Response of patients with myofascial pain-dysfunction syndrome to mock equilibration

Goodman, Phil; Greene, Charles S.; Laskin, Daniel M.

doi:10.14219/jada.archive.1976.0419

Cited by 116 publications

(29 citation statements)

References 14 publications

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“…Furthermore, in the absence of a control group (Okeson et al, 1982;Tsuga et al, 1989;Wilkinson et al, 1992), and in light of the evidence showing the cyclical fluctuation of MFP symptoms over time (Dworkin et al, 1991;Hampf, 1992; Dao et al, 1995a,b;Huggins et al, 1996), it is not possible to determine whether the decrease in pain observed in the study represented the specific outcome of the treatment or the natural progression of the condition toward a more quiescent phase. As well, it is likely that the positive results could be due, in part, to the placebo effect which is often associated with the treatment of MFP, and which has been observed in 30-64% of the patients (Greene and Laskin, 1971Laskin, , 1972Laskin, , 1983Goodman et al, 1976). One can also argue that the patients' desire to please or gratify their clinician may have accounted for the favorable data which were not collected under blind conditions (Greene and Laskin, 1972;Okeson et al, 1982;Clark et al, 1988;Suvinen and Reade, 1989;Tsuga et al, 1989;List et al, 1992;Wilkinson et al, 1992;Turk et al, 1993;Visser et al, 1995 (Verban, 1986;Wright, 1988;Ahlin, 1991;Bledsoe, 1991;Williams, 1991) and studies (Harkins et al, 1988;Wright et al, 1995), aggravation of the symptoms has been observed in some patients (Nevarro et al, 1985;Harkins et al, 1988).…”

Section: (C) Clinical Efficacy/effectivenessmentioning

confidence: 99%

Oral Splints: the Crutches for Temporomandibular Disorders and Bruxism?

Dao

Lavigne

1998

Critical Reviews in Oral Biology & Medicine

258

143

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Despite the extensive use of oral splints in the treatment of temporomandibular disorders (TMD) and bruxism, their mechanisms of action remain controversial. Various hypotheses have been proposed to explain their apparent efficacy (i.e., true therapeutic value), including the repositioning of the condyle and/or the articular disc, reduction in the electromyographic activity of the masticatory muscles, modification of the patient's "harmful" oral behavior, and changes in the patient's occlusion. Following a comprehensive review of the literature, it is concluded that any of these theories is either poor or inconsistent, while the issue of true efficacy for oral splints remains unsettled. However, the results of a controlled clinical trial lend support to the effectiveness (i.e., the patient's appreciation of the positive changes which are perceived to have occurred during the trial) of the stabilizing splint in the control of myofascial pain. In light of the data supporting their effectiveness but not their efficacy, oral splints should be used as an adjunct for pain management rather than a definitive treatment. For sleep bruxism, it is prudent to limit their use as a habit management aid and to prevent/limit dental damage potentially induced by the disorder. Future research should study the natural history and etiologies of TMD and bruxism, so that specific treatments for these disorders can be developed.Key words. Oral splints, temporomandibular disorders, bruxism, myofascial pain, disc displacement disorders. (I) IntroductionAmong the treatments provided for temporomandibular disorders (TMD), intra-oral dental appliances, whether with full or partial occlusal coverage, and referred to in this paper as oral splints, have been repeatedly reported as being the most widely adopted choice. Introduced by Karolyi in 1901 (see Ramfjord and Ash, 1994) for the treatment of bruxism, it is striking to see the versatility of their current applications. Other than their use in the prevention of dental injuries and oral soft-tissue trauma potentially induced by bruxism, sports, cheek biting (Walker and Rogers, 1992), and electroconvulsive therapy (Minneman, 1995), oral splints of various designs have been prescribed in the management of diverse disorders including: (a) motor disorders such as Parkinson's disease (Durham et al., 1993) and oral tardive dyskinesia (Kai et al., 1994); (b) sleep disorders such as snoring (George, 1993) and sleep apnea (George, 1993;Athanasiou et al., 1994;Lowe, 1994;Yoshida, 1994;Osseiran, 1995); (c) sensitive teeth related to chronic sinusitis (Dawson, 1974); (d) various headaches, from the tension-type to migraine (Ouayle et al., 1990;Lamey and Steele, 1996); and (e) all subgroups of TMD, e.g., myofascial pain, disc displacement disorders, and the arthritides (Table 1).It is also surprising to see the wide acceptance of oral splints and their "multi-purpose usage", while little is known about the mechanisms by which they exert their effect. For the TMD, a survey of 10,000 members of...

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Section: (C) Clinical Efficacy/effectivenessmentioning

confidence: 99%

Oral Splints: the Crutches for Temporomandibular Disorders and Bruxism?

Dao

Lavigne

1998

Critical Reviews in Oral Biology & Medicine

258

143

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“…In the past, it was assumed that occlusal analysis could identify those who were at risk (Dawson, 1989;Mahan and Alling, 1991). However, there is very little evidence of a cause-and-effect relationship between occlusion and TMD (Magnusson and Enbom, 1984;Mohl, 1993), and the efficacy of mock occlusal adjustments in reducing symptoms (Goodman et al, 1976;Tsolka and Preiskel, 1993) has undermined the rationale for prophylactic occlusal therapy. As mentioned above, joint sounds are very prevalent in the asymptomatic population (Dworkin et al, 1990a), and many sounds change or even disappear with time (Greene and Laskin, 1988;de Leeuw et al, 1994).…”

Section: Diagnostic Validitymentioning

confidence: 99%

Validity of Diagnostic and Monitoring Tests Used for Temporomandibular Disorders

1995

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Currently, diagnosis of temporomandibular disorders (TMD) depends on a comprehensive history and physical examination, supplemented, when indicated, by images of hard and soft tissues. However, there are electronic diagnostic devices being marketed to acquire other measures described as relevant to TMD and to use these for diagnosis of TMD and for monitoring the effects of treatment. This paper reviews the capacity of several devices to measure these variables accurately and reliably and to assess the theoretical basis of each of these tests. Diagnostic ability was established, when possible, according to the commonly accepted measures of sensitivity, specificity, and positive predictive values. It was found that many tests lack theoretical validity, that measurement validity tends to be poor, and that diagnostic ability can be even worse than chance, because of a high percentage of false-positive diagnoses. Based on these findings, the use of these instruments in clinical practice is inappropriate at this time and may lead to the treatment of large numbers of subjects who have no disorder.

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“…It is of considerable inter est that a fairly high percentage of patients respond to placebo treatment. In two studies, approximately one third to one half of the patients improved after treatment with a pla cebo drug [44.46], Some sort o f 'dental place bos' also proved effective: 28 patients out of 71 reported improvement in symptoms after wearing a non-occluding placebo splint for 2-6 weeks [47], while 16 patients out of 25 reported a striking subjective improvement after two sessions of mock equilibration [48]. These positive placebo responses do not mean that pain is imaginary or that the patients are gullible; rather, they probably reflect the psychophysiologic impact of the doctor-patient relationship [46], In a functional perspective, psychotherapy may be the therapy of choice.…”

Section: Treatmentmentioning

confidence: 99%

Temporomandibular Joint Pain-Dysfunction Syndrome and Bruxism: Etiopathogenesis and Treatment from a Psychosomatic Integrative Viewpoint

Biondi¹,

Picardi²

1993

Psychother Psychosom

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It is common opinion that temporomandibular joint pain-dysfunction (TMJPD) syndrome and bruxism have a major psychosomatic component. In this paper, we try to review these entities in an integrated manner, taking into account both medical and psychological aspects. Two etiological models have been developed: the structural model emphasizes the role played by malocclusion or alterations of the maxillomandibular relationship, while the functional model underscores the role of stress, emotional tension, and personality characteristics. In TMJPD and bruxist patients a careful physical and psychological examination has to be performed. The classical dental treatment is based on equilibration procedures, prostheses and drugs. Treatment strategy can also be based on psychotherapeutic and relaxation treatments; in this respect, the use of EMG biofeedback training has been subjected to intense study.

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Response of patients with myofascial pain-dysfunction syndrome to mock equilibration

Cited by 116 publications

References 14 publications

Oral Splints: the Crutches for Temporomandibular Disorders and Bruxism?

Oral Splints: the Crutches for Temporomandibular Disorders and Bruxism?

Validity of Diagnostic and Monitoring Tests Used for Temporomandibular Disorders

Temporomandibular Joint Pain-Dysfunction Syndrome and Bruxism: Etiopathogenesis and Treatment from a Psychosomatic Integrative Viewpoint

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