Acupuncture therapeutic protocols for the management of temporomandibular
                  disorders

Porporatti, André Luís; Costa, Yuri Martins; Stuginski-Barbosa, Juliana; Bonjardim, Leonardo Rigoldi; Conti, Paulo César Rodrigues

doi:10.5935/1806-0013.20150011

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REVIEW ARTICLES • Rev. dor 16 (1) • Jan-Mar 2015 • https://doi.org/10.5935/1806-0013.20150011 copy

Acupuncture therapeutic protocols for the management of temporomandibular disorders^* * Received from the Prosthesis Department, School of Dentistry of Bauru, University of São Paulo, Bauru, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND AND OBJECTIVES:

For most cases, temporomandibular disorders should be treated by a non-invasive, interdisciplinary and integrative process. In traditional Chinese medicine, acupuncture is an excellent tool aiming at treating and healing this disease. This study was a critical literature review to observe the efficacy of traditional Chinese acupuncture to treat muscular temporomandibular disorders and to identify primary acupoints.

Pubmed, LILACS, Scielo and Cochrane databases were queried to identify scientific articles relevant for the study. Articles were selected from January 2000 to May 2013. A total of 125 articles were found and 21 were included. Acupuncture treatment alone or as additional therapy, or even compared to other techniques, was superior and effective to improve pain and function of patients with temporomandibular disorders and most commonly used acupoints were IG4, E6, E7 and F3.

CONCLUSION:

This study has shown that acupuncture is a technique recommended by national and international literature to treat muscular temporomandibular disorders, promoting pain relief and/or total intensity, improvement of joint movements and oral function and decrease of masticatory muscles hyperactivity.

Acupuncture analgesia; Acupuncture points; Facial pain; Temporomandibular disorder syndrome; Temporomandibular joint disorder

Databases	Results	Initial selection by title	After applying inclusion and exclusion criteria
PubMed	116	67	20
LILACS	07	03	02
Scielo	01	01	00
Cochrane (including Central Cochrane)	01	00	00
Subtotal	125	71	21
Repeated articles	01	01	01
Total	124	70	21

Authors	Studied disease	Primary treatment	Additional treatment	Number of patients	Acupuncture sessions
Ferreira, de Oliveira, Guimaraes, et al.¹⁶16 Ferreira LA, de Oliveira RG, Guimarães JP, Carvalho AC, De Paula MV. Laser acupuncture in patients with temporomandibular dysfunction: a randomized controlled trial. Lasers Med Sci. 2013;28(6):1549-58.	Chronic TMD	Muscle relaxant plates	To compare real lasertherapy to placebo laser in acupuncture points	14 (7 for each group)	12
Ritenbaugh, Hammerschlag Dworkin, et al.¹⁷17 Ritenbaugh C, Hammerschlag R, Dworkin SF, Aickin MG, Mist SD, Elder CR, et al. Comparative effectiveness of traditional chinese medicine and psychosocial care in the treatment of temporomandibular disorders-associated chronic facial pain. J Pain. 2012;13(11):1075-89.	Chronic TMD	Muscle relaxant plates	Compare Traditional Chinese Medicine (acupuncture, phytotherapy, massage) to guidance	168 (84 for each group)	20
Vicente-Barrero, Yu-Lu, Zhang, et al.¹⁸18 Vicente-Barrero M, Yu-Lu SL, Zhang B, Bocanegra-Perez S, Duran-Moreno D, Lopez-Marquez A, et al. The efficacy of acupuncture and decompression splints in the treatment of temporomandibular joint pain-dysfunction syndrome. Med Oral Patol Oral Cir Bucal. 2012;17(6):e1028-33.	TMD	Compare acupuncture with Muscle relaxant plates	None	20 (10 for each group)	15
Itoh, Asai, Ohyabu, et al.¹⁹19 Itoh K, Asai S, Ohyabu H, Imai K, Kitakoji H. Effects of trigger point acupuncture treatment on temporomandibular disorders: a preliminary randomized clinical trial. J Acupunct Meridian Stud. 2012;5(2):57-62.	Chronic TMD	Compare real trigger points needling to placebo (sham)	None	16 (8 for each group)	5
Borin, Correa, Silva, et al.²⁰20 Borin GS, Corrêa EC, Silva AM, Milanes JM. Avaliação eletromiográfica dos músculos da mastigação de indivíduos com desordem temporomandibular submetidos a acupuntura. Rev Soc Bras Fonoaudiol. 2012;17(1):1-8.	TMD	Compare acupuncture with control (no treatment)	None	40 (20 for each group)	10
Borin, Correa, Silva, et al.²¹21 Borin GS, Corrêa EC, Silva AM, Milanes JM. Acupuntura como recurso terapêutico na dor e na gravidade da desordem temporomandibular. Fisioter Pesq. 2011;18(3):218-22.	TMD	Compare acupuncture with control (no treatment)	None	40 (20 for each group)	10
Bu, Chen, Chen, et al.²²22 Bu LX, Chen T, Chen X, Jing H, Li NY. [Clinical observation of acupuncture and massage therapy for temporomandibular joint disorders]. Shanghai Kou Qiang Yi Xue. 2011;20(3):292-5.Chinese.	Acute TMD	Compare electroacupuncture to electroacupuncture + massage therapy	None	96 (48 for each group)	1
Noiman, Garty, Maimon, et al.²³23 Noiman M, Garty A, Maimon Y, Miller U, Lev-Ari S. Acupuncture for treating temporomandibular disorder: retrospective study on safety and efficacy. J Acupunct Meridian Stud. 2010;3(4):260-6.	TMD and trigeminal neuralgia	Acupuncture (local and distant technique)	None	35 with TMD and 4 with neuralgia	08 to 10
Hotta, Hotta, Bataglion, et al.²⁴24 Hotta PT, Hotta TH, Bataglion C, Bataglion SA, de Souza Coronatto EA, Siéssere S, et al. Emg analysis after laser acupuncture in patients with temporomandibular dysfunction (TMD). Implications for practice. Complement Ther Clin Pract. 2010;16(3):158-60.	TMD	Lasertherapy in acupuncture points	None	10	10
Simma, Gleditsch, Simma, et al.²⁵25 Simma I, Gleditsch JM, Simma L, Piehslinger E. Immediate effects of micro system acupuncture in patients with oromyofacial pain and craniomandibular disorders (CMD): a double-blind, placebo-controlled trial. Br Dent J. 2009;19;207 (12):E26.	TMD	Compare acupuncture with control (sham)	None	23 (11 real and 12 placebo)	1
Rancan, Bataglion, Bataglion, et al. ²⁶26 Rancan SV, Bataglion C, Bataglion SA, Bechara OM, Semprini M, Siéssere S, et al. Acupuncture and temporomandibular disorders: a 3-month follow-up EMG study. J Alter Complement Med. 2009;15(12):1307-10.	TMD	Traditional acupuncture	None	17	10
Shen, Younger, Goddard, et al.²⁷27 Shen YF, Younger J, Goddard G, Mackey S. Randomized clinical trial of acupuncture for miofascial pain of the jaw muscles. J Orofac Pain. 2009;23(4):353-9.	TMD	Compare acupuncture with placebo acupuncture (sham)	None	28 (16 real and 12 placebo)	1
Wang eZhang²⁸28 Wang XH, Zhang W. [Acupuncture combined with magnetic therapy for treatment of temple-jaw joint dysfunction]. Zhongguo Zhen Jiu. 2009;29(4):279-80. Chinese.	TMD	Compare acupuncture + electromagnetictherapy to electromagnetictherapy	None	82 (52 acupuncture + magnetic and 30 magnetic only)	1
Shen e Goddard²⁹29 Shen YF, Goddard G. The short-term effects of acupuncture on miofascial pain patients after clenching. Pain Pract. 2007;7(3):256-64.	TMD	Compare acupuncture with placebo acupuncture (sham)	None	15 (09 real and 06 placebo)	1
Smith, Mosscrop, Davies, et al.³⁰30 Smith P, Mosscrop D, Davies S, Sloan P, Al-Ani Z. The efficacy of acupuncture in the treatment of temporomandibular joint miofascial pain: a randomized controlled trial. J Dent. 2007;35(3):259-67.	TMD	Compare acupuncture with placebo acupuncture (sham)	None	27	6
Shin, Ha, Song, et al.³¹31 Shin BC, Ha CH, Song YS, Lee MS. Effectiveness of combining manual therapy and acupuncture on temporomandibular joint dysfunction: a retrospective study. Am J Chin Med. 2007;35(2):203-8.	TMD	Treatment with acupuncture and massage therapy	None	49	08 to10
Schmid-Schwap, Simma-Kletschka, Stockner, et al.³²32 Schmid-Schwap M, Simma-Kletschka I, Stockner A, Sengstbratl M, Gleditsch J, Kundi M, et al. Oral acupuncture in the therapy of craniomandibular dysfunction syndrome - a randomized controlled trial. Wien Klin Wochenschr. 2006;118(1-2):36-42.	TMD	Compare acupuncture with placebo acupuncture (Laser in randomized points)	None	23	1
Goddard³³33 Goddard G. Short term pain reduction with acupuncture treatment for chronic orofacial pain patients. Med Sci Monit. 2005;11(2):CR71-4.	TMD	Traditional acupuncture	None	29	1
Wong e Cheng³⁴34 Wong YK, Cheng J. A case series of temporomandibular disorders treated with acupuncture, oclusal splint and point injection therapy. Acupunct Med. 2003;21(4):138-49.	TMD	Traditional acupuncture + muscle relaxant plate + trigger points injection	None	85	6
DeBar, Vuckovic, Schneider, et al.¹⁰10 DeBar LL, Vuckovic N, Schneider J, Ritenbaugh C. Use of complementary and alternative medicine for temporomandibular disorders. J Orofac Pain. 2003;17(3):224-36.	TMD	Application of questionnaires about Traditional Chinese Medicine	None	192	Not specified
Goddard, Karibe, McNeill, et al.³⁵35 Goddard G, Karibe H, McNeill C, Villafuerte E. Acupuncture and sham acupuncture reduce muscle pain in miofascial pain patients. J Orofac Pain. 2002;16(1):71-6.	TMD	Compare acupuncture in recognized acupoints to placebo acupuncture in non recognized points or away from meridians location	None	18 (10 real acupuncture, 8 placebo acupuncture)	1

Authors	Acupoints	Results
Ferreira, de Oliveira, Guimaraes,et al.¹⁶16 Ferreira LA, de Oliveira RG, Guimarães JP, Carvalho AC, De Paula MV. Laser acupuncture in patients with temporomandibular dysfunction: a randomized controlled trial. Lasers Med Sci. 2013;28(6):1549-58.	E6, ID19, VB20, VB43, IG4, F3, TA3 and Yintang	Real laser has shown significantly faster improvement with greater pain decrease
Ritenbaugh, Hammerschlag, Dworkin, et al.¹⁷17 Ritenbaugh C, Hammerschlag R, Dworkin SF, Aickin MG, Mist SD, Elder CR, et al. Comparative effectiveness of traditional chinese medicine and psychosocial care in the treatment of temporomandibular disorders-associated chronic facial pain. J Pain. 2012;13(11):1075-89.	E7 and/or E6, VB20 and/or VB21, F3, F4 and Taiyang	Faster pain and quality of life improvement of patients receiving Chinese Eastern treatment as compared to those who just received guidance
Vicente-Barrero, Yu-Lu, Zhang, et al.¹⁸18 Vicente-Barrero M, Yu-Lu SL, Zhang B, Bocanegra-Perez S, Duran-Moreno D, Lopez-Marquez A, et al. The efficacy of acupuncture and decompression splints in the treatment of temporomandibular joint pain-dysfunction syndrome. Med Oral Patol Oral Cir Bucal. 2012;17(6):e1028-33.	Local points: TA21, VB21, TA17, E6 and Taiyang. Distant points: F4, E36, TA5 and VB34	Results for both groups were similar, showing pain decrease and less pain at pressure in temporal and masseter muscles
Itoh, Asai, Ohyabu, et al.¹⁹19 Itoh K, Asai S, Ohyabu H, Imai K, Kitakoji H. Effects of trigger point acupuncture treatment on temporomandibular disorders: a preliminary randomized clinical trial. J Acupunct Meridian Stud. 2012;5(2):57-62.	Ashi points (painful points at pressure or trigger points)	Much higher pain intensity decrease in the group receiving real needling on trigger points, however there has been no difference between groups with regard to movement and oral function improvement
Borin, Correa, Silva, et al.²⁰20 Borin GS, Corrêa EC, Silva AM, Milanes JM. Avaliação eletromiográfica dos músculos da mastigação de indivíduos com desordem temporomandibular submetidos a acupuntura. Rev Soc Bras Fonoaudiol. 2012;17(1):1-8.	E7, E5, TA17, VB43, IG4, Taiyang and Yintang	Acupuncture has decreased temporal muscles activity in the position of mandibular rest, providing better muscle balance between these and masseter muscles
Borin, Correa, Silva, et al.²¹21 Borin GS, Corrêa EC, Silva AM, Milanes JM. Acupuntura como recurso terapêutico na dor e na gravidade da desordem temporomandibular. Fisioter Pesq. 2011;18(3):218-22.	E7, E5, TA17, VB43, IG4, Taiyang and Yintang	There has been significant decrease in pain and severity of temporomandibular disorder after treatment with acupuncture. Control group had no improvement
Bu, Chen, Chen, et al.²²22 Bu LX, Chen T, Chen X, Jing H, Li NY. [Clinical observation of acupuncture and massage therapy for temporomandibular joint disorders]. Shanghai Kou Qiang Yi Xue. 2011;20(3):292-5.Chinese.	VB3, E7, E6, ID19 and IG4	Effective improvement for the group with acupuncture + massage therapy as compared to acupuncture alone
Noiman, Garty A, Maimon Y, et al.²³23 Noiman M, Garty A, Maimon Y, Miller U, Lev-Ari S. Acupuncture for treating temporomandibular disorder: retrospective study on safety and efficacy. J Acupunct Meridian Stud. 2010;3(4):260-6.	Local: Ashi or trigger points, Distant: varied in the region of hand or foot. In general IG4 and F3	Patients with temporomandibular disorder had 88.6% pain improvement, while just 25% of patients with neuralgia had improvement
Hotta, Hotta, Bataglion, et al.²⁴24 Hotta PT, Hotta TH, Bataglion C, Bataglion SA, de Souza Coronatto EA, Siéssere S, et al. Emg analysis after laser acupuncture in patients with temporomandibular dysfunction (TMD). Implications for practice. Complement Ther Clin Pract. 2010;16(3):158-60.	IG4, C3, E6 and E7	Significant improvement in painful symptoms and masseter muscle function
Simma, Gleditsch, Simma, et al.²⁵25 Simma I, Gleditsch JM, Simma L, Piehslinger E. Immediate effects of micro system acupuncture in patients with oromyofacial pain and craniomandibular disorders (CMD): a double-blind, placebo-controlled trial. Br Dent J. 2009;19;207 (12):E26.	Ashi points or trigger points	Pain decrease was significantly better after acupuncture as compared to placebo treatment
Rancan, Bataglion, Bataglion, et al. ²⁶26 Rancan SV, Bataglion C, Bataglion SA, Bechara OM, Semprini M, Siéssere S, et al. Acupuncture and temporomandibular disorders: a 3-month follow-up EMG study. J Alter Complement Med. 2009;15(12):1307-10.	IG4, E6, E7, B2, VB14, VB20, ID18, ID19, F3, E36, VB34, E44 and R3	Decreased muscle activity during jaw movements and teeth clenching and decreased pain after acupuncture
Shen, Younger, Goddard, et al.²⁷27 Shen YF, Younger J, Goddard G, Mackey S. Randomized clinical trial of acupuncture for miofascial pain of the jaw muscles. J Orofac Pain. 2009;23(4):353-9.	IG4	Decreased pain and sensitivity of masticatory/face and neck muscles only for the group receiving real acupuncture
Wang & Zhang²⁸28 Wang XH, Zhang W. [Acupuncture combined with magnetic therapy for treatment of temple-jaw joint dysfunction]. Zhongguo Zhen Jiu. 2009;29(4):279-80. Chinese.	E7, E6, IG4	Significant pain improvement in 90.4% of the acupuncture + magnetic group, while improvement for the control group was only 66.7%.
Shen & Goddard²⁹29 Shen YF, Goddard G. The short-term effects of acupuncture on miofascial pain patients after clenching. Pain Pract. 2007;7(3):256-64.	IG4	Significant improvement of facial pain, neck pain and headache for real acupuncture
Smith, Mosscrop, Davies, et al.³⁰30 Smith P, Mosscrop D, Davies S, Sloan P, Al-Ani Z. The efficacy of acupuncture in the treatment of temporomandibular joint miofascial pain: a randomized controlled trial. J Dent. 2007;35(3):259-67.	E7	Better influence of real acupuncture on clinical results as compared to placebo
Shin, Ha, Song, et al.³¹31 Shin BC, Ha CH, Song YS, Lee MS. Effectiveness of combining manual therapy and acupuncture on temporomandibular joint dysfunction: a retrospective study. Am J Chin Med. 2007;35(2):203-8.	ID18, ID19, E6, E7, TA17 and IG4	Proposed treatment has significantly improved pain and mouth opening
Schmid-Schwap, Simma-Kletschka, Stockner, et al.³²32 Schmid-Schwap M, Simma-Kletschka I, Stockner A, Sengstbratl M, Gleditsch J, Kundi M, et al. Oral acupuncture in the therapy of craniomandibular dysfunction syndrome - a randomized controlled trial. Wien Klin Wochenschr. 2006;118(1-2):36-42.	Maxilla and mandible retromolar region, mandible and maxilla vestibular region. Extraoral points: IG4, ID2 and ID3	Decreased pain, better mouth opening and improved muscle sensitivity to palpation for the group receiving real acupuncture
Goddard³³33 Goddard G. Short term pain reduction with acupuncture treatment for chronic orofacial pain patients. Med Sci Monit. 2005;11(2):CR71-4.	Varied on a patient-by-patient basis, however IG4 was always used	Significant pain intensity decrease from 5.28 to 2.26
Wong & Cheng³⁴34 Wong YK, Cheng J. A case series of temporomandibular disorders treated with acupuncture, oclusal splint and point injection therapy. Acupunct Med. 2003;21(4):138-49.	Local: E7, E6, ID17 and extra point QianZheng, distant: IG4, TA5, F3 and E36	85% of patients with temporomandibular disorder had relieved symtoms
DeBar, Vuckovic, Schneider, et al.¹⁰10 DeBar LL, Vuckovic N, Schneider J, Ritenbaugh C. Use of complementary and alternative medicine for temporomandibular disorders. J Orofac Pain. 2003;17(3):224-36.	Not specified	63% of patients reported using Traditional Chinese Medicine to treat temporomandibular disorder pain, being acupuncture, massage therapy and chyropraxis the most satisfactory and helpful for patients
Goddard, Karibe, McNeill, et al.³⁵35 Goddard G, Karibe H, McNeill C, Villafuerte E. Acupuncture and sham acupuncture reduce muscle pain in miofascial pain patients. J Orofac Pain. 2002;16(1):71-6.	IG4 and E6 (real acupuncture) and points close to IG4 and E6 for placebo	Both groups had significant pain intensity decrease, without difference between groups

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[1] Correspondence to: André Luís Porporatti Al. Octávio Pinheiro Brizolla, 9-75 – Vila Universitária 17012-901Bauru, SP, Brasil. E-mail:andreporporatti@yahoo.com.br

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Acupuncture therapeutic protocols for the management of temporomandibular disorders* * Received from the Prosthesis Department, School of Dentistry of Bauru, University of São Paulo, Bauru, SP, Brazil.

BACKGROUND AND OBJECTIVES:

CONTENTS:

CONCLUSION:

Acupuncture therapeutic protocols for the management of temporomandibular disorders^* * Received from the Prosthesis Department, School of Dentistry of Bauru, University of São Paulo, Bauru, SP, Brazil.