Thermograph Evaluation of Masticatory and Cervical Muscles After Physiotherapeutic Treatment in Tmd Subjects
Condition: Temporomandibular Joint Dysfunction
MeSH terms: Joint Diseases; Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome
Study type: Interventional

Summary: 
      Background: Different therapeutic approaches have been proposed for the treatment of TMD.
      Myofascial and joint techniques, exercises, intraoral devices, thermal, electro and
      phototherapy applications, are among the most common. The combination of local treatments and
      adjacent structures such as the cervical region have also been studied in this area. It is
      believed that the anatomic proximity, neuronal interconnections and convergent afferents from
      the trigeminal and cervical areas can lead the understanding of the relationship of these
      structures. In order to assess the effects of these different forms of treatment studies have
      used different resources such as diagnostic imaging and biological signals, in order to
      complement the clinical diagnosis. Infrared thermography has been one of the resource
      assessment in the literature and it is interesting and stands out from other methods because
      it is functional, non-invasive and inexpensive.

      Purpose: To evaluate the thermograms concerning the masseter and anterior temporal muscles,
      severity, pain, range of mandibular motion and neck disability in TMD patients, before and
      after physical therapy applied to the cervical and thoracic regions.

      Methods: This is a randomized, placebo-controlled study, designed to evaluate the effects of
      indirect treatment on the thermography of the masticatory muscles, severity, pain, range of
      motion and neck disability in individuals with TMD. These will be randomized and allocated
      into two groups: GA (intervention) and GB (placebo) and assessed as: Diagnostic Criteria for
      Temporomandibular Research Disorders (RDC/TMD), Fonseca´s Anamnesic Index (FAI),
      Thermography, EVA, IDD-CF, Pachymetry and Neck Disability Index (NDI).

      Statistical analysis: The temperature of the orofacial region, acquired through thermography
      is considered the primary endpoint and as a secondary endpoint will be the evaluation of the
      severity according to FAI, pain by VAS and IDD-CF, the range of mandibular motion by
      pachymetry and neck disability by NDI.

      Statistical analysis: The normality of the data will be verified using the Kolmogorov-Smirnov
      test, which will be expressed as mean and standard deviation and/or median and interquartile
      range. Repeated measures analysis of variance of two factors, post hoc Bonferroni will be
      used for inter and intra-group comparisons. The significance level of p≤0.05 is set.
    

Detailed description: 
      This is a randomized, placebo-controlled, study designed to evaluate the thermograms
      concerning the masseter and anterior temporal muscles, severity, pain, range of mandibular
      motion and neck disability in TMD patients, before and after physical therapy applied to the
      cervical and thoracic regions.
    

Intervention name(s): Manual Therapy Treatment; Placebo Ultrasound
Intervention type(s): Other; Device
Intervention description(s): Treatment starts with 10 deep breathing movements for global relaxation. The anterior and posterior neck muscles, shoulder girdle and subdiaphragmatic will be addressed with myofascial techniques repeated 10 times in each stroke. The cervical spine will be pulled in the longitudinal direction. The draw will be held 1 time, lasting 1 minute. The thoracic region will receive mobilization technique in the anteroposterior direction,10 repeated movements involving all thoracic segment.
The treatment will be applied previously trained therapists, 4 weeks, 2 times a week, totaling eight sessions. The treatment time per session is about 25 minutes.; A detuned pulsed ultrasound will be applied to regions of the muscles around the shoulder girdle and anterior posterior cervical, for 25 minutes (2.5 minutes in each zone ). The device will be used with the internal cables disconnected for the placebo effect . However, you can handle it and adjust the doses and alarms as it is connected in order to simulate clinical practice and increase the credibility of the use of this device in the voluntary . The placebo treatment will be applied by previously trained therapists. Treatment will have 4 weeks, 2 times a week, totaling eight sessions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: TMD Infrared Thermography Physical Therapy Modalities