|Year : 2018 | Volume
| Issue : 2 | Page : 107-109
Efficacy of ultrasound massage therapy as an adjuvant pain control modality in TMDs: A clinical study
Roopika Handa, MK Sunil, Chandini Gupta, Anudeep Raina, Tabiha Khan, Arishah Gulzar
Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India
|Date of Submission||23-Jan-2018|
|Date of Acceptance||04-Jul-2018|
|Date of Web Publication||16-Jul-2018|
Dr. M K Sunil
Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Temporomandibular disorders (TMDs) are a collection of medical and dental conditions that affect the muscles of mastication along with transmittable tissue components. Physical modality such as ultrasound (US) therapy is considered to be an important treatment to relieve musculoskeletal pain, to reduce inflammation, and to restore oral motor function. Settings and Design: It was a prospective study and was carried out in the Department of Oral Medicine and Radiology at Teerthanker Mahaveer Dental College and Research Centre, Moradabad, to evaluate the efficacy of therapeutic US massage therapy in management of temporomandibular joint (TMJ) disorders. Aims and Objective: To determine the effectiveness of US massage therapy in patients with TMDs. Materials and Methods: This study included 10 patients with TMDs, according to research diagnostic criteria (RDC), within the age group of 18–50 years. All the patients were treated with US, once a week for 4 weeks for 8 min and pain intensity was evaluated using visual analog scale, at every sitting. Statistical Analysis Used: SPSS version 22 software was used and Student's t-test value was used. Results and Discussion: A significant pain reduction was found in US massage therapy. There was a decrease in pain in TMJ from 7.30 ± 1.70 to 4.00 ± 2.53 and mouth opening improved from 40.40 ± 6.50 to 41.80 ± 5.97 which was statistically significant. This therapy appears to be a valuable physiotherapy method for pain reduction in TMDs. Conclusion: US massage therapy appears to be useful in relieving pain and improves subsequent mouth opening, and hence can be considered as a valuable physiotherapy method. Thus, US massage therapy serves as a potent and independent therapeutic modality in TMDs.
Keywords: Pain, physiotherapy, Temporomandibular disorders, ultrasound massage therapy
|How to cite this article:|
Handa R, Sunil M K, Gupta C, Raina A, Khan T, Gulzar A. Efficacy of ultrasound massage therapy as an adjuvant pain control modality in TMDs: A clinical study. J Indian Acad Oral Med Radiol 2018;30:107-9
|How to cite this URL:|
Handa R, Sunil M K, Gupta C, Raina A, Khan T, Gulzar A. Efficacy of ultrasound massage therapy as an adjuvant pain control modality in TMDs: A clinical study. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2019 Feb 21];30:107-9. Available from: http://www.jiaomr.in/text.asp?2018/30/2/107/236730
| Introduction|| |
Temporomandibular disorders (TMDs) are a collection of medical and dental conditions that affect the muscles of mastication along with contagious tissue components and are considered as a musculoskeletal disorder of masticatory system.,
TMDs are characterized by several signs and symptoms which include orofacial pain, muscle tenderness, limited range of motion, joint noise, impaired jaw function, deviation or deflection, stiffness, pain or fatigue in facial muscles, and locking due to spasm of muscles. Other neurological symptoms may accompany TMDs, which include headache, tinnitus, fullness, and visual changes.
Physical therapy is considered to be an important treatment to relieve musculoskeletal pain to reduce inflammation and to restore oral motor function, and therefore various physical modalities are potentially effective in management of TMDs which include electrophysical modalities, exercise, and manual therapy techniques. Electrophysical modalities include ultrasound (US), microwaves, low-level laser therapy, and transcutaneous electrical nerve stimulation therapy. US has been used not only for diagnostic imaging module but also as a therapeutic modality in management of TMDs.
Electrophysical modalities are the new emerging modalities for treating temporomandibular joint (TMJ) disorders, and US massage therapy is one such effective procedure for its management. Therefore, this study aims to determine the effectiveness of US massage therapy in patients with TMDs.
| Materials and Methods|| |
This study was carried out in the Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Center, Moradabad. A total of 10 patients were included for the study within the age group of 18–50 years of either gender. Patients were clinically evaluated for TMJ disorders using research diagnostic criteria (RDC). Patients who were clinically diagnosed with TMJ disorders were included in the study; traumatic conditions of TMJ region, patients with TMJ ankylosis, patients with cardiac pacemakers and cardiac arrhythmias, pregnant ladies, any history of patients suffering from seizures, vascular disorders and neurological pain, any history of patient suffering from benign and malignant neoplastic conditions of TMJ disorders, mentally disabled patients, and patients with undiagnosed dental pain or who have skin lesions or facial abrasion at the site of acoustic gel placement were excluded from the study.
Pain was evaluated using visual analog scale (VAS). Data were recorded in the case proforma with a signed consent form. These patients were subjected to radiographic examination to rule out any bony changes in the condylar region and odontogenic infection. These patients were evaluated for pain intensity, mouth opening, and masticatory muscle tenderness such as masseter, medial pterygoid, lateral pterygoid, temporalis, and other accessory muscles, separately on VAS scale. The selected patients were subjected to ultrasonic massage therapy. This therapy was provided with a frequency of 1 MHz and pulse setting at 1:1 for 8 min each session, once a week for 4 comparative weeks. After the treatment, all the patients were evaluated again on their fifth visit for pain profile and tenderness of masticatory muscles using VAS. Later, data were tabulated and subjected to statistical analysis.
| Results|| |
This study comprised 10 subjects, of which 3 were males and 7 females. The mean age of study subjects was 31.60 ± 12.60 years [Table 1]. Mouth opening was significantly improved after US massage therapy. It was improved from 40.40 ± 6.50 to 41.80 ± 5.97. There was statistically significant improvement (P = 0.016) in mouth opening before and after US massage therapy. The mean improvement was in range of 40.40 ± 6.50 to 41.80 ± 5.97 [Table 2]. US massage therapy showed reduction in pain at each week for 4 consecutive weeks. The intensity of pain in TMJ before the treatment with mean pain score was 7.30 ± 1.70 standard deviation (SD); after treatment, the pain reduced to 4.00 ± 2.53 SD. A statistical significant difference was found between pain in each session (P = 0.01) [Table 3].
|Table 2: Assessment of mouth opening before and after ultrasound massage therapy|
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|Table 3: Assessment of pain in TMJ before and after ultrasound massage therapy|
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| Discussion|| |
Musculoskeletal pain can be relieved with the help of physical therapy to restore normal function. Massage is an effective trigger and a potential mechanical stimulus for the pain gate process. It reduces the naturally occurring discomfort, causes much better release of opiates, and helps in attaining more intense pain control without any side effects. This therapeutic method includes thermal and non-thermal effects. It may induce increase in blood flow, reduction in muscle spasm, and increase in extensibility of collagen fiber. Non-thermal effects include cavitation and acoustic microstreaming, which stimulate fibroblast repair and collagen synthesis, tissue regeneration, and bone healing.
In this ultrasonic massage therapy treatment, significant improvement was observed, and hence it can be used in management of TMD as a conservative low-cost intervention.
According to the available literature, a few studies reported effectiveness of ultrasonic massage therapy in management of TMDs. This study showed age distribution of second to the fourth decades of life with a mean age of 31.6 years [Table 1]. This was in accordance with a study done by Singh et al. Female predominance was reported in our study which was similar to a study done by Geissler and McPhee.
Psychologic stress or prolonged work is considered to the most common cause of TMD in patients. Maximum mouth opening measured before and after treatment was analyzed, and it was found that there is an increase in maximal mouth opening, which is statistically significant (0.016) [Table 2]. The mean ± SD of VAS scores of TMJ pain before and after treatment was found to be statistically highly significant (P< 0.05) [Table 3]. Rai et al. observed that the US group showed a higher success rate in pain improvement and concluded that for patients with TMDs it is a better pain relief. Trakroo et al. conducted a study and stated that US is less effective in reducing symptoms associated with disc and most successful in alleviating muscle symptoms. Some authors (Ucar et al.) demonstrated that some exercises such as active and passive stretching, relaxing exercise, and isometric tension and patient education are effective and beneficial in improving mandibular movements and increasing mouth opening. Similarly, Laat et al. reported a significant improvement in parameters of pain and jaw function in patients with myofunctional pain with these conservative and physical therapies. Fouda  carried out a similar study where mouth opening of patients receiving US therapy was found. Therefore, US therapy can be used as an adjunctive therapy.
Further research would require a larger sample size and some implications such as placebo effect of this therapy needs to be evaluated, thus leading to better and diverse analysis and interpretation.
| Conclusion|| |
US massage therapy in TM pain disorder is effective and showed significant improvement in pain as well as in mouth opening, before and after treatment. Hence, US massage therapy can be considered as a potent and independent therapeutic modality in relieving TMJ pain disorders.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sidebottom AJ, Farook S, Cascarini L. Current management of temporomandibular joint (TMJ) disease. J Arthritis 2014;3:3.
McNeely ML, Armijo Olivo S, Magee DJ. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Phys Ther 2006;86:710-25.
Herb K, Cho S, Stiles MA. Temporomandibular joint pain and dysfunction. Curr Pain Headache Rep 2006;10:408-14.
Fyfe M, Bullock MI. Therapeutic ultrasound: Some historical background and development in knowledge of its effects on healing. Aust J Physiother 1985;31:6.
Ariji Y, Katsumata A, Hiraiwa Y, Izumi M, Sakuma S, Shimizu M, et al.
Masseter muscle sonographic features as indices for evaluating efficacy of massage treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:517-26.
Singh H, Sunil MK, Kumar R, Singla N, Dua N, Garud SR. Evaluation of TENS therapy and placebo drug therapy in the management of TMJ pain disorders: A comparative study. J Indian Acad Oral Med Radiol 2014;26:139-44. [Full text]
Geissler PR, McPhee PM. Electrostimulation in the treatment of pain in the mandibular dysfunction syndrome. J Dent 1986;14:62-4.
Rai S, Ranjan V, Misra D, Panjwani S. Management of myofascial pain by therapeutic ultrasound and transcutaneous electrical nerve stimulation: A comparative study. Eur J Dent 2016;10:46-53.
] [Full text]
Trakroo A, Sunil MK, Trivedi A, Singla N. TENS versus ultrasonic massage therapy in temporomandibular disorders – A study. J Pearldent 2014;5:20-5.
Ucar M, Sarp U, Koca I, Eroǧlu S, Yetisgin A, Tutoglu A, et al
. Effectiveness of a home exercise program in combination with ultrasound therapy for temporomandibular joint disorders. J Phys Ther Sci 2014;26:1847-9.
Laat AD, Stappaerts K, Papy S. Counseling and physical therapy as treatment for myofascial pain of the masticatory system. J Orofac Pain 2003;17:42-9.
Atef Abd El Hameed Fouda. Ultrasonic therapy as an adjunct treatment of temporomandibular joint dysfunction. The journal of Oral and Maxillofacial Surgery Photon 2014;117:232-7.
[Table 1], [Table 2], [Table 3]