Towards an optimal therapy strategy for myogenous TMD, physiotherapy compared with occlusal splint therapy in an RCT

Temporomandibular Disorders (TMD) may be characterized by pain and restricted jaw movements. In the absence of somatic factors in the temporomandibular joint, mainly myogenous, psychobiological, and psychosocial factors may be involved in the aetiology of myogenous TMD. An occlusal appliance (splint) is commonly used as a basic therapy of the dental practice. Alternatively, a type of physiotherapy which includes, apart from massage of sore muscles, aspects of cognitive-behavioural therapy might be a basic therapy for myogenous TMD. Treatment outcome of physiotherapy (Ph-Tx) was evaluated in comparison to that of splint therapy (Sp-Tx), using the index Treatment Duration Control (TDC) that enabled a randomized controlled trial with, comparable to clinical care, therapy-and-patient-specific treatment durations.

Seventy-two patients were randomly assigned to either Ph-Tx or Sp-Tx, with an intended treatment duration between 10 and 21 or 12 and 30 weeks respectively. Using TDC, the clinician controlled treatment duration and the number of visits needed. A blinded assessor recorded anamnestic and clinical data to determine TDC-values following treatment and a 1-year follow-up, yielding success rate (SR) and effectiveness (mean TDC) as treatment outcomes. Cohen’s d, was determined for pain intensity. Overall SR for stepped-care was assessed in a theoretical model, i.e. a second of the two studied therapies was applied if the first treatment was unsuccessful, and the effect of therapy sequence and difference in success rates was examined.

SR and effectiveness were similar for Ph-Tx and Sp-Tx (long-term SR: 51-60%; TDC: -0.512- -0.575). Cohen’s d was 0.86 (Ph-Tx) and 1.39 (Sp-Tx). Treatment duration was shorter for Ph-Tx (on average 10.4 weeks less; p < 0.001). Sp-Tx needed 7.1 less visits (p < 0.001).

Physiotherapy may be preferred as initial therapy over occlusal splint therapy in stepped-care of myogenous TMD. With a similar SR and effectiveness, physiotherapy has a shorter duration. Thus patients whose initial physiotherapy is unsuccessful can continue earlier with subsequent treatment. The stepped-care model reinforces the conclusion on therapy preference as the overall SR hardly depends on therapy sequence.

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Rikki Stricker
Rikki Stricker
May 12, 2017 at 7:27 pm

Dear Scott! – Again I have to write a comment: Over the years I had the chance to compare several settings when it come to TMJ treatment: As Craniofacial specialist I do see patient with or without different kind of occlusion splints ( op and non op patients as well) and I have to say that – no matter with or without splint: the crux of the matter is MANUAL THERAPY. Even though some of my patient have been wearing a splint for some/longer time – THEY get stuck in the end, problems even get more severe – for example anterior disc dislocation with reposition turn to anterior disc dislocation without reposition – but once you´re starting with the manual therapy things get on the way pretty quickly and stay better! A splint is not the final solution; BUT working on a better range of motion, a proper disc placement, a good strength and coordination of the chewing system – IS! If you have any questions ( about my education system or what ever)- just hit me, I am glad to help – ´cause I know that the patients out there have a long history, a lot of questions, a lot of pain – but the good thing is: yes, once you feed “the system” with the adequate informations , it is healing quickly!!

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