MD: -12.30 point [95% CI -14.50, -10.10]) at the end of the treatment.

CONCLUSIONS

Aerobic exercise plus MT and general exercises achieved the greatest positive effects on pain and other outcomes in the short/medium term in patients with OFP. However, the scientific evidence supporting the isolated effects of AE for OFP is limited, indicating the need for more studies. Further studies are also needed to elaborate guidelines when using AE for individuals with OFP.

Potential adjunct therapies for the management of temporomandibular disorders: An evidence-based review

OBJECTIVE

The aim was to review the role of adjuvant therapies that may potentially contribute toward the management of temporomandibular disorders (TMD).

METHODS

The addressed focused question was, "Are there any adjuvant therapies that may contribute toward the management of TMD?". Indexed databases were searched up to June 2021. The eligibility criteria were the following: (a) original clinical studies and (b) randomized controlled clinical trials (RCTs).

RESULTS

Adjuvant therapies were comprised of acupuncture, manual therapy, jaw exercises, dietary modifications, botulinum toxin therapy, and photobiomodulation. Short-term follow-up results from each of these RCTs showed beneficial effects in terms of pain reduction and improvements in jaw movement among patients with TMD. There are no long-term follow-up results in this regard.

CONCLUSION

The most effective adjunct treatment for managing TMD remains unknown, primarily due to a lack of sufficient scientific evidence.

Effectiveness of resistance training of masticatory muscles for patients with temporomandibular disorders: protocol for a systematic review

INTRODUCTION

Temporomandibular disorders (TMDs) are musculoskeletal disorders characterised by jaw pain and typically temporomandibular joint limitations. Resistance training (RT) has been shown to be effective at reducing pain and improving function for different musculoskeletal conditions (eg, neck pain, low back pain); however, the effectiveness of RT for patients with TMDs remains unclear. This systematic review will evaluate the effectiveness of RT on pain and temporomandibular joint range of motion in people with TMDs.

METHODS AND ANALYSIS

The report of this protocol aligns with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. The search strategy will be conducted from 1 March 2024 to 31 March 2024 via the following electronic databases: MEDLINE (OVID interface), EMBASE (OVID interface), SCOPUS, Web of Science, PubMed and Cochrane Central Register of Controlled Trials. Any randomised controlled trials or non-randomised studies of interventions in adults with TMD that examine RT targeting the masticatory muscles, compared to other interventions not including RT, will be included. Primary outcomes will be jaw pain intensity and maximal mouth opening. Secondary outcomes will include measures of neuromuscular performance and pressure pain thresholds. Two independent reviewers will conduct the screening of articles for inclusion, data extraction, risk-of-bias assessment using the revised Cochrane risk-of-bias tool for included studies and will evaluate the overall quality of evidence following the Grading of Recommendations Assessment, Development and Evaluation framework. A meta-analysis will be performed where applicable. Alternately, a narrative synthesis will be performed by adhering to the synthesis without meta-analysis guidelines. Data will be summarised according to the outcome measures or, when this is not possible, according to other pertinent variables such as TMD type (ie, temporomandibular joint disorders, masticatory muscle disorders and mixed disorders).

ETHICS AND DISSEMINATION

Ethical approval is not necessary, since this study does not involve the collection of primary data. The results will be disseminated through presentations at scientific conferences and publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023476269.

Synthesis of temporomandibular disorders management intervention outcomes for development of core outcome sets: A systematic review

INTRODUCTION

The selection of appropriate outcomes in clinical trials and systematic reviews is a crucial factor in determining the results that are useful, reliable, and relevant for both patients and healthcare professionals. Clinicians and researchers have been encouraged to develop and apply core outcome sets (COS) to minimise the discrepancy between studies.

AIM

This systematic review is the first phase of the COS development project for clinical trials in temporomandibular disorders (COS-TMD). It aims to identify and synthesise the outcomes used in the randomised controlled trials (RCT) that evaluated the effectiveness of interventions used in TMD management.

MATERIALS AND METHODS

An electronic search was performed in several databases: MEDLINE (via PubMed), Scopus, Web of Science, Cochrane Library and EMBASE. The eligibility criteria comprised RCT that applied any intervention to treat temporomandibular joint disorders or masticatory muscle disorders. The identified outcomes were categorised according to domains of the Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT).

RESULTS

The electronic search resulted in 1606 studies. After removing duplicates and applying the eligibility criteria, 106 RCT were included. A total of 43 studies evaluated masticatory muscle disorders, 27 evaluated temporomandibular joint disorders, and 36 analysed mixed TMD.

CONCLUSIONS

The evaluation showed significant variability in the types of outcomes and their measurement instruments. In addition, some domains such as physical and emotional functioning, participant ratings of global improvement and adverse events have been neglected when determining the effectiveness of treatments for TMD.

Analysis of the Use of Sample Size and Effect Size Calculations in a Temporomandibular Disorders Randomised Controlled Trial-Short Narrative Review

BACKGROUND/OBJECTIVES

Temporomandibular disorder (TMD) is the term used to describe a pathology (dysfunction and pain) in the masticatory muscles and temporomandibular joint (TMJ). There is an apparent upward trend in the publication of dental research and a need to continually improve the quality of research. Therefore, this study was conducted to analyse the use of sample size and effect size calculations in a TMD randomised controlled trial.

METHODS

The period was restricted to the full 5 years, i.e., papers published in 2019, 2020, 2021, 2022, and 2023. The filter article type-"Randomized Controlled Trial" was used. The studies were graded on a two-level scale: 0-1. In the case of 1, sample size (SS) and effect size (ES) were calculated.

RESULTS

In the entire study sample, SS was used in 58% of studies, while ES was used in 15% of studies.

CONCLUSIONS

Quality should improve as research increases. One factor that influences quality is the level of statistics. SS and ES calculations provide a basis for understanding the results obtained by the authors. Access to formulas, online calculators and software facilitates these analyses. High-quality trials provide a solid foundation for medical progress, fostering the development of personalized therapies that provide more precise and effective treatment and increase patients' chances of recovery. Improving the quality of TMD research, and medical research in general, helps to increase public confidence in medical advances and raises the standard of patient care.

Assessment of self-rated pain perception and whole salivary cortisol levels among adolescents with and without temporomandibular disorders

OBJECTIVE

To assess the self-perceived pain perception (PP) and whole salivary cortisol levels (CL) among adolescents with and without temporomandibular disorders (TMD).

METHODS

Adolescents between 15 and 17 years were included. Participants were categorized into three groups: Group 1: patients with TMD; Group 2: nocturnalbruxers without TMD; and Group 3: controls. Demographic data CL and self-rated PP were assessed. A p-value < 0.05 was proposed as statistically significant.

RESULTS

Fifty-four patients (18 per group) were included. Scores of self-rated PP in the affected TMJ were higher in Group 1 than Group 2 (p < 0.001). Whole salivary CL were higher in groups 1 and 2 (p < 0.01) than in Group 3. Whole salivary CL were higher in Group 2 than Group 3 (p < 0.05).

CONCLUSION

Whole salivary CL are higher in adolescents with TMD, and there is a direct relationship between self-rated PP in the TMJ area and salivary CL.

Personalized pain management: The relationship between clinical relevance and reliability of measurements

Reliability is a topic in health science in which a critical appraisal of the magnitudes of the measurements is often left aside to favour a formulaic analysis. Furthermore, the relationship between clinical relevance and reliability of measurements is often overlooked. In this context, the aim of the present article is to provide an overview of the design and analysis of reliability studies, the interpretation of the reliability of measurements and its relationship to clinical significance in the context of pain research and management. The article is divided in two sections: the first section contains a step-by-step guide with simple and straightforward recommendations for the design and analysis of a reliability study, with a relevant example involving a commonly used assessment measure in pain research. The second section provides deeper insight about the interpretation of the results of a reliability study and the association between the reliability of measurements and their experimental and clinical relevance. SIGNIFICANCE: Reliability studies quantify the measurement error in experimental or clinical setups and should be interpreted as a continuous outcome. The assessment of measurement error is useful to design and interpret future experimental studies and clinical interventions. Reliability and clinical relevance are inextricably linked, as measurement error should be considered in the interpretation of minimal detectable change and minimal clinically important differences.

Korean Medicine Clinical Practice Guideline Update for Temporomandibular Disorders: An Evidence-Based Approach

Many updated clinical research results have been published since the Korean Medicine Clinical Practice Guidelines (KMCPGs) for temporomandibular disorders (TMDs) were published in 2018. Therefore, it is necessary to update the existing clinical practice guidelines (CPGs). This study presents updated recommendations for TMD treatment based on current research data published up to February 2020. The draft version of the level of evidence and grade of recommendation was determined through an assessment of the risk of bias and a meta-analysis of selected literature based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The final guidelines were derived using the Delphi method. Eighteen recommendations were derived for eight items of Korean medicine treatment for TMDs. Compared with previous Korean medicine CPGs for TMDs, the grades of seven recommendations, including acupuncture, pharmacopuncture, and Chuna manual therapy, were increased. The grades of the two recommendations have been changed. Six new recommendations were added to fully reflect clinical reality. Acupuncture, pharmacopuncture, and Chuna manual therapy are recommended for TMD patients in clinical practice. Concurrent conventional conservative therapy with Korean medicine or a combination of Korean medicines should be considered in clinical practice in patients with temporomandibular disorders.

Craniofacial disorders and headaches. A narrative review

OBJECTIVES

Craniofacial- and headache disorders are common co-morbid disorders. The aim of this review is to provide an overview of the research discussing craniofacial pain, especially temporomandibular disorders, and its relationship and impact on headaches, as well as suggestions for diagnostic assessment tools and physical therapeutic management strategies.

METHOD

A narrative structured review was performed. A search was conducted in MEDLINE using terms related to craniofacial pain and headaches. Additionally, papers regarding this topic were also extracted from the authors' personal libraries. Any study design (i.e., RCT, observational studies, systematic review, narrative review) that reported the concepts of interest was included, using Covidence. Results were narratively synthesized and described.

RESULTS

From an epidemiological perspective, craniofacial pain and headaches are strongly related and often co-existing. This may be due to the neuroanatomical connection with the trigeminal cervical complex, or due to shared predisposing factors such as age, gender, and psychosocial factors. Pain drawings, questionnaires, and physical tests can be used to determine the cause of pain, as well as other perpetuating factors in patients with headaches and craniofacial pain. The evidence supports different forms of exercise and a combination of hands-on and hands-off strategies aimed at both the craniofacial pain as well as the headache.

CONCLUSION

Headaches may be caused or aggravated by different disorders in the craniofacial region. Proper use of terminology and classification may help in understanding these complaints. Future research should look into the specific craniofacial areas and how headaches may arise from problems from those regions. (249 words).

Exercise therapy improves pain and mouth opening in temporomandibular disorders: A systematic review with meta-analysis

OBJECTIVE

To analyse the effectiveness of exercise therapy in improving pain and active or passive maximum mouth opening in patients with temporomandibular disorders.

DATA SOURCES

PubMed Medline, Web of Science, Scopus, CINAHL Complete and Physiotherapy Evidence Database, until April 2022, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

REVIEW METHODS

We included randomized controlled trials evaluating the effect of exercise therapy on pain and on active and passive maximum mouth opening in patients with temporomandibular disorders. Effect size was calculated using Cohen's standardized mean difference (SMD) and their 95% confidence interval (95% CI) in a random-effects model.

RESULTS

A total of 16 studies with 812 participants were included. Exercise therapy is effective in reducing pain (SMD: -0.58; 95% CI: -1.01 to -0.12) and increasing the pain pressure threshold (SMD: 0.45; 95% CI: 0.14-0.76), active and passive maximum mouth opening (SMD: 0.43; 95% CI: 0.14-0.71 and SMD: 0.4; 95% CI: 0.06-0.75, respectively). Subgroup analyses showed more effect of exercise therapy more splints versus splints on pain (SMD: -0.5; 95% CI: -0.73 to -0.26), active and passive maximum mouth opening (SMD: 1.14; 95% CI: 0.22-2.07 and SMD: 0.56; 95% CI: 0.06-1.06, respectively). On pain pressure threshold, exercise therapy was better than physiotherapy approach (manual therapy and electrotherapy) (SMD: 0.48; 95% CI: 0.09-0.87).

CONCLUSIONS

Therapeutic exercise is an effective therapy to reduce pain and increase pain pressure threshold and active and passive maximum mouth opening in patients with temporomandibular disorders.

Multimodal pain therapy for persistent idiopathic facial pain - a pilot study

OBJECTIVE

Persistent Idiopathic Facial Pain (PIFP) is a pain syndrome with missing evidence-based therapy recommendations. According to the biopsychosocial pain model, multidisciplinary pain treatment (MPT) offers a promising therapeutic option for chronic pain syndromes. MPT is an interprofessional treatment procedure, consisting of medical, physiotherapeutic and psychotherapeutic treatment units, which has not yet been studied in PIFP.

METHODS

This retrospective study included 25 patients with PIFP, who had been treated with MPT. Pain intensity on the numerical rating scale (NRS), perceived disability, habitual well-being, as well as anxiety/depression and stress scales were recorded. Moreover, the patients evaluated the efficacy of each type of the single therapeutic interventions.

RESULTS

There was a highly significant decrease in the characteristic pain intensity. Also habitual well-being improved significantly, as did anxiety and depression. The perceived disability and stress also improved, but without statistical significance. Physiotherapy was rated as the most effective therapeutic unit. Among the medical measures, consultations took first place (40% of the participants). Nearly three-fourths of the patients (72%) would recommend MPT.

CONCLUSION

The present study shows beneficial outcomes in patients with PIFP following MPT. Patients evaluate physiotherapeutic treatment as particularly efficacious. Therefore, MPT can be considered as a therapeutic option in patients with PIFP.

Efficacy of rehabilitation on reducing pain in muscle-related temporomandibular disorders: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Patients with temporomandibular disorders (TMD) mostly suffer from muscle-related pain. Several conservative interventions have been suggested as treatments for TMD in the last years.

OBJECTIVE

The aim of this systematic review with meta-analysis was to assess the efficacy of rehabilitative approaches in reducing pain in patients with muscle-related TMD.

METHODS

PubMed, Scopus, and Web of Science were systematically searched from inception until April 28th, 2021 to identify randomized controlled trials (RCTs) presenting: patients with painful muscle-related TMD; rehabilitative approaches as interventions; placebo or sham treatment as comparisons; pain intensity, using visual analogue scale as outcome. A meta-analysis was performed to evaluate the overall effect on painful muscle-related TMD patients. PROSPERO registration number of this systematic review is CRD42021251904.

RESULTS

Out of 1997 papers suitable for title/abstract screening, 189 articles were assessed for eligibility. Sixteen RCTs were included and most of them (n= 6, 37.5%) investigated the effects of the laser therapy. The meta-analysis revealed that rehabilitative interventions had a significant overall effect size (ES) of 1.44 (p< 0.0001) in decreasing pain in patients with muscle-related disorders.

CONCLUSION

Findings of this systematic review with meta-analysis suggested that rehabilitative approaches might be effective in reducing pain in muscle-related TMD patients. However, the low number of RCTs evaluating conservative approaches might impair the synthesis of evidence regarding the different techniques, calling for caution in the interpretation of these results.

Masticatory Myoelectric Side Modular Ratio Asymmetry during Maximal Biting in Women with and without Temporomandibular Disorders

There is no consensus on the role of electromyographic analysis in detecting and characterizing the asymmetries of jaw muscle excitation in patients with temporomandibular disorders (TMD). To analyze the TMD patients (n = 72) in comparison with the healthy controls (n = 30), the surface electromyography (sEMG) of the temporalis anterior muscle (TA) and masseter muscle (M) was recorded while a maximal biting task was performed. The differences in the asymmetry of the relationship between the masseter muscles were assessed in a module to determine the sensitivity (Sn) of binomial logistic models, based on the dominance of the TA or the M muscle, in accurately predicting the presence of TMD. All assumptions were met, and comparisons between the groups showed significant differences for the TA muscle ratio (p = 0.007), but not for the M muscle ratio (p = 0.13). The left side was predominant over the right side in the TMD group for both the TA (p = 0.02) and M muscles (p = 0.001), while the non-TMD group had a higher frequency of the right side. Binary logistic regression showed a significant model (χ² = 9.53; p = 0.002) for the TA muscle with Sn = 0.843. The model for the M muscle also showed significance (χ² = 8.03; p = 0.005) with Sn = 0.837. The TMD patients showed an increased TA muscle ratio and asymmetry of left dominance, compared to the healthy subjects. Both of the binomial logistic models, based on muscle dominance TA or M, were moderately sensitive for predicting the presence of TMD.

What conservative interventions improve bite function in those with temporomandibular disorders? A systematic review using self-reported and physical measures

BACKGROUND

Bite is an important function of the human stomatognathic system. Despite this, it is commonly impaired in temporomandibular disorder (TMD) populations. The aim of this review is to evaluate the effectiveness of conservative interventions on self-reported and physical measures of bite function in individuals with TMD.

METHODS

This review was performed in compliance with PRISMA guidelines. An electronic search was performed on databases including Pubmed, CINAHL, Embase, and Cochrane Central. Inclusion criteria were journal articles evaluating the effect of any non-pharmacological conservative interventions on bite function in participants diagnosed with TMD. Risk of bias for individual studies was assessed using the Cochrane risk-of-bias v2 tool, and the NIH NHLBI pre-post tool. Data was synthesised based on outcome measures of bite function, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Eleven studies were eligible for this review. Interventions included splinting, photobiomodulation, needling, exercise, manual therapy, and patient education; which were evaluated using mastication-related pain, self-reported chewing difficulty, and bite force/endurance outcome measures. Findings suggested manual therapy, needling, oral splinting, exercise and PBM interventions may improve bite function in TMD, although confidence in cumulative evidence ranged from moderate to very low. There was no evidence that patient education improved bite function.

CONCLUSION

Conservative interventions may be helpful to address bite-related impairments associated with TMD, although further research is needed to improve the quality of evidence and direct clinical guidelines.

Biofeedback eletromiográfico e feedback visual na terapia miofuncional: perfil de uso pelos fonoaudiólogos

RESUMO Objetivo: identificar o perfil de uso do espelho e do Biofeedback Eletromiográfico como suporte à terapia miofuncional por Fonoaudiólogos atuantes na área de Motricidade Orofacial no Brasil. Métodos: estudo quantitativo e transversal, por meio da aplicação de questionário online (plataforma SurveyMonkey). O questionário foi estruturado com perguntas sobre o uso do espelho e/ou do Biofeedback Eletromiográfico. Foi realizada análise descritiva e aplicação dos Testes U de Mann-Whitney e Qui-quadrado (p<0,05). Resultados: a maioria dos profissionais, 23 (82,14%), utiliza o espelho, enquanto apenas cinco (17,85%) utilizam o biofeedback eletromiográfico. O Biofeedback Eletromiográfico é eventualmente utilizado em todas as faixas etárias, assim como para as funções de mastigação, deglutição e mímica facial. As patologias referidas com uso regular e eventual foram a disfagia e a paralisia facial. Houve associação significante na percepção dos pacientes em relação ao uso de algum dos instrumentos, porém no grupo do Biofeedback Eletromiográfico houve consenso entre os pacientes e, no grupo espelho, aproximadamente metade 12 (52,17%) achou indiferente. Conclusão: o perfil encontrado foi de profissionais adultos jovens, com uso de instrumentação nacional. Os achados reforçam a necessidade de pesquisas voltadas aos procedimentos terapêuticos complementares na área de Motricidade Orofacial, sobretudo Biofeedback Eletromiográfico.

Electromyographic biofeedback and visual feedback in myofunctional therapy: usage profile by speech-language-hearing pathologists

ABSTRACT Purpose: to identify the usage profile of mirrors and electromyographic biofeedback to support myofunctional therapy by speech-language-hearing therapists who work with oral-motor function in Brazil. Methods: a quantitative cross-sectional study with an online (SurveyMonkey) questionnaire, which was structured with questions on the use of mirrors and/or electromyographic biofeedback. A descriptive analysis was made, and the Mann-Whitney U test and the chi-square test were applied (p < 0.05). Results: most professionals (23 [82.14%]) used mirrors, whereas only five (17.85%) used electromyographic biofeedback. The electromyographic biofeedback was used at some point with all age groups, to treat mastication and swallowing functions and facial mimics. Dysphagia and facial palsy were regularly or occasionally treated with it. The patients’ perception was significantly associated with the use of either instrument. The electromyographic biofeedback group showed a consensus among patients, while approximately half of the mirror group (12 [52.17%]) were indifferent to its use. Conclusion: the profile showed young adult professionals, who used national equipment. The findings reinforce the need for research on complementary therapeutic procedures in the field of oral-motor functions, particularly, electromyographic biofeedback.

Effects of 4-Week Diacutaneous Fibrolysis on Myalgia, Mouth Opening, and Level of Functional Severity in Women With Temporomandibular Disorders: A Randomized Controlled Trial

OBJECTIVE

The purpose of this study was to assess the effects of 4-week protocol of diacutaneous fibrolysis (DF) compared with simulated DF (sham-DF) on myalgia and mouth opening.

METHODS

In a sham randomized controlled trial, 34 women with temporomandibular disorders and myofascial pain were randomly divided as intervention group (IG) and sham-DF group (SG). The IG received 4 weeks of real DF, and the SG received sham. Pain was assessed through the visual analog scale and pressure pain thresholds (PPTs) on the temporomandibular joint (TMJ), and over the temporal and masseter muscles. The Mandibular Function Impairment Questionnaire was used to classify the participants regarding to the severity of the functional limitation related to TMD.

RESULTS

Pain scores decreased for both groups, but the IG showed lower values at week 4, with between-group differences. Bilateral temporal PPT showed higher values at week 4, with between-group differences. The SG had lower PPTs but the IG had higher PPTs, both compared to baseline results. The time-by-group interaction and the frequency of participants above 40 mm of mouth opening showed a significant difference for the IG over time with higher results at the 4-week assessment compared to its own baseline. Both groups showed lower MFIQ scores from baseline to 4-week assessment. There was a lower frequency of a moderate level of severity for the IG. No differences were observed for TMJ or for the masseter muscles PPT.

CONCLUSION

Improvements were observed for visual analog scale scores and PPTs on temporal muscles. There was a group-by-time interaction in the IG, suggesting a possible potential use of DF for mouth opening.

Effect of Manual Therapy and Splint Therapy in People with Temporomandibular Disorders: A Preliminary Study

Background: Isolated manual therapy techniques (MT) have shown beneficial effects in patients with temporomandibular disorders (TMD) but the effect of the combination of such techniques, together with the well-stablished splint therapy (ST) remains to be elucidated. Objective: This study was conducted to ascertain whether a combined program of MT techniques, including intraoral treatment, plus traditional ST improves pain and clinical dysfunction in subjects with TMD. Methods: A preliminary trial was conducted. 16 participants were assigned to either the MT plus ST-Experimental Group (EG, n = 8) or the ST alone—Control Group (CG, n = 8). Forty-five minute sessions of combined MT techniques were performed, once a week for four weeks. Three evaluations were conducted: baseline, post-treatment, and one-month follow-up. Outcome measures were pain perception, pain pressure threshold (PPT), TMD dysfunction, and perception of change after treatment. Results: EG showed significant reduction on pain, higher PPT, significant improvement of dysfunction and significantly positive perception of change after treatment (p < 0.05 all). Additionally, such positive effects were maintained at follow-up with a high treatment effect (R² explaining 26.6–33.2% of all variables). Conclusion: MT plus ST showed reduction on perceived pain (3 points decrease), higher PPT (of at least 1.0 kg/cm²), improvement of disability caused by pain (4.4 points decrease), and positive perception of change (EG: 50% felt “much improvement”), compared to ST alone.

Adhesive dentistry sensory stimulus technique as a neuromechanism for the treatment of orofacial pain associated to temporomandibular disorders: Case study

Purpose

The authors intend, by presenting a case study, emphasize the neuromodulation process of orofacial pain induced by the stimulation of the sensory and motor stimulation of the trigeminal nerve, which can play an important role on pain modulation.

Materials and methods

A 25 year-old woman presenting orofacial pain was referred to the stomatology service at the Centro Hospitalar do Porto. After collecting the patient's anamnesis, the thermographic camera FLIR i7 was used to record the thermal status of the orofacial structures, before the adhesive dentistry sensory stimulus protocol, after 45 minutes, and after one week.

Results

This study suggests the relation of adhesive dentistry sensory stimulus technique in the neuromodulation of orofacial pain and its association with the temporomandibular disorders . As the tongue senses the stimulus of the resin composite placed on the palatal surface of the 1^st premolar, 2^nd premolar and 1^st molar of the maxilla, this can promote and induce an effect regarding a peripheral nerve neuromodulation resulting in a blockage of the nociceptive trigeminal pathway from temporomandibular disorders.

Conclusion

Orofacial pain is a common complaint among the patients that come to a dentistry appointment, which may have different diagnosis and treatments. A positive effect on the patient's symptomatology was confirmed clinically on subsequent dental appointments and monitored by infrared thermography.