Forward Head Posture Correction Impact on Temporomandibular Dysfunction

Study Overview
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Brief Summary
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The goal of this clinical trial is to test the effect of nerd neck correction on damaged jaw in people who suffers from jaw problems and nerd neck. The main question it aims to answer: whether there are different effects of traditional nerd neck correction exercises, device correction method and dental splints on jaw features of pain and function. Participants will: participants will be given the consent to sign first. participants will be assessed to check jaw pain and function. participants will be divided randomly into 3 groups. Each group will be given the treatment sessions for 6 weeks. participants will come back after 6 weeks for one last assessment. Researchers will compare traditional, new and dental treatment groups to see if there is improvement in jaw characteristics.

Detailed Description
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The relationship between the two conditions of forward head posture (FHP) and temporomandibular joint dysfunction (TMD) have been previously stated with comparing the craniocervical angle (CVA) of TMD patients to the healthy individuals, still a clear relationship couldn't be drawn due to different study limitations such as the lack of subdivision in the TMD patients based on their diagnostic subcategories in addition to, patients posture might have been altered while the photo was captured. Ever since, multiple researchers deliberately investigated the two conditions association and inferred the following: 1. FHP can be a risk factor resulting in TMD where any alteration in the head position produces more tension on the masticatory muscles by changing the mandible position 2. TMD origins from muscular component is more significant than articular component yet the correlation between head posture and TMD is still not clear enough, however, if FHP and myogenic TMD were linked preventive measures can be taken. recently, multiple studies established a relation between the occurrence of FHP in TMD patients which supported the hypothesized relation between them. Till present, no study has investigated the FHP Denneroll cervical traction orthodontic (DCTO) correction impact alone on TMD and this is where the purpose of this study arises from.

Official Title
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Forward Head Posture Correction Impact on Temporomandibular Dysfunction: A Randomized Controlled Trial

Conditions
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Temporomandibular Disorder, Forward Head Posture

Intervention / Treatment
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* Device: Denneroll cervical traction orthodontic
* Other: stretching and strengthening exercises
* Device: Vacuum-formed soft occlusal splint


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The participant experiencing one or more of TMD signs or symptoms and has been diagnosed with TMD beside having forward head posture with craniocervical (CVA) angle < 50. The study will be limited to the patients in the dental clinic of the university of Sharjah. Participants experiencing mild to moderate myogenic TMD with symptoms of orofacial pain and limited range of jaw opening. Exclusion Criteria: Previous head, neck or TMJ traumas. History of temporomandibular joint surgery.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Permuted block randomization to ensure an equal number of allocations in each of the three groups (traditional, Denneroll cervical traction orthodontic and dental treatment). Each random block was stored in opaque sealed envelopes consecutively numbered with a third researcher. Once each participant officially joins the study the researcher will open the subsequent envelop.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Denneroll protocol<br>orthotic will be placed under participants' neck. Treatment session time begin with 3 minutes then increase of 2-3 minutes until they reach 15 to 20 minutes in each session. | Device: Denneroll cervical traction orthodontic<br>* traction for 3 to 15 minutes once daily<br>|
| Active Comparator: Traditional protocol<br>consists of one strengthening exercise for 10 repetitions in 3 sets each, and two stretching exercises with a hold for 20-30 seconds. | Other: stretching and strengthening exercises<br>* strengthening exercises with 10 repetitions twice per day 3 times per week stretching exercises with hold for 20 to 30 seconds 3 repetitions daily<br>|
| Active Comparator: Dental management<br>formed soft occlusal splint will be individually designed for the upper arch of each participant. | Device: Vacuum-formed soft occlusal splint<br>* 2 mm thick elastic rubber sheets<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Anamnestic questionnaire by Fonseca | To evaluate TMD by 10 questions with their corresponding scores from 0 to 1 | Baseline (pre-treatment) and week 7 (post-treatment) | 
| Craniocervical angle - CVA | photographic method to evaluate the angle where an angle less than 50 degrees will be considered as forward head posture | Baseline (pre-treatment) and week 7 (post-treatment) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Boley Gauge | Electronic Digital Caliper to assess mouth opening (active/passive) | Baseline (pre-treatment) and week 7 (post-treatment) | 
| Numerical Rating Scale (NRS) | 0-10 scale (zero represents no pain and 10 is the worst pain ever) to record orofacial pain | Baseline (pre-treatment) and week 7 (post-treatment) | 
| Mandibular Opening | Tape to measure the distance between the incisal edges of upper and lower teeth | Baseline (pre-treatment) and week 7 (post-treatment) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Traction, Exercise, Pain, Temporomandibular dysfunction