Intra-oral myofascial therapy, education and self-care for chronic myogenous temporomandibular disorder

Temporomandibular disorder (TMD) is widely recognised as a commonly occurring, complex clinical entity that can pose substantial challenges to health care practitioners. Its multifactorial nature has led to a proliferation of novel and diverse treatment approaches. The evolving biopsychosocial paradigm has emphasised the desirability of minimal treatment invasiveness as well as patient-centred care for chronic conditions, and appears to support a multi-modal, multi-disciplinary therapeutic approach. Intra-oral myofascial therapy (IMT) of the orofacial structures has a long established use among several disciplines- including dentistry, chiropractic, physiotherapy and massage therapy; however studies investigating its efficacy are lacking. The same can be said for education and self-care (ESC) strategies. It was considered that both IMT and ESC fulfil contemporary criteria of minimal invasiveness and patient centred care; so conducting a randomised controlled trial investigating their utility in TMD would contribute to the extant literature on conservative care for TMD. As myogenous forms of TMD are reported to be the most common subtype, and as IMT is in principle a myofascial intervention; selecting trial subjects diagnosed with myogenous TMD was considered to be a reasonable choice of clinical entity upon which to initiate this novel research project. A randomised, controlled pilot study was conceived that would be comprised of three trial arms: an IMT group; a combined IMT plus ESC group (IMTESC); and a wait-list (no-treatment) control group. This was to comprise Phase A of this thesis, which was itself made up of three elements: an interim study examining the finding of the first 30 enrolled participants; the final trial analysis; and a follow-up of the wait-list control group, their having received treatment at the conclusion of the study. Several outcomes emerged from Phase A. IMT appeared to be similar to IMTESC in decreasing jaw pain up until 6 months post treatment. At 1 year, however, IMTESC clearly appeared to be superior. This raised the possibility that the ESC component may not have positively contributed to the short and medium term outcomes of a combined treatment protocol. This led to the inception of a second randomised trial, designed to compare the short-term effectiveness of the ESC protocol as a stand-alone modality to the already established IMT protocol. This was to comprise Phase B of the thesis; the results of which demonstrated that while both ESC and IMT demonstrated statistically significant reductions in jaw pain, ESC did not achieve a clinically significant reduction.