Efficacy of stabilisation splint treatment on the oral health‐related quality of life–A randomised controlled one‐year follow‐up trial

The aim of this randomised controlled trial was to assess the efficacy of stabilisation splint treatment on the oral health‐related quality of life OHRQoL during a 1‐year follow‐up. Originally, the sample consisted of 80 patients (18 men, 62 women) with temporomandibular disorders (TMD) who had been referred to the Oral and Maxillofacial Department, Oulu University Hospital, Finland, for treatment. Patients were randomly designated into splint (n = 39) and control group (n = 41). Patients in the splint group were treated with a stabilisation splint. Additionally, patients in both groups received counselling and instructions on masticatory muscle exercises. The patients filled in the Oral Health Impact Profile‐14 (OHIP‐14) questionnaire before treatment and at 3 months, 6 months and 1 year. At total, 67 patients (35 in the splint group vs. 32 in the control group) completed the questionnaire at baseline. The outcome variables were OHIP prevalence, OHIP severity and OHIP extent. Linear mixed‐effect regression model was used to analyse factors associated with change in OHIP severity during the 1‐year follow‐up, taking into account treatment time, age, gender and group status. OHIP prevalence, severity and extent decreased in both groups during the follow‐up. According to linear mixed‐effect regression, decrease in OHIP severity did not associate significantly with group status. Compared to masticatory muscle exercises and counselling alone, stabilisation splint treatment was not more beneficial on self‐perceived OHRQoL among TMD patients over a 1‐year follow‐up     

Efficacy of stabilisation splint treatment on temporomandibular disorders

Summary The evidence supporting the use of stabilisation splints in the treatment of temporomandibular disorders (TMD) is scarce and a need for well‐controlled studies exists. The aim of this randomised, controlled trial study was to assess the efficacy of stabilisation splint treatment on TMD. The sample consisted of 80 consecutive referred patients who were randomly assigned to the splint group (n = 39) and the control group (n = 41). Subjects in the splint group were treated with a stabilisation splint, whereas subjects in the control group did not receive any treatment except counselling and instructions for masticatory muscle exercises which were given also to the subjects in the splint group. Outcomes were visual analogue scale (VAS) on facial pain intensity and clinical findings for TMD which were measured at baseline and after 1‐month follow‐up. The differences in change between the groups were analysed using regression models. Facial pain decreased and most of the clinical TMD findings resolved in both of the groups. The differences in changes in VAS or clinical TMD findings between the groups were not statistically significant. The findings of this study did not show that stabilisation splint treatment in combination with counselling and masticatory muscle exercises has additional benefit in relieving facial pain and increasing the mobility of the mandible than counselling and masticatory muscle exercises alone in a short time‐interval.     

Efficacy of Appliance Therapy on Temporomandibular Disorder Related Facial Pain and Mandibular Mobility: A Randomized Controlled Study

There is limited evidence supporting the role of occlusal splints in Temporomandibular disorder (TMD) therapy. The aim of this randomized controlled clinical trial was to assess the efficacy of stabilization splint therapy on TMD related facial pain and mandibular mobility. The sample of study consisted of eighty consecutive patients diagnosed with TMD. Patients were randomly assigned into two groups: a splint group (n = 40) comprising of patients treated with stabilization splint, councelling and masticatory muscle exercises, and a control group (n = 40), comprising of patients treated with councelling and masticatory muscle exercises alone. Data from both the groups were collected at the beginning of the study and after a 6-month follow up. The outcome variables were visual analogue scale on facial pain intensity and clinical findings for TMD (anterior maximal opening, mandibular right laterotrusion, mandibular left laterotrusion, mandibular protrusion, and number of painful muscle sites). Changes within the splint and control groups (before treatment and 6 months after treatment) were analyzed using paired samples t test. Differences in change between the splint and control groups were analyzed using independent samples t-test. The level of significance was set at p < 0.05. Facial pain and number of painful muscle sites decreased, and the mandibular mobility increased significantly in both groups after treatment; however the differences in changes in VAS or clinical TMD findings between the two groups were not statistically significant. The findings of this study show that stabilization splint treatment in combination with counselling and masticatory muscle exercises has no additional benefit in relieving facial pain and increasing the mobility of the mandible than counselling and masticatory muscle exercises alone over a 6-months’ time interval.     

Efficacy of stabilisation splint therapy combined with non‐splint multimodal therapy for treating RDC/TMD axis I patients: a randomised controlled trial

Stabilisation splint therapy has long been thought to be effective for the management of temporomandibular disorders (TMD). However, the superiority of stabilisation splint therapy compared to other TMD treatments remains controversial. The aim of this study was to determine the efficacy of stabilisation splint therapy combined with non‐splint multimodal therapy for TMD. A total of 181 TMD participants were randomly allocated to a non‐splint multimodal therapy (NS) group (n = 85) or a non‐splint multimodal therapy plus stabilisation splint (NS+S) group (n = 96). Non‐splint multimodal therapy included self‐exercise of the jaw, cognitive–behavioural therapy, self‐management education and additional jaw manipulation. Three outcome measurements were used to assess treatment efficacy: mouth‐opening limitation, oro‐facial pain and temporomandibular joint sounds. A two‐factor repeated‐measures analysis of variance (anova ) was used to evaluate the efficacy of the two treatment modalities (NS vs. NS+S), and Scheffe's multiple comparison test was used to compare the treatment periods. Subgroup analyses were performed to disclose the splint effects for each TMD diagnostic group. All three parameters significantly decreased over time in both groups. However, there were no significant differences between the two treatment groups in the total comparison or subgroup analyses; an exception was the group with degenerative joint disease. No significant difference between the NS and NS+S treatment approaches was revealed in this study. Therefore, we conclude that the additional effects of stabilisation splint are not supported for patients with TMD during the application of multimodal therapy.     

Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation

Summary The aim of this research was to test the hypothesis that treatment with intra‐oral appliances with different occlusal designs was beneficial in the management of pain of masticatory muscles compared with a control group. A total of 51 patients were analysed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) to obtain the diagnosis of masticatory myofascial pain (MMP). The sample was then randomly divided into three groups: group I (n = 21) wore a full coverage acrylic stabilisation occlusal splint; group II (n = 16) wore an anterior device nociceptive trigeminal inhibitory (NTI) system; and group III (n = 14) only received counselling for behavioural changes and self‐care (the control group). The first two groups also received counselling. Follow‐ups were performed after 2 and 6 weeks and 3 months. In these sessions, patients were evaluated by means of a visual analogue scale (VAS) and pressure pain threshold (PPT) of the masticatory muscles. Possible adverse effects were also recorded, such as discomfort while using the appliance and occlusal changes. The results were analysed with Kruskal–Wallis, anova , Tukey’s and Friedman tests, with a significance level of 5%. Group I showed improvement in the reported pain at the first follow‐up (2 weeks), whereas for groups II and III, this progress was detected only after 6 weeks and 3 months, respectively. The PPT values did not change significantly. It was concluded that behavioural changes are effective in the management of pain in MMP patients. However, the simultaneous use of occlusal devices appears to produce an earlier improvement.     

Comparison of device‐supported sensorimotor training and splint intervention for myofascial temporomandibular disorder pain patients

This study was to compare the short‐term therapeutic efficacy of device‐supported sensorimotor training with that of standard splint therapy for patients with myofascial temporomandibular disorder (TMD) pain over a treatment period of 3 months. We tested the hypothesis that both types of intervention are equally effective for pain reduction. In addition, the electromyographic (EMG) activity of the temporal and masseter muscles was recorded under conditions of force‐controlled submaximum and maximum biting in intercuspation. Of consecutive patients seeking treatment for non‐odontogenic oro‐facial pain, 45 patients with myofascial TMD pain (graded chronic pain status, GCPS, I and II) were randomly assigned to 2 treatment groups (sensorimotor training and conventional splint treatment). Patients were evaluated 4 times (initial examination, 2, 6 and 12 weeks later) by use of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Electromyographic activity was recorded at the initial session and after 3 months. Ease‐of‐use of the treatment options was also evaluated. Significant (P < .0001) pain reduction (sensorimotor training 53%, splint therapy 40%) was achieved for both groups, with no significant differences (P > .05) between the groups. Force‐controlled sub‐maximum normalized electromyographic activity was significantly different between T0 and T3 for group A (sensorimotor training, P < .05) but was not significantly different for group B (splint, P > .05). For normalized maximum‐biting EMG activity in intercuspation, however, a significant increase in EMG activity was observed for group A for the masseter and temporal muscles (P < .001) and for group B for the masseter muscle only (P < .001). Moreover, sensorimotor training was significantly (P < .05) less easy to use than the splint. The results of this study confirm the pain‐reducing effect of sensorimotor training for patients with myofascial TMD pain (GCPS I and II). This innovative active treatment might be a promising option for TMD pain patients.     

A novel vibratory stimulation‐based occlusal splint for alleviation of TMD painful symptoms: a pilot study

This pilot study introduces a novel vibratory stimulation‐based occlusal splint (VibOS) for management of pain related to temporomandibular disorders (TMD). The study sample consisted of 10 patients (mean age: 40·5 ± 13·7 years, male/female: 3/7) who were using stabilisation splints for more than 2 months prior to the study onset and still complained of pain. Patients utilised the active and inactive VibOS during 15 days in a crossover designed clinical trial. The analysed variables were self‐reported VAS pain levels and number of painful sites to palpation (PSP). Statistical analysis was performed with repeated measures anova . At baseline, mean VAS pain levels for group I and II were 45·6 ± 21·0 mm and 37·4 ± 16·3 mm, respectively. Comparison between these baseline values showed no statistical difference (P > 0·05, unpaired t‐test). In group I, the inactive VibOS caused a slight increase in VAS pain levels, whereas the active VibOS promoted a significant decrease in VAS pain levels and PSP (P < 0·01). In group II, which received the active VibOS first, a significant decrease in VAS levels (P < 0·05) and in PSP (P < 0·01) was observed. No significant decrease in VAS pain levels or PSP (P > 0·05) was observed with the use of the inactive VibOS. In conclusion, this study demonstrated a good tendency of this novel VibOS in the alleviation of painful symptoms related to TMD after a 15‐day management period compared to control VibOS.     

Clinical outcomes of patients with bilateral anterior disc displacement without reduction and erosive change of the temporomandibular joint after performance of unilateral arthrocentesis and stabilisation splint therapy

The efficacy of a combination treatment of arthrocentesis and stabilisation splint for patients with bilateral anterior disc displacement without reduction (ADDWoR) and erosive change of the TMJ remains controversial. To evaluate clinical outcomes of patients with ADDWoR and erosive change of the TMJ after performance of unilateral arthrocentesis and stabilisation splint therapy. A retrospective study of 44 patients (37 females, 7 males, mean age of 34 years) with bilateral ADDWoR and erosive change of the TMJ were included in this study. Their clinical outcomes before and after arthrocentesis and stabilisation splint therapy were compared. Evaluation criteria were as follows: (a) Maximal mouth opening (MMO); (b) Right and left maximal lateral movement (RLM, LLM) and maximal protrusive movement (PM); (c) Visual analog scale (VAS) pain score during MMO, RLM, LLM and PM; and (d) VAS pain score during palpation of masticatory muscles. Wilcoxon signed-rank test, Mc Nemar test and paired t test were used for statistical analysis. Differences in VAS pain score between arthrocentesis and non-arthrocentesis sites were not statistically significant except MMO and LLM (P < .05) after 6 months. Differences in mean VAS pain scores for all variables between before arthrocentesis and 6 months follow-up in the arthrocentesis site were statistically significant. (P < .01). Unilateral arthrocentesis on more symptomatic TMJ and subsequent stabilisation splint therapy was highly successful for pain and achievement of normal range of mandibular movements in patients with both ADDWoR and bony change.     

Headache attributed to masticatory myofascial pain: impact on facial pain and pressure pain threshold

There is no clear evidence on how a headache attributed to temporomandibular disorder (TMD) can hinder the improvement of facial pain and masticatory muscle pain. The aim of this study was to measure the impact of a TMD‐attributed headache on masticatory myofascial (MMF) pain management. The sample was comprised of adults with MMF pain measured according to the revised research diagnostic criteria for temporomandibular disorders (RDC/TMD) and additionally diagnosed with (Group 1, n = 17) or without (Group 2, n = 20) a TMD‐attributed headache. Both groups received instructions on how to implement behavioural changes and use a stabilisation appliance for 5 months. The reported facial pain intensity (visual analogue scale – VAS) and pressure pain threshold (PPT – kgf cm^?2) of the anterior temporalis, masseter and right forearm were measured at three assessment time points. Two‐way anova was applied to the data, considering a 5% significance level. All groups had a reduction in their reported facial pain intensity (P < 0·001). Mean and standard deviation (SD) PPT values, from 1·33 (0·54) to 1·96 (1·06) kgf cm^?2 for the anterior temporalis in Group 1 (P = 0·016), and from 1·27 (0·35) to 1·72 (0·60) kgf cm^?2 for the masseter in Group 2 (P = 0·013), had significant improvement considering baseline versus the 5th‐month assessment. However, no differences between the groups were found (P > 0·100). A TMD‐attributed headache in patients with MMF pain does not negatively impact pain management, but does change the pattern for muscle pain improvement.     

Natural course of temporomandibular disorders with low pain‐related impairment: a 2‐to‐3‐year follow‐up study

To describe the natural course of temporomandibular disorders (TMD) in patients with low levels of pain‐related impairment, independently by the physical diagnoses they received. Amongst all patients who attended the TMD Clinic, University of Padova, Italy, during the year 2009, those who: (i) had Research Diagnostic Criteria for TMD (RDC/TMD) axis II Graded Chronic Pain Scale (GCPS) grade 0 or 1 scores, (ii) received counselling on their signs and symptoms at the time of their first visit and suggestions on how to self‐manage their symptoms, (iii) did not attend the Clinic since the time of their last visit and (iv) were visited by the same resident, were recalled for a follow‐up assessment during the period from September to December 2011. Sixty‐nine patients (79% females; mean age 47.4 ± 11.3 years; range 26–77) of 86 who were potentially eligible accepted to enter the study. The time span since the first visit ranged from 23 to 36 months. At the follow‐up assessment, the percentage of patients with muscle disorders decreased from 68.1% to 23.1%; disc displacement with reduction remained unchanged (52.1%), whilst the 5.7% of patients who had disc displacement without reduction with limited opening then showed absence of limitation; diagnoses related to other joint disorders decreased from 30.4% to 14.4% for arthralgia and from 27.5% to 24.6% for osteoarthritis/osteoarthrosis. In a sample of patients TMD with low pain‐related impairment followed up with a single recall assessment at 2‐to‐3 years, the natural course of disease was generally favourable.     

Questionable effect of lavage for treatment of painful jaw movements at disc displacement without reduction: a 3‐year randomised controlled follow‐up

The present randomised controlled study compared the 3‐year outcome of local anaesthetics with anaesthetics and lavage in patients suffering from painful temporomandibular joint (TMJ) locking. The study included 45 patients referred for treatment of temporomandibular disorders (TMD) to the Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden. All patients received a history questionnaire and clinical examination according to the Research Diagnostic Criteria for TMD, panoramic radiographs and magnetic resonance imaging at baseline. Twenty‐five patients were randomised to anaesthetics alone and 20 patients to anaesthetics and lavage. Three years after treatment, we sent the 37 patients who were available for follow‐up a questionnaire that evaluated pain intensity, physical and emotional functioning, and global improvement. Thirty‐four patients responded. The primary outcome was defined as ≥ 30% pain relief. In an intention‐to‐treat analysis, 28 of 45 patients (62%) reported ≥ 30% pain relief at the follow‐up. At 3 years, improvement in pain relief, physical functioning, emotional functioning and global improvement differed non‐significantly between local anaesthetics and anaesthetics and lavage. Compared with baseline, significant improvements (P < 0·05) in pain intensity, physical functioning, emotional functioning and global changes had occurred in both groups after 3 years. Because outcome measurements in the local anaesthetics and lavage and the local anaesthetics groups differed non‐significantly 3 years after treatment of painful TMJ disc displacement without reduction, use of lavage (50 mL saline) has an equivalent effect as local anaesthetics.     

Improvement in patients with a TMD‐pain report. A 6‐month follow‐up study

Even though chronic TMD pain tends to persist in most patients, some chronic patients show improvement. It is largely unknown which factors contribute to the improvement of chronic pain. The aim of this study is to investigate which factors, from a biopsychosocial perspective, help to predict improvement in patients with a report of TMD pain. Methods: Subjects with a report of TMD pain were recruited in seven TMD clinics. They received a baseline questionnaire which included a wide range of possible predictors for improvement. After 6 months they received a follow‐up questionnaire which included a measure to determine which participants were ‘improved’ or ‘not improved’. To study which predictive variables were associated with improvement, multiple regression models were built. Results: From the 129 patients who responded to the baseline questionnaire, 100 patients also filled in the follow‐up questionnaire (85% women, mean age (years) ± s.d. = 46·0 ± 13·8). Fifty percentage of these subjects had improved at the 6‐month follow‐up. Pain duration was the strongest (negative) predictor for 6‐month improvement (P = 0·009). Also the number of care providers (P = 0·017) and the degree of hindrance on function (P = 0·045) helped to predict improvement. Conclusions: The duration of the TMD‐pain complaint, the number of care practitioners attended and the degree of hindrance on function (negatively) helped to predict 6‐month improvement. No evidence is found to support the role of psychological or social factors on the improvement in patients with a report of TMD pain.     

Delayed‐onset muscle soreness in human masticatory muscles increases inhibitory jaw reflex responses

The effects of masticatory muscles’ overloading on jaw‐motor control are not yet fully clarified. Therefore, it was tested whether eccentric and concentric exercises of the human masticatory muscles would influence inhibitory jaw reflex responses. Eleven participants (6 males, 5 females) performed 6, 5‐minutes bouts of eccentric‐concentric contractions. Before, immediately after, 24 hours, 48 hours and 1 week afterwards, visual analogue scale (VAS) scores for jaw muscle fatigue and pain, maximum voluntary bite force (MVBF) and inhibitory jaw reflexes were recorded. Reflex data were analysed with the cumulative sum control chart error box method. Immediate and delayed masticatory muscle fatigue and pain were provoked. Further, 24 hours after the exercises, MVBF tended to decrease (P = .056), suggesting that delayed‐onset muscle soreness (DOMS) was provoked in the masticatory muscles. In addition, the inhibitory jaw reflex showed a delayed increase in size 24 hours after the exercise (P < .05). In conclusion, DOMS provoked in the masticatory muscles alters jaw motor control by inducing a delayed increase in the size of the inhibitory jaw reflex.     

2种咬合板治疗颞下颌关节紊乱病的临床疗效分析

目的：研究松弛型咬合板和稳定型咬合板治疗颞下颌关节紊乱病(TMD)的疗效。方法：选择以口颌面部疼痛为主诉的TMD患者68例(急性30例,慢性38例),每组分别戴用松弛型咬合板和稳定型咬合板,比较分析治疗前、后颞肌前束(TA)、咬肌(MM)肌电值及关节疼痛强度的变化。采用SPSS 11.0 软件包对数据进行方差分析和t检验。结果：①静息状态下,2种咬合板治疗后,患者双侧TA及MM肌电电位均较治疗前显著下降(P<0.05)。②紧咬状态下,松弛型咬合板治疗的急性组患者双侧TA及MM肌电电位均较治疗前显著上升,而慢性组患者仅双侧MM肌电电位较治疗前显著上升(P<0.05);稳定型咬合板治疗组患者双侧TA肌电电位治疗前后无显著差异,仅双侧MM肌电电位较治疗前显著上升。③2种咬合板治疗后,患者疼痛指数均较治疗前显著下降;但松弛型咬合板治疗后,在功能状态下,急性组患者疼痛缓解的程度更显著。结论：松弛型和稳定型咬合板均对咀嚼肌有松弛作用,能缓解TMD疼痛,但松弛型咬合板治疗急性TMD患者的疗效更加显著。     

不同类型咬合板缓解TMD疼痛症状的研究

目的:研究松弛型咬合板和稳定型咬合板缓解颞下颌关节紊乱病(TMD)疼痛症状的疗效。方法:选择TMD患者68例(急性期30例,慢性期38例),每组又分两个亚组,分别戴用松弛型咬合板和稳定型咬合板,使用视觉模拟量表评价患者治疗前后疼痛强度的变化。结果:①戴咬合板后静息状态下急、慢性组患者疼痛指数均较戴咬合板前明显下降(P<0.05),两种咬合板缓解疼痛的程度无明显差异;②戴咬合板后功能状态下急、慢性组患者疼痛指数均较戴咬合板前明显下降(P<0.05),但急性组戴松弛型咬合板疼痛缓解程度更显著。结论:松弛型和稳定型咬合板能缓解TMD疼痛,松弛型咬合板缓解TMD急性患者疼痛症状更显著。     

Two repetitive bouts of intense eccentric‐concentric jaw exercises reduce experimental muscle pain in healthy subjects

High‐intensity eccentric‐concentric contractions of the jaw‐closing muscles induce muscle soreness, fatigue and functional impairment of the jaw, resembling the symptoms of myalgia, according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). However, it is claimed that repetition of similar exercises can minimise these detrimental effects. This study aimed to evaluate the response of jaw‐closing muscles following two series of intense eccentric‐concentric exercises of the masticatory muscles in healthy subjects. Twelve pain‐free participants underwent 2 sessions of intense eccentric‐concentric jaw exercises, with 1‐week interval in between. Each session of jaw exercises comprises 6 sets of 5‐minute‐long bouts of concentric‐eccentric contractions. Self‐reported muscle fatigue and pain, maximum mouth opening without pain (MMO), pain pressure thresholds (PPTs) of temporalis and masseter muscles and maximum voluntary bite force (MVBF) were recorded before, immediately after, 24 and 48 hours after each bout of exercises. ANOVA for repeated measurements was used to analyse the data. During session 2, muscle pain and fatigue were statistically significantly decreased (P < .05) as compared to session 1. Furthermore, statistically significant increases of MVBF (P < .005), MMO (P < .005) and PPTs (P < .005) were found at session 2 as compared to session 1. Within the limitations of the study, is can be concluded that the repetition of eccentric‐concentric jaw‐closing exercises results in signs of muscle training. Future studies can elucidate whether this motor training might be useful for the treatment of myalgia.     

The efficacy of occlusal appliance therapy in patients with temporomandibular disorders of mainly myogenous pain. A randomized controlled trial in a short-term perspective

The aim of the present study was to compare the efficacy of physiotherapy and counselling for the treatment of myofascial pain of the jaw muscles. Sixty-three consecutive myogenous TMD patients, diagnosed according to the RDC-TMD criteria, were assigned to two treatment groups with a balanced-block randomization. The first group received only counselling with general information about self-care of jaw musculature. The second group received the same general information supplemented by self-massage, application of moist heating pads and stretching exercises of the masticatory muscles.
Treatment success was decided on treatment contrast (TC), based on relative changes of sufficiently large anamnestic and clinical scores ( van der Glas and van Grootel, 2000 ). Additional measurements included pressure pain threshold (PPT) of the masseter, anterior temporalis and Achilles' tendon, pain during gum chewing and spontaneous muscle pain scores rated on visual analogue scales (VAS). Data were collected at baseline and 3 months after start of treatment. Mann–Whitney's test and Fisher's exact test were used for statistical analysis. Sixteen patients dropped out from the study: eight from the counselling and eight from the physiotherapy group. The success rate was 13 of 23 (57%) patients for counselling and 18 of 24 (75%) for the physiotherapy group ( P  > 0·05). There was no significant difference between groups in all the other variables.
Over a short-term period, physiotherapy, as used in this protocol, does not appear superior to counselling for the treatment of TMD myofascial pain .     

Effect of high‐frequency bio‐oxidative ozone therapy for masticatory muscle pain: a double‐blind randomised clinical trial

To evaluate the effect of bio‐oxidative ozone application at the points of greatest pain in patients with chronic masticatory muscle pain. A total number of 40 (40 women, with a mean age of 31·7) were selected after the diagnosis of myofacial pain dysfunction syndrome according to the Research Diagnostic Criteria for temporomandibular disorder (RDC/TMD). The patients were randomly divided into two groups: patients received the ozone therapy at the point of greatest pain, ozone group (OG; n = 20); patients received the sham ozone therapy at the point of greatest pain, placebo group (PG; n = 20). Ozone and placebo were applied three times per week, for a total of six sessions. Mandibular movements were examined, masticator muscles tenderness were assessed and pressure pain threshold (PPT) values were obtained. Subjective pain levels were evaluated using visual analogue sale (VAS). These assessments were performed at baseline, 1 month and 3 months. Ozono therapy decreased pain intensity and increased PPT values significantly from baseline to 1 month and 3 months in OG compared with PG. PPTs of the temporal (OG = 24·85 ± 6·65, PG = 20·65 ± 5·43, P = 0.035) and masseter (OG = 19·03 ± 6·42, PG = 14·23 ± 2·95, P = 0.007) muscles at 3 months of control (T2) were significantly higher in the OG group. PPT value of the lateral pole was also significantly higher at T2 in the OG group (OG = 21·25 ± 8·43, PG = 15·35 ± 4·18, P = 0.012). Mandibular movements did not show significant differences between treatment groups except right lateral excursion values at T2 (OG = 8·90 ± 1·77, PG = 6·85 ± 2·41, P = 0.003); however, OG demonstrated significantly better results over time. Overall improvements in VAS scores from baseline to 3 months were OG 67·7%; PG 48·4%. Although ozone therapy can be accepted as an alternative treatment modality in the management of masticatory muscle pain, sham ozone therapy (placebo) showed significant improvements in the tested parameters.     

Validity of self‐reported sleep bruxism among myofascial temporomandibular disorder patients and controls

Sleep bruxism (SB), primarily involving rhythmic grinding of the teeth during sleep, has been advanced as a causal or maintenance factor for a variety of oro‐facial problems, including temporomandibular disorders (TMD). As laboratory polysomnographic (PSG) assessment is extremely expensive and time‐consuming, most research testing this belief has relied on patient self‐report of SB. The current case–control study examined the accuracy of those self‐reports relative to laboratory‐based PSG assessment of SB in a large sample of women suffering from chronic myofascial TMD (n = 124) and a demographically matched control group without TMD (n = 46). A clinical research coordinator administered a structured questionnaire to assess self‐reported SB. Participants then spent two consecutive nights in a sleep laboratory. Audiovisual and electromyographic data from the second night were scored to assess whether participants met criteria for the presence of 2 or more (2+) rhythmic masticatory muscle activity episodes accompanied by grinding sounds, moderate SB, or severe SB, using previously validated research scoring standards. Contingency tables were constructed to assess positive and negative predictive values, sensitivity and specificity, and 95% confidence intervals surrounding the point estimates. Results showed that self‐report significantly predicted 2+ grinding sounds during sleep for TMD cases. However, self‐reported SB failed to significantly predict the presence or absence of either moderate or severe SB as assessed by PSG, for both cases and controls. These data show that self‐report of tooth grinding awareness is highly unlikely to be a valid indicator of true SB. Studies relying on self‐report to assess SB must be viewed with extreme caution.     

Effects of delayed‐onset muscle soreness on masticatory function

The aim was to clarify the effects of experimentally provoked delayed‐onset muscle soreness (DOMS) in the jaw‐closing muscles on subjective and objective measures of masticatory function. Twenty‐one dentate female subjects, without pain‐related signs and symptoms of temporomandibular disorders, participated. Delayed‐onset muscle soreness was provoked with eccentric and concentric contractions of the jaw‐closing muscles using a custom‐made apparatus. At baseline, and 24 h and 1 wk after the exercises, data were gathered on the subjective measures of muscle fatigue, muscle pain, and masticatory chewing ability using visual analogue scale (VAS) scores, on the maximum voluntary bite force (MVBF), and on the food Mixing Ability Index (MAI). After 24 h, muscle fatigue and muscle pain had increased and the MAI had decreased. All had returned to baseline levels after 1 wk. There were no significant changes found in the chewing ability VAS scores and in the MVBF over time. After correction for its baseline value, the MAI after 24 h was found to be significantly related to the muscle pain after 24 h. In conclusion, DOMS in the jaw‐closing muscles can cause a decrease in the objectively scored chewing ability, while the subjectively scored chewing ability remained the same.