The Effects of Proprioceptive Neuromuscular Facilitation, Myofascial Releasing Maneuvers and Home Exercises on Pain and Jaw Function in Patients With Bruxism
Condition: Exercise; Bruxism; Myofascial
MeSH terms: Bruxism
Study type: Interventional

Summary: 
      This study was planned to evaluate the effects of proprioceptive neuromuscular facilitation,
      myofascial releasing maneuvers and home exercises on pain and jaw function in patients with
      bruxism aged 16-50 years .
    

Detailed description: 
      Bruxism is different from temporomandibular joint disease because of long periods of muscle
      contraction. It is considered an eloquent contributory factor in the etiology of
      temporomandibular disorders (TMD). The incidence of bruxism is estimated to be approximately
      between 5% and 10% of the adult population. Especially long term contraction of masseter,
      temporalis and medial pterygoid muscle cause restriction of opening mouth, problem of closing
      the jaw, problems of chewing, articulation, movement of tongue. Bruxism is common illness
      which is seen with in mood disorders such as anxiety and depression. According to Orofacial
      Pain Guidelines, Bruxism is a diurnal or nocturnal parafunctional activity including
      clenching, bracing, grinding and gnashing of the teeth. An oral habit consisting of
      involuntary rhythmic or spasmodic nonfunctional horizontally and vertically gnashing,
      grinding or clenching of teeth, in other than chewing movements of the mandible, this may
      bring about occlusal trauma.

      The factors involving anatomical- morphological, psychophysiological, pathophysiological
      factors and other cause diurnal or nocturnal bruxism. Researchers say that genetics account
      for 30 to 50 percent of bruxism with nocturnal or diurnal and behaviour, environmental
      account for the remainder. Dental malocclusion, anatomical- morphological differences,
      anomalies of the oro-facial region (condyles height asymmetry, hypognathism, larger cranial,
      bizygomatic width, rectangular form of dental arch of maxilla, rectangular morphology of
      face) psychophysiological reasons including stress in which result from emotional, physical,
      psychosocial stimulation, anxiety, depression, psychosomatic disorders, personality disorders
      such as hyperactivity, hysteria, aggressiveness, tendency of perfectionist affect oral
      function and cause bruxism . Sleep disturbances known as especially sleep apnea, behaviour
      disorder during REM ( rapid eye movement) and Non-REM (non- rapid eye movement) sleep
      stimulate of nocturnal bruxism. Consume of drug such as antidepressants (SSRI) have
      suppression and stimulate effects on patients seen. Vulnerable disorders of central
      dopaminergic neurotransmission, hemifacial spasm, stroke brain haemorrhage, Huntington
      chorea, Parkinson disease give rise to bruxism. While the acute use of L- dopa drugs inhibits
      bruxism activity, the chronic use of L- dopa in patients with Parkinson lead to bruxism. This
      situation is same effect with antiepileptic drugs. According to some criteria bruxism may be
      categorized by when it appears awake bruxism which is presented when the person is awake,
      sleep bruxism which is presented when the person is sleep and combined bruxism which is
      presented when seen two situations . By etiology researcher classified with primary or
      idiopathic bruxism which no apparent cause is known. Secondary bruxism occurs with diseases
      (coma, ictus, cerebral palsy), medicinal products (e.g. antipsychotic medication), drugs
      (such as amphetamines, ecstasy). Bruxism classified motor activity type of tonic, phasic,
      combined and by current or past presence such as past bruxism, current or present bruxism.
      Sleep bruxism major seen during REM and Non- REM sleep and is the most common type of bruxism
      than others. Its incidence has been the highest in childhood (vitally 14%) and decreases from
      about 8% in younger adults to almost 3% in elderly people called negative correlation . In
      awake bruxism is an involuntary activity of the jaw muscles that is characterized, by jaw
      clenching, by tooth gnashing and/or grinding. During sleep bruxism, both clenching and tooth
      grinding are observed. Sleep bruxism can lead to tooth destruction, temporomandibular pain
      and crepitation, headaches and grinding sounds . A lot of patients are complain of jaw
      tightness and grinding sounds daily or nightly, while others said these infrequently. In
      cases of severe and frequent sleep bruxism, the variation of the number of episodes per hour
      of sleep is 25%, and the variation of tooth-grinding frequency is 53.5%. Symptoms of bruxism
      are abnormal tooth wear, teeth gliding or clenching, sounds because of clenching and gliding,
      gingival inflammation, headache, ocular pain, limited opening of mouth, decrease of salivary
      flow, erythema, photosensitivity, tinnitus, ear plugging sensation, temporomandibular pain
      (TMP), destruction and click sounds. When overtime in patients have chronic bruxism will
      bring about hypertrophy of masseter and temporal muscles. Therefore, patients facial
      appearance seems either too square or too masculine. One of the general symptoms are jaw
      clicking, when opening of mouth; oral muscle deviation to one side, pain in cheek muscles,
      uncontrollable movement of jaw. Effects of bruxism on throat are swallowing difficulties,
      voice irregularities, frequence coughing, feeling of foreign things in throat. In addition it
      causes neck problems such as pain of the shoulders and ache of back, lack of mobility,
      stiffness, pain of neck. Facial changing are seen patients with bruxism skin and facial
      muscles atrophy due to not using, vermilion thighs, dropping corners of mouth., Treatment of
      bruxism includes botulinum toxin, using occlusal splint, perioral rejuvenation and an
      antidepressant drugs. Our study shows that self-care, Proprioceptive neuromuscular
      facilitation exercise, myofascial thingness and home exercise including facial muscle
      stimulation for weight transform between bilateral side. Mainly self-care is more important
      than others. Therefore, we informed patients about causes, etiology, triggered effects,
      prevalence, incidence of bruxism, normal treatment of bruxism and our treatment stages and
      goals. It includes that patients are aware of bruxism. When the patients who have bruxism
      diagnosis, feel pain on face muscle, they need to use ice on jaw muscle. In addition they
      avoid eating rigid, hard stick, candy and nuts. Also, they avoid chewing gum and elastic
      rating, avert jaw movement forward. They should sleep the least 8 hours and need to learn
      stretching exercise to restore of the facial muscle and joints. In addition flexibility and
      stretching training of orbicularis oris and oculi, extensor muscle stabilization exercises
      are used for bruxism treatment. Main purpose of this study is to evaluate of the effects of
      proprioceptive neuromuscular facilitation , myofascial releasing maneuvers and home exercises
      on temporomandibular joint pain and jaw function in patients with bruxism.
    

Intervention name(s): PNF, Myofascial Releasing Maneuvers, Home Exercise Group; Myofascial Releasing Maneuvers and Home Exercises Group; Control Group
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): For Group 1 (n:20), the PNF, myofascial releasing and home exercises were used to decrease pain, jaw restriction and improve functional mobility on the masseter, lateral and medial pterygoid, buccinator, temporalis, orbicularis oris, orbicularis oculi, upper side of trapezius muscle, splenius, scalenous, and cervical extensor muscle in 20 patients with bruxism, for 2 and 6 weeks after pre-evaluation. PNF, myofascial releasing and home exercises were administered for 2 weeks, followed by 3 sets of 10 repeat home exercises and 6 weeks under physiotherapist control.; In Group 2 (n:15), as myofascial releasing and home exercise group,final evaluation was made with 10 sets of myofascial releasing and home exercises for 2 and 6 weeks.; In Group 3 (n:17), as the control group, no myofascial releasing or Proprioceptive Neuromuscular Facilitation exercises were applied.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Experimental, Randomized Controlled Study
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Bruxism; Pain; Exercises; Myofascial; Releasing