Background Temporomandibular joint disorders are common and lead to functional disability not only in temporomandibular joint but also in teeth, soft tissues and components of mastication. Patients with temporomandibular joint (TMJ) disorders report symptoms which include jaw and neck pain, headache and clicking or grating within the joint. Pharmacotherapy, physical therapy modalities, injection and exercise are all used for the treatment of TMJ disorders however no therapies have been shown to be uniquely superior for the treatment of pain or oral dysfunction in this chronic syndrome.
Objectives The aim of this study was to evaluate the comparative effects of physical therapy and injection therapy along with the exercises in a group of patients with TMJ disorders.
Methods Fourty nine patients with a mean age 37.57±15.14 years were recruited to the study. Patients were evaluated for complaints and clinical findings and then randomly allocated to three treatment groups. All patients got education and learned TMJ exercises to perform as home exercise program. The patients in the first group (n=17) received pharmacotherapy (non-steroidal anti-inflammatory drugs for a duration of 10 days with anti-inflammatory doses), the second group (n=15) received physical therapy comprising superficial local heat and TENS for 10 sessions; the third group (n=17) received hyaluronic acid injection to TMJ. The main outcome measures were pain at rest and movement of jaw assessed by VAS; and mouth opening distance. Oral health impact profile (OHIP-14) was used in all patients to assess people’s perceptions of the social impact of oral disorders on their well-being. All the measurements were performed at baseline, at the end of therapies, one month and three months after therapies.
Results Fourteen men and 35 women were completed the study. All patients reported to perform their home exercise program twice a day. Pain by VAS in rest and movement of jaw decreased in all patient groups (5.9±1.4 vs 5.6±1.9 vs 6.2±2.2; 1.1±0.9 vs 1.4±1.1 vs 2.5±1.6 respectively) but the most significant improvement was observed in the injection group than in other groups at first and third months (p<0.05). The improvement in mouth opening distances and well being scores were similar between the groups after first and third months (p>0.05).
Conclusions Our results indicated that all of the treatments including pharmacotherapy, physiotherapy, hyaluronic acid injection therapy improved the patients’ pain and functional status at the end of the therapies but hyaluronic acid injection treatment to TMJ were found to be more efficacious and long lasting in regard to pain, than in other therapies. Further studies are needed to confirm our results in larger groups of patients suffering from TMJ disorders.
Disclosure of Interest None Declared
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