Effect of a Passive Jaw Motion Device on Pain and Range of Motion in TMD Patients Not Responding to Flat Plane Intraoral Appliances
Abstract
This study was designed to compare the effectiveness of a passive jaw motion device, the Therabite, and wooden tongue depressors (WTD), in patients with temporomandibular joint and muscle disorders, who did not improve after manual manipulation of the mandible and flat bite plane therapy. Forty-three patients were enrolled in the study and were classified as joint or muscle groups according to the Research Diagnostic Criteria for TMD. Twenty-four were assigned to the joint group, and 19 patients were assigned to the muscle group. The patients were assigned at random to three treatment subgroups: 1. passive jaw motion device therapy (Therabite); 2. wooden tongue depressors therapy (WTD); and 3. control group. All subjects received flat bite plane appliance therapy throughout the treatment period. Mandibular range of motion was measured for maximum opening (MO), right and left lateral (Rt. Lateral, Lt. Lateral) and protrusive (Pr) movements. Pain level was also assessed at the beginning and at the end of the treatment. The results suggested that a passive jaw motion device is effective in increasing range of motion in both groups of temporomandibular disorder patients, joint (intracapsular) and muscle (extracapsular). It also appears to decrease pain in patients with temporomandibular disorders. Pain was relieved to a greater degree in the muscle group than the joint group.
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Twenty-one of the studies used the RDC/TMD established by Dworkin and LeResche to classify patients as having TMD.
“Twenty-one of the studies 57-76 used the RDC/TMD established by Dworkin and LeResche 27 to classify the patients as having TMD.”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [58]
One study looked at both myogenous and arthrogenous TMD.
“One study looked at both myogenous and arthrogenous TMD.58”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [58]
Eight studies looked at the effect of exercises alone or combined with other therapies for myogenous TMD.
“Eight studies 56 -58,62,63,66,79,80 looked at the effect of exercises alone or combined with other therapies for myogenous TMD.”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [58]
Three studies showed better outcomes, especially on pain and ROM, compared with control groups.
“However, 3 studies 58,63,66 showed better outcomes, especially on pain and ROM, compared with control groups.”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [58]
The SMD for pain intensity pooling 5 studies was 0.43 (95% CI=-0.02, 0.87).
“The SMD for pain intensity pooling 5 studies 57,58,62,63,66 was 0.43 (95% CIϭϪ0.02,0.87)”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [58]
Data from studies 56,58,62,66 indicated that there was a trend to favor exercise therapy for pain-free maximum mouth opening and pain intensity compared with a control group.
“Data from these studies 56,58,62,66 indicated that there was a trend to favor exercise therapy for pain-free maximum mouth opening and pain intensity compared with a control group.”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [58]
When pooling results of studies investigating the effectiveness of exercise alone or in combination with other conservative therapies on pain intensity, there was no statistically significant difference in pain between exercise and control groups.
“When pooling the results of the studies investigating the effectiveness of exercise alone or in combination with other conservative therapies on pain intensity, 58,61,68,86 we found that there was no statistically significant difference in pain between exercise and control groups.”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [58]
Most of the studies favored the use of exercises alone or as part of a general regimen to treat people with arthrogenous TMD, including disk displacements with or without reduction.
“Although the results were mixed, most of the studies favored the use of exercises alone or as part of a general regimen to treat people with arthrogenous TMD, including disk displacements with or without reduction.58,68,84 -86”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [58]
Regarding active mouth opening, a nonsignificant effect was found between general jaw exercises and education, splint therapy, or a control group when pooling 3 studies.
“Regarding active mouth opening, a nonsignificant effect was found between general jaw exercises and education, splint therapy, or a control group when pooling 3 studies.58,61,86”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [58]
When comparing exercises and splint therapy, a statistically and clinically meaningful effect was found (12.31 mm; 95% CI=7.73, 16.89).
“However, when comparing exercises and splint therapy, 56,58 a statistically and clinically meaningful effect was found (12.31 mm; 95% CIϭ7.73, 16.89).”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [58]
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Comparison of fixed interval and visual analogue scales for rating chronic pain
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Range of movement of the mandiblew
Posselt, U., & D., O. (1958) · The Journal of the American Dental Association · doi:10.14219/jada.archive.1958.0017 · Cited by 45 · see citing works
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Armijo-Olivo, S., Pitance, L., Singh, V., Neto, F., Thie, N., & Michelotti, A. (2016) · Physical Therapy · doi:10.2522/ptj.20140548 · Cited by 413 · see citing works
Klobas, L., Axelsson, S., & Tegelberg, Å. (2006) · Acta Odontologica Scandinavica · doi:10.1080/00016350600825310 · Cited by 18 · see citing works
- Authors
- Maloney, G. E., Mehta, N., Forgione, A. G., Zawawi, K. H., Al-Badawi, E. A., & Driscoll, S. E.
- Affiliations
- Tufts University (US)
- Corresponding author
- Zawawi, Khalid H.
- ORCID
- Zawawi, Khalid H.
- Venue
- CRANIO®
- Publisher
- Informa UK Limited
- Published
- 2002-01
- Volume
- 20
- Issue
- 1
- Pages
- 55-66
- ISSN
- 0734-5410 (ISSN-L)
- 0886-9634
- 2151-0903
- OpenAlex
- W3958970
- Cited by
- 65
- References
- 2
- Citations by year
- 2025: 5 · 2024: 6 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 4 · 2019: 5 · 2018: 7 · 2016: 6 · 2015: 2 · 2014: 2 · 2013: 3 · 2012: 1
- FWCI
- 2.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CRANIO® (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Health Sciences › Health Professions › Medical Laboratory Technology › Occupational health in dentistry
- Keywords
- temporomandibular disorders, mandibular range of motion, orofacial pain, Research Diagnostic Criteria for TMD, mandibular movement
- MeSH terms
- Analysis of Variance, Dental Occlusion, Equipment Design, Facial Pain, Follow-Up Studies, Humans, Mandible, Manipulation, Orthopedic, Masticatory Muscles, Movement, Pain Measurement, Statistics as Topic, Temporomandibular Joint, Temporomandibular Joint Disorders, Motion Therapy, Continuous Passive, Range of Motion, Articular, Treatment Outcome, Occlusal Splints, Craniomandibular Disorders
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