Masticatory Muscle Pain Research Articles

Effect of Masticatory Muscle Pain on Life Quality and Anxiety Level

ÖZET 
 Amaç: Bu çalışmanın amacı, yalnızca çiğneme kası ağrısına sahip TMD hastalarının ağız sağlığını değerlendiren OHIP-14 anketi ile GAD-7 anket puanlanma sonuçlarını cinsiyet, eğitim durumu ve mesleki duruma göre karşılaştırmak ve yaş ile arasındaki korelasyonu incelemektir.
 Gereç ve Yöntem: Yaşları 18 ile 68 arasında değişen, yalnızca çiğneme kası ağrısına sahip ve şikayeti olan 80 hasta, kinisyen tarafından DC/TMD Eksen I formunun Türkçe versiyonuna göre muayene edilmiş ve teşhis konmuştur. Ardından, hastalardan sırasıyla GAD-7 ve OHIP-14 anketlerinin Türkçe versiyonunu doldurmaları istenmiştir. 
 Bulgular: Erkeklerin OHIP-14(7+8) ve OHIP-14(13+14) puanları kadınların puanlarından istatistiksel olarak daha yüksek bulunmuştur. Yaş, eğitim ve meslek gruplarına göre GAD-7 toplam, OHIP-14 toplam ve alt skorları arasında istatistiksel olarak anlamlı fark bulunamamıştır. GAD-7 Toplam skoru ile OHIP-14 toplam skoru ve OHIP-14‘ün psikolojik değerlendirmesi için alt skorları arasında yapılan korelasyon analizinde pozitif yönlü orta düzeyde anlamlı korelasyon bulunmuştur
 Sonuç: Erkek hastaların fiziksel açıdan ağız sağlığı ile ilgili yaşam kalitesinin, çiğneme kas ağrısından daha çok etkilendiği belirlenmiştir. Ayrıca, yaş, meslek ve eğitim durumu farklılıkları; çiğneme kası ağrısı olan hastalarda ağız sağlığı ile ilgili yaşam kalitesi ve anksiyete açısından herhangi bir değişim göstermemiştir. 
 
 Anahtar Kelimeler: Çiğneme kası ağrısı; GAD-7; OHIP-14

Differences between Maximum Tongue Force in Women Suffering from Chronic and Asymptomatic Temporomandibular Disorders-An Observational Study.

Background: Temporomandibular disorders are craniofacial disorders characterized by the presence of chronic pain in masticatory muscles, with higher incidence in the women population. There is little research that has studied tongue force related to temporomandibular disorders, but there are a lot of studies that have demonstrated the impact of tongue force in vital functions, such as chewing, swallowing, phonation, or breathing. According to this, the aim of this study was to compare the maximum force of the tongue between females with chronic temporomandibular disorders and asymptomatic females. We also wanted to establish whether any relationship existed between the pain and fatigue versus the maximum force developed in females with chronic temporomandibular disorders. Material and methods: A cross-sectional study of 67 women between the ages of 18 and 65 years old was performed. The included women were assigned to one of two groups, according to whether they had chronic temporomandibular disorders or not. The procedure was the same for both groups. Outcome measures included the maximum tongue force, intensity of perceived orofacial pain, and intensity of perceived orofacial fatigue. Results: The results showed significant statistical differences for the maximum tongue force measurement between the chronic temporomandibular disorders group and the control group (p < 0.05) for all the movements, except the lip pressure measurement. Furthermore, the analysis revealed significant statistical differences between the intensity of perceived orofacial fatigue between the groups (p < 0.05). Moreover, the data showed no significant correlations between variables. Conclusion: The study found significant differences in maximum tongue force when comparing women with chronic temporomandibular disorders and asymptomatic women (being superior in these). Likewise, we found that the intensity of perceived orofacial fatigue after tongue exercises showed significant differences between groups. However, this study reveals no correlations between the intensity of perceived orofacial pain and fatigue and the maximum tongue force.

Incidence of dental barotrauma and temporomandibular joint problems of divers in Turkey

Introduction: In this study, we aimed to examine dental barotrauma and temporomandibular joint (TMJ) complaints in a large group of divers. Method: This survey study included scuba divers older than 18. The questionnaire contained 25 questions about the demographic characteristics of divers, dental health behaviors, and diving-related dental, sinus and/or temporomandibular joint pain Results: The study group consisted of 287 instructors, recreational and commercial divers (mean age 38.96 years) (79.1% males). A total of 46% of divers reported a frequency of tooth brushing less than twice a day; 28% never receive a routine dental examination; 22.6% experienced dental pain after and/or during diving, mostly in the upper posterior teeth (40%); 17% required dental treatment; 77% of these cases are restoration fracture. TMJ symptoms after diving were statistically significantly higher in women (p=0.04). Jaw and masticatory muscle pain in the morning (p&lt;0.001) limitation of mouth opening (p=0.04) and joint sounds in daily life (p&lt;0.001) were recorded as exacerbated after diving; the results were found to be statistically significant. Conclusion: In our study, the localization of barodontalgia was consistent with the distribution of caries and restored tooth areas in the literature. Dive-related TMJ pain was also more common in those with pre-dive problems such as bruxism and joint noise. Our results are important to remind us of the necessity of preventive dentistry practices and early diagnosis of problems in divers. Divers should take personal precautions, such as brushing their teeth twice a day and avoiding the need for urgent treatment. The use of a personalized mouthpiece is also recommended for divers to prevent dive-related temporomandibular joint diseases.

Common therapeutic approaches in sleep and awake bruxism - an overview.

Bruxism, a common medical condition characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible, can occur during sleep, when it is known as sleep bruxism (SB), or during wakefulness, when it is known as awake bruxism (AB). Although bruxism often causes headaches, temporomandibular joint pain, masticatory muscle pain, mechanical tooth wear, prosthodontic complications and cracked teeth, there is still not enough data to define and support a standardised approach to its treatment. The aim of this review was to present the pathophysiology, consequences, types and treatment methods of bruxism in order to increase readers' knowledge of this topic. Differences between awake and nocturnal bruxism are included, as well as risk factors and indicators visible during the clinical examination of affected patients. Among the causes we consider are genetics, stress, oral parafunctions and changes in the Central Nervous System (CNS). Potential and common methods of treatment are presented, along with suggested guidelines that should be followed when determining an appropriate treatment method. We draw attention to the notably dynamic development of bruxism in today's society and the importance of informational and preventive projects, especially those targeted at high-risk patients as well as those targeted at specialists, in order to better tackle the bruxism 'epidemic'.

Establishment of quantitative indicators for an efficient treatment on masticatory muscle pain.

Although several studies have investigated effective treatments for masticatory muscle pain (MMP), no unified conclusion has been drawn regarding the effectiveness of these treatments. This study aimed to define quantitative indicators for predicting the outcome of MMP treatment. In total, patients aged 20-70 years were recruited and divided into the MMP (n = 24) and control (n = 36) groups, based on the presence of MMP according to the Diagnostic Criteria for Temporomandibular Disorders. At pretreatment, the MMP group was assessed using quantitative indicators such as subjective pain levels, pain duration, graded chronic pain scale (GCPS), and perceived stress scale (PSS). Salivary alpha-amylase (sAA) and interleukin-6 (IL-6) levels were analyzed. The masticatory muscle palpation score and the range of mouth opening were measured. At posttreatment, subjective pain levels, mouth opening, and treatment/medication duration were examined. The PSS and sAA levels were assessed in the control group. sAA levels in the MMP group were significantly higher than those in the control group (p < .05). The masseter muscle palpation score (MPS) showed a positive correlation with IL-6 levels (ρ = 0.503, p < .05) and a negative correlation with nonsteroidal anti-inflammatory drug (NSAID) treatment period (ρ = -0.462, p < .05). The temporalis muscle palpation score (TPS) was positively correlated with pain duration and GCPS grade (ρ = 0.483, p < .05, and ρ = 0.445, p < .05, respectively). Treatment with NSAIDs was effective in the MMP group with high MPS and IL-6 levels, but not in the MMP group with high TPS, pain duration, and GCPS grade.

Pelatihan Peregangan dan Relaksasi Otot Wajah pada Populasi Pekerja Kantor Pengguna Masker Sehari-hari di Jakarta, Indonesia

The COVID-19 pandemic requires office workers to wear masks in their daily lives. The reported side effects of wearing mask in long time period include orofacial pain. Self physiotherapy can be an easy solution in preventing and treating the pain. The purpose of this training is to train people to be able to strengthen and relax their facial muscles to prevent masticatory muscle pain. The online training was conducted on July 5, 2022 to 29 participants with Indonesian Attorney General's Office health workers as the majority. The evaluation results showed improvements in all training topics regarding personal protection, side effects of wearing masks, and ways to overcome side effects of wearing masks. Self physiotherapy skills could not be done in detail because of the limitations of online communication. Online training can improve participants' ability to practice stretching and muscle relaxation better.

Are acupuncture and dry needling effective in the management of masticatory muscle pain: A network meta-analysis of randomised clinical trials.

Several studies have shown that both acupuncture and dry needling are effective in the treatment of musculoskeletal pains. Therefore, the aim of this network meta-analysis (NMA) was to investigate the treatment outcome of acupuncture and dry-needling for masticatory muscle pain (TMD-M) and to compare with active and inactive placebo. An electronic search was performed to identify randomised controlled trials (RCTs) published until September 2019, comparing dry-needling, acupuncture, and inactive as well as active placebo in patients with TMD-M. Outcome variables were post-treatment pain intensity, pressure pain threshold (PPT), and maximum mouth opening (MMO). The quality of evidence was rated according to Cochrane's tool for assessing the risk of bias. Mean difference was used to analyse via frequentist NMA using STATA-software. Both NMA and direct pairwise meta-analysis have shown that there was no difference between active treatment with either acupuncture or dry-needling when compared to active and inactive placebo in patients with TMD-M with respect to pain intensity, and PPT (p > .05). However, there was a significant increase in MMO following dry-needling when compared to the placebo (very low-quality evidence). Despite the short-term positive effect of MMO by dry-needling, this NMA could not show any pain-reducing effect in patients with TMD-M by acupuncture or dry-needling when compared to an active or inactive placebo. Taken together, this NMA indicates that it is the placebo effect that accounts for the majority of the treatment effect of TMD-M, rather than a real therapeutic effect of acupuncture/dry-needling.

Effects of Contact Sports on Temporomandibular Disorders: An Observational Study.

The study investigated the prevalence of temporomandibular disorders in 100 competitive athletes in contact sports, equally grouped by the practiced game: Soccer (SoG), Rugby (RG), American Football (AFG), Boxing (BoG), Basketball (BaG), compared to a randomly control group of 20 non-athletes (CG). Symptoms and signs were examined according to the standardized Diagnostic Criteria for Temporomandibular Disorders through a questionnaire and clinical evaluation. Arthralgia showed significant differences between RG and CG and between AFG and CG (p < 0.05). Study groups reported masticatory muscle pain during function, neck and shoulder pain more frequently than CG, except for BoG. Closing click was significantly more present in study groups than CG, while crepitation was significantly higher only in RG and AFG. The deviation was wider in SoG, RG and AFG compared to CG (p < 0.05). Tukey’s multiple comparisons test showed a statistically significant reduction in right laterotrusion in RG vs. CG (p < 0.05); the comparison showed a decrease in right laterotrusion in RG vs. SoG and BoG (p < 0.05), a decrease in endfeel in RG vs. CG, BaG and AFG (p < 0.05). The data seem to support a relationship between the prevalence of TMD symptoms and signs in competitive athletes in contact sports, especially in RG and AFG compared to CG.

The contribution of autonomic mechanisms to pain in temporomandibular disorders: A narrative review.

Temporomandibular disorders (TMD) are diagnosed based on symptom presentation and, like other functional pain disorders, often lack definitive pathology. There is a strong association between elevated stress levels and the severity of TMD-related pain, which suggests that alterations in autonomic tone may contribute to this pain condition. This narrative review examines the association between altered autonomic function and pain in TMD. Relevant articles were identified by searching PubMed and through the reference list of those studies. TMD sufferers report an increased incidence of orthostatic hypotension. As in other chronic musculoskeletal pain conditions, TMD is associated with increased sympathetic tone, diminished baroreceptor reflex sensitivity and decreased parasympathetic tone. It remains to be determined whether ongoing pain drives these autonomic changes and/or is exacerbated by them. To examine whether increased sympathetic tone contributes to TMD-related pain through β2 adrenergic receptor activation, clinical trials with the beta blocker propranolol have been undertaken. Although evidence from small studies suggested propranolol reduced TMD-related pain, a larger clinical trial did not find a significant effect of propranolol treatment. This is consistent with human experimental pain studies that were unable to demonstrate an effect of β2 adrenergic receptor activation or inhibition on masticatory muscle pain. In preclinical models of temporomandibular joint arthritis, β2 adrenergic receptor activation appears to contribute to inflammation and nociception, whereas in masticatory muscle, α1 adrenergic receptor activation has been found to induce mechanical sensitisation. Some agents used to treat TMD, such as botulinum neurotoxin A, antidepressants and α2 adrenergic receptor agonists, may interact with the autonomic nervous system as part of their analgesic mechanism. Even if dysautonomia turns out to be a consequence rather than a causative factor of painful TMD, the study of its role has opened up a greater understanding of the pathogenesis of this condition.

Effect of Botulinum Toxin Injection on EMG Activity and Bite Force in Masticatory Muscle Disorder: A Randomized Clinical Trial.

Botulinum toxin type A (BoNT-A) is increasingly used in treating masticatory muscle pain disorder; however, safe doses and reinjection intervals still need to be established. The purpose of this randomized clinical trial was to evaluate the degree and duration of the impairment of masticatory muscle performance. Fifty-seven subjects were randomly divided into two groups: one of which received BoNT-A first (n = 28) while the other received saline first (n = 29), with the cross-over being in week 16, and a total follow-up period of 32 weeks. A total dose of 50 U of BoNT-A was injected in the masseter and temporal muscles bilaterally. Electromyographic (EMG) activity and bite forces were assessed. A significant reduction in EMG activity was observed up to week 18 (p ≤ 001), with total recovery at week 33. A significant reduction in maximum bite force was observed up to week 11 (p ≤ 005), with total recovery at week 25. In conclusion, when treating masticatory muscle pain disorder with 50 U of BoNT-A, a reinjection interval of 33 weeks can be considered safe since the recovery of muscle function occurs by that time.

Clinical Manifestations, Imaging Features, and Pathogenic/Prognostic Risk Factors for Temporomandibular Disorders (TMD): A Case-Control Study Based on Psychogenic Factors of Patients.

Objective To survey the clinical manifestations and imaging features of temporomandibular disorders (TMD) and analyze the risk factors for pathogenesis/prognosis through a case-control study based on psychogenic factors of patients. Methods According to the inclusion criteria, 200 adult patients were randomly enrolled from the maxillofacial department of our hospital from January 2020 to May 2021, including 100 patients with TMD as the study group and 100 healthy patients as the control group. The study group can be assigned into four subgroups according to their clinical manifestations: (1) articular area or/and masticatory muscle pain group, (2) mandibular movement abnormality group, (3) joint murmur group, and (4) two or more symptom groups. Based on the study of psychogenic factors of patients, the clinical manifestations and imaging features of TMD were determined, and the risk factors for pathogenesis/prognosis were analyzed. Results The distribution of psychological status in the TMD group was higher than that in the control group (P < 0.05). The distribution of anxiety, depression, and somatic symptoms in the TMD group was significantly different from that in the control group (P < 0.05). Anxiety, depression, and somatic symptoms were the risk factors for TMD. Compared with the control group, the incidence of abnormal MRI images in patients with temporomandibular disorders was significantly different (P < 0.05). There were significant differences in psychological status (anxiety, depression, and somatic symptoms) among the three groups (P < 0.05). Anxiety, depression, and somatic symptoms were the risk factors for abnormal mandibular movement and joint tremor and murmur (P < 0.05). Somatic symptoms were the risk factors for various clinical symptoms of TMD (P < 0.05). Depression was the risk factor for pain (P < 0.05). Conclusion In patients with TMD, MRI can early identify disc abnormalities and other related imaging features, which is helpful for more comprehensive clinical evaluation and treatment of TMD patients. There exhibits no significant difference in psychological status (anxiety, depression, and somatic symptoms) of patients with different clinical symptoms, and abnormal psychological status may be one of the risk factors leading to different clinical symptoms and development of different types of TMD patients.

Masticatory muscle disorders and treatment from the perspective of prosthodontics

Masticatory muscle disorders (MMD) is the biggest subtype of temporomandibular disorders (TMD). Among them, local fibromyalgia and myofascial pain are localized lesions, manifested as masticatory muscle pain, which can be aggravated with jaw function. MMD is caused by a combination of multiple factors. Occlusal disharmony such as occlusal trauma, occlusal interference, and decreased vertical dimension of occlusion have the potential risk of inducing or aggravating the MMD. During prosthodontic treatment, iatrogenic occlusal interference should be avoided. Most patients with MMD can be relieved by comprehensive treatment, and occlusal therapy or prosthodontic treatment is used as an auxiliary means of diagnosis and treatment. By means of occlusal splint, occlusal adjustment and denture restoration, the goal of relieving masticatory muscle tension, stabilizing occlusal support, eliminating occlusal interference and adjusting jaw position can be achieved, so as to eliminate some risk factors of MMD and relief the pain faster.

Temporomandibular Disorders, Bruxism, Perceived Stress, and Coping Strategies among Medical University Students in Times of Social Isolation during Outbreak of COVID-19 Pandemic.

The COVID-19 pandemic caught universities along with their students off-guard, enforcing online education. Fear of the unknown, disinformation, and isolation resulted in an increased stress level in the entire population. Medical university students are particularly endangered with high stress levels and developing TMD. Temporomandibular disorders (TMD) are of multifactorial etiology, and manifest with jaw dysfunction, masticatory muscle tension or pain, as well as headache. Though bruxism can act as an exacerbating factor for TMD, stress can also play crucial role in the onset. The study aimed to measure occurrence of TMD and bruxism symptoms in the medical student population, asses the stress level, and evaluate adopted stress-coping strategies during the COVID-19 pandemic outbreak. A survey study was performed among 1018 students at Medical University of Lodz during April 2020. A self-designed questionnaire for screening TMD and bruxism symptoms, Perceived Stress Scale (PSS-10), and Brief-COPE questionnaires were applied. TMD and bruxism symptoms were observed in the majority of subjects during social isolation. The perceived stress levels were significantly higher in those experiencing TMD and bruxism symptoms. Mostly maladaptive, emotion-focused coping strategies were chosen by study subjects experiencing high levels of stress. Choosing Self-Blaming as a coping strategy is the strongest predictor of perceived stress.

Apical periodontitis after intense bruxism

BackgroundBruxism is known to cause masticatory muscle pain, temporomandibular joint pain, headaches, mechanical tooth wear, prosthodontic complications and cracked teeth. Less known to the practitioner, and described only experimentally in literature, is that bruxism can also damage the pulp. To our knowledge, this is the first known clinical case of a patient developing apical periodontitis due to bruxism.Case presentationThis article presents the case and successful treatment of a 28-year-old healthy male patient with apical periodontitis on teeth 36 and 46 requiring root canal treatment after an intense phase of bruxism. Due to an unclear diagnosis, treatment had been delayed.ConclusionsIncomprehensible tooth pain can be the result of bruxism. Practitioners need to be informed that intense bruxism can possibly lead to apical periodontitis. It is important, therefore, that a thorough anamnesis is collected and taken into account during diagnostics.

Prevalence and severity of TMD in orthodontic patients

Introduction. Temporomandibular disorder (TMD) is a collective term for numerous symptoms, with the most common being masticatory muscle pain, pain in temporomandibular joints, limited mouth opening, irregular jaw movements, headaches and sound effects in TMJ. The aim was to determine the prevalence and severity of TMD in orthodontic patients determining whether the type of malocclusion affects the prevalence and severity of TMD. Material and Methods. The study was conducted in the form of Fonseca Anamnestic Index, which classifies TMD severity among examinees (no TMD, mild, moderate and severe TMD). The experimental group consisted of orthodontic patients with confirmed malocclusions, while the control group consisted of dental students with a Class I occlusion and no need for orthodontic treatment. Orthodontic patients were classified into the three subgroups based on malocclusions. Results. In the experimental group, 45.03% of orthodontic patients had some degree of TMD, while among students, that percentage was 56.41%. Compared to Class I, higher percentage of TMD was found among patients with distal and mesial occlusion in experimental group. In the experimental and control groups, the greatest percentage of participants showed mild TMD. The prevalence of TMD was greater in females than in males in the experimental group. Conclusion. The high prevalence of TMD in the control group speaks in favor of its complex etiology, with stress having an important role. Malocclusion is one of many factors which can contribute to the occurrence and severity of TMD, but it cannot be considered the most significant.

Long-term effects of botulinum toxin A injection on pain and quality of life in patients with myofascial pain of masticatory muscles: a retrospective study

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Develi T, Uzel T, Cesur E, Uçkan S. Long-term effects of botulinum toxin A injection on pain and quality of life in patients with myofascial pain of masticatory muscles: a retrospective study. Journal of Stomatology. 2022;75(1):13-18. doi:10.5114/jos.2022.114218. APA Develi, T., Uzel, T., Cesur, E., & Uçkan, S. (2022). Long-term effects of botulinum toxin A injection on pain and quality of life in patients with myofascial pain of masticatory muscles: a retrospective study. Journal of Stomatology, 75(1), 13-18. https://doi.org/10.5114/jos.2022.114218 Chicago Develi, Tuba, Tansu Uzel, Emre Cesur, and Sina Uçkan. 2022. "Long-term effects of botulinum toxin A injection on pain and quality of life in patients with myofascial pain of masticatory muscles: a retrospective study". Journal of Stomatology 75 (1): 13-18. doi:10.5114/jos.2022.114218. Harvard Develi, T., Uzel, T., Cesur, E., and Uçkan, S. (2022). Long-term effects of botulinum toxin A injection on pain and quality of life in patients with myofascial pain of masticatory muscles: a retrospective study. Journal of Stomatology, 75(1), pp.13-18. https://doi.org/10.5114/jos.2022.114218 MLA Develi, Tuba et al. "Long-term effects of botulinum toxin A injection on pain and quality of life in patients with myofascial pain of masticatory muscles: a retrospective study." Journal of Stomatology, vol. 75, no. 1, 2022, pp. 13-18. doi:10.5114/jos.2022.114218. Vancouver Develi T, Uzel T, Cesur E, Uçkan S. Long-term effects of botulinum toxin A injection on pain and quality of life in patients with myofascial pain of masticatory muscles: a retrospective study. Journal of Stomatology. 2022;75(1):13-18. doi:10.5114/jos.2022.114218.

Thermoformed Occlusal Splints for the Treatment of Masticatory Muscle Pain: A Clinical Trial

Objective: Compare the clinical effectiveness of custom thermoformed occlusal splints (OS) alongside behavioraland self-care therapy (BST) in the management of myalgia of the masticatory muscles. Material and methods:A controlled clinical trial was conducted with a total of 46 subjects with a diagnosis of myalgia according tothe Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). All subjects were treated with BST at thebeginning of the study and were then randomized into four groups: behavioral and self-care control group;Thermoformed Tough-elastic splint group; Thermoformed Soft-elastic splint group, and non-occlusive splintgroup. Follow-ups were carried out at 2, 6, and 10 weeks, where it was evaluated: pain in the masticatorymuscles, mandibular range of motion, mandibular functional limitation, and occlusal discomfort. Data wereanalyzed with Doornik and Hansen, Shapiro–Wilk, and ANOVA at p=0.05. Results: All the variables showedsignificant improvement (p&lt;0.05) from the first follow-up and were maintained later. BST control group, aswell as groups with BST associated with OS, were able to reduce pain and increase the mandibular range ofmotion without significant differences between them (p&gt;0.05), while the Thermoformed Tough-elastic splintwas the most efficient in terms of the mandibular functional limitation. The occlusal discomfort decreased overtime, but without statistically significant differences in terms of time and design of OS. Conclusion: The additionof thermoformed OS to behavioral and self-care therapy does not have a significant impact on myalgia of themasticatory muscles. KEYWORDSMyalgia; Occlusal splint; Self-care; Temporomandibular joint disorders; Thermoformed splint.

Effectiveness of low-level gallium aluminium arsenide laser therapy for temporomandibular disorder with myofascial pain: A systemic review and meta-analysis.

Purpose:Temporomandibular disorder (TMD) causes masticatory muscle pain and mouth opening limitations and affects patients’ ability to eat, practice oral health and perform other activities of daily living. Although the benefits of low-energy lasers in treating TMD have been reported, the results vary greatly depending on the equipment used and the energy output. This study systematically evaluated the efficacy of a low-level gallium aluminium arsenide (GaAlAs) laser treatment for TMD with myofascial pain and maxillary pain.Methods:We searched the PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) published since database inception to April 5, 2020, that compared low-level laser treatment to sham/placebo treatment or no intervention in patients suffering from TMD with myofascial pain. Three reviewers independently screened the literature, extracted data, and assessed the quality of the included studies according to the risk-of-bias tool recommended by the Cochrane Handbook V.5.1.0 (Cochrane Collaboration, London, UK). Then, a meta-analysis was performed using RevMan 5.3 and Stata 15.1 software.Results:The data from 8 randomized controlled trials including 181 patients were analyzed. The severity of myofascial TMD pain (measured on a visual analogue scale, VAS) at the end of treatment was significantly different between the control laser therapy and the low-level GaAlAs laser therapy (weighted mean difference [WMD] = −0.76, 95% confidence interval [CI] −1.51 to 0.01, P = .046); at 3 to 4 weeks after treatment, there was no significant difference (WMD = 1.24, 95% CI −0.04 to 2.51, P = .057). In addition, there was no significant improvement in maximum mouth opening (MMO) at the end of treatment (WMD = −0.03, 95% CI −4.13 to 4.06, P = .987) or at 3 to 4 weeks after treatment (WMD = 1.22, 95% CI −2.94 to 5.39, P = .565).Conclusions:The results of this study suggest that there is insufficient evidence to indicate an efficacy of low-level GaAlAs laser therapy in improving TMD pain and maximal oral opening. These results suggest that clinicians should make appropriate recommendations to inform patient decision-making.

The Application of Manual Techniques in Masticatory Muscles Relaxation as Adjunctive Therapy in the Treatment of Temporomandibular Joint Disorders.

Temporomandibular disorders (TMD) are primarily characterized by pain as well as disorders concerning the proper functioning of individual elements of the stomatognathic system (SS). The aim of the study was to compare the degree of relaxation of the anterior part of the temporal muscles and the masseter muscles, achieved through the use of post-isometric relaxation and myofascial release methods in patients requiring prosthetic treatment due to temporomandibular joint disorders with a dominant muscular component. Sixty patients who met the inclusion criteria were alternately assigned to one of the two study groups, either group I—patients received post-isometric relaxation treatment (PIR), or group II—patients received myofascial release treatment (MR). The series of ten treatments were performed in both groups. The comparative assessment was based on physiotherapeutic examination, a surface electromyography (sEMG) of the anterior temporal and masseter muscles and the intensity of spontaneous masticatory muscle pain, assessed using the Visual Analogue Scale (VAS). We observed a significant decrease in the electrical activity of examined muscles and a significant drop in the intensity of spontaneous pain in the masticatory muscles both in group I and II. There were no significant differences between groups. Both therapeutic methods may be used as successful forms of adjunctive therapy in the prosthetic treatment of TMD. The trial was registered with an international clinical trials register.

Effects of Therapeutic and Aerobic Exercise Programs on Pain, Neuromuscular Activation, and Bite Force in Patients with Temporomandibular Disorders.

Pain in masticatory muscles is one of the most frequent symptoms in patients with temporomandibular disorders (TMD) and can lead to changes in the patterns of neuromuscular activity of masticatory muscles and decrease in bite force. This study assesses the effects of three eight-week exercise programs on pain intensity, neuromuscular activation, and bite force of masticatory muscles in patients with TMD. Forty-five patients were divided into three groups: a therapeutic exercise program (G1), a therapeutic and aerobic exercise program (G2), and an aerobic exercise program (G3). The masticatory muscles’ pain was evaluated using the numeric pain rating scale (NPRS), surface electromyographic (sEMG) activity of the masseter was recorded during maximum voluntary contraction and at rest, and bite force was evaluated using a dynamometer. These parameters were evaluated twice at baseline (A01/A02), at the end of the eight-week intervention period (A1), and 8–12 weeks after the end of the intervention (A2). After intervention, G2 showed the best results, with a significantly decrease in masticatory muscles’ pain and increase in bite force. These results suggest that interventions to reduce pain in patients with TMD should be multimodal.