Self‐exercise programmes and occlusal splints in the treatment of TMD‐related myalgia—Evidence‐based medicine?

Abstract

Myalgia is a subdivision of temporomandibular dysfunction (TMD), which in turn comprises disorders of the temporomandibular joint and surrounding musculature. Schiffman et al 1 defined myalgia as pain of muscle origin that is affected by jaw movement, function or parafunction, and replication of this pain occurs with provocation testing of the masticatory muscles. The low-cost, and reversible treatments concerning disorders of the masticatory muscles represent a vast array of regimens. Common treatments include information, 2 stretching exercises, 2 manual therapy, 3 acrylic splints 4 and cognitive behavioural therapy. 5 In addition, Norwegian national recommendations include, acupuncture, sleep, posture correction, diaphragmatic breathing and NSAIDs. 30 The National Board of Health and Welfare in Sweden also ranks the different treatments from 1 to 10, based on level of evidence, cost vs effect and probability for success. Many of the treatments prescribed by general practitioners today are labelled as self-care, implicating that the patients themselves are responsible for performing the prescribed treatment. 2,4,6-13 These reversible and low-cost treatments entail little risk for patient injury, but one would still expect the treatments to be supported by scientific evidence.While, the prevalence of TMD in Scandinavia is reported to be as This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Abstract Background: The low-cost and reversible treatments concerning disorders of the masticatory muscles represent a vast array of regimens. Common treatments include information, stretching exercises, manual therapy, acrylic splints and cognitive behavioural therapy.Objective: The aim of this study was to evaluate the evidence behind the use of self-exercising programmes and occlusal splints in the treatment of myofascial pain. Methods:We conducted a thorough search of five databases, using four cardinal search terms in combination with twelve supporting terms. We also assessed the evidence quality, using GRADEpro software. Results:The search resulted in 4967 individual studies. 18 studies met the inclusion criteria and were re-evaluated. Conclusion:The selected studies were in favour of a self-care or an occlusal splint treatment of myalgia. However, a GRADE assessment showed that 14 of the 18 selected studies had low or very low evidence quality. Studies also showed weaknesses with regard to nomenclature and reproducibility. Hence, it is our professional opinion that the evidence level for prescribing self-exercises and occlusal splints in the treatment of myalgia is low. K E Y W O R D Sevidence-based medicine, myalgia, myofascial pain, self-care, temporomandibular dysfunction How to cite this article: Eliassen M, Hjortsjö C, Olsen-Bergem H, Bjørnland T. Self-exercise programmes and occlusal ...

Effectiveness of exercise therapy versus occlusal splint therapy for the treatment of painful temporomandibular disorders: a systematic review and meta-analysis

“…In this review, the hypothesis was not met, there was no significant difference in pain relief and mandibular ROM improvement between exercise therapy and occlusal splint therapy for patients with painful TMD. Treatment strategies for exercise therapy and occlusal splint therapy are founded on non-invasive, reversible interventions (13). List et al (25) concluded that conservative treatment including exercise therapy and occlusal splint therapy could effectively relieve TMD pain and increase jaw opening.…”

“…Another conservative treatment option is exercise therapy, which is used to improve strength, mobility, coordination, and to reduce pain in the joints and muscles (10). Previous reviews have already dwelt on the effectiveness of exercise therapy in the treatment of TMD (11)(12)(13). In this review, therapeutic exercise modalities are defined as follows: muscle-strengthening exercise, stretching exercise, jaw-opening exercise, postural exercise, and mobilization exercise (10,12).…”

“…Clinical and study-based outcomes have confirmed the effectiveness of therapeutic exercise modalities for the management of TMD due to improvements in local analgesia, muscle function, and restoration of local blood flow (10,14). As techniques in which patients learn to relieve pain and stress through exercise therapy could help avoid the use of an occlusal splint in the long term, it is necessary to compare the efficacy of therapeutic exercise therapy with occlusal splint therapy (12,13). To our knowledge, few data of reviews comparing the effectiveness of exercise therapy with occlusal splint therapy for the treatment of painful TMD have been reported (12,13).…”

“…As techniques in which patients learn to relieve pain and stress through exercise therapy could help avoid the use of an occlusal splint in the long term, it is necessary to compare the efficacy of therapeutic exercise therapy with occlusal splint therapy (12,13). To our knowledge, few data of reviews comparing the effectiveness of exercise therapy with occlusal splint therapy for the treatment of painful TMD have been reported (12,13). Armijo-Olivo et al (12) conducted a systematic review and found no clear indication of superiority of exercise therapy versus other conservative treatments for TMD.…”

“…Armijo-Olivo et al (12) conducted a systematic review and found no clear indication of superiority of exercise therapy versus other conservative treatments for TMD. A recent review concluded that the evidence level for prescribing exercises and occlusal splints in the treatment of painful TMD is low (13). Previous studies have provided inconclusive and controversial results; in addition, none of these systematic reviews provided a meta-analysis of the trials to investigate comparative effectiveness of exercise therapy and occlusal splint therapy for the treatment of painful TMD.…”