A COMPARISON OF MANUAL THERAPY AND SPLINT THERAPY IN PATIENTS DIAGNOSED WITH MYOFASCIAL TEMPOROMANDIBULAR DYSFUNCTION WITH SLEEP BRUXISM

Yıl 2022, Cilt: 33 Sayı: 2, 89 - 97, 20.08.2022

Süreyya Damar Örenler , Ayşenur Tuncer , Eldar Najafov

https://doi.org/10.21653/tjpr.1027272

Cited By: 2

Öz

Purpose: The aim of this study was to examine the effect of manual therapy on temporomandibular pain, range of motion, functionality level of the jaw, sleep quality, and patient satisfaction, and to compare the efficacy with splint therapy among female patients with myofascial temporomandibular dysfunction (M-TMD) accompanied by sleep bruxism (SB).
Methods: A total of 29 female patients, aged 18-50 years, diagnosed with M-TMD were separated into two groups using a simple random sampling method as the manual therapy group (MT; n:15) and the splint therapy group (ST; n:14). All the patients were informed about bruxism and its effects and were given home exercises. The patients in the ST group were instructed to use a static splint for one month. The MT group patients received a total of 8 sessions, 45 minutes twice a week of treatment, including joint and soft tissue mobilizations to the temporomandibular joint (TMJ) and cervical region. Pain severity, symptoms, TMJ range of motion, jaw functionality, sleep quality, and patient satisfaction were evaluated. The evaluations were repeated after 4 weeks and compared with baseline values.
Results: A statistically significant difference was determined in both groups in pain, TMJ range of motion, and sleep quality (p<0.05). In the comparison between the groups after treatment, the pain, TMJ range of motion values, and sleep quality were seen to be statistically significantly better in the MT group (p<0.05). The patient satisfaction measurements of mean general satisfaction, interpersonal attitude, mean healthcare services score, and general satisfaction total points were found to be statistically significant in the MT group (p<0.05).
Conclusion: The applications of both MT and ST were seen to be effective in patients with M-TMD with bruxism. In the comparisons between the groups, the MT method was seen to be more effective than ST. It can be thought that the application of stabilization splint therapy together with manual therapy would significantly increase the treatment efficacy in patients with M-TMD.

Anahtar Kelimeler

Bruxism, Manual Therapy, Pain, Splint, Temporomandibular Dysfunction

UYKU BRUKSİZMİ OLAN MİYOFASYAL TEMPOROMANDİBULAR DİSFONKSİYON TANILI HASTALARDA MANUEL TEDAVİ İLE SPLİNT TEDAVİSİNİN KARŞILAŞTIRILMASI

Öz

Amaç: Çalışmada, uyku bruksizmin (SB) eşlik ettiği myofasyal temporomandibular disfonksiyonu (M-TMD) olan kadın hastalarda, manuel tedavinin temporomandibular ağrı, eklem açıklığı, çenenin fonksiyonellik düzeyi, uyku kalitesi ve hasta memnuniyeti üzerine etkisini incelemek ve splint tedavisi ile etkinliğini karşılaştırmak amaçlandı.
Yöntem: M-TMD tanılı, 18-50 yaş arası 29 kadın hasta, basit rastgele örnekleme yöntemi ile Manuel Tedavi (MT; n:15) ve Splint Tedavi (ST; n:14) olarak iki gruba ayrıldı. Tüm hastalara bruksizm ve etkileri üzerine eğitim ve ev egzersizi verildi. ST grubundaki bireylerden stabilizasyon splintini bir ay süre ile kullanmaları istendi. MT grubuna, temporomandibular eklem (TME) ve servikal bölgeye eklem ve yumuşak doku mobilizasyonlarını içeren haftada 2 seans 45 dk süreyle, toplam 8 seans tedavi uygulandı. Ağrı şiddeti, semptomlar, TME açıklığı, çene fonksiyonellik düzeyi, uyku kalitesi ve hasta memnuniyeti değerlendirildi. Değerlendirmeler 4 hafta sonunda tekrarlandı ve tedavi öncesi bulgular ile karşılaştırıldı.
Sonuçlar: Her iki grupta kendi içinde ağrı, TME hareket açıklığı ve uyku kalitesinde istatistiksel olarak anlamlı fark bulundu (p<0,05). Grupların karşılaştırılmasında ağrı, TME hareket açıklığı değerleri ile uyku kalitesinde MT grubu lehine anlamlı sonuçlar alındı (p<0,05). Hasta memnuniyet ölçümlerinde, genel memnuniyet, kişilerarası tutum, sağlık hizmetleri skor ortalaması ile genel memnuniyet total puanı MT grubu bireylerinde anlamlı olarak daha yüksek bulundu (p<0,05).
Tartışma: MT ve ST uygulamaları bruksizmin eşlik ettiği M-TMD’si olan hastalarda etkili bulundu, ancak grupların karşılaştırılmasında MT yönteminin ST’ye göre daha etkili olduğu tespit edildi. M-TMD’u olan hastalarda splint tedavisi ile manuel tedavinin birlikte uygulanması tedavi etkinliğini önemli ölçüde arttırabilir.

Anahtar Kelimeler

Bruksizm, Manuel Terapi, Ağrı, Splint, Temporomandibular Disfonksiyon

Kaynakça

• Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lobbezoo F. Epidemiology of bruxism in adults: a systematic review of the literature. J Orofac Pain. 2013;27(2), 99-110.
• Van der Meulen M J, Ohrbach R, Aartman I H, Naeije M, Lobbezoo F. Temporomandibular disorder patients' illness beliefs and self-efficacy related to bruxism. Journal of orofacial pain. 2010;24(4), 367.
• Lobbezoo F, Ahlberg J, Raphael K G, Wetselaar P, Glaros A G et all. International consensus on the assessment of bruxism: Report of a work in progress. Journal of oral rehabilitation. 2018;45(11), 837-844.
• Medlicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Physical Therapy. 2006;86(7):955-973.
• Cuccia AM, Caradonna C, Annunziata V, Caradonna D. Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2010;14(2):179-184.
• Shimada A, Ishigaki S, Matsuka Y, et al. Effects of exercise therapy on painful temporomandibular disorders. J Oral Rehabil. 2019;46(5):475-481.
• 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 Therapy. 2012;35(1):26-37.
• Tuncer AB, Ergun N, Tuncer AH, Karahan S. Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: A randomized controlled trial. J Bodyw Mov Therapy. 2013;17(3):302-308.
• Espí-López GV, Arnal-Gómez A, Cuerda Del Pino A, Benavent-Corai J, Serra-Añó P, Inglés M. Effect of Manual Therapy and Splint Therapy in People with Temporomandibular Disorders: A Preliminary Study. J Clin Med. 2020;9(8):2411.
• Thayaparan AJ, Mahdi E. The Patient Satisfaction Questionnaire Short Form (PSQ-18) as an adaptable, reliable, and validated tool for use in various settings. Med Educ Online. 2013; 18:21747.
• Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8(12):1153-1157.
• Ohrbach R, Larsson P, List T. The jaw functional limitation scale: development, reliability, and validity of 8-item and 20-item versions. J Orofac Pain. 2008;22(3):219-230.
• Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.
• Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A. Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis. Physical Therapy. 2016;96(1):9-25.
• Riley P, Glenny AM, Worthington HV, et al. Oral splints for temporomandibular disorder or bruxism: a systematic review. Br Dent J. 2020;228(3):191-197.
• Hardy RS, Bonsor SJ. The efficacy of occlusal splints in the treatment of bruxism: A systematic review. J Dent. 2021; 108:103621.
• Puri J, Bellinger LL, Kramer PR. Estrogen in cycling rats alters gene expression in the temporomandibular joint, trigeminal ganglia and trigeminal subnucleus caudalis/upper cervical cord junction. J Cell Physiol. 2011;226(12):3169-3180.
• Poveda Roda R, Bagan JV, Díaz Fernández JM, Hernández Bazán S, Jiménez Soriano Y. Review of temporomandibular joint pathology. Part I: classification, epidemiology and risk factors. Med Oral Patol Oral Cir Bucal. 2007;12(4): E292-E298.
• Wadhwa S, Kapila S. TMJ disorders: future innovations in diagnostics and therapeutics. J Dent Educ. 2008;72(8):930-947.
• Sessle BJ. Peripheral and central mechanisms of orofacial pain and their clinical correlates. Minerva Anestesiol. 2005;71(4):117-136.
• Younger JW, Shen YF, Goddard G, Mackey SC. Chronic myofascial temporomandibular pain is associated with neural abnormalities in the trigeminal and limbic systems. Pain. 2010;149(2):222-228.
• von Piekartz H, Lüdtke K. Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: a single-blind, randomized controlled study. Cranio. 2011;29(1):43-56.
• Kraus SL. Characteristics of 511 patients with temporomandibular disorders referred for physical therapy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118(4):432-439.
• Giannakopoulos NN, Rauer AK, Hellmann D, Hugger S, Schmitter M, Hugger A. Comparison of device-supported sensorimotor training and splint intervention for myofascial temporomandibular disorder pain patients. J Oral Rehabil. 2018;45(9):669-676.
• Kokkola O, Suominen AL, Qvintus V, et al. Efficacy of stabilisation splint treatment on the oral health-related quality of life-A randomised controlled one-year follow-up trial. J Oral Rehabil. 2018;45(5):355-362.
• Fouda AAH. No evidence on the effectiveness of oral splints for the management of temporomandibular joint dysfunction pain in both short and long-term follow-up systematic reviews and meta-analysis studies. J Korean Assoc Oral Maxillofac Surg. 2020;46(2):87-98.
• 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. J Am Dent Assoc. 2012;143(1):47-53.
• Shousha TM, Soliman ES, Behiry MA. 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. J Phys Ther Sci. 2018;30(9):1156-1160.
• Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole MR. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149-158.
• Dias GM, Bonato LL, Guimarães JP, et al. A Study of the Association Between Sleep Bruxism, Low Quality of Sleep, and Degenerative Changes of the Temporomandibular Joint. J Craniofac Surg. 2015;26(8):2347-2350.