Professional Assignment Project Temporo-Mandibular Dysfunction ESP2008

Participants Coach Mr. R. Hoogland: PT, MT, Clinician, Professor,Author Client Miss N. Jagdewsing: PT, Clinician Authors Third year students from ESP programme: Alexa Wirtz Alexa Wirtz Xue Zhang Xue Zhang

Abbreviations TMJ = Temporo – Mandibular Joint TMD = Temporo-Mandibular Disorder

Introduction The TMJ connects the mandible to the temporal bone. The TMJ connects the mandible to the temporal bone. One of the most complicated joints due to hinge and sliding motions. One of the most complicated joints due to hinge and sliding motions. A unique pair of joints A unique pair of joints

Introduction Temporo-Mandibular Disorder (TMD) Masticatory musculature Masticatory musculature TMJ and associated structures TMJ and associated structures A variety of symptoms may be linked to TMD Pain in the masticatory musculature and/or in the TMJ are the most common ones Pain in the masticatory musculature and/or in the TMJ are the most common ones Others Others

Introduction About 8% of the whole population is diagnosed with TMD.

Introduction Invasive treatments Non-Invasive treatments

Research question Which treatment is more effective in adults who suffer from TMD ? Exercise therapy or splint therapy ?

Hypothesis Splint therapy Exercise therapy

Materials and Methods Sources: AMC HVA Library ACTA (Academisch Centrum Tandheelkunde Amsterdam) Databases: PubMed Medline Google Scholar

Materials and Methods 520 abstracts 32 articles were related 17 full articles Our systematic review

Materials and Methods TMD physiotherapy RCT splint therapy exercise treatment myofascial pain adult patient

Materials and Methods Criteria Language: English and German Time: < 20 years At least two keywords in the abstract

Materials and Methods Criteria List Self-formulated specific grading form Maximally 70 points

Results Maximally 64.5 points(92%) Minimally 12.5 points(18%) 11 articles > 60% (4 articles > 80%) 4 articles < 30%

Discussion Balanced articles for both treatments. Majority of the articles are in English. All articles were written in the last two decades.

Discussion Articles are not specific for the research question. In no article there is a pure comparison. Additional symptoms and outcome measures Articles did take psycho-social problems into account.

Conclusion Both treatment modalities have positive outcomes. A combination of therapies seems to be even more beneficial than one type of treatment only.

References Conti, P.C., dos Santos, C.N., Kogawa, E.M., de Castro Ferreira Conti, A.C. & de Araujo Cdos, R. (2006). The treatment of painful temporomandibular joint clicking with oral splints: a randomized clinical trial. Journal of the American Dental Association. Aug; 137(8), pp Dao, T.T. & Lavigne, G.J. (1998). Oral splints: the crutches for temporomandibular disorders and bruxism? Critical review oral biological medical. 9(3), pp De Laat, A., Stappaerts, K. & Papy, S. (2003). Counseling and physical therapy as treatment for myofascial pain of the masticatory system. Journal of orofacial pain. Winter;17(1), pp Dos Santos, J. Jr. (1995). Supportive conservative therapies for temporomandibular disorders. Dental clinics of north America. Apr;39(2), pp Feine, J. & Lund, J.P. (1999). An assessment of the efficacy of physical therapy and physical modalities fort he control of chronic musculoskeletal pain. Pain, 71, pp Gavish, A., Winocur, E., Astandzelov-Nachmias, T. & Grazit, E. (2006). Effect of controlled masticatory exercise on pain and muscle performance in myofascial pian patients: A pilot study. Cranio. Jul; 24(3), pp Gray, R.J. & Davies, S.J. (2001). Occlusal splints and temporomandibular disorders: why, when, how? Dental Update, May; 28(4), pp Gray, R.J., Quayle, A.A., Hall, C.A. & Schofield, M.A. (1994). Physiotherapy in the treatment of temporomandibular joint disorders: a comparative study of four treatment methods. British dental journal. Apr9;176(7), pp James, H. & Quinn, D.D.S. (1995). Mandibular exercises to control bruxism and deviation problems. Cranio. Jan; 13(1), pp Komiyama, O., Kawara, M., Arai, M., Asano, T. & Kobayashi, K. (1999). Posture correction as part of behavio7ural therapy in treatment of myofascial pain with limited opening. Journal of oral rehabilitation. Oct;24(10), pp

References Kurita, H., Kurashina, K. & Kotaini, A. (1997). Clinical effect of full coverage occlusal splint therapy for specific temporomandibular disorder conditions and symptoms. The journal of prosthetic dentistry. Nov;78(5), pp Major, P.W. & Nebbe, B. (1997). Use and effectiveness of splint appliance therapy: review of literature. The journal of craniomandibular practice. Apr;15(2), pp Michelotti, A., Steenks, M.H., Farella, M., Parisini, F., Cimino, R. & Martina, R. (2004). The additional value of a home physical therapy regimen versus patient education only for myofascial pain of the jaw muscles: short-term results of a randomized clinical trial. Journal of orofacial pain. Apring;18(2), pp Nicolakis, P., Erdogmus, B., Kopf, A., Nicolakis, M., Piehslinger, E. & Fialka-Moser, V. (2002). Effectiveness of exercise therapy in patients with myofascial pain dysfunction syndrome. Journal of oral rehabilitation. Apr;29(4), pp Okeson, J.P. (1988). Long-term treatment of disk-interference disorders of the temporomandibular joint with anterior repositioning occlusal splints. The journal of prosthetic dentistry. Nov;60(5), pp Pierce, C.J., Weyant, R.J., Block, H.M. & Nemir, D.C. (1995). Dental splint prescription patterns: a survey. Journal of the American Dental Association, 126, pp Siegert, R. & Gundlach, K.K. (1989). Stabilizing splint versus relaxing appliances in the treatment of myofacial pain. Preliminary results of a prospective randomized study. Dtsch zahnarztl Z. Nov;44(11 spec no), pp. s Suvien, T.I., Hanes, K.R. & Reade, P.C. outcome of therapy in the conservative management of temporomandibular pain dysfunction disorder. Journal of oral rehabilitation. Oct;24(10), pp Tullberg, M. & Ernberg, M. (2006). Long-term effect on tinnitus by treatment of temporomandibular disorders: a two-year follow up by questionnaire. Acta odontologica scandinavica. Apr;64(2), pp

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