Treatment of temporomandibular disorders-Beyond splints!

Introduction

Temporomandibular disorders are a group of neuro-musculoskeletal disorders that have a multifaceted causation. The current study was a retrospective study undertaken to evaluate the outcome of different modalities of treatment provided in one office.

Materials and methods

Out of a cadre of 425 patients who had undergone TM joint treatment and had finished treatment at least 2 years before 2017, 171 patients were successfully recalled for the purpose of the study. The patients that were recalled were divided into groups based on the treatment they had received. The groups were 1. Splint only group. 2. Splint and Braces group. 3. Splint Braces and equilibration group, 4. Splint, Braces and Jaw surgery. 5. Splint braces Joint surgery and Jaw surgery. Pre-treatment Helkimo index scores of anamnestic score Ai, dysfunction scores Di were extracted from the medical records and compared to the Helkimo index scores at the time of recall appointments. Modification was made to the Helkimo index made to include the consistency of food the patient could eat without pain and was called the food index (Fi). This data was also extracted from the pre-treatment records and compared to the post treatment records. Data gathered was subjected to Pearson correlation and Kruskal Wallis analysis of variance. The test was considered significant at a p value of less than or equal to 0 .05. (95 percent confidence). Data was also gathered to evaluate the number of pain episodes post- treatment and compared to the per-treatment data from the chart.

Results

All patients treated in the group showed both clinical and statistical significance is all parameters of Ai. Di, and Fi scores. Acute exacerbation of pain was also reduced. Ai, Di, and Fi, scores showed most improvement in the groups that had Splint, braces and jaw surgery and the group Splint braces joint surgery and jaw surgery. Acute exacerbations of pain was also least in the aforementioned groups. Patients treated with splint only showed the most amount of acute exacerbation in pain. Another interesting observation in the study was that a linear relation was present between Ai and Fi with a nonlinear relation between Ai and Di, and Di and Fi, indicating that it is lack of pain and not the degree of mouth opening that is important that allows the patient to consume the hard and chewy foods.

Conclusion

1. In our study all modalities of treatment gave an improvement in patient status pretreatment to post treatment periods. 2. Most relief was attained in the groups of Splint braces and jaw surgery and splint braces joint surgery and jaw surgery. 3. Linearity in relation between Ai and Fi, indicated that it is lack of pain and not the degree of mouth opening that allows patients to consume diet of chewy and hard consistency. 4. Although our study indicates that the surgical options gave the best results, surgical options should be considered after all options are tried. 5. Our study demonstrates TM joint problems cannot be cured but by controlling the contributing factors it can be managed very effectively.