Does combining oro-facial manual therapy with bruxism neuroscience education affect pain and function in cases of awake bruxism? A pilot study.

BACKGROUND: Although awake bruxism is associated with temporomandibular disorder (TMD) as well as head and neck pain, the effects of physical therapy and bruxism education to address these factors have not been investigated. OBJECTIVE: The aim of this study was to evaluate the effects of oro-facial manual therapy and bruxism neuroscience education (BNE) on awake bruxism over a 3-week period with an open-ended follow-up questionnaire after 3 months. METHODS: Subjects (n = 28) were randomly allocated to one of two groups, an intervention group and a control group. Data regarding disability, function and pain were collected pre- and post-assessment, with all measures administered in a single-blind fashion. Participants in both groups received six treatment sessions during this period. In addition to manual therapy, participants were provided with information on the neurophysiological mechanisms of bruxism and contributing factors. Individual behavioural guidelines and daily exercises were determined in consultation with the therapist. An introduction to a bruxism specific app (Brux.App) was also provided, which all participants used as an adjunct to their treatment. RESULTS: The intervention group demonstrated notable improvement as indicated by their scores in the Neck Disability Index (NDI) (p = .008), Pain Disability Index (PDI) (p = .007) and Jaw Disability List (JDL) (p = .03). Furthermore, clinical assessments of the temporomandibular joint (TMJ) revealed a significant progress in terms of mouth opening (p = .03) and lateral jaw movement (laterotrusion) (p = .03). The mechanical pain threshold (PTT) of both the masseter (p = .02) and temporalis muscle (p = .05) also showed significant improvement. At 3-month follow-up, the questionnaire revealed that the majority of the intervention group (13/15, 87%) reported a benefit from the treatment. CONCLUSION: The reduction in pain and disability together with improvement in function and increased coping suggest a potential modification of awake bruxism through specialised musculoskeletal intervention and BNE tailored to the individual patient.

Cross-Cultural Adaption and Psychometric Evaluation of the German Craniofacial Pain and Disability Inventory (CF-PDI).

BACKGROUND: The Craniofacial Pain and Disability Inventory (CF-PDI) is a cross-culturally adapted instrument designed from a biopsychosocial perspective to measure pain, disability, and function in orofacial head and neck pain with shown psychometric properties; however, the German cross-cultural adaption is lacking. OBJECTIVES: To carry out a transcultural translation of CF-PDI into German and assess its psychometric properties in patients with painful temporomandibular disorders (TMD) with respect to construct and clinical validity, internal consistency and reproducibility. STUDY DESIGN: Multicenter, prospective, cross-sectional design. SETTING: Patients (n = 398) were recruited from dental and physical therapy clinics in middle and south Germany. METHODS: Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We investigated know-group validity by means of the scale's potential to discriminate between affected and unaffected subjects. Multiple linear regression analysis was used to estimate convergent validity. We tested test-retest reliability by the intraclass correlation coefficient and the Internal consistency by Cronbach's alpha, or each dimension separately, and the total score. Multiple linear regression analysis was used to estimate convergent validity. RESULTS: Two hundred forty-six heterogeneous chronic craniofacial pain patients and 152 patients without complaints were recruited from the middle and south of Germany. The German version CF-PDI-G presents 21 items, 4 factors, and adequate psychometric properties. The test-retest reliability and internal consistency of the CF-PDI-G were both excellent for the entire instrument and also for all sub-scales (intraclass correlation coefficient [ICC] > 0.90) except for the comorbidities and interference with work which was acceptable (ICC = 0.69). Standard error of the measurement (SEM) and minimal detectable change values are sufficiently low. Assessment of clinical validity shows good potential of discrimination and classification into categories "no," "mild," "moderate," and "severe." The multiple linear regression model showed a strong association between neck disability index, Visual Analog Scale, and anamnestic questionnaire (supporting the scale's convergent validity). LIMITATIONS: Our sample has a higher prevalence of women and the sample was not recruited consecutively, which may lead to a biased estimation of psychometric properties. CONCLUSIONS: The CF-PDI-G represents valid and reliable instrument to assess pain and disability in patients with orofacial pain and headache suitable for research and clinical practice.

International consensus on the most useful assessments used by physical therapists to evaluate patients with temporomandibular disorders: A Delphi study.

OBJECTIVE: To identify assessment tools used to evaluate patients with temporomandibular disorders (TMD) considered to be clinically most useful by a panel of international experts in TMD physical therapy (PT). METHODS: A Delphi survey method administered to a panel of international experts in TMD PT was conducted over three rounds from October 2017 to June 2018. The initial contact was made by email. Participation was voluntary. An e-survey, according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), was posted using SurveyMonkey for each round. Percentages of responses were analysed for each question from each round of the Delphi survey administrations. RESULTS: Twenty-three experts (completion rate: 23/25) completed all three rounds of the survey for three clinical test categories: 1) questionnaires, 2) pain screening tools and 3) physical examination tests. The following was the consensus-based decision regarding the identification of the clinically most useful assessments. (1) Four of 9 questionnaires were identified: Jaw Functional Limitation (JFL-8), Mandibular Function Impairment Questionnaire (MFIQ), Tampa Scale for Kinesiophobia for Temporomandibular disorders (TSK/TMD) and the neck disability index (NDI). (2) Three of 8 identified pain screening tests: visual analog scale (VAS), numeric pain rating scale (NRS) and pain during mandibular movements. (3) Eight of 18 identified physical examination tests: physiological temporomandibular joint (TMJ) movements, trigger point (TrP) palpation of the masticatory muscles, TrP palpation away from the masticatory system, accessory movements, articular palpation, noise detection during movement, manual screening of the cervical spine and the Neck Flexor Muscle Endurance Test. CONCLUSION: After three rounds in this Delphi survey, the results of the most used assessment tools by TMD PT experts were established. They proved to be founded on test construct, test psychometric properties (reliability/validity) and expert preference for test clusters. A concordance with the screening tools of the diagnostic criteria of TMD consortium was noted. Findings may be used to guide policymaking purposes and future diagnostic research.

Bruxism, temporomandibular dysfunction and cervical impairments in females - Results from an observational study.

PURPOSE: Bruxism is highly prevalent and defined as abnormal habitual mouth activity including clenching of the teeth and increased jaw muscle activity. The association between bruxism and temporomandibular dysfunction (TMD) is debated, in particular the association between cervical spine impairments, bruxism, and TMD. Hence the purpose of this study was to identify the relationship between bruxism, TMD, and cervical spine impairments. METHODS: This observational study categorized 55 female volunteers suitable for evaluation to a bruxism (n = 33) or non-bruxism group (n = 22) based on comprehensive screening using questionnaires and visual observation of the mouth by 2 independent dentists. Following this, both groups were evaluated for TMD, severity and location of head/neck pain, neck disability index (NDI), cervical spine impairments, and tissue mechanosensitivity. Regression analysis was used to evaluate the relationship between bruxism, TMD severity, and cervical impairments. RESULTS: Coefficients of pain and bruxism were significantly associated with NDI scores (0.43, p < 0.001; 3.24, p = 0.01) with large and medium sized effects. As a consequence, both severity of TMD and bruxism status are independently associated with cervical impairments. Having TMD is an independent predictor for head/neck pain and cervical impairments. Pain associated with movement tests and tissue mechanosensitivity was found to be an important factor in bruxism. CONCLUSION: Clinicians need to be aware that signs of cervical movement impairment are not likely to be associated with bruxism, rather they should focus on improving orofacial function and tissue mechanosensitivity.

Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study.

INTRODUCTION: Tests to evaluate the integrity of the alar ligaments are important clinical tools for manual therapists, but there is limited research regarding their validity. METHOD: A single blinded examiner assessed alar ligament integrity using the lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST) on a sample of convenience comprising 7 subjects with MRI confirmed alar ligament lesions and 11 healthy people. Alar ligament lesions were identified using both supine and high-field strength upright MRI. RESULTS: The RST had a sensitivity of 80% and a specificity of 69.2%. The SBST and the LST both showed a sensitivity of 80% and a specificity of 76.9%. In cases where all three tests were positive, the specificity increased to 84.6%. DISCUSSION: Tests of manual examination of alar ligament integrity have some diagnostic utility; however, these findings require further corroboration in a larger sample.