Temporomandibular Eklem Rahatsızlığında Farklı Tedavi Yöntemlerinin Çiğneme Kas Aktivitesi, Ağrı, Postür, Psikolojik Durum ve Yaşam Kalitesi Üzerine Etkilerinin Karşılaştırılması

Abstract

The aim of this study was to compare the effects of three different treatment methods on muscle activity during chewing, pain, temporomandibular joint (TMJ) and cervical region joint range of motion (ROM), psychological status, and quality of life in Temporomandibular Joint Disorder (TMJD). 42 individuals with myofascial TMJD and 12 healthy individuals (HG) participated in the study. Individuals with TMJD were divided into three groups consisting of 14 individuals each, namely Exercise Group (EG), TENS Group (TG), and Manual Therapy Group (MTG). An exercise program consisting of stretching, strengthening and postural exercises was applied to the TMJ and cervical region for 6 weeks in all three groups. While the only exercise program was applied to EG, TENS treatment in addition to exercise was applied to TG, and manual treatment (classical massage, friction massage and joint mobilization) in addition to exercise was applied to MTG, 3 sessions per week for 6 weeks. Pain intensity (visual analog scale-VAS), pressure pain threshold (PPT) (algometer), muscle activity of the masseter and anterior temporalis muscles during chewing (superficial electromyography), chewing quality (VAS), TMJ range of motion (ROM) (millimetric scale), cervical region ROM (Cervical Range of Motion Device-CROM), TMJ functional status (Fonseca Anamnestic Questionnaire-FAQ and Mandibular Function Impairment Questionnaire-MFIQ), psychological status (Hospital Anxiety Depression Scale) and quality of life (SF-36 Scale) were evaluated. In order to compare the post-treatment data of individuals with TMJD with healthy individuals, the muscle activity during chewing and TMJ ROM of the HG was evaluated. After the treatment, it was observed that there were significant improvements in all parameters in all three treatment groups (p<0.05), but some parameters could not reach the values of the healthy group. In the comparison between the groups; all improvements were greater in MTG than in EG (p<0.05). Improvements in PPT, right/left lateral movements of the TMJ, cervical flexion and extension, chewing quality, and muscle activity during chewing were greater in MTG than in TG (p<0.05). Improvements in pain intensity, PPT values, chewing quality, cervical flexion and extension, and left lateral movement of the TMJ were higher in TG than in EG (p<0.05). As a result, although all three treatment methods are effective in TMJD, it was found that the combination of manual therapy and exercise was the most effective treatment option according to the effect size. We think that the success of treatment and functional level will increase with studies where dentists and physiotherapists work as a team and long-term patient follow-ups are carried out.