Randomized Clinical Study of Initial Treatment for Temporomandibular Disorder ADDWOR

Objectives: A various treatment modalities have been proposed for patients with temporomandibular disorders (TMD) anterior disc displacement without reduction (ADDWOR). This study compared the effectiveness of splint and physical therapy for ADDWOR patients in a prospective randomized manner. Methods: From consecutive series of 856 TMD new patients who visited TMJ clinic at Tokyo Medical and Dental University from January to June 2006, 26 subjects (female: 23, male: 3, age: 37.3 ± 15.1) were selected according to the following inclusion criteria: over 18 years old, having pain on mouth opening with TMJ affected side, over 2 weeks after an onset of locking, mouth opening range < 40mm, and ADDWOR confirmed with MRI. Subjects were randomly assigned to one of two treatment groups: a splint treatment; a joint mobilization exercise. The splint group subjects were treated with flat occlusal appliance wearing while sleeping. The joint mobilization exercise group subjects were instructed to perform manual jaw opening exercise by themselves four times a day. The measured four outcome variables were maximum mouth opening range, visual analogue scale (VAS) for present pain intensity and food intake difficulty, and limitation of daily activities. The effect of these treatments was evaluated at a 4-week time point. For statistical analysis, the paired t-test was used to compare the outcome variables before and after treatment in each group (P<.05). Results: After 4-week follow up, significant improvement was observed in the joint mobilization exercise group with maximum mouth opening range, VAS for present pain intensity and food intake difficulty (P=.00), but no significant changes in splint group. Variable of limitation of daily activities significantly improved in both groups (P<.03). Conclusion: Applying a self joint mobilization exercise for TMD ADDWOR patients proved to be effective for better improvement of TMJ function and impairment of daily life.