Hiroyuki Ishiyama1, Shusuke Inukai2, Akira Nishiyama1, Masayuki Hideshima3, Shuhei Nakamura3, Meiyo Tamaoka4, Yasunari Miyazaki5, Kenji Fueki6, Noriyuki Wakabayashi6. 1. Orofacial Pain Management, Department of Oral Health Sciences Graduate School, Tokyo Medical and Dental University, Tokyo, Japan; Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo, Japan. 2. Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo, Japan; Removable Partial Prosthodontics, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: shu.inukai.rpro@tmd.ac.jp. 3. Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo, Japan. 4. Department of Sleep Modulatory Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 5. Health Administration Center, Tokyo Medical and Dental University, Tokyo, Japan. 6. Removable Partial Prosthodontics, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Abstract
PURPOSE: There are no studies on the prevention of temporomandibular joint and/or masticatory muscle pain (TMD pain) associated with oral appliance (OA) therapy in patients with obstructive sleep apnea (OSA). The aim of this study was to determine the effect of jaw-opening exercise on TMD pain associated with OA therapy in OSA patients. METHODS:Twenty-five OSA patients without pain-related TMD were consecutively enrolled into a two-arm, randomized, double-blind, placebo-controlled trial. One group performed jaw-opening exercise (JE, n=13), and the other group performed placebo exercise (PE, n=12) for 1-month, and had started 2-weeks prior to insertion of an adjustable OA. TMD sign using the Research Diagnostic Criteria for Temporomandibular Disorders and TMD pain intensity using a visual analog scale (VAS) in the morning and daytime were evaluated at baseline (pre-exercise) and at 2-weeks, 1-month, and 3-months after OA insertion. RESULTS:Pain-related TMD was not observed in the JE-group at all evaluation periods, although one subject in the PE-group was diagnosed with arthralgia at the 1-month evaluation. The JE-group showed lower morning and daytime VAS scores than the those of the PE-group at all evaluation periods, and significant group differences were found in terms of chewing pain and jaw-opening pain in the morning at the 1-month evaluation, and of jaw-opening pain during daytime at the 3-month evaluation (P<0.05). CONCLUSIONS: Within the limitations of the study, jaw-opening exercise prior to OA therapy reduced the risk of TMD pain associated with OA use. Therefore, jaw-opening exercise may contribute to the prevention of TMD pain.
RCT Entities:
PURPOSE: There are no studies on the prevention of temporomandibular joint and/or masticatory muscle pain (TMD pain) associated with oral appliance (OA) therapy in patients with obstructive sleep apnea (OSA). The aim of this study was to determine the effect of jaw-opening exercise on TMD pain associated with OA therapy in OSA patients. METHODS: Twenty-five OSA patients without pain-related TMD were consecutively enrolled into a two-arm, randomized, double-blind, placebo-controlled trial. One group performed jaw-opening exercise (JE, n=13), and the other group performed placebo exercise (PE, n=12) for 1-month, and had started 2-weeks prior to insertion of an adjustable OA. TMD sign using the Research Diagnostic Criteria for Temporomandibular Disorders and TMD pain intensity using a visual analog scale (VAS) in the morning and daytime were evaluated at baseline (pre-exercise) and at 2-weeks, 1-month, and 3-months after OA insertion. RESULTS:Pain-related TMD was not observed in the JE-group at all evaluation periods, although one subject in the PE-group was diagnosed with arthralgia at the 1-month evaluation. The JE-group showed lower morning and daytime VAS scores than the those of the PE-group at all evaluation periods, and significant group differences were found in terms of chewing pain and jaw-opening pain in the morning at the 1-month evaluation, and of jaw-opening pain during daytime at the 3-month evaluation (P<0.05). CONCLUSIONS: Within the limitations of the study, jaw-opening exercise prior to OA therapy reduced the risk of TMD pain associated with OA use. Therefore, jaw-opening exercise may contribute to the prevention of TMD pain.