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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Towards an optimal therapy strategy for myogenous TMD, physiotherapy compared with occlusal splint therapy in an RCT with therapy-and-patient-specific treatment durations

Authors: Robert J. van Grootel, Rob Buchner, Daniël Wismeijer, Hilbert W. van der Glas

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

Temporomandibular Disorders (TMD) may be characterized by pain and restricted jaw movements. In the absence of somatic factors in the temporomandibular joint, mainly myogenous, psychobiological, and psychosocial factors may be involved in the aetiology of myogenous TMD. An occlusal appliance (splint) is commonly used as a basic therapy of the dental practice. Alternatively, a type of physiotherapy which includes, apart from massage of sore muscles, aspects of cognitive-behavioural therapy might be a basic therapy for myogenous TMD. Treatment outcome of physiotherapy (Ph-Tx) was evaluated in comparison to that of splint therapy (Sp-Tx), using the index Treatment Duration Control (TDC) that enabled a randomized controlled trial with, comparable to clinical care, therapy-and-patient-specific treatment durations.

Methods

Seventy-two patients were randomly assigned to either Ph-Tx or Sp-Tx, with an intended treatment duration between 10 and 21 or 12 and 30 weeks respectively. Using TDC, the clinician controlled treatment duration and the number of visits needed. A blinded assessor recorded anamnestic and clinical data to determine TDC-values following treatment and a 1-year follow-up, yielding success rate (SR) and effectiveness (mean TDC) as treatment outcomes. Cohen’s d, was determined for pain intensity. Overall SR for stepped-care was assessed in a theoretical model, i.e. a second of the two studied therapies was applied if the first treatment was unsuccessful, and the effect of therapy sequence and difference in success rates was examined.

Results

SR and effectiveness were similar for Ph-Tx and Sp-Tx (long-term SR: 51–60%; TDC: −0.512– −0.575). Cohen’s d was 0.86 (Ph-Tx) and 1.39 (Sp-Tx). Treatment duration was shorter for Ph-Tx (on average 10.4 weeks less; p < 0.001). Sp-Tx needed 7.1 less visits (p < 0.001).

Conclusions

Physiotherapy may be preferred as initial therapy over occlusal splint therapy in stepped-care of myogenous TMD. With a similar SR and effectiveness, physiotherapy has a shorter duration. Thus patients whose initial physiotherapy is unsuccessful can continue earlier with subsequent treatment. The stepped-care model reinforces the conclusion on therapy preference as the overall SR hardly depends on therapy sequence.

Trial registration

isrctn.​com/​ISRCTN17469828. Retrospectively registered: 11/11/2016
Appendix
Available only for authorised users
Literature
1.
Okeson JP. Orofacial pain: guidelines for assessment, classification, and management. The American Academy of Orofacial Pain. Illinois: Quintessence; 1996.
2.
Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular mandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6:301–55.PubMed
3.
Diatchenko L, Nackley AG, Slade GD, Fillingim RB, Maixner W. Idiopathic pain disorders – Pathways of vulnerability. Pain. 2006;123:226–30.CrossRefPubMed
4.
Benoliel R, Svensson P, Eliav E. Pathophysiology of masticatory myofascial pain. In: Greene CS, Laskin DM, editors. Treatment of TMDs: bridging the gap between advances in research and clinical patient management. Illinois: Quintessence; 2013. p. 17–32.
5.
Dubner R, Ren K, Sessle BJ. Sensory mechanisms of orofacial pain. In: Greene CS, Laskin DM, editors. Treatment of TMDs: bridging the gap between advances in research and clinical patient management. Illinois: Quintessence; 2013. p. 3–16.
6.
Tracey I, Patrick W, Mantyh PW. The cerebral signature for pain perception and its modulation. Neuron. 2007;55:377–91.CrossRefPubMed
7.
Ebrahim S, Montoya L, Busse JW, Carrasco-Labra A, Guyatt GH. The effectiveness of splint therapy in patients with temporomandibular disorders. A systematic review and meta-analysis. JADA. 2012;143:847–57.PubMed
8.
Lobbezoo F, van der Glas HW, van Kampen FMC, Bosman F. The effect of an occlusal stabilization splint and the mode of visual feedback on the activity balance between jaw-elevator muscles during isometric contraction. J Dent Res. 1993;72:876–82.CrossRefPubMed
9.
Chandu A, Suvinen TI, Read PC, Borromeo GL. The effect of an interocclusal appliance on bite force and masseter electromyography in asymptomatic subjects and patients with temporomandibular pain and dysfunction. J Oral Rehab. 2004;31:530–7.CrossRef
10.
Dao TT, Lavigne GJ. Oral splints: the crutches for temporomandibular disorders and bruxism? Crit Rev Oral Biol Med. 1998;9:345–61.CrossRefPubMed
11.
Schindler HJ, Svensson P. Myofascial Temporomandibular Disorder pain: pathophysiology and management. In: Türp JC, Sommer C, Hugger A, editors. The puzzle of orofacial pain: integrating research into clinical management, vol. 15. Basel: Karger; 2007. p. 91–123.CrossRef
12.
Dao TTT, Lavigne GJ, Charbonneau A, Feine JS, Lund JP. The efficacy of oral splints in the treatment of myofascial pain of the jaw muscles: a controlled clinical trial. Pain. 1994;56:85–94.CrossRefPubMed
13.
Rudy TE, Turk DC, Kubinski JA, Zaki HS. Differential treatment responses of TMD patients as a function of psychological characteristics. Pain. 1995;61:103–12.CrossRefPubMed
14.
Ekberg EC, Vallon D, Nilner M. The efficacy of appliance therapy in patients with temporomandibular disorders of mainly myogenous origin. A randomized, controlled, short-term trial. J Orofac Pain. 2003;17:133–9.PubMed
15.
Ekberg EC, Nilner M. Treatment outcome of appliance therapy in temporomandibular disorder patients with myofascial pain after 6 and 12 months. Acta Odontol Scand. 2004;62:343–9.CrossRefPubMed
16.
Truelove E, Huggins KH, Mancl L, Dworkin SF. The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder. JADA. 2006;137:1099–107.PubMed
17.
Turner JA, Mancl L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial. Pain. 2006;121:181–94.CrossRefPubMed
18.
Michelotti A, Iodice G, Vollaro S, Steenks MH, Farella M. Evaluation of the short-term effectiveness of education versus an occlusal splint for the treatment of myofascial pain of the jaw muscles. JADA. 2012;143:47–53.PubMed
19.
van der Glas HW, van Grootel RJ. The index ‘Treatment Duration Control’ for enabling randomized controlled trials with variation in duration of treatment of chronic pain patients. BMC Med Res Methodol. 2013;13:123.CrossRefPubMedPubMedCentral
20.
Türp JC, Jokstad A, Motschall E, Schindler HJ, Windecker-Gétaz I, Ettlin DA. Is there a superiority of multimodal as opposed to simple therapy in patients with temporomandibular disorders? A qualitative systematic review of the literature. Clin Oral Implants Res. 2007;18(suppl):S138–50.CrossRef
21.
van der Glas HW, Buchner R, van Grootel RJ. Vergelijking tussen behandelingsvormen bij myogene temporomandibulaire dysfunctie [Comparison between different types of therapy for myogenous temporomandibular disorders]. Ned TijdschrTandheelk. 2000;107:505–12.
22.
Dao TTT, Lavign GJ, Feine JS, Tanguay R, Lund JP. Power and sample size calculations for clinical trials of myofascial pain of jaw muscles. J Dent Res. 1991;70:118–22.CrossRefPubMed
23.
van Grootel RJ, van der Glas HW, Buchner R, de Leeuw JR, Passchier J. Patterns of pain variation related to myogenous temporomandibular disorders. Clin J Pain. 2005;21:154–65.CrossRefPubMed
24.
Türp JC, Schindler H. The dental occlusion as a suspected cause for TMDs: epidemiological and etiological considerations. J Oral Rehab. 2012;39:502–12.CrossRef
25.
Solow RA. The dental literature on occlusion and myogenous orofacial pain: application of critical thinking. Cranio. 2016;34:323–31.CrossRefPubMed
26.
Lobbezoo-Scholte AM, De Leeuw JRJ, Steenks MH, Bosman F, Buchner R, Olthoff LW. Diagnostic subgroups of craniomandibular disorders, part I: self-report data and clinical findings. J Orofac Pain. 1995;9:24–36.PubMed
27.
Ramfjord SP, Ash MM. Reflections on the Michigan occlusal splint. J Oral Rehabil. 1994;21:491–500.CrossRefPubMed
28.
van Grootel RJ, van der Glas HW. Statistically and clinically important change of pain scores in patients with myogenous temporomandibular disorders. Eur J Pain. 2009;13:506–10.CrossRefPubMed
29.
van der Glas HW, de Putter C. Gedifferentieerde diagnostiek en therapie bij CraniomandibulaireDysfunctie. Rapport voor de Ziekenfondsraad in het kader van Ontwikkelingsgeneeskunde [Differential diagnosis and therapy of Craniomandibular Disorders. Report to the Health Care Board, Dept of Developmental Medicine]. Utrecht; 1998. p. 1–98.
30.
31.
Guyatt G, Walter S, Norman G. Measuring change over time: assessing the usefulness of evaluative instruments. J Chron Dis. 1987;40:171–8.CrossRefPubMed
32.
Hedges LV, Olkin I. Statistical methods for meta-analysis. Orlando: Academic; 1985.
33.
Raphael KG, Marbach JJ. Widespread pain and the effectiveness of oral splints in myofascial face pain. JADA. 2001;132:305–16.PubMed
34.
Kalamir A, Bonello R, Graham P, Vitiello AL, Pollard H. Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial. J Manipulative Physiol Ther. 2012;35:26–37.CrossRefPubMed
35.
Pereira LJ, Steenks MH, de Wijer A, Speksnijder CM, van der Bilt A. Masticatory function in subacute TMD patients before and after treatment. J Oral Rehab. 2009;36:391–402.CrossRef
36.
Komiyama O, Kawara M, Arai M, Asano T, Kobayashi K. Posture correction as part of behavioural therapy in treatment of myofascial pain with limited opening. J Oral Rehabil. 1999;26:428–35.CrossRefPubMed
37.
De Laat A, Stappaerts K, Papy S. Counseling and physical therapy as treatment for myofascial pain of the masticatory system. J Orofac Pain. 2003;17:42–9.PubMed
38.
Clark CT. Interocclusal appliance therapy. In: Mohl ND, Zarb GA, Carlsson GE, Rugh JD, editors. A textbook of occlusion. Chicago: Quintessence; 1988. p. 271–84.
39.
Greenwood LF. Masticatory muscle disorders. In: Zarb GA, Carlsson GE, Sessle BJ, Mohl ND, editors. Temporomandibular joint and masticatory muscle disorders. Copenhagen: Munksgaard; 1994. p. 256–70.
40.
Manfredini D, Ahlberg J, Winocur E, Lobbezoo F. Management of sleep bruxism in adults: a qualitative systematic literature review. J Oral Rehab. 2015;42:862–74.CrossRef
41.
Buhrman M, Syk M, Burvall O, Hartig T, Gordh T, Andersson G. Individualized guided internet-delivered cognitive-behavior therapy for chronic pain patients with comorbid depression and anxiety. Clin J Pain. 2015;31:504–16.CrossRefPubMed
42.
Heapy AA, Higgins DM, Cervone D, Wandner L, Fenton BT, Kerns RD. A systematic review of technology-assisted self-management interventions for chronic pain. Looking across treatment modalities. Clin J Pain. 2015;31:470–92.CrossRefPubMed
43.
Manfredini D, Piccotti F, Ferronato G, Guarda-Nardini L. Age peaks of different RDC/TMD diagnoses in a patient population. J Dent. 2010;38:392–9.CrossRefPubMed
44.
Kraus SL. Characteristics of 511 patients with temporomandibular disorders referred for physical therapy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118:432–9.CrossRefPubMed
45.
Michelotti A, Cioffi I, Festa P, Scale G, Farella M. Oral parafunctions as risk factors for diagnistic TMD subgroups. J Oral Rehab. 2010;37:157–62.CrossRef
46.
Plesh O, Sinisi SE, Crawford PB, Gansky SA. Diagnosis based on the Research Diagnostic Criteria for temporomandibular disorders in a biracial population of young women. J Orofacial Pain. 2005;19:65–75.PubMed
47.
O’Leary KD, Borkovec TD. Conceptual, methodological, and ethical problems of placebo groups in psychotherapy research. Am Psychol. 1978;33:821–30.CrossRefPubMed
48.
Staud R, Robinson ME, Goldman CT, Price DD. Attenuation of experimental pain by vibro-tactile stimulation in patients with chronic local or widespread musculoskeletal pain. Eur J Pain. 2011;15:836–42.CrossRefPubMedPubMedCentral
49.
Vigotsky AD, Bruhns RP. The role of descending modulation in manual therapy and its analgesic implications: a narrative review. Pain Res Treat. 2015;2015(Article ID 292805):11.
Metadata
Title
Towards an optimal therapy strategy for myogenous TMD, physiotherapy compared with occlusal splint therapy in an RCT with therapy-and-patient-specific treatment durations
Authors
Robert J. van Grootel
Rob Buchner
Daniël Wismeijer
Hilbert W. van der Glas
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1404-9

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