Comparison of three treatment options for painful temporomandibular joint clicking

A randomized clinical trial was performed to evaluate the efficacy of three treatment options, including anterior positioning splint therapy, physical therapy, and physical therapy in addition to splint therapy, in terms of treatment outcome, in patients with painful temporomandibular joint clicking. Sixty patients suffering from acute pain and dysfunction were divided randomly into three treatment groups. Twenty patients underwent anterior positioning splint therapy (group I), 20 patients received solely physical therapy (group II), and 20 subjects received physical treatment in addition to splinting (group III). All patients were examined before and after the treatment using a visual analogue scale (VAS) and digital palpation of joint sounds. The data were analyzed using the Kruskal-Wallis, one-way ANOVA and Tukey tests at a significance level of P < 0.05. In comparison with the baseline, subjective pain was decreased significantly (P < 0.05) in all three groups. A significant difference was observed between groups I and II (P <0.05), whereas no significant difference was detected between groups II and III. Six patients in group III did not continue the treatment after physical therapy. The numbers of pain-free patients were 12 in group I, 5 in group II and 9 in group III. We observed a reduction in the frequency of joint sounds across the entire sample (P < 0.05). Anterior positioning splint therapy appears to be the best treatment method for reduction of pain and joint sounds in patients with TMD, compared with the other two methods studied.