Abstract
BackgroundMyogenous temporomandibular disorders (TMD) are considered to be a common musculoskeletal condition. No studies exist comparing intra-oral myofascial therapies to education, self-care and exercise (ESC) for TMD. This study evaluated short-term differences in pain and mouth opening range between intra-oral myofascial therapy (IMT) and an ESC program.MethodsForty-six participants with chronic myogenous TMD (as assessed according to the Research Diagnostic Criteria Axis 1 procedure) were consecutively block randomised into either an IMT group or an ESC group. Each group received two sessions per week (for five weeks) of either IMT or short talks on the anatomy, physiology and biomechanics of the jaw plus instruction and supervision of self-care exercises. The sessions were conducted at the first author’s jaw pain and chiropractic clinic in Sydney, Australia. Primary outcome measures included pain at rest, upon opening and clenching, using an eleven point ordinal self reported pain scale. A secondary outcome measure consisted of maximum voluntary opening range in millimetres. Data were analysed using linear models for means and logistic regression for responder analysis.ResultsAfter adjusting for baseline, the IMT group had significantly lower average pain for all primary outcomes at 6 weeks compared to the ESC group (p < 0.001). These differences were not clinically significant but the IMT group had significantly higher odds of a clinically significant change (p < 0.045). There was no significant difference in opening range between the IMT and ESC groups. Both groups achieved statistically significant decreases in all three pain measures at six weeks (p ≤ 0.05), but only the IMT group achieved clinically significant changes of 2 or more points.ConclusionThis study showed evidence of superiority of IMT compared to ESC over the short-term but not at clinically significant levels. Positive changes over time for both IMT and ESC protocols were noted. A longer term, multi-centre study is warranted.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12610000508077.
Highlights
Myogenous temporomandibular disorders (TMD) are considered to be a common musculoskeletal condition
The authors have previously published the results of a clinical trial comparing intra-oral myofascial therapy (IMT) to a combined IMT, education and self-care protocol [32,33]
That trial’s results suggested that combining education and self-care (ESC) with IMT did not appear to afford any significant superiority in pain outcomes in the short term when compared to IMT alone
Summary
Myogenous temporomandibular disorders (TMD) are considered to be a common musculoskeletal condition. Temporomandibular disorder (TMD) treatment trends in recent decades have leaned toward multi-modal as well as multi-disciplinary management, in line with that of other chronic musculoskeletal conditions [1] Such strategies often suggest the use of less invasive and reversible interventions, and has been mainly represented by the involvement of psychotherapy (utilising technology such as biofeedback [2], cognitive and behavioural therapies [3,4]); physiotherapy [5,6,7,8,9] (utilising exercises, mobilisation and various electro-medical therapies); and complementary and alternative medicine therapies (chiropractic [10,11], osteopathy [12,13], massage [14,15,16,17], relaxation therapy [18], acupuncture [19,20] and others [21,22,23,24,25]). A secondary outcome measure of inter-incisal opening range measured in millimetres was adopted for the study
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