Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: A randomized, controlled trial A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders. Efficacy of stabilisation splint therapy combined with non-splint multimodal therapy for treating RDC/TMD axis I patients: a randomised controlled trial. Headache and Temporomandibular Disorders: Evidence for Diagnostic and Behavioural Overlap Mediators, moderators, and predictors of therapeutic change in cognitive–behavioral therapy for chronic pain Biofeedback-based Cognitive-Behavioral Treatment Compared With Occlusal Splint for Temporomandibular Disorder: A Randomized Controlled Trial Brief cognitive-behavioral treatment for TMD pain: Long-term outcomes and moderators of treatment Momentary pain and coping in temporomandibular disorder pain: Exploring mechanisms of cognitive behavioral treatment for chronic pain Clinical Evaluation of Amitriptyline for the Control of Chronic Pain Caused by Temporomandibular Joint Disorders Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy. Long-Term Efficacy of Biobehavioral Treatment of Temporomandibular Disorders Trigger point injection therapy in the management of myofascial temporomandibular pain. [Acupuncture and ultrasound therapy for temporomandibular disorders]. Reliability of clinical temporomandibular disorder diagnoses Efficacy of low-level laser therapy in the treatment of temporomandibular disorder. Effect of Treatment of Temporomandibular Disorders (TMD) in Patients with Cervicogenic Headache: A Single-Blind, Randomized Controlled Study Is there a link between tinnitus and temporomandibular disorders? Dysfunctional patients with temporomandibular disorders: evaluating the efficacy of a tailored treatment protocol. Adapting the diagnostic definitions of the RDC/TMD to routine clinical practice: a feasibility study. Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial. Can an NTI‐tss device be effective as a first‐line therapy in patients with TMD myofascial pain? Efficacy of Appliance Therapy on Temporomandibular Disorder Related Facial Pain and Mandibular Mobility: A Randomized Controlled Study
Abstract We evaluated the short‐ and long‐term efficacy of a brief cognitive‐behavioral therapy ( CBT ) for chronic temporom and ibular disorder ( TMD ) pain in a r and omized controlled trial . TMD clinic patients were assigned r and omly to four sessions of either CBT ( n = 79 ) or an education/attention control condition ( n = 79 ) . Participants completed outcome ( pain , activity interference , jaw function , and depression ) and process ( pain beliefs , catastrophizing , and coping ) measures before r and omization , and 3 ( post‐treatment ) , 6 , and 12 months later . As compared with the control group , the CBT group showed significantly greater improvement across the follow‐ups on each outcome , belief , and catastrophizing measure ( intent‐to‐treat analyses ) . The CBT group also showed a greater increase in use of relaxation techniques to cope with pain , but not in use of other coping strategies assessed . On the primary outcome measure , activity interference , the proportion of patients who reported no interference at 12 months was nearly three times higher in the CBT group ( 35 % ) than in the control group ( 13 % ) ( P = 0.004 ) . In addition , more CBT than control group patients had clinical ly meaningful improvement in pain intensity ( 50 % versus 29 % showed ≥50 % decrease , P = 0.01 ) , masticatory jaw function ( P < 0.001 ) , and depression ( P = 0.016 ) at 12 months ( intent‐to‐treat analyses ) . The two groups improved equivalently on a measure of TMD knowledge . A brief CBT intervention improves one‐year clinical outcomes of TMD clinic patients and these effects appear to result from specific ingredients of the CBT AIMS To test the usefulness of tailoring cognitive-behavioral therapy ( CBT ) for patients with temporom and ibular disorders ( TMD ) who demonstrated poor psychosocial adaptation to their TMD condition , independent of physical diagnosis . METHODS A r and omized clinical trial compared a 6-session CBT intervention delivered in conjunction with the usual TMD treatment to the usual conservative treatment by TMD specialist dentists . For study inclusion , Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) , Axis II criteria , were used to target patients with elevated levels of TMD pain-related interference with daily activities , independent of physical diagnosis ( i.e. , Axis I ) . RESULTS At the post-treatment assessment , about 4 months after the baseline evaluations , the comprehensive care group , when compared to the usual treatment group , showed significantly lower levels of characteristic pain intensity , significantly higher self-reported ability to control their TMD pain , and a strong trend ( P = .07 ) toward lower pain-related interference in daily activities . From post-intervention to 1-year follow-up , all subjects showed improvement . At the 1-year follow-up , the comprehensive care group , while not losing any of its early gains , was not significantly different from the usual care group with regard to reported levels of pain , ability to control pain , and levels of interference in activities . For many of these psychosocially disabled TMD patients , pain and interference 1 year after treatment remained at the same or higher levels than those observed at baseline among a group of patients selected for a separate r and omized clinical trial on the basis of better psychosocial adaptation . CONCLUSION The 6-session CBT intervention for patients with heightened psychologic and psychosocial disability was effective in improving pain-related variables over the course of the CBT in conjunction with usual treatment , but was too brief an intervention to result in further improvement after the sessions ended . Patient ratings of treatment satisfaction and helfulness were high for both groups , but they were significantly higher for the comprehensive care group Stabilisation splint therapy has long been thought to be effective for the management of temporom and ibular disorders ( TMD ) . However , the superiority of stabilisation splint therapy compared to other TMD treatments remains controversial . The aim of this study was to determine the efficacy of stabilisation splint therapy combined with non-splint multimodal therapy for TMD . A total of 181 TMD participants were r and omly allocated to a non-splint multimodal therapy ( NS ) group ( n = 85 ) or a non-splint multimodal therapy plus stabilisation splint ( NS+S ) group ( n = 96 ) . Non-splint multimodal therapy included self-exercise of the jaw , cognitive-behavioural therapy , self-management education and additional jaw manipulation . Three outcome measurements were used to assess treatment efficacy : mouth-opening limitation , oro-facial pain and temporom and ibular joint sounds . A two-factor repeated- measures analysis of variance ( anova ) was used to evaluate the efficacy of the two treatment modalities ( NS vs. NS+S ) , and Scheffe 's multiple comparison test was used to compare the treatment periods . Subgroup analyses were performed to disclose the splint effects for each TMD diagnostic group . All three parameters significantly decreased over time in both groups . However , there were no significant differences between the two treatment groups in the total comparison or subgroup analyses ; an exception was the group with degenerative joint disease . No significant difference between the NS and NS+S treatment approaches was revealed in this study . Therefore , we conclude that the additional effects of stabilisation splint are not supported for patients with TMD during the application of multimodal therapy To assess the diagnostic and behavioural overlap of headache patients with temporom and ibular disorders ( TMD ) , individuals recruited from the general population with self-described headaches were compared with non-headache controls . The examination and diagnostic procedures in the Research Diagnostic Criteria ( RDC ) for TMD were applied to both sets of subjects by a blinded examiner . Following their examination , subjects used experience sampling methods to obtain data on pain , tooth contact , masticatory muscle tension , emotional states and stress . Results showed that a significantly higher proportion of the headache patients received an RDC/TMD diagnosis of myofascial pain than non-headache controls . Headache patients also reported significantly more frequent and intense tooth contact , more masticatory muscle tension , more stress and more pain in the face/head and other parts of the body than non-headache controls . These results are similar to those reported for TMD patients and they suggest that headache patients and TMD patients overlap considerably in diagnosis and oral parafunctional behaviours Abstract Although cognitive – behavioral therapies ( CBT ) have been demonstrated to be effective for a variety of chronic pain problems , patients vary in their response and little is known about patient characteristics that predict or moderate treatment effects . Furthermore , although cognitive – behavioral theory posits that changes in patient beliefs and coping mediate the effects of CBT on patient outcomes , little research has systematic ally tested this . Therefore , we examined mediators , moderators , and predictors of treatment effects in a r and omized controlled trial of  CBT for chronic temporom and ibular disorder ( TMD ) pain . Pre‐ to post‐treatment changes in pain beliefs ( control over pain , disability , and pain signals harm ) , catastrophizing , and self‐efficacy for managing pain mediated the effects of CBT  on pain , activity interference , and jaw use limitations at one year . In individual mediator analyses , change in perceived pain control was the mediator that explained the greatest proportion of the total treatment effect on each outcome . Analyzing the mediators as a group , self‐efficacy had unique mediating effects beyond those of control and the other mediators . Patients who reported more pain sites , depressive symptoms , non‐specific physical problems , rumination , catastrophizing , and stress before treatment had higher activity interference at one year . The effects of CBT generally did not vary according to patient baseline characteristics , suggesting that all patients potentially may be helped by this therapy . The results provide further support for cognitive – behavioral models of chronic pain and point to the potential benefits of interventions to modify specific pain‐related beliefs in CBT and in other health care encounters Objectives : Cognitive-behavioral treatment has proven efficacy for chronic temporom and ibular disorder ( TMD ) . However , most patients receive dental treatment that may not address psychological comorbidities often present in TMD . The aim of the present study was to evaluate the efficacy of biofeedback-based cognitive-behavioral treatment ( BFB-CBT ) versus dental treatment with occlusal splint ( OS ) . Moreover , changes in nocturnal masseter muscle activity ( NMMA ) were investigated . Methods : Fifty-eight patients with chronic TMD were r and omly assigned to receive either 8 weekly sessions of BFB-CBT or 8 weeks of OS treatment . Diagnoses were established using Research Diagnostic Criteria for TMD . Pain intensity and disability were defined as primary outcomes . Secondary outcomes included emotional functioning , pain coping , somatoform symptoms , treatment satisfaction , and adverse events . NMMA was assessed during 3 nights pretreatment and posttreatment with portable devices . Follow-up assessment took place 6 months after the treatment . Results : Both treatments result ed in significant reductions in pain intensity and disability , with similar amounts of clinical ly meaningful improvement ( 45 % for BFB-CBT and 48 % for OS ) . Patients receiving BFB-CBT showed significantly larger improvements in pain coping skills . Satisfaction with treatment and ratings of improvement were higher for BFB-CBT . Effects were stable over 6 months , and tended to be larger in the BFB-CBT group for all outcomes . No significant changes were observed in NMMA . Discussion : The fact that BFB-CBT result ed in larger improvements in pain coping skills , and was well accepted by the patients , underlines the importance and feasibility of psychological treatments in the clinical management of TMD & NA ; The purpose of this study was to determine whether a brief ( 6–8 sessions ) cognitive‐behavioral treatment for temporom and ibular dysfunction‐related pain could be efficacious in reducing pain , pain‐related interference with lifestyle and depressive symptoms . The patients were 101 men and women with pain in the area of the temporom and ibular joint of at least 3 months duration , r and omly assigned to either st and ard treatment ( STD ; n = 49 ) or st and ard treatment + cognitive‐behavioral skills training ( STD + CBT ; n = 52 ) . Patients were assessed at posttreatment ( 6 weeks ) , 12 weeks , 24 weeks , 36 weeks , and 52 weeks . Linear mixed model analyses of reported pain indicated that both treatments yielded significant decreases in pain , with the STD + CBT condition result ing in steeper decreases in pain over time compared to the STD condition . Somatization , self‐efficacy and readiness for treatment emerged as significant moderators of outcome , such that those low in somatization , or higher in self‐efficacy or readiness , and treated with STD + CBT reported of lower pain over time . Somatization was also a significant moderator of treatment effects on pain‐related interference with functioning , with those low on somatization reporting of less pain interference over time when treated in the STD + CBT condition . It was concluded that brief treatments can yield significant reductions in pain , life interference and depressive symptoms in TMD sufferers , and that the addition of cognitive‐behavioral coping skills will add to efficacy , especially for those low in somatization , or high in readiness or self‐efficacy ABSTRACT The purpose of this study was to determine whether cognitive – behavioral treatment ( CBT ) operates by effecting changes in cognitions , affects , and coping behaviors in the context of painful episodes . Patients were 54 men and women with temporom and ibular dysfunction‐related orofacial pain ( TMD ) enrolled in a study of brief ( 6 weeks ) st and ard conservative treatment ( STD ) or st and ard treatment plus CBT ( STD + CBT ) . Momentary affects , pain , and coping processes were recorded on a cell phone keypad four times per day for 7 days prior to treatment , and for 14 days after treatment had finished , in an experience sampling paradigm . Analyses indicated no treatment effects on general retrospective measures of pain , depression , or pain‐related interference with lifestyle at post‐treatment . However , mixed model analyses on momentary pain and coping recorded pre‐ and post‐treatment indicated that STD + CBT patients reported greater decreases in pain than did STD patients , significantly greater increases in the use of active cognitive and behavioral coping , and significantly decreased catastrophization . Analyses of experience sampling data indicated that post‐treatment momentary pain was negatively predicted by concurrent active coping , self‐efficacy , perceived control over pain , and positive‐high arousal affect . Concurrent catastrophization was strongly predictive of pain . Active behavioral coping and self‐efficacy reported at the prior time point ( about 3 h previously ) were also protective , while prior catastrophization and negative‐high arousal mood were predictive of momentary pain . The results suggest that CB treatment for TMD pain can help patients alter their coping behaviors , and that these changes translate into improved outcomes ABSTRACT Temporom and ibular disorder ( TMD ) is characterized by a combination of symptoms affecting the temporom and ibular joint and /or chewing muscles . The two most common clinical TMD symptoms are pain and dysfunction . Pain is usually caused by dysfunction , and emergency therapy has focused on controlling it . Recent investigations into TMD have led to the recommendation of antidepressants as a supporting treatment against constant neuralgic pain . The aim of this double-blind study was to verify the efficiency of antidepressants ( amitriptyline ) as a support in the treatment of chronic TMD pain .  Twelve female volunteers presenting chronic TMD pain were divided into two groups and treated for 14 days : Group 1 with 25 mg/day of amitriptyline and Group 2 with a placebo . The intensity of pain and discomfort was evaluated daily , using a visual analog scale ( VAS ) , over a period of seven days preceding the treatment ( baseline ) , during the 14-day treatment , and for seven days after the treatment . The results revealed a significant reduction of pain and discomfort in Group 1 ( 75 % ) compared to Group 2 ( 28 % ) during the three weeks beginning at baseline ( p < 0.01 ) . Amitriptyline proved to be an efficient alternative treatment for chronic pain in TMD patients The objective of this study was to assess variations in the occurrence of temporom and ibular disorders ( TMDs ) and the risk of developing pain and function impairment of the temporom and ibular complex in obstructive sleep apnea syndrome ( OSAS ) patients treated with either an oral appliance ( m and ibular advancement device )  or continuous positive airway pressure ( CPAP )  in a 2-year follow-up study . In addition , we assessed the relationship between the mean m and ibular protrusion and the frequency of wearing the appliance during follow-up with the occurrence of pain and function impairment of the temporom and ibular complex . Fifty-one patients were r and omized to oral appliance therapy and 52 patients to CPAP therapy .  TMDs ( diagnosed according to the Axis I Research Diagnostic Criteria for TMD ) , pain intensity and disability and m and ibular function impairment were recorded at baseline , after 2 months , 1 year and 2 years of therapy . Only in the initial period of treatment the occurrence of pain-related TMDs was considerably higher ( 24 % ) in the oral appliance group compared to CPAP ( 6 % ) . Oral appliance therapy furthermore result ed in more temporom and ibular pain compared to CPAP ( odds ratio 2.33 , 95 % confidence interval ( 1.22–4.43 ) ) . However , there were no limitations in m and ibular function in both groups during the ( entire ) follow-up period . Although generally not serious and of transient nature , oral appliance therapy results in more pain-related TMDs in the initial period of use compared with CPAP therapy . Oral appliance therapy is associated with increased pain in the temporom and ibular complex in the initial period of use . Because of the transient nature , this pain is not a reason to contra-indicate an oral appliance in OSAS patients . Moreover , TMDs and the risk of developing pain and function impairment of the temporom and ibular complex appear limited with long-term oral appliance use The aim of this study was to investigate the frequency of otologic symptoms and their relationship to orofacial signs and symptoms of temporom and ibular disorder ( TMD ) , and the effect of orofacial myofunctional therapy . The study was conducted on eight asymptomatic subjects ( Group C ) and 20 subjects with articular TMD , r and omly distributed over two groups :  one  treated using orofacial myofunctional therapy ( OMT Group ) and a control group with TMD ( Group CTMD ) . Patient selection was based upon the Research Diagnostic Criteria for TMD ( RDC/TMD ) . All subjects su bmi tted to a clinical examination with self-reporting of symptom severity , and to orofacial myofunctional and electromyographic evaluation at diagnosis and again , at the end of the study . Correlations were calculated using the Pearson test and inter- and intragroup comparisons were made ( p < 0.05 ) . In the diagnosis phase , subjects with TMD reported earache ( 65 % ) , tinnitus ( 60 % ) , ear fullness ( 90 % ) , and 25 % of the asymptomatic subjects reported tinnitus . The otologic symptoms were correlated with tenderness to palpation of the temporom and ibular muscles and joints and with orofacial symptoms . Only the OMT group showed a reduction of otologic and orofacial symptoms , of tenderness to palpation and of the asymmetric index between muscles .  OMT may help with muscle coordination and a remission of TMD symptoms This study evaluated the relative long-term efficacy of biofeedback , cognitive – behavioral skills training ( CBST ) , combined biofeedback and CBST ( Combined ) , and no-treatment comparison groups in 108 patients suffering from chronic temporom and ibular disorder ( TMD ) . After an initial evaluation , patients were assigned to one of the four treatment conditions . The three biobehavioral treatment interventions consisted of 12 st and ardized sessions . Patients were reevaluated 1 year after completing treatment . Results demonstrated that patients who received the biobehavioral treatments reported significant improvement in subjective pain , pain-related disability , and m and ibular functioning 1 year after receiving treatment . The no-treatment comparison group did not demonstrate such improvements . The combined biofeedback and CBST treatment produced the most comprehensive improvements across all outcome measures . These results again demonstrate the heuristic value of adopting a biopsychosocial perspective to the assessment and treatment of chronic medical/dental disorders such as TMD OBJECTIVES Myofascial pain is the most common temporom and ibular disorder . The objective of this study was to compare the effectiveness of combined treatment modalities in the management of myofascial temporom and ibular pain . METHODS Fifty patients ( 44 female , 6 male ) clinical ly and radiologically diagnosed with myofascial temporom and ibular disorder ( TMD ) were selected for the study and r and omly assigned to two groups of 25 patients . Group 1 patients were treated with stabilization splint ( SS ) and Group 2 patients were treated with trigger point injection combined with SS therapy . RESULTS Positive improvement in overall signs and symptoms with statistically significant differences was observed in both groups . Group 2 showed significant reduction in visual analogue scale ( VAS ) scores , and statistical analysis revealed a significant difference between the VAS scores of Group 1 and Group 2 at the 4th and 12th weeks of treatment follow-up ( p<0.001 ) . CONCLUSION Our results indicate that trigger point injection therapy combined with splint therapy is effective in the management of myofascial TMD pain . Further research , especially r and omized controlled trials , should be carried out to ascertain its effectiveness over other treatment modalities This study was design ed to compare the therapeutic effect  acupuncture in combination with ultrasound therapy with that of ultra short-wave electrotherapy on temporom and ibular disorders ( TMD ) . Sixty-eight patients with TMD were r and omized equally into 2 groups to receive the two treatments respectively , and the therapeutic effects were found to be significantly different ( P<0.05 ) . Acupuncture combined with ultrasound therapy yielded better results in a shorter treatment course & NA ; Temporom and ibular disorders ( TMD ) diagnoses can be viewed as the most useful clinical summary for classifying subtypes of TMD . The Research Diagnostic Criteria for TMD ( RDC/TMD ) is the most widely used TMD diagnostic system for conducting clinical research . It has been translated into 18 language s and is used by a consortium of 45 RDC/TMD‐based international research ers . While reliability of RDC/TMD signs and symptoms of TMD has been amply reported , the reliability of RDC/TMD diagnoses has not . The aim of the study was to determine the reliability of clinical TMD diagnoses using st and ardized methods and operational definitions contained in the Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) . Data came from reliability assessment trials conducted at 10 international clinical centers , involving 30 clinical examiners assessing 230 subjects .  Intraclass correlation coefficients ( ICC ) were calculated to characterize the reliability . The reliability of the diagnoses was fair to good . Median ICCs for the diagnoses myofascial pain with and without limited opening were 0.51 and 0.60 , respectively . Median ICC for arthralgia was 0.47 and 0.61 for disc displacement with reduction . RDC/TMD diagnoses of disc displacement without reduction , osteoarthritis and osteoarthrosis were not prevalent enough to calculate ICC 's , but percent agreement was always > 95 % . The reliability of diagnostic classification improved when diagnoses were grouped into pain versus non‐pain diagnoses ( ICC=0.72 ) and for detecting any diagnosis versus no diagnosis ( ICC=0.78 ) . In clinical decision‐making and research , arriving at a reliable diagnosis is critical in establishing a clinical condition and a rational approach to treatment . The RDC/TMD demonstrates sufficiently high reliability for the most common TMD diagnoses , supporting its use in clinical research and decision making AIMS To evaluate the effectiveness of low-level laser therapy ( LLLT ) in patients presenting with temporom and ibular disorder ( TMD ) in a r and om and placebo-controlled research design . METHODS The sample consisted of 40 patients , divided into an experimental group ( G1 ) and a placebo group ( G2 ) . The treatment was done with an infrared laser ( 830 nm , 500mW , 20s , 4J/point ) at the painful points , once a week for four consecutive weeks . The patients were evaluated before and after the treatment through a Visual Analogue Scale ( VAS ) and the Craniom and ibular Index ( CMI ) . RESULTS The baseline and posttherapy values of VAS and CMI were compared by the paired T-test , separately for the placebo and laser groups . A significant difference was observed between initial and final values ( p < 0.05 ) in both groups . Baseline and post-therapy values of pain and CMI were compared in the therapy groups by the two- sample T-test , yet no significant differences were observed regarding VAS and CMI ( p > 0.05 ) . CONCLUSION After either placebo or laser therapy , pain and temporom and ibular symptoms were significantly lower , although there was no significant difference between groups . The low-level laser therapy was not effective in the treatment of TMD , when compared to the placebo Abstract The present study was comprised of 43 patients ( 16 men ) with cervicogenic headaches for over three months , diagnosed according to the International Classification of Diagnostic Criteria of Headaches ( ICDH-ll ) . The patients were r and omly assigned to receive either manual therapy for the cervical region ( usual care group ) or additional manual therapy techniques to the temporom and ibular region to additionally influence temporom and ibular disorders ( TMD ) . All patients were assessed prior to treatment , after six sessions of treatment , and at a six-month follow-up . The outcome criteria were : intensity of headaches measured on a colored analog scale , the Neck Disability Index ( Dutch version ) , the Conti Anamnestic Question naire , noise registration at the m and ibular joint using a stethoscope , the Grade d Chronic Pain Status ( Dutch version ) , m and ibular deviation , range of mouth opening , and pressure/pain threshold of the masticatory muscles . The results indicate in the studied sample of cervicogenic headache patients , 44.1 % had TMD . The group that received additional temporom and ibular manual therapy techniques showed significantly decreased headache intensities and increased neck function after the treatment period . These improvements persisted during the treatment-free period ( follow-up ) and were not observed in the usual care group . This trend was also reflected on the question naires and the clinical temporom and ibular signs . Based on these observations , we strongly believe that treatment of the temporom and ibular region has beneficial effects for patients with cervicogenic headaches  , even in the long-term STATEMENT OF PROBLEM The frequent concurrence of tinnitus and temporom and ibular joint and masticatory muscle disorders ( TMD ) has led to the assumption that a possible relationship exists between these 2 conditions . PURPOSE The present prospect i ve clinical study was conducted to assess the possible association between tinnitus and TMD and to investigate the effect of stomatognathic therapy on tinnitus distress . MATERIAL AND METHODS The prevalence of TMD and tinnitus was investigated in a consecutive series of 951 patients at the Department of Prosthetic Dentistry at the University Medical Center Regensburg , Germany . Patients with TMD and simultaneous tinnitus were included in the prospect i ve clinical trial ( n=25 ) . Baseline examination comprised a detailed functional analysis , diagnosis of temporom and ibular joint and masticatory muscle disorder , and a tinnitus question naire . All the participants received individual dental functional therapy ( oral splints , physiotherapy ) . The effects of functional therapy on TMD and tinnitus symptoms were examined 3 to 5 months after the initiation of dental functional therapy . Means ( st and ard deviations ) were calculated , and 1-way ANOVA was used to investigate statistical differences ( α=.05 ) . The differences of the 2 binary outcomes were compared with the Pearson χ(2 ) test , and the relative risk was calculated . RESULTS Prevalence of tinnitus was found to be 8 times higher in participants with TMD ( 30 of 82 [ 36.6 % ] ) than in participants without TMD ( 38 of 869 [ 4.4 % ] ) . All the participants with unilateral TMD and unilateral tinnitus showed these conditions on the same side . Stomatognathic therapy improved tinnitus symptoms in 11 of 25 participants ( 44 % ) . CONCLUSIONS The results of this study and the prospect i ve clinical trial showed a significant correlation between tinnitus and TMD . The observed treatment outcome suggests that dental functional therapy may have a positive effect on TMD-related tinnitus Forty-eight dysfunctional patients ( i.e. , high levels of pain , interference , and affective distress and low levels of perceived control ) with temporom and ibular disorders ( TMDs ) were r and omly assigned either to a treatment consisting of an intraoral appliance ( IA ) and stress management with biofeedback ( SM ) plus nondirective , supportive counseling ( SC ) -- IA + SM + SC -- or to a customized treatment that included cognitive therapy ( CT ) with the IA and SM -- IA + SM + CT . Both treatment groups reported statistically significant reductions on a set of physical , psychosocial , and behavioral measures posttreatment and at a 6-month follow-up . However , the intervention that included CT demonstrated significantly greater reductions in pain , depression , and medication use . Only the groups receiving the treatment that included the CT demonstrated continued improvements to the follow-up on pain associated with muscle palpation , self-reported pain severity , depression , and use of medications . These results support the efficacy of the tailored treatment for dysfunctional TMD UNLABELLED The Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) is a well-known diagnostic tool for clinical trials on TMD . OBJECTIVES This study aims to assess the reliability , validity and feasibility of a new method of physically diagnosing temporom and ibular disorders ( TMD ) , design ed for routine clinical use . This version , known as Clinical Examination Protocol -TMD ( CEP-TMD ) , was compared to the gold st and ard original RDC/TMD . METHODS A total of 49 subjects ( 41 referred TMD patients and 8 symptom free subjects ) were examined using both RDC/TMD and CEP-TMD versions . Three examiners , with varying levels of experience in diagnosing TMD , worked in pairs . Each member of a pair saw the same patient twice , once for the RDC/TMD and once for the CEP-TMD examination . The examination order was r and omized . Each patient 's examinations alternated between examiners to reduce the memory effect . Examinations could yield single , multiple or no diagnosis . Kappa statistics were calculated to estimate reliability . RESULTS There was substantial overall agreement between the CEP-TMD and the RDC/TMD ( kappa=0.70 ) . Intra-examination agreements were substantial in both RDC/TMD ( kappa=0.70 ) and CEP-TMD ( kappa=0.90 ) . For examination and diagnosis , the CEP-TMD was almost 3 min faster than the RDC/TMD ( p<0.05 ) . CONCLUSIONS It was concluded that the CEP-TMD 's diagnosis is comparable to the RDC/TMD thus providing a convenient and intuitive approach for dentists to physically diagnose TMD in clinical practice . The well-established RDC/TMD remains the gold st and ard for research diagnosis of TMD OBJECTIVE Temporom and ibular disorders ( TMD ) is a term reflecting chronic , painful , craniofacial conditions usually of unclear etiology with impaired jaw function . The effect of osteopathic manual therapy ( OMT ) in patients with TMD is largely unknown , and its use in such patients is controversial . Nevertheless , empiric evidence suggests that OMT might be effective in alleviating symptoms . A r and omized controlled clinical trial of efficacy was performed to test this hypothesis . METHODS We performed a r and omized , controlled trial that involved adult patients who had TMD . Patients were r and omly divided into two groups : an  OMT group ( 25 patients , 12 males and 13 females , age 40.6+/-11.03 ) and a conventional conservative therapy ( CCT ) group ( 25 patients , 10 males and 15 females , age 38.4+/-15.33 ) . At the first visit ( T0 ) , at the end of treatment ( after six months , T1 ) and two months after the end of treatment ( T2 ) , all patients were subjected to clinical evaluation . Assessment s were performed by subjective pain intensity ( visual analogue pain scale , VAS ) , clinical evaluation ( Temporom and ibular index ) and measurements of the range of maximal mouth opening and lateral movement of the head around its axis . RESULTS Patients in both groups improved during the six months . The OMT group required significantly less medication ( non-steroidal medication and muscle relaxants ) ( P<0.001 ) . CONCLUSIONS The two therapeutic modalities had similar clinical results in patients with TMD , even if the use of medication was greater in CCT group . Our findings suggest that OMT is a valid option for the treatment of TMD This study was conducted to evaluate whether integrating a nociceptive trigeminal inhibition-tension suppression system ( NTI-tss ) device with first-line therapy of myofascial pain , which includes guidance , assurance , counselling and behavioural changes , would be more effective in alleviating symptoms . This r and omised controlled clinical trial included 40 patients who were clinical ly diagnosed with myofascial pain according to Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) . Patients were r and omly divided into two groups : the first group comprised patients who received guidance , assurance , counselling and behavioural changes ; an NTI-tss device was integrated to this protocol in the second group . Both groups exhibited reduction in pain levels and improvement of jaw function compared with baseline values , but the difference was not significant . Both groups demonstrated improvements in 6 weeks ; however , the integration of NTI-tss device into the therapy protocol did not provide any additional benefit in relieving symptoms of myofascial pain There is limited evidence supporting the role of occlusal splints in Temporom and ibular disorder ( TMD ) therapy . The aim of this r and omized controlled clinical trial was to assess the efficacy of stabilization splint therapy on TMD related facial pain and m and ibular mobility . The sample of study consisted of eighty consecutive patients diagnosed with TMD . Patients were r and omly assigned into two groups : a splint group ( n = 40 ) comprising of patients treated with stabilization splint , councelling and masticatory muscle exercises , and a control group ( n = 40 ) , comprising of patients treated with councelling and masticatory muscle exercises alone . Data from both the groups were collected at the beginning of the study and after a 6-month follow up . The outcome variables were visual analogue scale on facial pain intensity and clinical findings for TMD ( anterior maximal opening , m and ibular right laterotrusion , m and ibular left laterotrusion , m and ibular protrusion , and number of painful muscle sites ) . Changes within the splint and control groups ( before treatment and 6 months after treatment ) were analyzed using paired sample s t test . Differences in change between the splint and control groups were analyzed using independent sample s t-test . The level of significance was set at p < 0.05 . Facial pain and number of painful muscle sites decreased , and the m and ibular mobility increased significantly in both groups after treatment ; however the differences in changes in VAS or clinical TMD findings between the two groups were not statistically significant . The findings of this study show that stabilization splint treatment in combination with counselling and masticatory muscle exercises has no additional benefit in relieving facial pain and increasing the mobility of the m and ible than counselling and masticatory muscle exercises alone over a 6-months ’ time interval
There is insufficient evidence to make firm recommendations for the use of CBT over other intervention for the treatment of TMD .
Cognitive-behavioural therapy ( CBT ) and its effects on  temporom and ibular disorders ( TMD ) have been examined in several studies .
We are trying to combine results of these studies and to explore the effectiveness .