ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Therapeutic Ultrasound Will Provide Better Management of Patients with Temporomandibular Myofascial Pain as Compared to Transcutaneous Electrical Nerve Stimulation
Clinical Question For adult patients with temporomandibular myofascial pain, will therapeutic ultrasound better reduce pain levels as compared to transcutaneous electrical nerve stimulation?
Clinical Bottom Line Therapeutic ultrasound (Th US) will provide better management of patients with temporomandibular myofascial pain as compared to transcutaneous electrical nerve stimulation (TENS). This is supported by a randomized comparative study in which the effectiveness of Th US versus TENS was found to be statistically significant.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27011739Panjwani/201690 patients of either sex between 20-60 years of age (healthy or diagnosed with temporomandibular myofascial pain)Randomized comparative study
Key resultsAfter 12 weeks of treatment (three times every 2 weeks, or until the visual analog scale [VAS] score for muscle pain was less than 10), statistically significant findings on the following parameters were observed in Th US group as compared to TENS: VAS score of muscle pain: After treatment, there was a statistical difference between Th US (247.87 pretreatment to 20.87 posttreatment) and TENS (240.60 pretreatment to 32.37 post-treatment) as evidenced by P = 0.001. There was no statistical difference between the groups before treatment. VAS score of impediment to daily life: After treatment, there was a statistical difference between Th US (32.45 pretreatment to 16.08 posttreatment) and TENS (40.21 pretreatment to 26.67 posttreatment) as evidenced by P < 0.05. VAS score of massage impression: After treatment, there was a statistical difference between Th US (101.45 pretreatment to 202.35 posttreatment) and TENS (110.11 pretreatment to 179.53 posttreatment) as evidenced by P < 0.05. Disappearance or reduced size of anechoic areas (an internal pathological thickening of the masseter muscle, measured with a sonogram): 95.5% in Th US as compared to 74.4% in TENS.
Evidence Search ("temporomandibular joint"[MeSH Terms] OR ("temporomandibular"[All Fields] AND "joint"[All Fields]) OR "temporomandibular joint"[All Fields] OR "tmj"[All Fields]) AND myofascial[All Fields] AND ("pain"[MeSH Terms] OR "pain"[All Fields]) AND ("diagnostic imaging"[Subheading] OR ("diagnostic"[All Fields] AND "imaging"[All Fields]) OR "diagnostic imaging"[All Fields] OR "ultrasound"[All Fields] OR "ultrasonography"[MeSH Terms] OR "ultrasonography"[All Fields] OR "ultrasound"[All Fields] OR "ultrasonics"[MeSH Terms] OR "ultrasonics"[All Fields]) AND ("transcutaneous electric nerve stimulation"[MeSH Terms] OR ("transcutaneous"[All Fields] AND "electric"[All Fields] AND "nerve"[All Fields] AND "stimulation"[All Fields]) OR "transcutaneous electric nerve stimulation"[All Fields] OR "tens"[All Fields])
Comments on
The Evidence
Validity: Due to the nature and organization of this randomized comparative study, there is reason to believe the results are valid. There was random assignment to groups, each group seemed to be measured equally, and there was a 100% completion rate. Also, in the article's Discussion section, the authors have cited the results of some related studies that provide consistency in features such as age distribution of patients with temporomandibular myofascial pain and measuring techniques. All of these attributes shed a positive light on this study. One item that might lend greater credibility to this study would be if the evaluators were blinded to the treatment each patient received. Although there are no systematic reviews or other trials, this study is a good starting point for learning more about the efficacy of therapeutic ultrasound for temporomandibular myofascial pain.
Applicability Temporomandibular-related myofascial pain is not an uncommon diagnosis in a general dental practice. Practitioners may have to experiment with a variety of therapeutic techniques for managing each patient, so it is important to be aware of many options and to tailor the treatment plan to the needs of the individual. Patients with significant myofascial pain could benefit from therapeutic ultrasound, but a choice would have to be made about the cost effectiveness of visiting a physical therapist for this treatment.
Specialty/Discipline (General Dentistry)
Keywords Temporomandibular dysfunction, myofascial pain, therapeutic ultrasound, TENS
ID# 3235
Date of submission: 04/26/2017spacer
E-mail isgrigg@livemail.uthscsa.edu
Author Kiersten Isgrigg
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward Wright, DDS, MS
Faculty mentor/Co-author e-mail wrighte2@uthscsa.edu
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