Physical Therapy for TMJ Dysfunction
Recruiting in Palo Alto (17 mi)
Age: 18 - 65
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Brooke Army Medical Center
Disqualifiers: Trainee status, Oral device, Facial injection, Facial surgery, Spinal pathology, Neurological disease, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The goal of this randomized clinical trial among US military active-duty service-members with temporomandibular disorders (TMD) is to determine whether standard care plus 6-weeks of tailored, individualized physical therapy (PT) treatment provides greater benefit than standard care alone in patient-reported outcomes, and maximal mouth opening.
The aims of the study are to compare outcomes in individuals with TMD that receive standard care treatment versus standard care plus PT interventions at 0-, 6-, and 12-weeks. The investigators anticipate that subjects in the standard care plus PT group will exhibit improved patient-reported outcomes, and maximal mouth opening compared to those who received standard care alone.
Additionally, the investigators will compare the amount and type of healthcare utilization between the two groups (Standard Care and Standard Care + PT) in the 12-month period following enrollment in the study.
All participants will be managed by their primary dental provider and receive care as deemed appropriate by their provider. All participants will complete patient-reported outcome measures and have their jaw motion measured. Those randomized to the standard care plus PT group will also receive a tailored PT evaluation followed by an individualized plan of care two times per week for up to six weeks.
Will I have to stop taking my current medications?
The trial protocol does not specify whether you need to stop taking your current medications. It seems that participants will continue to receive care as deemed appropriate by their primary dental provider.
What data supports the effectiveness of the treatment for TMJ dysfunction?
Research shows that combining manual physical therapy and exercise can improve symptoms of temporomandibular joint dysfunction, with one study noting a 13.9% improvement in disability scores after two weeks of treatment.
12345Is physical therapy safe for treating TMJ dysfunction?
The research does not specifically address safety concerns, but physical therapy is generally considered a safe treatment for temporomandibular disorders (TMD) and is often recommended as part of a standard treatment approach.
45678How does physical therapy for TMJ dysfunction differ from other treatments?
Physical therapy for TMJ dysfunction is unique because it focuses on exercises and manual techniques to improve jaw function and reduce pain, unlike surgical options or medications. It can include specific exercises to maintain and improve jaw mobility, and may be combined with other techniques like strapping to enhance effectiveness.
49101112Eligibility Criteria
This trial is for active-duty US military service-members with temporomandibular disorders (TMD). Participants must be receiving routine dental care. Those with additional conditions that might interfere with the study or who cannot commit to the full duration of treatment are likely excluded.Inclusion Criteria
Must be able to be followed for twelve weeks after consent
Active-Duty Service Members
TMD Screener score ≥ 3 45
+1 more
Exclusion Criteria
Retiring or separating from the military within a year
Currently under litigation related to temporomandibular or cervical spine pain(s)
Currently undergoing Medical Evaluation Board (MEB)
+6 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
1 hour
1 visit (in-person)
Treatment
Participants receive standard care plus physical therapy interventions over a 6-week period, attending up to 12 sessions.
6 weeks (+/- 2 weeks)
Up to 12 visits (in-person)
Follow-up
Participants are monitored for safety and effectiveness after treatment, with outcomes collected at 6 and 12 weeks.
6 weeks
2 visits (in-person)
Long-term Follow-up
Healthcare utilization data is collected to determine medical utilization related to TMD in the 12-month period following enrollment.
12 months
Participant Groups
The study is testing if adding a tailored, individualized physical therapy program twice a week for six weeks to standard dental care improves outcomes in TMD patients more than standard dental care alone. Outcomes measured include patient-reported improvements and jaw movement.
2Treatment groups
Experimental Treatment
Active Control
Group I: Standard care plus physical therapyExperimental Treatment2 Interventions
Participants randomized to this group will receive standard care from their treating dental provider. In addition, they will receive routine physical therapy interventions over a 6-week (+/- 2 week) period. Study participants will receive treatments based on their clinical examination. Subjects will attend up to 12 sessions over 6-weeks (+/- 2 weeks). The initial physical therapy visit will be 60-minutes long with all subsequent appointments being 30-minutes, to include any booster sessions. The interventions will be pragmatic in nature, with provided treatment being specific to the subject's specific complaints, goals, and examination identified impairments.
Group II: Standard CareActive Control1 Intervention
Those randomized to the standard care (control) group will follow the plan of care determined by their treating dental provider. This group will receive standard (routine) care from the dental provider for the treatment of TMD. These decisions will be based on the clinical judgment of the dental provider, as is customary with routine care for TMD.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Brooke Army Medical CenterFort Sam Houston, TX
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Who Is Running the Clinical Trial?
Brooke Army Medical CenterLead Sponsor
References
Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test. [2022]To investigate the effect of a rehabilitation program based on cervical mobilization and exercise on clinical signs and mandibular function in subjects with temporomandibular disorder (TMD).
The effectiveness of exercise therapy for temporomandibular dysfunction: a systematic review and meta-analysis. [2018]To investigate the effectiveness of exercise therapy on pain, function, and mobility outcomes in patients with temporomandibular joint dysfunction.
A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. [2018]This systematic review analyzed studies examining the effectiveness of various physical therapy interventions for temporomandibular disorder.
Manual physical therapy interventions and exercise for patients with temporomandibular disorders. [2015]The purpose of this study was to investigate the outcome of a series of consecutive patients with temporomandibular disorder (TMD) who were treated with manual physical therapy interventions and exercise. Consecutive patients with the clinical presentation of TMD completed several self-report measures and underwent a standardized historical and physical examination. Following the examination, patients received a multimodal treatment approach incorporating manual physical therapy and exercise. All self-report questionnaires were completed at a 2-week follow-up. Paired t-tests were performed between the baseline and 2-week follow-up scores. The mean TMD Disability Index scores were 32.1% (15.4%) at baseline and 18.3% (12.5%) at the 2-week follow-up, representing an improvement of 13.9% (CI: 8.2%, 19.5%) (p
Physical therapy for temporomandibular disorders and orofacial pain. [2008]In the past year, physical therapy has been increasingly advocated as a standard part of the multidisciplinary approach to treating temporomandibular disorders and other orofacial pain conditions. This literature has focused primarily on review articles of the characteristics, indications, and efficacy of physical therapy interventions, which generally include exercises and modalities. However, most of the evidence regarding physical therapy is from clinical reports and lacks well-controlled studies. The purpose of this review is to discuss the current literature in the context of past literature supporting the clinical use of physical therapy for orofacial pain.
Physical therapists' self-perceived adequacy of entry-level education and their current confidence levels with respect to temporomandibular disorders: A pilot study. [2020]Physical therapy (PT) has been shown to be one of the most effective conservative treatments for temporomandibular disorders (TMD). The objectives of this pilot study are to determine the self-perceived knowledge, adequacy of entry-level education, and the current confidence levels of PTs in Florida regarding TMD treatment.
Is Irritable Bowel Syndrome Considered in Clinical Trials on Physical Therapy Applied to Patients with Temporo-Mandibular Disorders? A Scoping Review. [2021]The aim of the current scoping review was to identify if the presence of irritable bowel syndrome was included as eligibility criteria of participants included in clinical trials investigating the effects of physical therapy in individuals with temporomandibular pain disorders (TMDs). A systematic electronic literature search in the Web of Science database was conducted. Scientifically relevant, randomized clinical trials (those cited in other studies at least 5 times, or clinical trials published in high-impact journals, i.e., first and second quartiles (Q1-Q2) of any category of the Journal Citation Report (JCR)) evaluating the effects of any physical therapy intervention in patients with TMDs were included. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of the selected trials. Authors affiliated to a clinical or non-clinical institution, total number of citations, objective, sex/gender, age, and eligibility criteria in each article were extracted and analyzed independently by two authors. From a total of 98 identified articles, 12 and 19 clinical trials were included according to the journal citation criterion or JCR criterion, respectively. After removing duplicates, a total of 23 trials were included. The PEDro score ranged from 4 to 8 (mean: 6.26, SD: 1.48). Based on the eligibility criteria of the trials systematically reviewed, none considered the presence of comorbid irritable bowel syndrome in patients with TMDs. The comorbidity between TMDs and irritable bowel syndrome is not considered within the eligibility criteria of participants in highly cited clinical trials, or published in a high-impact journal, investigating the effects of physical therapy in TMDs.
A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. [2022]The purpose of this qualitative systematic review was to assess the evidence concerning the effectiveness of physical therapy interventions in the management of temporomandibular disorders.
Strapping for temporomandibular joint dysfunction. [2019]Temporomandibular joint dysfunction (TMJD) is a common problem seen in many of the dental clinics. Management of this depends on an accurate diagnosis of the cause for the TMJD. Physical therapy and rehabilitation play a vital role in the management of these dysfunctions. Physical therapy is useful in treating post-traumatic stiffness of the TMJ while strapping of the TMJ for a dysfunction along with conventional physical therapy is of benefit in terms of reduction in click, decrease in pain, and an improvement in function.
Postoperative physical therapy in temporomandibular joint arthroplasty. [2019]This article offers a revised physical therapy treatment approach for rehabilitating a temporomandibular joint (TMJ) following arthroplastic surgical intervention. Surgical repair is only advised in those chronic cases where refractory symptoms affect the quality of the patient's life and prevent patients from carrying out their normal daily activities. Previous nonsurgical and surgical management usually fails to correct the problem in these types of cases. Rehabilitation guidelines discussed include plication, diskectomy (with or without interpositional implant), costochondral graft, fossa implant, and total joint replacement.
Postarthroscopy physical therapy management of a patient with temporomandibular joint dysfunction. [2005]Arthroscopy of the temporomandibular joint (TMJ) is a new, relatively noninvasive surgical procedure for treating patients with TMJ dysfunction beyond nonsurgical management. The purpose of this commentary is to introduce a four-stage rehabilitation protocol currently used by the authors in the physical therapy management of a postarthroscopy TMJ patient with a diagnosis of bilateral capsular impingement and adhesions. The patient underwent diagnostic TMJ arthroscopy and the four-stage rehabilitation protocol. Stage I exercises to maintain mandibular mobility began in the recovery room. Stage II exercises consisted of hands-on and take-home stretching exercises. Stage III and IV exercises were completed to improve muscular function. The patient was discharged from physical therapy in a month with full range of motion and diminished pain and headaches. At 1-year follow-up, the patient demonstrated full range of motion without pain, further treatment, or medications.
Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review. [2022]The purpose of this study was to complete a systematic review of manual and manipulative therapy (MMT) for common upper extremity pain and disorders including the temporomandibular joint (TMJ).