Comparison of Habit Awareness Training and Interocclusal Appliances as Treatments for TMD Pain

Objectives: This study tested the hypothesis that a behaviorally-oriented habit awareness program emphasizing awareness and reduction of parafunctional activities would be as effective in the treatment of temporomandibular disorder pain as splint therapy. Methods: A randomized trial design was employed. Thirteen TMD patients diagnosed with myofascial pain and/or arthralgia (according to the Research Diagnostic Criteria) were assigned to either an interocclusal appliance therapy group or to a behavioral intervention group. Patients assigned to the interocclusal appliance therapy group received a flat plane splint, adjusted for comfort. Patients were instructed to avoid contact with the splint. Patients wore the splint during the day and at night and were instructed to taper their use of the splint during the day as treatment progressed. Patients assigned to the behavioral intervention group were instructed on the impact that parafunctional clenching has on pain. They were also given a demonstration of the impact of tooth contact or “jaw setting” on the activity of the masticatory muscles. They were then given a pager and instructed to check tooth position and masticatory muscle tension when they were paged. If they detected contact or tension at this or any other time, they were instructed to relax the masticatory muscles. The pagers contacted these patients approximately every two hours during the day, but not at night. The initial phase of treatment lasted one month, and follow-up measures were collected approximately 9 months after the end of treatment. Results: Self-report measures of pain decreased significantly for both groups, p < .001, but pain levels did not differ between groups. Conclusions: Behavioral treatment techniques emphasizing awareness and control of parafunctional activity and masticatory muscle tension may be effective treatments for TMD-related pain. This project was conducted with the support of grant DE13563 from the National Institute of Dental and Craniofacial Research