Management of painful temporomandibular joint clicking with different intraoral devices and counseling: a controlled study

Abstract

Objective The benefit of the use of some intraoral devices in arthrogenous temporomandibular disorders (TMD) patients is still unknown. This study assessed the effectiveness of the partial use of intraoral devices and counseling in the management of patients with disc displacement with reduction (DDWR) and arthralgia.Materials and Methods A total of 60 DDWR and arthralgia patients were randomly divided into three groups: group I (n=20) wore anterior repositioning occlusal splints (ARS); group II (n=20) wore the Nociceptive Trigeminal Inhibition Clenching Suppression System devices (NTI-tss); and group III (n=20) only received counseling for behavioral changes and self-care (the control group). The first two groups also received counseling. Follow-ups were performed after 2 weeks, 6 weeks and 3 months. In these sessions, patients were evaluated by means of a visual analogue scale, pressure pain threshold (PPT) of the temporomandibular joint (TMJ), maximum range of motion and TMJ sounds. Possible adverse effects were also recorded, such as discomfort while using the device and occlusal changes. The results were analyzed with ANOVA, Tukey’s and Fisher Exact Test, with a significance level of 5%.Results Groups I and II showed improvement in pain intensity at the first follow-up. This progress was recorded only after 3 months in Group III. Group II showed an increased in joint sounds frequency. The PPT values, mandibular range of motion and the number of occlusal contacts did not change significantly.Conclusion The simultaneous use of intraoral devices (partial time) plus behavioral modifications seems to produce a more rapid pain improvement in patients with painful DDWR. The use of NTI-tss could increase TMJ sounds. Although intraoral devices with additional counseling should be considered for the management of painful DDWR, dentists should be aware of the possible side effects of the intraoral device’s design.

Can an NTI‐tss device be effective as a first‐line therapy in patients with TMD myofascial pain?

“…Patients’ initial attention to professional guidance, natural course of the disease and regression to the mean may explain the improvements observed in pain and dysfunction among patient groups from our study . Furthermore, this improvement in the control group definitely reveals the benign feature of myofascial pain and indicates no need for irreversible therapies . Increase in the vertical dimension of jaws enables a more distinct inhibition of muscle activity as previously reported , and also owing to the alleged therapeutic mechanism of the NTI‐tss device; it was expected that the device would have a more positive impact on the pain levels.…”

“…The material re‐polymerises again, becomes rigid, fits to the anterior teeth and avoids contact of canines and molars . This splint was developed to trigger the jaw‐opening reflex, which protects teeth from excessive forces . Besides, according to the manufacturer, NTI‐tss allows for optimum musculoskeletal stability in the condylar position.…”

“…Besides, according to the manufacturer, NTI‐tss allows for optimum musculoskeletal stability in the condylar position. If a patient's condylar position is not optimal, the condyle may re‐position more posteriorly/superiorly during resolution of symptoms . In June 2001, the FDA approved the use of NTI‐tss for the following indications:…”

Efeito da prática de instrumentos musicais nas disfunções temporomandibulares e distúrbios do sono

“…1 Embora a prática de um instrumento musical possa ser considerada uma atividade relaxante, há dúvidas quanto à eficácia dessa atividade na diminuição dos distúrbios temporomandibulares, uma vez que há indícios que instrumentistas profissionais estão expostos a riscos ocupacionais que os predispõem a problemas musculoarticulares e a dores, desvios posturais, problemas auditivos, entre outros. 22,23 A elevada carga horária dedicada ao aperfeiçoamento técnico, posturas incorretas ao tocar, inadequações anatômicas dos instrumentos musicais, além de ensaios e apresentações em GRÁFICO 1 | Distribuição de frequência entre os grupos pouca prática musical e alta prática musical em relação a presença ou ausência de distúrbio da ATM.…”

“…1 Seus sinais e sintomas podem ser facilmente confundidos com outras desordens ou doenças. No entanto, geralmente acarretam dor na região pré-auricular, limitação ou assimetria de movimentos mandibulares e sons articulares.…”