March 2009

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Manual therapy and acupuncture help treat TMD

Symptoms of temporomandibular joint dysfunction (TMD) consist of pain, limited mouth opening, crepitus, and a clicking sound.

Typically, treatment of TMD, a disease that negatively affects the temporomandibular joint (TMJ) or the surrounding masticatory musculature, is nonspecific, with a wide range of therapies, including physical therapy, chiropractic treatment, and acupuncture — not producing full results.

However, one study, titled “Effectiveness of Combining Manual Therapy and Acupuncture on Temporomandibular Joint Dysfunction: A Retrospective Study,” investigated the combined use of manual therapy and acupuncture in treating clients with TMD. The results were favorable.

Forty-nine participants with TMD were analyzed for this retrospective study. They were treated with a combination of manual therapy and acupuncture two or three times a week at Wonkwang Medical Center in South Korea. These participants included 15 men and 34 women, with an average age of 30.47.

Stainless-steel acupuncture points were inserted into treatment locations and were rotated back and forth until the subject experienced the sensation of De-Qi. The acupuncture procedure lasted 20 minutes and was administered without electrical stimulation. Gentle muscle-release and manipulation techniques were applied to the lateral and medial pterygoid masseter and temporalis muscles on either the involved side or both sides after acupuncture.

The participants were measured on a Visual Analogue Scale (VAS) for their pain level and maximal mouth opening (MMO) before and after the first and fourth week of treatment.

The combination of acupuncture and manual therapy showed a significant decrease in pain (36.9 percent after one week and 69.1 percent after four weeks), as well as an increase in MMO (11.7 after one week and 21.7 percent after four weeks).

While the authors say the study provides a foundation for the exploration of manual therapy and acupuncture as a nonpharmacological therapy for reducing pain and MMO in people with TMD, they recommend a follow-up study, with possibly a control treatment, be conducted to further investigate the efficacy of the combined treatment.

References

1 Research Reports, MASSAGE Magazine, Issue 134, July 2007.

2 Byung-Cheul Shin, Chung-Hyo Ha, Yung-Sun Song, and Myeong Soo Lee. Department of Oriental Rehabilitation Medicine, College of Oriental Medicine, WonkwangUniversity, Iksan, South Korea. “Effectiveness of Combining Manual Therapy and Acupuncture on temporomandibular Joint Dysfunction: A Retrospective Study.” The American Journal of Chinese Medicine, Vol. 35, No. 2, 203-208.

3 Byung-Cheul Shin, Chung-Hyo Ha, Yung-Sun Song, and Myeong Soo Lee. Center for Integrative Medicine,

TEMPOROMANDIBULAR DISORDERS (TMD/TMJ)

More than 15 percent of American adults suffer from chronic facial pain. Some common symptoms include pain in or around the ear, tenderness of the jaw, clicking or popping noises when opening the mouth, or headaches and neck aches.

Two joints and several jaw muscles make it possible to open and close the mouth. They work together when you chew, speak, and swallow. These structures include muscles and ligaments, as well as the jaw bone, the mandible (lower jaw) with two joints, the TMJs.

The TM joint is located on each side of the head, and work together to make many different movements, including a combination of rotating and translocational (gliding) action, used when chewing and speaking.

Several muscles help open and close the mouth. They control the lower jaw (mandible) as it moves forward, backward, and side-to-side. Each TM joint has a disc between the ball and socket.

The disc cushions the load while enabling the jaw to open widely and perform rotating and translocational movements. Any problem that prevents this complex system of muscles, ligaments, discs, and bones from working together properly may result in a painful TMJ disorder.

Diagnosis and treatment

Some TM problems result from arthritis, dislocation, and injury. All of these conditions can cause pain and dysfunction. Muscles that move the joints are also subject to injury and disease. Injuries to the jaw, head, or neck, and diseases, such as arthritis, might result in some TM problems. Other factors that relate to the way the teeth fit together (the bite) may cause some types of TMD, and stress is thought to be a factor.

There are several ways the TMJ disorders may be treated. A dentist will recommend what type of treatment is needed for a patient’s particular problem, or refer to a specialist. Treatment may involve a series of steps because sometimes only minor, relatively noninvasive treatment may be needed.

Part of the examination includes checking the joints and muscles for tenderness, and for any clicking, popping, or difficulty moving. The patient’s complete medical history may be reviewed, so records must be kept up-to-date. Often times x-rays or a “cast” of the patient’s teeth to see how his or her bite fits together are necessary.

Source: American Dental Association, www.ada.org

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