The relative effectiveness of three treatment protocols in the management of temporomandibular disorder

Abstract

The relationship between TMD and dysfunction in the cervical spine has been reported in the literature and there are many case studies which have shown favourable results when treatment was aimed at the TMJ, cervical spine relationship. However, the numerous TMD treatment protocols described in the literature concerning this relationship, and the effectiveness of these treatments have not been well established. In spite of this many chiropractors treat TMD. TMD is a multifactoral condition and conservative treatment options need to be further investigated in order to determine if manual interventions directed at the cercival spine in the treatment of TMD are beneficial. Objectives: The purpose of this study was to compare myofascial trigger point therapy and manipulative therapy of either the TMJ, cervical spine or a combination of the two in order to determine their effectiveness for the TMD. Method: Thirty participants with TMD were randomly assigned to one of three treatment groups. Participants in each group received two treatments per week for two weeks with a follow up consultation in the third week. Data were collected before the commencement of the first, second, and fourth treatments and at the follow up consultation. Outcome measures included algometer readings, CROM, Mouth opening readings, NRS and a disability questionnaire. SPSS version 15.0 was used for analysis of the data. A p value <0.05 was considered as statistically significant. Multivariate testing was used for intra- and inter-group comparisons. Profile plots were generated to assess the direction and trend of the effect and to visually compare the trends in the different treatment groups. Results: Inter-group comparisons did not reveal any statistically significant different improvements between the three treatment groups. Conclusion: All groups responded favourably to treatment and showed trends towards improvement. However, statistically analysis revealed that no one treatment protocol was superior to the other. Although no definitive inferences may be drawn regarding the effectiveness of each treatment approach, within group trends indicated that the combination of the two treatment approaches may be preferred.