Additional Effect of Forward Head Posture Correction 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 additional correction effect of nerd neck on damaged jaw in people who suffers from jaw problems and nerd neck at the same time. The main question it aims to answer: • whether the additional correction of nerd neck impact the 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 2 groups. Each group will be given the treatment sessions for 6 weeks. participants will come back after 6 weeks for another last assessment. Researchers will compare regular treatment for Jaw with new device, regular only 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 suspected relation between them but without a clear association. Till present, no study has investigated the additional effect of FHP DCTO correction impact on myogenic TMD, and this is where the purpose of this study arises from.

Official Title
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Additional Effect of Forward Head Posture Correction on Temporomandibular Dysfunction: A Randomized Controlled Trial.

Conditions
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Temporomandibular Disorder, Forward Head Posture

Intervention / Treatment
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* Device: Conservative with Denneroll
* Other: Conservative


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: 40 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 (Conservative only and conservative with Denneroll cervical traction orthodontic). 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: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Conservative<br>consists of teaching the patient the relaxed jaw position and stretching exercises for masseter and medial pterygoid muscles with hold of 20-30 seconds and 3-5 repetitions. In addition to placebo traction. | Other: Conservative<br>* conservative management of stretching and relaxation with placebo traction.<br>|
| Experimental: Conservative with Denneroll<br>Participants will be supine lining with the 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 with the conservative management for TMD. | Device: Conservative with Denneroll<br>* Denneroll cervical traction orthodontic traction for 3 to 15 minutes once daily with conservative management of stretching and relaxation.<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 10 | Baseline (pre-treatment), 3rd 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), 3rd 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), 3rd and week 7 (post-treatment) | 
| Visual Analog Scale (VAS) | 0-10 scale (zero represents no pain and 10 is the worst pain ever) to record orofacial pain | Baseline (pre-treatment), 3rd and week 7 (post-treatment) | 
| Mandibular Opening | Tape to measure the distance between the incisal edges of upper and lower teeth | Baseline (pre-treatment), 3rd and week 7 (post-treatment) | 

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