Physical Exercises for Temporomandibular Disorders
Physical Exercises for Temporomandibular Disorders
Temporomandibular Disorders are a common clinical picture that appear in particular in people
 between the age of 20 and 40 years. About 33% of the total population shows symptoms and
 signs of TMD. Among the temporomandibular joint disorders anterior disc displacement appear
 to be the most common. In case of limitations of jaw movements and or pain conservative
 methods including combinations of behavior change, physiotherapy, stabilization appliance
 therapy and medication are most popular. The benefit of a self-treatment program to
 strengthen the lateral pterygoid muscle and to learn a properly executed lower jaw sideways
 movement to achieve pain reduction is up to now not well investigated. The aim of this study
 is to examine the effectiveness of muscle training for the treatment of patients with
 anterior disc displacement with reduction (DDWR). 60 patients with DDWR and pain (≥18 years)
 will be randomly allocated to two groups: 1. Physical exercises, 2. Stabilization appliance
 therapy. All patients receive a functional examination according to the Diagnostic Criteria
 for Temporomandibular Disorders (DC/TMD) at baseline.

 The training in group 1 includes eccentric and concentric counter-movements of the lower jaw
 muscle to strengthen and restore a physiological lateral movement of the mandible. The muscle
 exercises should be performed once a day with 5-6 repetitions per side. The treatment with an
 equilibration appliance in the lower jaw serves as a comparison group. Patients are
 instructed to wear the appliance while sleeping. The wearing rhythm is described as
 intermittent. (three nights - wearing the appliance, one night - not wearing the appliance).
 The primary target variable is the occurrence of pain in the head and joint area before and
 during therapy. The variable is measured using a numeric rating scale (NRS; 0-10) during the
 baseline examination and control check-ups after 2, 4 and 6 months.
The literature describes the cause of a temporomandibular disorder (TMD) as a multifactorial
 event. It can be influenced by anatomical, neuromuscular, traumatic or psychosocial factors.
 Disturbances often occur in the condyle-disc complex of the temporomandibular joint. The
 relationship between the articular disc and the condyle head is pathologically altered. The
 Diagnostic Criteria for Temporomandibular disorders (DC / TMD) describe the displacement of
 the disc in 4 different forms: disc displacement with reduction; disc displacement with
 reduction and intermittent locking; disc displacement without reduction with limited opening
 and disc displacement without reduction without limited opening. TMDs are a common clinical
 picture that appears in particular in people between the age of 20 and 40 years. About 33% of
 the total population show signs and symptoms of TMD.

 Studies prove that the displacement of the disc with reduction is the most common disorder
 among temporomandibular joint disorders. According to the DC / TMD, this clinical picture
 shows intracapsular and biomechanical alterations. If the mouth is closed, the articular disc
 is often located in front of the mandibular condyle; if the mouth is opened, the disc moves
 back to its original position on the condyle. Anterior disc displacement appears to be the
 most common, although a medial or lateral displacement is also possible. During the disc
 repositioning clicking, popping or snapping noises are usually recorded. Temporomandibular
 joint disorders such as disc displacement, can also cause pain. Overstretching of the
 posterior ligament and a compression of the bilaminar zone mandibular movements can be
 pain-related. Therefore, clicking, popping or snapping noises in the area of the
 temporomandibular joint (TMJ) correlate with pain in the surrounding tissue. Those complaints
 intensify when opening the mouth or chewing food.

 The treatment of TMD should be oriented on evidence-based procedures that are easy to
 implement in practice and have a long-term positive effect on the patient's symptoms.
 Conservative methods including combinations of behavior change, physiotherapy, splint-therapy
 and medication are most popular. The physiotherapeutic treatment should pursue different
 strategies, including manual therapy methods (e.g. mobilization and stretching of the
 temporomandibular joint and / or the neck area) and the demonstration of exercises in
 everyday life (e.g. self-mobilization and stretching of the masticatory muscles and / or
 cervical spine) and in addition educating the patient (e.g. about the perception of
 parafunctions or relaxation techniques). Conservative attempts for patients with TMD should
 be the first choice. However, there is still no clear data situation and the data pool of
 randomized clinical studies on this topic needs to be improved. So far studies demonstrate a
 positive effect of the tested therapy forms. But the individual studies differ greatly in
 terms of the patient pool, diagnosis, treatment modalities and the result. Furthermore, a
 precisely described procedure is missing in some papers. Therefore, an exact reproducibility
 for practitioners is not executable. More research is needed into the benefits of various
 non-invasive treatments for TMD.

 The primary goal of this study is to decrease the ambiguity in this scientific field. In the
 past various manual and physiotherapeutic exercise methods have already been tested.

 This study is also intended to examine the effectiveness of muscle training for the treatment
 of patients with anterior disc displacement with reduction. The exercises are primarily
 supposed to train the lateral pterygoid muscle. The treatment with an equilibration appliance
 in the lower jaw serves as a comparison group.
Inclusion Criteria:

 -  Orofacial pain in the joint or muscles, degree NRS≥3

 -  Clicking phenomenon during TMJ opening or closing movement

 -  Deviation movement during opening of the lower jaw

 -  Legal competence and presence of the signed declaration of consent

 Exclusion Criteria:

 -  Drug abuse

 -  Depression

 -  Polyarthritis