A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder
Open accessAbstract
Background Temporomandibular pain has multiple etiologies and a range of therapeutic options. In this pilot study, the authors assessed the feasibility of conducting a larger trial to evaluate chiropractic treatment of temporomandibular disorders (TMDs). Methods The authors assigned 80 participants randomly into one of the following four groups, all of which included a comprehensive self-care program: reversible interocclusal splint therapy (RIST), Activator Method Chiropractic Technique (AMCT) (Activator Methods International, Phoenix), sham AMCT and self-care only. They made assessments at baseline and at month 2 and month 6, including use of the Research Diagnostic Criteria for Temporomandibular Disorders. Results The authors screened 721 potential participants and enrolled 80 people; 52 participants completed the six-month assessment. The adjusted mean change in current pain over six months, as assessed on the 11-point numerical rating scale, was 2.0 (95 percent confidence interval, 1.1-3.0) for RIST, 1.7 (0.9-2.5) for self-care only, 1.5 (0.7-2.4) for AMCT and 1.6 (0.7-2.5) for sham AMCT. The authors also assessed bothersomeness and functionality. Conclusions The authors found the study design and methodology to be manageable. They gained substantial knowledge to aid in conducting a larger study. AMCT, RIST and self-care should be evaluated in a future comparative effectiveness study. Practical implications This pilot study was a necessary step to prepare for a larger study that will provide clinicians with information that should be helpful when discussing treatment options for patients with TMD.
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HVLA techniques applied to the jaw and cervical spine demonstrated efficacy in reducing pain and improving maximum mouth opening.
“HVLA techniques applied to the jaw [24,29,31] and cervical spine [21,23,25–27] demonstrated efficacy in reducing pain and improving MMO.”
From Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials (2026) · cites this paper as [29]
The Methods (AMCT; page not provided) describe instrument-assisted, quick, shallow thrusts that can involve the temporomandibular joint and spine. The Results (Study outcomes; page not provided) report reduced pain in the AMCT group, but no statistically significant improvement over the comparison groups. The paper does not report an improvement in maximum mouth opening or establish the efficacy of HVLA techniques applied specifically to the jaw and cervical spine. (LLM, conf=0.88)
Experimental — accuracy not yet measuredChiropractic interventions and dental practice-based treatments, including those by dentists and dental nurses, also showed positive effects.
“Chiropractic interventions [29,34] and dental practice-based treatments, including those by dentists [36] and dental nurses [34], also showed positive effects.”
From Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials (2026) · cites this paper as [29]
The Results (Study outcomes; page not provided) report improvement in all groups, including the chiropractic intervention group. The Methods (Self-care; page not provided) describe care provided by a dentist or dental care coordinator, but the paper does not identify dental nurses or report a positive effect specifically attributable to nurse-delivered treatment. Thus, it supports the chiropractic portion of citation [34], not the dental-nurse portion. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAxis I subtypes, particularly myofascial temporomandibular disorder, responded well to manual therapy interventions.
“Axis I subtypes, particularly myofascial TMD, responded well to manual therapy interventions [28–30,33–35].”
From Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials (2026) · cites this paper as [29]
The Methods (Inclusion criteria; page unavailable) specify an Axis I diagnosis of myofascial pain, and the Results (Study outcomes; page unavailable) report improvement in the chiropractic-intervention group. But all groups improved, including sham treatment and self-care, and none of the differences between the chiropractic group and the other groups was statistically significant. The pilot therefore does not establish that Axis I subtypes generally responded well to manual therapy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSeveral studies emphasized that manual therapy was performed by professionals with specialized training, reinforcing the notion that clinical expertise is critical to achieving effective results.
“Several studies [21,22,25,26,29,31,34] emphasized that manual therapy was performed by professionals with specialized training, reinforcing the notion that clinical expertise is critical to achieving effective results.”
From Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials (2026) · cites this paper as [29]
The Methods (AMCT; page not provided) say that one chiropractor performed all chiropractic treatment. The Discussion says the trial was expertise-based, but its statement about training and technique calibration refers to clinicians who performed diagnostic assessments, not the chiropractor. The paper does not establish that specialized training was critical to effective treatment results. (LLM, conf=0.84)
Experimental — accuracy not yet measuredComparator groups varied widely, including sham or no-treatment control, standard care, splint therapy, and pharmacological treatments.
“Comparator groups varied widely, including sham or no-treatment control [23,27], standard care [21], splint therapy [25,29,32] and pharmacological treatments [38].”
Cuccia et al. and DeVocht et al. demonstrated significant improvements at six months, while Kalamir et al. reported sustained efficacy up to one year, particularly in chronic myogenous temporomandibular disorder.
“Cuccia et al. [24] and DeVocht et al. [29] demonstrated significant improvements at six months, while Kalamir et al. [34] reported sustained efficacy up to one year, particularly in chronic myogenous TMD.”
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Research works printed but not linked: 25
- [2]Jerjes W Upile T Abbas S Muscle disorders and dentition-related aspects in temporomandibular disorders: controversies in the most commonly used treatment modalities Int Arch Med 2008 1 1 23 18973654 PMC2585563
- [3]DeBar LL Vuckovic N Schneider J Ritenbaugh C Use of complementary and alternative me dicine for temporomandibular disorders J Orofac Pain 2003 17 3 224 236 14520768
- [4]Ritenbaugh C Hammerschlag R Dworkin SF 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 1089 23059454 PMC3490702
- [5]La Touche R Goddard G De-la-Hoz JL Acupuncture in the treatment of pain in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials Clin J Pain 2010 26 6 541 550 20551730
- [6]Li LC Wong RW Rabie AB Clinical effect of a topical herbal ointment on pain in temporomandibular disorders: a randomized placebo-controlled trial J Altern Complement Med 2009 15 12 1311 1317 20001836
- [7]Cuccia AM Caradonna C Annunziata V Caradonna D Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial J Bodyw Mov Ther 2010 14 2 179 184 20226365
- [8]Kalamir A Bonello R Graham P Vitiello AL Pollard H Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial J Manipulative Physiol Ther 2012 35 1 26 37 22079052
- [9]Houle S Descarreaux M Conservative care of temporomandibular joint disorder in a 35-year-old patient with spinal muscular atrophy type III: a case study J Chiropr Med 2009 8 4 187 192 19948309 PMC2786227
- [10]DeVocht JW Schaeffer W Lawrence DJ Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument and protocol Altern Ther Health Med 2005 11 6 70 73 16320863
- [11]DeVocht JW Long CR Zeitler DL Schaeffer W Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument: a prospective case series J Manipulative Physiol Ther 2003 26 7 421 425 12975628
- [12]Dworkin SF Huggins K Wilson L A randomized clinical trial using Research Diagnostic Criteria for Temporomandibular Disorders-Axis II to target clinic cases for a tailored self-care TMD treatment program J Orofac Pain 2002 16 1 48 63 11889659
- [14]Jaeschke R Singer J Guyatt GH A comparison of seven-point and visual analogue scales: data from a randomized trial Control Clin Trials 1990 11 1 43 51 2157581
- [15]Jensen MP Karoly P Braver S The measurement of clinical pain intensity: a comparison of six methods Pain 1986 27 1 117 126 3785962
- [16]Devereaux PJ Bhandari M Clarke M Need for expertise based randomised controlled trials BMJ 2005 330 7482 88 15637373 PMC543877
- [17]Truelove E Huggins KH Mancl L Dworkin SF The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: a randomized controlled trial JADA 2006 137 8 1099 1107 16873325
- [18]Michelotti A Iodice G Vollaro S Steenks MH Farella M Evaluation of the short-term effectiveness of education versus an occlusal splint for the treatment of myofascial pain of the jaw muscles JADA 2012 143 1 47 53 22207667
- [19]Fuhr AW The Activator Method 2nd St Louis Mosby Elsevier 2009
- [20]Farrar JT Young JP Jr LaMoreaux L Werth JL Poole RM Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale Pain 2001 94 2 149 158 11690728
- [21]Locker D Slade G Oral health and the quality of life among older adults: the oral health impact profile J Can Dent Assoc 1993 59 10 830 833 837-388, 844 8221283
- [22]Slade GD Spencer AJ Development and evaluation of the Oral Health Impact Profile Community Dent Health 1994 11 1 3 11 8193981
- [23]Slade GD Derivation and validation of a short-form Oral Health Impact Profile Community Dent Oral Epidemiol 1997 25 4 284 290 9332805
- [24]Slade GD Assessing change in quality of life using the Oral Health Impact Profile Community Dent Oral Epidemiol 1998 26 1 52 61 9511843
- [25]Locker D Allen PF Developing short-form measures of oral health-related quality of life J Public Health Dent 2002 62 1 13 20 14700084
- [26]Patrick DL Deyo RA Atlas SJ Singer DE Chapin A Keller RB Assessing health-related quality of life in patients with sciatica Spine (Phila Pa 1976) 1995 20 17 1899 1908 8560339
- [28]Al Ani MZ Davies SJ Gray RJ Sloan P Glenny AM Stabilisation splint therapy for temporomandibular pain dysfunction syndrome Cochrane Database Syst Rev 2004 1 CD002778 14973990
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Chiaramonte, R., Ferrillo, M., de Sire, A., & Vecchio, M. (2026) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2026.2629282
“HVLA techniques applied to the jaw [24,29,31] and cervical spine [21,23,25–27] demonstrated efficacy in reducing pain and improving MMO.”
Influential
- Authors
- DeVocht, J. W., Goertz, C. M., Hondras, M. A., Long, C. R., Schaeffer, W., Thomann, L., Spector, M., & Stanford, C. M.
- Affiliations
- Palmer College of Chiropractic (US)
- University of Iowa (US)
- Corresponding author
- Stanford, Clark M.
- Venue
- The Journal of the American Dental Association
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 144
- Issue
- 10
- Pages
- 1154-1163
- ISSN
- 0002-8177 (ISSN-L)
- PMC
- PMC4103021
- OpenAlex
- W2093208067
- Cited by
- 19
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 2 · 2016: 2 · 2015: 1 · 2014: 1
- FWCI
- 2.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of the American Dental Association (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (1c06rr015433-01, UL1TR000442)
- National Center for Research Resources (C06RR15433-01, C06-RR015433)
- National Center for Advancing Translational Sciences
- National Center for Complementary and Integrative Health (U19AT004663)
- Topics
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- temporomandibular disorders, myofascial pain, chiropractic treatment, self-care, sham treatment, feasibility, temporomandibular joint pain, Research Diagnostic Criteria
- MeSH terms
- Adult, Facial Pain, Female, Humans, Male, Pain Measurement, Pilot Projects, Self Care, Temporomandibular Joint Disorders, Treatment Outcome, Occlusal Splints, Manipulation, Chiropractic, Chronic Pain
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