The influence of cervical spine rehabilitation on bioelectrical activity (sEMG) of cervical and masticatory system muscles.

BACKGROUND: Coexistence of temporomandibular joint discomfort along with cervical spine disorders is quite common, and is associated with many limitations and adverse symptoms for the patient. Both diagnostics and treatment of these ailments are difficult, and in many cases, the effects of therapy are not satisfactory. This study assessed the impact of a 3-week neck-only rehabilitation programme without direct intervention in the craniofacial area on the bioelectric activity of both the cervical spine and muscles in the craniofacial area among patients with idiopathic neck pain who do not report TMJ pain. DESIGN: A parallel group trial with follow-up; Setting: Rehabilitation Clinic. METHODS: Twenty five patients experiencing idiopathic neck pain underwent the 3-week rehabilitation programme. Thirty five age-matched subjects with no cervical spine and temporomandibular joint (TMJ) dysfunctions were control group. At baseline and after 3 weeks the cervical and craniofacial area muscles' bioelectrical activity (sEMG) was evaluated. RESULTS: In the experimental group during cervical flexion, a significant decrease of sEMG amplitude was noted in the right (mean 25.1 µV; 95% CI: 21.5-28.6 vs mean 16.8 µV; 95% CI: 13.8-19.7) and left (mean 25.9 µV; 95% CI: 21.7-30.0 vs mean 17.2 µV; 95% CI: 13.6-20.7) Sternocleidomastoid as well as a significant increase in sEMG amplitude of the right (mean 11.1 µV; 95% CI: 7.9-14.2 vs mean 15.7 µV; 95% CI: 12.1-19.2) and left (mean 15.3 µV; 95% CI: 11.9-18.6 vs mean 20.2 µV; 95% CI: 15.7-24.2) Upper Trapezius muscles. In the experimental group, after therapy right and left Sternocleidomastoid, Temporalis Anterior and Masseter muscles presented lower fatigue levels. CONCLUSIONS: Three weeks of rehabilitation without any therapeutic intervention in temporomandibular joint significantly decreased the bioelectrical activity of the neck and craniofacial muscles while improving the muscle pattern of coactivation in participants with idiopathic neck pain who do not report temporomandibular joint pain. These observations could be helpful in the physiotherapeutic treatment of neck and craniofacial area dysfunctions. TRIAL REGISTRATION: ID ISRCTN14511735-retrospectively registered.

The influence of cranio-cervical rehabilitation in patients with myofascial temporomandibular pain disorders.

OBJECTIVE: The aim of the study was to prove the causality between the craniocervical dysfunction and myofascial pain in the head and neck and to demonstrate the clinical value and usefulness of physiotherapy as one of the therapeutic options for myofascial pain. METHODS: The group of patients diagnosed with myofascial dysfunctional pain syndrome contained 98 patients out of which 79 patients (81 %) were females and 19 patients (19 %) were males. The majority of the patients were aged between 26 and 35 years; the total age range was 14-77 years with the average of 38 years. Observed patients were subdivided into three groups. Standard therapeutic methods aimed at the temporomandibular joint were provided to the patients of the first group. The second group of the patients received therapy aimed at cervical muscles only. Complex rehabilitation was applied in the third group of patients. The most frequent method used in the evaluation of chronic musculoskeletal pain in clinical studies is the visual analogue scale (VAS). RESULTS: According to our results, all three groups of patients saw an improvement in pain perception, but the overall subjective remission of painful sensations in the third group took place in as many as 88 % of patients. In this group, there was a significant decrease in the tenderness of trigger points in the trapezius and sternocleidomastoid muscles. CONCLUSION: It was proved that a combination of simple relaxing and stretching exercises of cervical muscles with a standard method used in the therapy of masticatory muscles is significantly more efficient (Fig. 5, Ref. 18).

[Tinnitus and temporomandibular joint: State of the art]. / Acouphènes et articulation temporo-mandibulaire : état des connaissances.

Tinnitus has been described in temporomandibular joint dysfunction for a long time. Yet, other disorders, such as hearing loss, stress, anxiety and depression, play a major role in the pathophysiology of tinnitus. Temporomandibular joint dysfunctions seem to increase the risk of tinnitus in patients with other predisposing factors. Especially somatosensory tinnitus, which is characterized by sound modulations with neck or mandible movements, is frequently associated with temporomandibular joint dysfunction, but it is not pathognomonic of such a disorder. In such cases, functional therapy of the temporomandibular joint should be part of the multidisciplinary rehabilitation of patients with tinnitus.

Efeitos do hiperboloide masticator apparatus na desordem temporomandibular ­ estudo de caso / Effects of hyperboloid masticator apparatus in temporomandibular disorder ­ case study

Introdução: A disfunção temporomandibular caracteriza-se por um conjunto de alterações clínicas envolvendo os músculos mastigatórios, a articulação temporomandibular e outras estruturas associadas. Objetivo: A estimulação proprioceptiva condicionada pelo uso do hiperboloide diminui o quadro álgico e aumenta a amplitude do movimento mandibular. Métodos: Apresentamos o caso de uma jovem de 22 anos com diagnostico de Disfunção temporomandibular, que recebeu o tratamento fisioterapêutico utilizando hiperboloide mastigador apparatus 3 vezes por semana durante 8 semanas sendo realizadas duas avaliações específicas: extensão vertical do movimento mandibular e mensuração do limiar de dor por pressão sobre o músculo masseter, pré atendimento, pós imediato e pós tratamento. Resultados: Observou-se aumento expressivo na abertura mandibular e no aumento de limiar de dor. Conclusão: O uso do hiperboloide levou a um aumento mobilidade mandibular e diminuição de dores nos músculos masseteres e consequente melhora na mastigação.

Introduction: temporomandibular dysfunction is characterized by a set of clinical changes involving the masticatory muscles, the temporomandibular joint and other associated structures. Goal: proprioceptive stimulation conditioned by the use of the hyperboloid influences on pain and mandibular movement pattern. Methods: we present the case of a young man of 22 years with diagnosis of temporomandibular joint Dysfunction, which received physiotherapy treatment using hyperboloid Cruncher apparatus 3 times per week for 8 weeks being held two specific reviews: vertical extension of the mandibular movement and measurement of pressure pain threshold on the masseter muscle, pre care, immediate post and post treatment. Results: it was observed significant increase in mandibular opening and increased pain threshold. Conclusion: the use of hyperboloid has led to an increase in mandibular mobility and decrease of myalgia masseteres and consequent improvement in chewing.

Effects of upper thoracic manipulation on pressure pain sensitivity in women with temporomandibular disorder: a randomized, double-blind, clinical trial.

OBJECTIVE: The aim of the present study was to evaluate the effects of upper thoracic manipulation on pain in subjects with temporomandibular disorder. DESIGN: Thirty-two women with a diagnosis of temporomandibular disorder were randomly allocated to an experimental group (n = 16), submitted to upper thoracic manipulation, and a placebo group (n = 16), submitted to a procedure in the thoracic region with no therapeutic effect. All volunteers underwent an evaluation of pain in the masticatory muscles and the temporomandibular joint using an algometer and the visual analog scale before and immediately after the procedure as well as after 48-72 hrs. Two-way repeated-measures analysis of variance was used for the intragroup and intergroup analyses, with the level of significance set to 5% (P < 0.05). Cohen d was calculated for the determination of the effect size. RESULTS: No significant group-by-time interaction was found (P > 0.05) for algometry in any analysis, and Cohen d revealed no significant effect of the treatment. Moreover, no significant group-by-time interaction was found for facial pain intensity determined using the visual analog scale (P > 0.05), and Cohen d also revealed no significant effect of the treatment regarding this variable. CONCLUSIONS: On the basis of the present findings, upper thoracic spinal manipulation does not lead to a reduction in pain in women with temporomandibular disorder.

A better definition of counselling strategies is needed to define effectiveness in temporomandibular disorders management.

DATA SOURCES: The Cochrane Library databases and Medline were searched along with the reference lists of identified articles and The Journal of the American Dental Association, Journal of Orofacial Pain and Journal of Oral Rehabilitation. STUDY SELECTION: Controlled clinical trials in which the intervention included the treatment in at least one group with counselling techniques were included. Studies in English, Portuguese or Spanish were considered. DATA EXTRACTION AND SYNTHESIS: A standard data set was retrieved from the articles and a qualitative synthesis was undertaken. RESULTS: Seven randomised controlled trials involving a total of 489 patients were included. Follow-up periods ranged from four weeks to 12 months. The studies suggested that counselling was able to improve tenderness upon masticatory muscle palpation and maximum mouth opening with and without pain in patients with TMD, with similar results to those of interocclusal appliances approaches. CONCLUSIONS: Although counselling- and self-management-based therapies could be a conservative low-cost and beneficial treatment alternative for treating TMD, with good results for the relief and control of TMD signs and symptoms by improving psychological domains and potentially reducing harmful behaviours, the evidence remains unclear due to the small number of controlled and randomised well-designed clinical trials. Thus, further studies with higher level of evidence and more representative samples should be conducted to validate the performance of this treatment modality.

Counselling and self-management therapies for temporomandibular disorders: a systematic review.

The aim of this review was to investigate the effectiveness of counselling and other self-management-based therapies on muscle and temporomandibular joint (TMJ) pain relief and increasing the functional abilities of patients with temporomandibular disorders (TMD). A systematic literature review was conducted by three independent reviewers and included articles published up to 2012. PubMed and Cochrane Library electronic databases were used in addition to hand-searching to assess clinical outcomes for counselling and self-management approaches for TMD treatment. The review yielded 581 records that were narrowed down to 7. All included studies were classified as blind-randomized controlled clinical trials. The selected articles analysed revealed that counselling was able to improve tenderness upon masticatory muscle palpation and maximum mouth opening with and without pain in patients with TMD, with similar results to those of interocclusal appliances approaches. Thus, counselling- and self-management-based therapies could be considered a conservative low-cost and beneficial treatment alternative for treating TMD to potentially improve psychological domains and remove harmful behaviours for the control of the signs and symptoms of TMD.

[Complex prosthetic rehabilitation of a patient with temporomandibular dysfunction. Case report]. / Temporomandibuláris ízületi panaszokkal rendelkezo páciens okklúziójanak teljes rehabilitációja. Esetbemutatás.

There are varying opinions regarding the contribution of occlusal interferences to the development and progression of temporomandibular dysfunction (TMD). Several studies have demonstrated that the use of occlusal adjustment might prevent the development of TMD and the exacerbation of its symptoms. Since the aetiology of TMD is multiple, the prosthodontic treatment cannot always be sufficient, but tends to be effective in some cases. The present article describes a case of a complex prosthetic rehabilitation of a patient with TMD that originates from her previous prosthesis, resulting in reduced vertical dimension. Treatment included the registration of vertical and horizontal dimensions of occlusion by gothic arch (arrow-point) tracing. Degrees of the mandibular movement were recorded by digital axiograph (ARCUSdigma-KaVo) and transferred to a semi-adjustable articulator (KaVo Protar 5B). Appropriate vertical and horizontal occlusal dimensions and individual mandibular movements were then transferred to the final prosthesis.

Criterio de diagnóstico para el tratamiento quirúrgico de los Meniscopatias de la Articulación Temporomandibular / Diagnostic criteria for the surgical treatment of temporomandibular joint disorders

La alteración en el normal funcionamiento de la Articulación Temporomandibular (ATM), puede tener repercusiones en forma aguda o crónica, con especial énfasis en los músculos de la masticación y/o inflamación de la articulación, que conecta la mandíbula con el cráneo. La principal causa es la hiperfunción o parafunción muscular, como en el caso del bruxismo, con repercusión en el sistema musculo-esqueletal de la cavidad oral, como también diferentes tipos de desplazamientos del disco en la ATM. El desorden trasciende los límites entre diferentes disciplinas de la salud, en particular, odontología y neurología que tienen diferentes enfoques de tratamiento. La ATM es susceptible a muchas otras afecciones que afectan a otras articulaciones del cuerpo, incluyendo anquilosis, artritis, trauma, luxaciones, desarrollo de anomalías, neoplasias y lesiones recidivantes. La decisión para intervenir una ATM debería ser tomada con cautela y basada en un análisis racional y apropiado de la enfermedad subyacente. En csos selectos, la cirugía de ATM es el tratamiento de elección para un subconjunto de desordenes Temporomandibulares, incluyendo trastornos articulares internos, enfermedad degenerativa de la articulación, artritis reumatoide, artritis infecciosa, luxación mandibular, anquilosis e hiperplasia o hipoplasia condilar. El objetivo del presente trabajo es enmarcar la cirugía de ATM como un ámbito indiscutible de la cirugía oral y maxilofacial, que bajo un diagnóstico certero y criterio quirúrgico apropiado lleva a una resolución definitiva del cuadro patológico.

Temporomandibular joint disorder a term covering acute or chronic pain, especially in the muscles of mastication and/or inflammation of the temporomandibular joint, which connects the mandible to the skull. The primary cause is muscular hyper or parafunction, as in the case of bruxism, with secondary effects on the oral musculoskeletal system, like various types of displacement of the disc in the temporomandibular joint. The disorder transcends the boundaries between several health-care disciplines in particular, dentistry and neurology there are a variety of treatment approaches. The temporomandibular joint is susceptible to many of the conditions that affect other joints in the body, including ankylosis, arthritis, trauma, dislocations, developmental anomalies, enoplasia and rective lesions. The decision to perform temporomandibularjoint (TMJ) surgery should be made carefully and must be based on a rational and appropiate analysis of the underlying disease. In selected cases, TMJ surgery is the preferred treatment for a subset of temporomandibular disorders (TMDs), incluiding internal derangement, degenerative joint disease, rheumatoid arthritis, infectious arthritis, mandibular dislocation, ankylosis, and condylar hyperplasia or hypoplasia. The aim of this article is to establish that TMJ surgery is the undisputed purview of the maxillofacial surgeon, thatunder accurate diagnosis and adquate surgical criteria leads to a definitive resolution of the pathology.

Criterio de diagnóstico para el tratamiento quirúrgico de los Meniscopatias de la Articulación Temporomandibular / Diagnostic criteria for the surgical treatment of temporomandibular joint disorders

La alteración en el normal funcionamiento de la Articulación Temporomandibular (ATM), puede tener repercusiones en forma aguda o crónica, con especial énfasis en los músculos de la masticación y/o inflamación de la articulación, que conecta la mandíbula con el cráneo. La principal causa es la hiperfunción o parafunción muscular, como en el caso del bruxismo, con repercusión en el sistema musculo-esqueletal de la cavidad oral, como también diferentes tipos de desplazamientos del disco en la ATM. El desorden trasciende los límites entre diferentes disciplinas de la salud, en particular, odontología y neurología que tienen diferentes enfoques de tratamiento. La ATM es susceptible a muchas otras afecciones que afectan a otras articulaciones del cuerpo, incluyendo anquilosis, artritis, trauma, luxaciones, desarrollo de anomalías, neoplasias y lesiones recidivantes. La decisión para intervenir una ATM debería ser tomada con cautela y basada en un análisis racional y apropiado de la enfermedad subyacente. En csos selectos, la cirugía de ATM es el tratamiento de elección para un subconjunto de desordenes Temporomandibulares, incluyendo trastornos articulares internos, enfermedad degenerativa de la articulación, artritis reumatoide, artritis infecciosa, luxación mandibular, anquilosis e hiperplasia o hipoplasia condilar. El objetivo del presente trabajo es enmarcar la cirugía de ATM como un ámbito indiscutible de la cirugía oral y maxilofacial, que bajo un diagnóstico certero y criterio quirúrgico apropiado lleva a una resolución definitiva del cuadro patológico.(AU)

Temporomandibular joint disorder a term covering acute or chronic pain, especially in the muscles of mastication and/or inflammation of the temporomandibular joint, which connects the mandible to the skull. The primary cause is muscular hyper or parafunction, as in the case of bruxism, with secondary effects on the oral musculoskeletal system, like various types of displacement of the disc in the temporomandibular joint. The disorder transcends the boundaries between several health-care disciplines in particular, dentistry and neurology there are a variety of treatment approaches. The temporomandibular joint is susceptible to many of the conditions that affect other joints in the body, including ankylosis, arthritis, trauma, dislocations, developmental anomalies, enoplasia and rective lesions. The decision to perform temporomandibularjoint (TMJ) surgery should be made carefully and must be based on a rational and appropiate analysis of the underlying disease. In selected cases, TMJ surgery is the preferred treatment for a subset of temporomandibular disorders (TMDs), incluiding internal derangement, degenerative joint disease, rheumatoid arthritis, infectious arthritis, mandibular dislocation, ankylosis, and condylar hyperplasia or hypoplasia. The aim of this article is to establish that TMJ surgery is the undisputed purview of the maxillofacial surgeon, thatunder accurate diagnosis and adquate surgical criteria leads to a definitive resolution of the pathology.(AU)

Improvement in patients with a TMD-pain report. A 6-month follow-up study.

UNLABELLED: Even though chronic TMD pain tends to persist in most patients, some chronic patients show improvement. It is largely unknown which factors contribute to the improvement of chronic pain. The aim of this study is to investigate which factors, from a biopsychosocial perspective, help to predict improvement in patients with a report of TMD pain. METHODS: Subjects with a report of TMD pain were recruited in seven TMD clinics. They received a baseline questionnaire which included a wide range of possible predictors for improvement. After 6 months they received a follow-up questionnaire which included a measure to determine which participants were 'improved' or 'not improved'. To study which predictive variables were associated with improvement, multiple regression models were built. RESULTS: From the 129 patients who responded to the baseline questionnaire, 100 patients also filled in the follow-up questionnaire (85% women, mean age (years) ± s.d. = 46·0 ± 13·8). Fifty percentage of these subjects had improved at the 6-month follow-up. Pain duration was the strongest (negative) predictor for 6-month improvement (P = 0·009). Also the number of care providers (P = 0·017) and the degree of hindrance on function (P = 0·045) helped to predict improvement. CONCLUSIONS: The duration of the TMD-pain complaint, the number of care practitioners attended and the degree of hindrance on function (negatively) helped to predict 6-month improvement. No evidence is found to support the role of psychological or social factors on the improvement in patients with a report of TMD pain.

Validity of the 'protocol of oro-facial myofunctional evaluation with scores' for young and adult subjects.

UNLABELLED: The aims of this study were to analyse the validity, sensitivity and specificity of the protocol of oro-facial myofunctional evaluation with scores (OMES) for oro-facial myofunctional disorder (OMD) diagnosis in young and adult subjects. Eighty subjects were examined. The OMES was validated against the Nordic orofacial test-screening (NOT-S) protocol (criterion validity) (Spearman correlation test). The construct validity was tested by analysis of the ability of the OMES (i) to differentiate healthy subjects (n = 22) from temporomandibular disorder (TMD) patients (n = 22), which frequently have OMD (Mann-Whitney test) and (ii) to measure the changes that occurred in a subgroup with TMD between the period before and after oro-facial myofunctional therapy (T group, n = 15) (Wilcoxon test). Two speech therapists trained with the OMES participated as examiners (E). There was a statistically significant correlation between the OMES and NOT-S protocols, which was negative because the two scales are inverse (r = -0·86, P < 0·01). There was a significant difference between the healthy and TMD subjects regarding the oro-facial myofunctional status (OMES total score, P = 0·003). After therapy, the T group showed improvement in the oro-facial myofunctional status (OMES total score, P = 0·001). Inter- and intra-examiner agreement was moderate, and the reliability coefficients ranged from good to excellent. The OMES protocol presented mean sensitivity and specificity = 0·80, positive predictive value = 0·76 and negative predictive value = 0·84. CONCLUSION: The OMES protocol is valid and reliable for clinical evaluation of young and adult subjects, among them patients with TMD.

Study on the effectiveness of the kinetic method in patients with rheumatic diseases and temporomandibular joint dysfunction.

UNLABELLED: Selecting the appropriate treatment decision is essential for achieving optimal results in the management of algo-dysfunctional syndrome of the temporo-mandibular joint (TMJD). The study aims to decide on the most effective (symptomatic control, preserved motility) kinetic program in patients with TMJ involvement. MATERIAL AND METHODS: prospective observational study on 83 consecutive patients with rheumatic diseases and TMJ dysfunction. Clinical assessment (pain, noises, muscle spasm, range of motion, ROM) was performed at baseline and after 3 months of specific kinetic rehabilitation program. Change in clinical parameters and TM3 index was reported, p<0.05. RESULTS: over 45% TMJ involvement at baseline as defined by TMJ index (mean value of 13.56) and only 36.66% at 3 months (p<0.05). Significant improvement in pain (presence, severity) was demonstrated at 3 moths (p<0.05): 18.05% spontaneous pain, 75.9% provoked pain, with 12.11% respectively 2.41% decreased in nocturnal respectively diurnal pain. Significant decrease (p<0.05) in joint noises at movements: 27.71% when opening and 12.04% when closing the mouth, 8.43 at protrusion and 3.61% at retraction, while 18% at the side movements. CONCLUSIONS: Complex accurate kinetic reeducation is mandatory for achieving correct posture (head, neck and trunk), normal mastication, swallowing and respiration, as well as correction of neuromuscular imbalances in patients with TMJD secondary to rheumatic disorders.

Integration of rehabilitation and acupuncture in the treatment of a professional musician with temporomandibular joint dysfunction.

This case study describes the use of acupuncture in a professional musician with myogenic temporomandibular dysfunction. The 3-year history of symptoms was associated with persistent episodic tension-type headaches. Acupuncture was used for trigger point release, primarily of the masticatory muscles, in conjunction with exercise therapy. After 8 weekly acupuncture sessions, the patient's pain had completely resloved, headaches had resolved and the Patient-Specific Functional Scale showed significant improvements.

The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles.

DESIGN: A randomized controlled trial. OBJECTIVE: To investigate the immediate effects on pressure pain thresholds over latent trigger points (TrPs) in the masseter and temporalis muscles and active mouth opening following atlanto-occipital joint thrust manipulation or a soft tissue manual intervention targeted to the suboccipital muscles. BACKGROUND: Previous studies have described hypoalgesic effects of neck manipulative interventions over TrPs in the cervical musculature. There is a lack of studies analyzing these mechanisms over TrPs of muscles innervated by the trigeminal nerve. METHODS: One hundred twenty-two volunteers, 31 men and 91 women, between the ages of 18 and 30 years, with latent TrPs in the masseter muscle, were randomly divided into 3 groups: a manipulative group who received an atlanto-occipital joint thrust, a soft tissue group who received an inhibition technique over the suboccipital muscles, and a control group who did not receive an intervention. Pressure pain thresholds over latent TrPs in the masseter and temporalis muscles, and active mouth opening were assessed pretreatment and 2 minutes posttreatment by a blinded assessor. Mixed-model analyses of variance (ANOVA) were used to examine the effects of interventions on each outcome, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. RESULTS: The 2-by-3 mixed-model ANOVA revealed a significant group-by-time interaction for changes in pressure pain thresholds over masseter (P<.01) and temporalis (P = .003) muscle latent TrPs and also for active mouth opening (P<.001) in favor of the manipulative and soft tissue groups. Between-group effect sizes were small. CONCLUSIONS: The application of an atlanto-occipital thrust manipulation or soft tissue technique targeted to the suboccipital muscles led to an immediate increase in pressure pain thresholds over latent TrPs in the masseter and temporalis muscles and an increase in maximum active mouth opening. Nevertheless, the effects of both interventions were small and future studies are required to elucidate the clinical relevance of these changes. LEVEL OF EVIDENCE: Therapy, level 1b.J Orthop Sports Phys Ther 2010;40(5):310-317, Epub 12 April 2010. doi:10.2519/jospt.2010.3257.

The effects of manual therapy and exercise directed at the cervical spine on pain and pressure pain sensitivity in patients with myofascial temporomandibular disorders.

No studies have investigated the effects of the treatments directed at the cervical spine in patients with temporomandibular disorders (TMD). Our aim was to investigate the effects of joint mobilization and exercise directed at the cervical spine on pain intensity and pressure pain sensitivity in the muscles of mastication in patients with TMD. Nineteen patients (14 females), aged 19-57 years, with myofascial TMD were included. All patients received a total of 10 treatment session over a 5-week period (twice per week). Treatment included manual therapy techniques and exercise directed at the cervical spine. Outcome measures included bilateral pressure pain threshold (PPT) levels over the masseter and temporalis muscles, active pain-free mouth opening (mm) and pain (Visual Analogue Scale) and were all assessed pre-intervention, 48 h after the last treatment (post-intervention) and at 12-week follow-up period. Mixed-model anovas were used to examine the effects of the intervention on each outcome measure. Within-group effect sizes were calculated in order to assess clinical effect. The 2 x 3 mixed model anova revealed significant effect for time (F = 77.8; P < 0.001) but not for side (F = 0.2; P = 0.7) for changes in PPT over the masseter muscle and over the temporalis muscle (time: F = 66.8; P < 0.001; side: F = 0.07; P = 0.8). Post hoc revealed significant differences between pre-intervention and both post-intervention and follow-up periods (P < 0.001) but not between post-intervention and follow-up period (P = 0.9) for both muscles. Within-group effect sizes were large (d > 1.0) for both follow-up periods in both muscles. The anova found a significant effect for time (F = 78.6; P < 0.001) for changes in pain intensity and active pain-free mouth opening (F = 17.1; P < 0.001). Significant differences were found between pre-intervention and both post-intervention and follow-up periods (P < 0.001) but not between the post-intervention and follow-up period (P > 0.7). Within-group effect sizes were large (d > 0.8) for both post-intervention and follow-up periods. The application of treatment directed at the cervical spine may be beneficial in decreasing pain intensity, increasing PPTs over the masticatory muscles and an increasing pain-free mouth opening in patients with myofascial TMD.

Use of sonographic elastography of the masseter muscles for optimizing massage pressure: a preliminary study.

To examine the stiffness of the masseter muscle using sonographic elastography and to investigate its relationship with the most comfortable massage pressure in the healthy volunteers. In 16 healthy volunteers (10 men and 6 women), the Masseter Stiffness Index (MSI) was measured using EUB-7000 real-time tissue elastography. They underwent massages at three kinds of pressures using the Oral Rehabilitation Robot (WAO-1). A subjective evaluation regarding the comfort of each massage was recorded on the visual analogue scale. Elastography was also performed in two patients with temporomandibular joint dysfunction with the myofascial pain. The mean MSI of the right and left muscles in the healthy volunteers were 0.85 +/- 0.44 and 0.74 +/- 0.35 respectively. There was no significant difference between the right and left MSI in the healthy volunteers. The MSI was related to massage pressure at which the healthy men felt most comfortable. The two temporomandibular disorder patients had a large laterality in the MSI. The MSI was related to the most comfortable massage pressure in the healthy men. The MSI can be one index for determining the massage pressure.

What can human experimental pain models teach us about clinical TMD?

Human experimental pain (HEP) models applied to the orofacial area have been widely used over the last decades and several reviews are available on the interaction between HEP and jaw-motor function. In this selective review some of the possibilities and limitations with HEP models are discussed based on the current experience with HEP models. For example, it is appropriate to consider how closely HEP models may mimic the clinical phenomenon, i.e., do they represent a reasonable "proxy" of temporomandibular disorders (TMD) and what can HEP models offer for the understanding of jaw-motor function in relation to painful TMD conditions. Finally, are there any clinical implications of the knowledge derived from HEP studies? This present review suggests that HEP models, indeed, are valuable and can provide clinically relevant information by serving as a bridge between basic animal experiments and studies in pain populations; however, there are several caveats to this suggestion which needs to be acknowledged.