Investigation of the effectiveness of manual therapy and splint therapy in patients with bruksizm-induced myofascial temporomandibular dysfunction

This study was aimed to examine the effect of manual therapy on temporomandibular pain, joint patency, jaw functionality, sleep quality, fatigue, neck disability and patient satisfaction, and to compare its effectiveness with splint therapy among female patients with bruxism-induced Myofascial Temporomandibular Dysfunction (M-TMD). 29 female patients with diagnosis of bruxism, ages of 18-50, who were admitted to the dental clinics of Kahramanmaraş Sütçü İmam University Faculty of Dentistry and Türkoğlu Dr. Kemal Beyazıt Physical Therapy and Rehabilitation Hospital were included. Simple randomization method was applied to divide subjects into two groups: Manual Therapy (MT)(n = 15) and Splint Therapy (ST)(n = 14). Patient education, home exercise and a static splint designed by the dentist, was provided to the subjects in ST group. It was required to use the dental splint for a month as instructed. Subjects in the MT group received comprehensive manual therapy program, including cranial and cervical mobilizations in addition to the same program of the ST group. MT program was applied 2 sessions with 45 minutes each per week, for a total of 8 sessions. The demographic data of the subjects were recorded before the treatment. Posture, cervical and temporomandibular joint range of motion, pain severity, and trigger point sensitivity were evaluated. All the subjects were evaluated with the following tests; the level of jaw functionality with Jaw Function Limitation Scale (JFLS), quality of sleep with Pittsburgh Sleep Quality Index (PUKI), disability of neck level with Neck Disability Index (NDI), level of fatigue with the Fatigue Severity Scale (FSS), level of headache with Headache Impact Test (HIT-6) and satisfaction of the patients with Patient Satisfaction Quality Form (PSQ-18). Assessments were repeated at the end of the four-weeks and analyzed with the appropriate statistical programs. Comparing the pre and post-treatment data of both groups, a statistically significant difference was found in jaw, head and neck pain, trigger point sensitivity, cervical and temporomandibular joint range of motion, fatigue level and sleep quality (p<0.05). After the treatment, comparing the two groups to each other, there was a statistically significant difference among all the parameters in favor of the MT group (p<0.05). Among PSQ-18 measurements, overall satisfaction average, interpersonal attitude, health care score average and overall satisfaction total score were found to be statistically significant in the MT group (p <0.05). As a result, we believe the manual therapy program, including cervical and cranial mobilizations is effective in patients with bruxism-induced myofascial temporomandibular dysfunction. It is thought that the combination of splint therapy and manual therapy program will increase the effectiveness of the treatment.