Osteopathy treatment of temporomandibular joint dysfunction in young teens
Open accessAbstract
Introduction and Objective.Pain symptoms of the temporomandibular joint constitute a challenge for clinicians as well as patients having to cope with this issue.Presently, there are no clear cut factors that could cause TMD in children and youths.The differentiation of the diagnostic significance of symptoms of TMD constitutes an ever greater challenge in dental and orthodontic treatment.The manual procedure used in the treatment of diseases of the musculoskeletal systems, as well as in temporomandibular diseases (TMD), seems to be promising, although at present there is no high-quality proof that would indicate the efficacy of this therapy.Materials and Methods.30 young teens transferred to osteopathic specialists due to pain diseases of the TMJ, and subjected to treatment using osteopathic therapy.Assessment of symptoms related to the TMJ was by the TMJ Symptom intensity scale (SIS) and the TMJ Symptom Frequncy Scale (SFS), constituting modifications of the Steigerwald/ Maher questionnaire.Results.Statistically significant improvement was found in the most severe cases (p=0.0032) and usual (p=0.0007)jaw pain.Improvements were also found for painful jaw clicking (most severe p=0.0076 and usual p=0.0220).The intensity of the jawlocking symptom on a daily basis was the same, but the greatest intensity of locking decreased (p=0.0077).A beneficial effect was found for osteopathic intervention on jaw pain (p=0.0207),painful jaw clicking (p=0.0011) and headaches (p=0.0122).Conclusions.1) Osteopathic therapy positively influences the reduction of pain in the TMJ in children aged 12-14 years.2) Osteopathic techniques positively influence the reduction of occurring pain symptoms of the head in TMD.
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TL;DR
In 30 young teens aged 12–14 with temporomandibular joint pain, osteopathic manual treatment over three monthly visits was associated with statistically significant reductions in some jaw pain, clicking, and headache measures. The authors conclude osteopathy may reduce TMJ and head pain symptoms, but the study is small, uncontrolled, and reports some inconsistent p-values.
Key findings
- On the TMJ Symptom Intensity Scale (SIS), usual jaw pain improved from mean 6.1 to 3.1 (p=0.0007), and most severe jaw pain improved from 9.6 to 5.5 (p=0.032 in Results/Table 2; the abstract states p=0.0032).
- SIS improvements were also reported for painful jaw clicking (usual p=0.0220; most severe p=0.0076 in the abstract/Results text, while Table 2 lists p=0.076 for most severe) and for greatest jaw-locking intensity (p=0.0077 in the text, while Table 2 lists p=0.482 for most severe).
- On the TMJ Symptom Frequency Scale (SFS), significant beneficial effects were found for jaw pain (p=0.0207), painful jaw clicking (p=0.0011), and headaches (p=0.0122); no significant change was found for ringing in the ears, dizziness, or neck/upper shoulder muscle pain.
- The authors conclude that osteopathic therapy positively influences reduction of TMJ pain in children aged 12–14 years and positively influences reduction of head pain symptoms in TMD.
Methods
- Single-group before–after study of 30 young teens (average age 13 years; Table 1 age 12.3 ± 0.7) referred by an orthodontist for TMJ pain and joint jumping, with no bite dysfunctions or TMJ dislocations; conducted June–December 2023 at a private practice in Gdańsk, Poland.
- Intervention: osteopathic manual treatment using inhibition techniques on masticatory muscles (temporalis, masseter, lateral and medial pterygoid) and ligaments (joint capsule/lateral, sphenomandibular, stylomandibular), delivered over three visits at monthly intervals, plus self-treatment twice daily; patients avoided chewing gum and noted symmetrical biting during eating.
- Assessment and analysis: TMJ Symptom Intensity Scale (SIS) and TMJ Symptom Frequency Scale (SFS), modified from the Steigerwald/Maher questionnaire, completed before therapy and one month after the last visit; results analyzed with Student’s t-test for dependent samples.
Limitations
- The paper states there is no high-quality proof of efficacy for manual therapy in TMD, that efficacy in children is “advantageous yet inconclusive,” and that further research is necessary.
- Evident from the text: small single-group sample (n=30), no control/comparison group reported, single private practice, unblinded self-report outcomes, and short follow-up (one month after the last visit).
- Evident from the text: internal inconsistencies between the abstract, Results text, and tables for several p-values (e.g., most severe jaw pain p=0.0032 vs 0.032; most severe painful jaw clicking p=0.0076 vs Table 2 p=0.076; jaw locking p=0.0077 vs Table 2 p=0.482), and Table 1 BMI categories sum to more than 100%.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 6 cited sources checked · 0 supported · 0 flagged
- Findingown data
In the study sample, no significant change was found on the SFS for ringing in the ears, dizziness, or neck and/or upper shoulder muscle pain.
“No significant change was found in terms of ringing in the ears, dizziness, neck and/or upper shoulder muscle pain.”
Quote in the paperNot a substantial claim - Findingown data
In the study sample, improvements were found for painful jaw clicking on the SIS (most severe p=0.0076 and usual p=0.0220).
“Improvements were also found for painful jaw clicking (most severe p=0.0076 and usual p=0.0220).”
Quote in the paperSubstantial claim - Interpretationown data
Osteopathic treatment reduces the subjective perception of pain in the temporomandibular joint in children aged 12-14 years.
“On the basis of the performed statistical analysis and the results, the zero hypothesis is rejected and the alternative hypothesis confirmed, indicating that osteopathic treatment reduces the subjective perception of pain in the temporomandibular joint in children aged 12-14 years.”
- Also stated in: § Abstract · plain
“1) Osteopathic therapy positively influences the reduction of pain in the TMJ in children aged 12-14 years.”
Quote in the paperSubstantial claim - Also stated in: § Abstract · plain
- Interpretationown data
Osteopathic techniques positively influence the reduction of occurring pain symptoms of the head in temporomandibular disorders.
“2) Osteopathic techniques positively influence the reduction of occurring pain symptoms of the head in TMD.”
Quote in the paperSubstantial claim
- May combine two claims. 7
- The quote only partly states this claim. 1
- Classified as probably not a substantial claim. 1
May combine two claims. The quote only partly states this claim.
Findingown dataIn the study sample, osteopathic treatment was associated with statistically significant improvement in most severe jaw pain (p=0.032) and usual jaw pain (p=0.0007) on the SIS.
“The conducted tests revealed a statistically significant improvement in most severe (p=0.032) and usual (p=0.0007)jaw pain.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataIn the study sample, the intensity of the jaw-locking symptom on a daily basis was unchanged, but the greatest intensity of locking decreased (p=0.0077) on the SIS.
“The intensity of the jaw-locking symptom on a daily basis was the same, but the greatest intensity of locking decreased (p=0.0077).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataIn the study sample, a beneficial effect of osteopathic intervention was found on the SFS for jaw pain (p=0.0207), painful jaw clicking (p=0.0011), and headaches (p=0.0122).
“A beneficial effect was found for osteopathic intervention on jaw pain (p=0.0207),painful jaw clicking (p=0.0011) and headaches (p=0.0122).”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationOther recent studies show improvement after the use of physical intervention, with particular improvement in reduction of pain and improvement of jaw function.
“Other recent studies also show improvement after the use of physical intervention, with particular improvement noted in the reduction of pain and improvement of jaw function [19,20].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [19]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [20]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationManual treatment carried out among patients aged 5-30 years has resulted in significant improvement in pain symptoms and mouth opening.
“Further research has also confirmed that manual treatment carried out among patients aged 5-30 years has resulted in a significant improvement in terms of pain symptoms, as well as opening of the mouth [18].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [18]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationThe efficacy of treatment of illnesses in children has advantageous yet inconclusive indications, with unwanted events during manual therapy being transient, gentle to moderate.
“The efficacy of treatment of illnesses in children, however, has advantageous yet inconclusive indications, with unwanted events during the application of manual therapy being transient, gentle to moderate [14].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [14]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationAssessment of symptoms related to the temporomandibular joint used the TMJ Symptom Intensity Scale (SIS) and the TMJ Symptom Frequency Scale (SFS), which are modifications of the Steigerwald/Maher questionnaire.
“The assessment of symptoms related to the TMJ used the TMJ Symptom intensity scale (SIS) and the TMJ Symptom Frequncy Scale (SFS), a modification of the Steigerwald/ Maher questionnaire [9] with a data section.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationRecent years have seen development of manual techniques and a decidedly lower volume of unwanted effects compared to other interventions.
“Recent years have influenced the development of manual techniques, as well as a registered, decidedly lower volume of unwanted effects compared to other interventions [14].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [14]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
The paper relies on this without support.
There is no reliable research proving the efficiency of TMD treatment, especially in children.
“There is no reliable research proving the efficiency of TMD treatment, especially in children, hence the need for clinical trials in this regard.”
The paper relies on this without support.
Presently, there are no clear cut factors that could cause TMD in children and youths.
“Presently, there are no clear cut factors that could cause TMD in children and youths.”
The paper relies on this without support.
At present there is no high-quality proof that would indicate the efficacy of manual therapy for temporomandibular diseases.
“The manual procedure used in the treatment of diseases of the musculoskeletal systems, as well as in temporomandibular diseases (TMD), seems to be promising, although at present there is no high-quality proof that would indicate the efficacy of this therapy.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Most-severe clicking is called significant despite Table 2 p-value
MajorThe text reports p=0.0076 for most-severe painful jaw clicking, whereas Table 2 reports 0.076. The table value does not support the stated statistically significant improvement.
“Improvements were also found for painful jaw clicking (most severe p=0.0076 and usual p=0.0220).”
“| jaw clicking | Most severe | 8.6 | 2.2 | 3.3 | 1.9 | 0.076 |”
Jaw-locking significance claim conflicts with Table 2
MajorThe Results section reports p=0.0077 for the decrease in greatest jaw-locking intensity, but Table 2 gives p=0.482 for that outcome.
“the greatest intensity of locking decreased (p=0.0077).”
“| | Most severe | 7.4 | 4.8 | 7.1 | 6.0 | 0.482 |”
Usual jaw-locking intensity is described as unchanged
MajorThe text says daily jaw-locking intensity was the same, but Table 2 shows its usual-intensity mean rising from 4.5 before treatment to 8.9 after treatment.
“The intensity of the jaw-locking symptom on a daily basis was the same”
“| | usual | 4.5 | 4.2 | 8.9 | 3.2 | 0.077 | | Jaw locking | | | | | | |”
Most-severe jaw-pain p-value differs between sections
MinorThe abstract gives p=0.0032 for most-severe jaw pain, while the Results section gives p=0.032 for the same outcome.
“Statistically significant improvement was found in the most severe cases (p=0.0032) and usual (p=0.0007)jaw pain.”
“The conducted tests revealed a statistically significant improvement in most severe (p=0.032) and usual (p=0.0007)jaw pain.”
BMI categories total more than 100%
MinorThe four mutually exclusive weight categories for the study group sum to 121.4%, so they cannot all describe the same group.
“| Normal range | 32.7% | | Overweight | 47% | | Obese ( Class I) | 15.7% | | Obese (Class II) | 26% |”
“| | Research group n=30 |”
Ringing-in-the-ears mean exceeds the scale maximum
MinorEach symptom is scored from zero to ten, but Table 3 reports an after-treatment mean of 26.64 for ringing in the ears.
“| Ringing in the ears | 5.04 | 4.09 | 26.64 | 4.74 0.5211 | |”
“For each affliction, the patient provides a score, between zero -no symptoms, and ten -strongest symptoms.”
Usual jaw-pain p-value differs from Table 2
MinorThe Results section reports p=0.0007 for usual jaw pain, but Table 2 reports 0.007.
“usual (p=0.0007)jaw pain.”
“| | usual | 6.1 | 2.0 | 3.1 | 3.9 | 0.007 |”
Cites
The publisher hasn’t deposited this paper’s reference list.
Research works printed but not linked: 3
- Szczepańska J. Disturbances of masticatory system at children and adoloscents -on the basis of literature. Nowa Stomatologia. 2011;2:45-9.
- Steigerwald DP MJH. The Steigerwald/Maher TMD Disability Questionnaire. Today's Chiro. 1997;26:86-91.
- Hruby RJ. Management of Temporomandibular Disorders: New Opportunities for Osteopathic Medicine? Journal of Osteopathic Medicine. 2019;119:340-1.
Cited by
Sorted by citations
Osteopathic treatment of temporomandibular joint dysfunction
Abirova, R., & Eshiev, A. (2025) · Journal of Human Biology and Clinical Medicine · doi:10.63621/jhbcm/1.2026.08
“J. Pawłowski et al. [13] investigated the effects of osteopathic treatment on TMJ in adolescents and reported a marked reduction in pain along with improved functional outcomes.”
- Authors
- Pawłowski, J., Pawłowska, K. M., & Grochulska, A.
- Affiliations
- Uniwersytet Pomorski w Słupsku (PL)
- Corresponding author
- Pawłowski, Jakub
- Venue
- Journal of Pre-Clinical and Clinical Research
- Publisher
- Institute of Rural Health
- Published
- 2024-12-23
- Volume
- 18
- Issue
- 4
- Pages
- 299-302
- ISSN
- 1898-2395 (ISSN-L)
- 1898-7516
- OpenAlex
- W4405980648
- Semantic Scholar
- 5e65addda12757b7faf3c2ed56e72a8ae04f715c
- Cited by
- 0
- References
- 0
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Journal of Pre-Clinical and Clinical Research (publishedVersion, cc-by-nc)
- Topics
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Keywords
- osteopathic treatment, temporomandibular disorders, jaw pain, jaw clicking, jaw locking, headache, adolescents, manual therapy
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