The effect of a short term conservative physiotherapy versus occlusive splinting on pain and range of motion in cases of myogenic temporomandibular joint dysfunction: a randomized controlled trial.
Tamer Mohamed Shousha, Elsadat Saad Soliman, Mohamed Ahmed Behiry
PMID 30214116WHAT IT FOUND
For 112 adults with myogenic jaw muscle pain, six weeks of physiotherapy lowered average pain to 2.4 on a 10 cm scale, compared with 4.7 for daily occlusal splint, and improved jaw opening more.
Key findings
01A conservative physiotherapy package of relaxed jaw position, masseter stretching and medial pterygoid stretching, given for 15 min twice weekly for six weeks, reduced pain and improved range of motion more than occlusive splinting at six weeks.
02Mean VAS pain fell from 7.3 ± 1 to 2.4 ± 0.4 in the physiotherapy group and from 7.7 ± 1.4 to 4.7 ± 1.2 in the splint group.
03Mean TMJ opening index changed from 14.4 ± 1.12 to 3.5 ± 1 in the physiotherapy group and from 12.6 ± 3.1% to 1.4 ± 1.9 in the splint group, with significant improvement in favor of physiotherapy.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study had no follow-up period beyond six weeks, so it does not show whether the difference persisted. Patients could not be blinded to treatment, and pain was measured with a subjective visual analogue scale. The baseline pain values in the results text (7.3 and 7.7) do not match Table 1 (5.1 and 4.7), so the starting scores are unclear. The trial excluded structural temporomandibular joint changes such as arthritis, rheumatoid disease, ankylosing spondylitis, disc degeneration, or Bell's palsy, so the results apply only to myogenic TMD. The physiotherapy group received a package of relaxation and stretching components, so the study cannot identify the effect of any single component.
Declared interests
This study did not receive any funding, and the authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that physiotherapy is proven better than splints for all temporomandibular disorders or for long-term care. The trial excluded structural joint disease, had no follow-up beyond six weeks, and patients knew which treatment they received.