ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Effective Interventions Involving Physical Therapy and Oral Exercises to Reduce Symptoms Associated with TMD
Clinical Question In an adult dental patient experiencing TMJ dysfunction, does the combined efforts of physical therapy and exercise relieve TMD symptoms?
Clinical Bottom Line Results show significantly less pain and improved oral opening with a combined therapy of active exercises and occlusal splint therapy. More studies need to be done for validation of long-term results.
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) 16649894McNeely/2006Thirty Six articles; Twelve selected studies (participants diagnosed with TMD, Adults 18 yrs +, musculoskeletal dysfunction, pain impairment, no other serious conditions.Systematic Review
Key resultsThere were two of the twelve selected TMD studies that evaluated postural exercises for TMD patients. The positive findings from these studies were reduced pain and improved oral opening in comparison to the control group or patients only receiving cognitive therapy. The study is a result after one month of treatment. One other study evaluated the effect of manual therapy in combination with active exercises with occlusal splint therapy on anteriorly displaced temporomandibular disks in patients with arthrogenous TMD. Results from the study concluded with significantly less pain and improved oral opening.
#2) 16813476Medlicott/2006Thirty studies with criteria of being in one of three groups in axis of researched diagnostic TMD, in realm of physical therapy practice, an experimental design, and has presenting TMD symptoms.Systematic Review
Key resultsThirty studies included in this systematic review were categorized into groups based on techniques used. Fourteen studies investigated the use of exercise or manual therapy, eight studies investigated the use of electrotherapy, seven studies investigated the use of relaxation training or biofeedback, and one study investigated the use of exercise and electrotherapy. The analysis from this systemic review of articles and controlled clinical trials revealed that symptoms improved during treatment with the majority forms of physical therapy, including placebo. Almost always, physical therapy was a better outcome as compared to no treatment, with quality of outcome improving in direct proportion to the amount of treatment received. Understandably, such subjects who received more treatment techniques appeared to do better than those who received fewer types of treatment.
Evidence Search TMD and Physical Therapy
Comments on
The Evidence
The McNeely and Medlicott articles are systematic reviews that analyzed articles using valid methods of measuring results. Both studies presented with TMD symptoms and were thoroughly evaluated during and after treatment for determining clinical results. McNeely presents a systematic review in which thirty-six articles were relevant, twelve met selection criteria, and three showed significant benefits from utilizing postural and manual therapy training. Medlicott reveals thirty studies that use multi-factorial techniques in treating TMD. Strategies used in these studies included manual mobilization, mid-laser therapy, postural training, and relaxation techniques. More studies need to be done to determine long-term results and to validate the similar results from these two studies.
Applicability These studies emphasis the importance of dentists and physical therapists recognizing a combined effort can be beneficial for patients in relieving their TMD symptoms.
Specialty/Discipline (Public Health) (General Dentistry) (Prosthodontics)
Keywords TMD, physical therapy, TMJ
ID# 2487
Date of submission: 08/21/2013spacer
E-mail trevinoa10@livemail.uthscsa.edu
Author Alejandro J. Trevnio
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward F. Wright, DDS, MS
Faculty mentor/Co-author e-mail wrighte2@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
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