| Priebe, Antunes and Corrêa33 Priebe M, Antunes AG, Corrêa EC. Estabilidade dos efeitos da fisioterapia na disfunção temporomandibular. Rev Dor. 2015;16(1):6-9.
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Average age: 31.6 years. Individuals of both gender: 20 women and 5 men |
Questionnaire on Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD).Evaluation records of joint noises presence, painful sensation of muscle and articulation regions, pressure pain threshold values in 16 muscles evaluated bilaterally: anterior, mid and posterior temporal, superior, mid and inferior masseter, sternocleidomastoid and upper trapezium, through pressure algometer. |
Longitudinal study |
Physiotherapy program included the combination of therapeutic modalities, focusing on the craniocervicomandibular system structures, such as therapeutic ultrasound, myofascial release, manual therapy, stretching and neuromuscular exercises, as well as self-care and home exercise guidelines. |
76% presented no diagnosis of TMD soon after treatment. Of these, 17 (68%) maintained this result at the two-month follow-up, according to the RDC/TMD evaluation. Regarding the sensitivity of pain to pressure, there was no significant difference in pain threshold in the comparison of results shortly after treatment and after two months of its end.Joint noises kept absent in 60% of patients.Regarding pain during palpation, 21 of the 24 structures analyzed in RDC/TMD maintained post-treatment results in the follow-up period, except for the right lower masseter, right lateral pterygoid and left temporal tendon. |
| Franco et al.1616 Franco AL, Zamperini CA, Salata DC, Silva EC, Albino Júnior W, Camparis CM. Fisioterapia no tratamento da dor orofacial de pacientes com disfunção temporomandibular crônica. Rev Cubana Estomatol. 2011;48(1):56- 61.
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A 35-year-old female patient10 sessions, 1 time per week |
Physiotherapeutic evaluation sheet, composed of ROM evaluation, inspection, palpation, physical exams. |
Case report, evaluated before and after intervention and reassessed 15, 30 and 60 days after intervention. |
Performed passive stretching of ECOM and trapezium, low-intensity laser application of gallium arsenide (AS-GA) 4J parameters for the area of the joint in a punctual form and 8J in the muscular area in the punctual form and scanning with 1mm, with pulsatile mode 1 min per point. Facial relaxation with slip techniques, guidelines for complementary home exercises, active stretching of the cervical muscles, extensors and flexors of the head and neck. MTP deactivation technique. Night maintenance of the myorelaxing occlusal plaque |
There was a gradual reduction of painful sensations through VAS, the relief average of pain symptoms was 20% per session, reaching zero in the last sessions. |
| Freire et al.6
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Average age: 34.5 years24 individuals (21 females and 3 males) |
Questionnaire on Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD)Temporomandibular index (TMI) and its sub-indexes |
Longitudinal study, 10 sessions. Evaluated before treatment (AV1), immediately after treatment (AV2) and two months after the end of treatment (AV3) |
Continuous 3 MHz ultrasound, with the intensity of 1.3 W/cm2, for 3 minutes for chronic pain; in pulsed mode with an intensity of 0.5 W/cm 2, for 3 minutes for acute pain.Superficial thermotherapy with infrared radiation for 20 minutes.Myofascial release and stretching bilaterally.Techniques of distraction and therapeutic massage in the cervical spine and the TMJ.Exercise with silicone rubber tube |
Reduction in diagnoses number in all subgroups and diagnosis absence in 41.7% of the 24 participants after treatment. Significant reduction of TMI in the comparison between AV1 and AV2 (p = 0.000). There was no difference between AV2 and AV3 (p = 0.204) in 13 participants evaluated two months after the end of treatment. |
| Amaral et al.77 Amaral AP, Politti F, Hage YE, Arruda EE, Amorin CF, Biasotto-Gonzalez DA. Efeito imediato da mobilização mandibular inespecífica sobre o controle postural em indivíduos com disfunção temporomandibular: ensaio clínico controlado, randomizado, simples cego. Br J Phys Ther. 2013;7(2):121-7.
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Average age: 25.6 years.50 individuals of both gender |
Questionnaire on Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD)Stabilometric evaluation on a force platform, with eyes open and closed. |
Longitudinal study DTM Group (presenting TMD, mandibular deviation or deflection) and control group (not presenting TMD) |
Non-specific mandibular mobilization (MMI). The patient is positioned in dorsal decubitus and disposable gloves were used by the therapist; the fifth chierodactyl positioned on top of the second or third molar (if present) to perform the MMI in a small degree intermittently for one minute, with five replicates being performed. Between each mobilization, a buccal opening with tongue was performed ten times on the incisive papilla, to promote local relaxation. |
Statistically significant difference was only for the TMD group at the center of pressure oscillation (p <0.03) in the mediolateral displacement (p <0.006), in the mediolateral amplitude (p <0.01) and in the velocity variable in the anteroposterior directions, (p <0.03) and mediolateral (p <0.03). |
| Gomes et al.55 Gomes NC, Berni-Schwarzenbeck KC, Packer AC, Bigaton DR. Efeitos da estimulação elétrica de alta voltagem catódica sobre a dor em mulheres com DTM. Rev Bras Fisioter. 2012;16(1):10-5.
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Average age: 22.5 years.25 individuals of both gender. |
RDC/TMD questionnaire. - Evaluation of pain through VAS. |
Randomized, double-blind clinical trial. EG (experimental group): 10 applications of HVES and in PG (placebo group): 10 applications with the device switched off. |
Electrodes placed bilaterally on the lateral portion of the temporalis muscle (channel 1), on the masseter (channel2) and the electrode dispersed in the cervical-thoracic (lower cervical high thoracic) region. Parameters used 10Hz frequency; pulse width fixed by the device in two twin pulses of 20us each with an interval of 100us voltage at 100 volts both channels lasting 30 min 2 to 3 times per week. |
Intragroup comparison observed that 10 applications of cathodic HVES promoted the reduction of pain in the EG, while in the GP no difference was noticed. EG presented greater reduction of pain intensity compared to PG. |
| Borin et al.88 Borin GS, Corrêa EC, Silva MT, Milanesi JM. Acupuntura como recurso terapêutico na dor e na gravidade da desordem temporomandibular. Fisioter Pesqui. 2011;18(3):217-22.
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40 women, aged between 20 and 40 years |
RDC-TMD questionnaire, the severity of TMD was verified before and after treatment by Fonseca's Index. It was also evaluated the Craniomandibular Dysfunction Index. The pain was assessed before and after treatment, by VAS. |
Randomized clinical trial. Individuals divided into two groups: AG: acupuncture, who performed intervention twice a week (n = 20); and control CG: who did not undergo treatment |
AG participants underwent acupuncture twice a week for five uninterrupted weeks. The treatment was performed with disposable needles (0.25 x 0.15 mm) inserted in the respective points with the skin previously cleaned with cotton and ethylic alcohol at 70%. Acupuncture therapy amounted 10 assistances. The points selected for treatment were those referred to in the literature as points for the treatment of TMD and points for anxiety. |
There was an improvement in the severity level by the craniomandibular index (p = 0.004) and by the Fonseca's Index (p = 0.000) of individuals with TMD after acupuncture treatment, and in the pain level (p = 0.000). According to the classification by Fonseca's Index. Before treatment, the individuals had the following classification for TMD: 6 with a moderate degree and 14 with a severe degree. After treatment, this classification was observed: 7 with a mild degree, 10 moderate and 3 severe. |
| Basso, Corrêa and Silva44 Basso D, Corrêa E, Silva MA. Efeitos da reeducação postural global no alinhamento corporal e nas condições clínicas de indivíduos com disfunção temporomandibular associada a desvios posturais. Fisioter Pesqui. 2010;17(1):63-8.
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RDC/TMD questionnaire.Photography with a digital camera for postural evaluation. |
Transversal, qualitative study, 10 weeks of intervention.GI: muscle disorder; GII: disk displacement; GIII: other joint conditions. |
The intervention group was submitted to 10 sessions of GPR for 45 minutes, once a week adopting two postures per session of therapy. Postures without load and postures with load. |
GII obtained an improvement in the reduction of chronic orofacial pain. |
| Calixtre et al.1212 Calixtre LB, Grüninger BL, Haik MN, Albuquerque-Sendín F, Oliveira AB. Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test. J Appl Oral Sci. 2016;24(3):188-97.
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12 women with a mean age of 22.08 ± 2.23 years |
The mandible's pain and function were evaluated with the MFIQ, in addition to the opening level of the mouth without pain and the GP of masseter and temporal muscle were evaluated. |
Longitudinal study, pre-and post-evaluation 5 weeks of intervention. |
Submitted to 10 sessions of approximately 35 min. Mobilization of cervical under flexion, anteroposterior and posteroanterior mobilization in C5, stabilization exercise of craniocervical flexion, stretching |
Mandibular function increased by 7 points on the scale after the intervention (p = 0.019) and pain decreased significantly (p = 0.009). The mandible level of opening ranged from ± 8.8 to 38.8.8 mm to 38 ± 8.8 showing significant improvement (p = 0.017), pain on both masseters and temporalis improved |
| Machado et al.1111 Machado CC, Mazzeto MO, da Silva MA, de Felício CM. Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up. Lasers Med Sci. 2016;31(5):945-54.
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Participated in the study 82 individuals with chronic TMD and 20 healthy individuals (average age 30 ± 9.6 years) |
DTM severity through Part II of ProDTMMulti Questionnaire, stress points due to palpation, and orofacial functionality by Orofacial Myofunctional Evaluation with Scores. |
Randomized clinical trial. Participants were divided into GI: Laser and oromandibular exercises, GII: orofacial muscular therapy, GIII: placebo laser and oromandibular exercises, GIV: Laser, CG: healthy. |
Submitted to 12 sessions of 45min. GI: continuous laser I = 60mW by 40s and D = 60 ± 1.0 J/cm2 and exercises for tongue, cheeks and mandibular muscles, functional orofacial training; GII: exercises for tongue, cheeks and mandibular muscles, functional orofacial training; laser; strategies for pain reduction; GIII: placebo laser and exercises; GIV: laser. |
There was an improvement in both groups in all scopes assessed with stability at follow-up when compared to each other all treated groups did not show differences in stress points due to palpation at follow-up. GI, GII and GIII showed no difference with the control over orofacial function, while they differed significantly from GIV (p <0.01). |
| Oliveira et al.1515 Oliveira LB, Lopes TS, Soares C, Maluf R, Goes BT, Sá KN, Baptista AF. Transcranial direct current stimulation and exercises for treatment of chronic temporomandibular disorders: a blind randomised-controlled trial. J Oral Rehabil. 2015;42(10):723-32.
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32 young adults with an average age of 24.7 ± 6.8 years diagnosed with TMD. |
Fonseca's questionnaire was used for the initial screening of patients; then VAS was used for pain and WHOQOL-BREF was used for Quality of Life. |
Clinical trial, double-blind. The patients were divided into two groups: A - active submitted to exercise plus transcranial noninvasive stimulation and B - control who performed exercises plus false stimulation. |
The treatment protocol lasted 4 weeks; all participants performed exercises that included myofascial release, muscle stretching, cervical traction, exercises to improve mandible's ROM, muscle strengthening, among others. In addition, Group A received 20 min of noninvasive transcranial stimulation with an amplitude of 2 mA, with electrodes located on C3 or C4 (motor cortex region); in the individuals of Group B the electrodes were positioned in the same place, but the current lasted 30 seconds. |
The clinical characteristics of the disease in the two groups were the same after the treatment, and regarding the quality of life, it can be perceived that both groups obtained positive results. Groups' pain intensity decreased after the second day of treatment, but in different ways and, in the end, it was noticed that Group A had lower pain levels than Group B, but the difference was not statistically significant. |
| Tosato et al.99 Tosato JP, Biazotto-Gonzalez DA, Caria PH. Efeito da massoterapia e da estimulação elétrica nervosa transcutânea na dor e atividade eletromiográfica de pacientes com disfunção temporomandibular. Fisioter Pesqui. 2007;14(2):21-6.
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n = 20 women, aged between 22 and 46 years, with an average of 31.75±8.71 years, with myogenic TMD, with masticatory muscle pain. |
After this, RDC-TMD for pain used the VAS and surface electromyography to capture the electrical signal of the masseter and temporal muscles. |
Randomized clinical study. Individuals divided into G1: control and G2: intervention |
The sample was divided into 2 groups: Group 1 received a 30-minute session of massotherapy on the face, masseter and temporal region, while Group 2 received transcutaneous electrical nerve stimulation for 30 minutes in the region of the masseter and temporal muscles. |
Both groups showed an increase in the electromyographic activity of the masseter and temporal muscles, both in isometric contractions and concentric isotonic. There was also a significant reduction in pain in both groups. |
| Freitas et al.1010 Freitas DG, Pinheiro IC, Vantin K, Meinrath NC, De Carvalho NA. Os efeitos da desativação dos pontos-gatilho miofasciais, da mobilização articular e do exercício de estabilização cervical em uma paciente com disfunção temporomandibular: um estudo de caso. Fisioter Mov. 2011;24(1):33-8.
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1 patient, 37 years old, diagnosed with TMD for 5 years. |
From the VAS, the pain was evaluated; mandibular ROM and postural clinical evaluation were measured. |
Clinical case study |
The laser was used in the TMJ region using ad-hoc technique with energy density (ΔE) 3J/cm² and reaching a final energy of 2.6 J, deactivation of myofascial trigger points in the masseter, pterygoid, temporal, occipital, scalene, ECOM and trapezius upper fibers, for 45 seconds at each point and joint mobilization using the longitudinal and anterior cephalic slide technique of TMJ grade II |
The patient presented improvement in pain, increased the joint amplitude of TMJ and in the following postural alterations:prognata mandible, head in neutral position, cervical spine with physiological lordosis and shoulders aligned. In the muscular portion, there was an improvement in the time of muscular activation in the face muscles. |
