The effectiveness of neck strengthening exercises on jaw mobility and clicking in anterior disc displacement with reduction of temporomandibular joint: A randomized controlled trial

Document Type : Original Article

Authors

1 University of Lahore

2 University Institute of Physical Therapy, University of Lahore, Lahore Pakitan

3 University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan

4 School of Dentistry, Fatima Jinnah dental college for women, Karachi, Pakistan.

5 DOW University of Health Sciences, Institute of Physical Therapy and Rehabilitation, Karachi, Pakistan

6 Research department, Knowledge research and innovation center, Lahore, Pakistan

7 Research Department, Knowledge Research and Innovation Center, Lahore, Pakistan

8 School of Physiotherapy, Liaquat National Hospital, Karachi, Pakistan

Abstract

 Abstract
Background: The studies in the literature have focused on the biomechanical and neurophysiological aspects of cervical and temporomandibular joint function. Addressing the cervical spine correlation with the temporomandibular joint may lead to long-term improvement in the derangement. This study desired to deduce the effectiveness of deep neck muscle strengthening exercises on jaw motion and clicking sounds in anterior disc displacement with reduction of the temporomandibular joint.
Methods: This controlled clinical trial was conducted using a single-blinded design in a tertiary care teaching hospital affiliated with The University of Lahore- from March 2020 to January 2021. A count of 68 patients were enrolled each with 34 patients. The inclusion criteria were being 18–50 years old, suffering from temporomandibular joint pain and disc displacement with reduction, medical referral for temporomandibular disorders by a dentist or a maxillofacial surgeon, and having symptoms for more than one month before the first treatment. The exclusion criteria were having a tumor, fracture, or trauma in recent medical history, systemic, rheumatic diseases, degenerative changes, and history of surgery of the cervical spine or temporomandibular joint. The control group (Group A) was only given temporomandibular joint mobilization and soft tissue release. The Intervention group (Group B) did neck strengthening exercises in addition to the temporomandibular joint mobilization. The subjects were assessed twice.
Results: To analyze the data, SPSS version.21 was used. To assess the frequency of qualitative factors like clicking, the chi-square test was employed. The mean scores of quantitative factors such as mandibular lateral deviation and maximal mouth opening were approximated between the two categories of subjects using the Mann-Whitney test. The findings demonstrated that there was no change between the groups' pre- and post-treatment means for jaw mobility and clicking sounds. Nonetheless, the Intervention group's mandibular lateral deviation significantly improved (P-value ≤0.037)*. 
Conclusion: The findings revealed that neck strengthening exercises in addition to routine physical therapy of the temporomandibular joint do not affect clicks and mobility between the two groups. The exercises were found out to be effective only in improving the lateral deviation of the mandible.

Keywords

Main Subjects


1. Buescher JJ. Temporomandibular joint disorders. Am
Fam Physician. 2007;76(10):1477-82.
2. Koh H, Robinson PG. Occlusal adjustment for treating and
preventing temporomandibular joint disorders. J Oral Rehabil.
2004;31(4):287-92. doi: 10.1046/j.1365-2842.2003.01257.x.
3. Marpaung C, van Selms MK, Lobbezoo F. Temporomandibular
joint anterior disc displacement with reduction in a youngpopulation:
prevalence and risk indicators. Int J Paediatr Dent. 2019;29(1):66-73.
doi: 10.1111/ipd.12426.
4. Rahman SA, Sukumaram M, Haque S, Alam MK. Disc displacement
with reduction (TMD) in teenagers. Int Med J.
2019;26(3):252-3.
5. Poluha RL, De la Torre Canales G, Costa YM, Grossmann E, Bonjardim LR,
Conti PC. Temporomandibular joint disc
displacement with reduction: a review of mechanisms and clinical presentation.
J Appl Oral Sci. 2019;27:e20180433.
doi: 10.1590/1678-7757-2018-0433.
6. Lazarin R, Previdelli IT, Silva R, Iwaki LC, Grossmann E, Filho LI.
Correlation of gender and age with magnetic
resonance imaging findings in patients with arthrogenic
temporomandibular disorders: a cross-sectional study. Int J
Oral Maxillofac Surg. 2016;45(10):1222-8. doi: 10.1016/j.ijom.2016.04.016.
7. Dergin G, Kilic C, Gozneli R, Yildirim D, Garip H, Moroglus.
Evaluating the correlation between the lateral pterygoid
muscle attachment type and internal derangement of the
temporomandibular joint with an emphasis on MR imaging
findings. J Craniomaxillofac Surg. 2012;40(5):459-63.
doi:10.1016/j.jcms.2011.08.002.
8. Nitzan DW. Intraarticular pressure in the functioning human
temporomandibular joint and its alteration by uniform
elevation of the occlusal plane. J Oral Maxillofac Surg.
1994;52(7):671-9. doi: 10.1016/0278-2391(94)90476-6.
9. Ikeda K, Kawamura A, Ikeda R. Prevalence of disc displacement
of various severities among young preorthodontic population:
a magnetic resonance imaging study. J Prosthodont.
2014;23(5):397-401. doi: 10.1111/jopr.12126.
10. Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A.
Effectiveness of manual therapy and therapeutic exercise for
temporomandibular disorders: systematic review and meta-analysis.
Phys Ther. 2016;96(1):9-25. doi: 10.2522/
ptj.20140548.
11. Yoda T, Sakamoto I, Imai H, Honma Y, Shinjo Y, Takano A, et al.
A randomized controlled trial of therapeutic exercise for clicking
due to disk anterior displacement with reduction in the
temporomandibular joint. Cranio. 2003;21(1):10-6.
doi:10.1080/08869634.2003.11746226.
12. Garefis P, Grigoriadou E, Zarifi A, Koidis PT. Effectiveness of conservative
treatment for craniomandibular disorders: a
2-year longitudinal study. J Orofac Pain. 1994;8(3):309-14.
13. Lalue-Sanches M, Gonzaga AR, Guimaraes AS, Ribeiro EC.
Disc displacement with reduction of the temporomandibular joint:
the real need for treatment. J Pain Relief. 2015;4(5):200.
doi: 10.4172/21670846.1000200.
14. Calixtre LB, da Silva Grüninger BL, Haik MN, AlburquerqueSendín F, Oliveira AB.
Effects of cervical mobilization and
exercise on pain, movement and function in subjects with
temporomandibular disorders: a single group pre-post test.
J Appl Oral Sci. 2016;24(3):188-97. doi: 10.1590/1678-775720150240.
15. Jull G, Falla D, Treleaven J, Sterling M, O’Leary S. A.
Therapeutic Exercise Approach for Cervical Disorders.
Edinburgh, UK: Churchill Livingstone, Elsevier Science; 2004. 
16. Au AR, Klineberg IJ. Isokinetic exercise management of
temporomandibular joint clicking in young adults. J Prosthet
Dent. 1993;70(1):33-9. doi: 10.1016/0022-3913(93)90034-l.
17. Mohamed N, Abd El Azizi O. Splint therapy for treatment
of anterior disc displacement with reduction. Egypt Dent J.
2021;67(3):2055-9. doi: 10.21608/edj.2021.76076.1632.