- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03849534
Treatment of Temporomandibular Disorders in Children and Adolsecents (TMD/PED)
Evaluation of Different Treatment Modalities in Children With Myalgia or Arthralgia in the Temporomandibular Region - a Randomized, Single-blinded, Controlled Non-inferiority Study
Children and adolescents are treated with routine treatment approaches for adults and one of the most commonly used treatments are occlusal appliances. The use of occlusal appliances in managing orofacial pain conditions is supported by evidence, but only for adults. However, the efficacy of the treatment approaches and any possible side-effects/impairment of mandibular growth are absent.
Therefore, the aim of this project is to investigate the effectiveness and possible side-effects of different treatment modalities, such as an occlusal appliance, jaw exercises, NSAID for the conditions myalgia orarthralgia in the orofacial region in children with primary or mixed dentition.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
It is well known that the impact of pain in the orofacial region is not only the unpleasant sensory experience but also an emotional experience with feelings of failure, misery, guilt, alienation, and co-morbid depression. TMD is a collective term embracing chronic pain conditions affecting the temporomandibular joint or the masticatory muscles as well as their associated structures. TMD has a prevalence of approximately 10-20% and is 1.5 to 2 times more prevalent in women. It is often associated with restricted mouth opening capacity, pain upon chewing, muscle soreness and headache, thus affecting quality of life considerably although it is not life threatening. The prevalence of reported chronic pain in children and adolescents is high, and similar to the prevalence in adults. The worldwide variation in the prevalence of TMD in children and adolescents ranges from 6% to 69%. Many studies reported that TMD, headache and abdominal pain are the most common chronic pain affecting children and adolescents.
Children and adolescents are treated with routine treatment approaches for adults and one of the most commonly used treatments are occlusal appliances. The use of occlusal appliances in managing orofacial pain conditions is supported by evidence, but only for adults. However, the efficacy of the treatment approaches and any possible side-effects/impairment of mandibular growth are absent. To our knowledge the only two high-quality studies present have investigated adolescents with permanent dentition (12-19 years), but there are no studies in the growing child with primary or mixed dentition (7-14 years). Hence, there is no knowledge if there is an effective treatment and if such a treatment with a resilient occlusal appliance impair the mandibular growth in these children.
Taken together there is immense need for research on treatment of children/adolescents with orofacial pain and following their growth in order to be able to provide effective and safe treatment. Also, to investigate the knowledge-base among care-givers, giving the opportunity to improve the content of the education which in turn would lead to better, faster management of these children/adolescents who actually are our future.
Therefore, the aim of this non-inferiority project is to investigate the effectiveness and possible side-effects of different treatment modalities, such as an occlusal appliance, jaw exercises, NSAID for the conditions myalgia orarthralgia in the orofacial region in children with primary or mixed dentition.
The hypotheses are that: 1) there will be no significant differences in treatment outcome between the use of a soft occlusal appliance and standardized jaw exercises in children with myalgia but that the soft occlusal appliance and the standardized jaw exercises are superior to instructions of self-care; 2) the soft occlusal appliance does not affect the mandibular growth nor the dental eruption pattern; 3) there will be no significant differences in treatment outcome between the use of a soft occlusal appliance, or NSAIDs in children with arthralgia, but that the soft occlusal appliance and the NSAIDs are superior to instructions of self-care.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Nikolaos Christidis, PhD
- Phone Number: +46700374967
- Email: nikolaos.christidis@ki.se
Study Contact Backup
- Name: Sofia Louca Jounger, PhD
- Phone Number: +46852488229
- Email: sofia.louca@ki.se
Study Locations
-
-
-
Huddinge, Sweden, 141 04
- Recruiting
- Karolinska Institutet, Department of Dental Medicine
-
Contact:
- Nikolaos Christidis, PhD, DDS
- Phone Number: +46852488000
- Email: nikolaos.christidis@ki.se
-
Principal Investigator:
- Nikolaos Christidis, PhD, DDS
-
Sub-Investigator:
- Georgios Tsilingaridis, Professor
-
Sub-Investigator:
- Idil Alatli Burt, PhD, DDS
-
Sub-Investigator:
- Sofia Louca, PhD, DDS
-
Sub-Investigator:
- Raghdah Abduljabbar, DDS
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- age 7-14 years
- a diagnosis of myalgia or arthralgia according to DC/TMD
- self-assessed average TMD pain intensity of ≥ 30 mm on a 100-mm visual analogue scale (VAS) during one week prior to examination.
The patients will remain included with one or several co-diagnoses of:
- disc displacement with or without reduction according to DC/TMD
- degenerative joint disease.
Exclusion Criteria:
- diagnosed systemic muscular or joint diseases (e.g. fibromyalgia, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis)
- whiplash associated disorder (WAD)
- neuropathic pain or neurological disorders (e.g. myasthenia gravis, orofacial dystonia)
- history of psychiatric disorders, and 5) pain of dental origin.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Soft occlusal appliance
Individually casted appliances
|
According to Best Practice in Sweden the soft occlusal appliance is ranked as gold standard for children with mixed or primary dentition
The participants do three exercises twice a day.
Open and closing mouth against resistance as well as stretch
The patients are instructed to minimize jaw parafunctions, chewing chewing gum etc, to do exercises, to take pain-killers or NSAIDs etc.
|
Active Comparator: Jaw exercises
Resistance exercises to do twice a day
|
According to Best Practice in Sweden the soft occlusal appliance is ranked as gold standard for children with mixed or primary dentition
The participants do three exercises twice a day.
Open and closing mouth against resistance as well as stretch
The patients are instructed to minimize jaw parafunctions, chewing chewing gum etc, to do exercises, to take pain-killers or NSAIDs etc.
|
Active Comparator: Counseling
Just information at the first visit
|
According to Best Practice in Sweden the soft occlusal appliance is ranked as gold standard for children with mixed or primary dentition
The participants do three exercises twice a day.
Open and closing mouth against resistance as well as stretch
The patients are instructed to minimize jaw parafunctions, chewing chewing gum etc, to do exercises, to take pain-killers or NSAIDs etc.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Responders to treatment - median weekly pain intensity
Time Frame: 1-6 months
|
30% decrease in median weekly pain intensity using a numeric rating scale 0-10 rating the worst pain daily
|
1-6 months
|
Responders to treatment - Patients global impression change scale
Time Frame: 1-6 months
|
The patients global impression change scale (PGIC) will be used.
PGIC is a 7-point scale with the following options: 0 = eliminated, 1 = much improved, 2 = improved, 3 = unchanged, 4 = impaired, 5 = much impaired and 6 = very much impaired
|
1-6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in physical functioning using the Graded Chronic Painscale (GCPS)
Time Frame: 1-6 months
|
The graded chronic pain scale include 3 questions regarding pain intensity and 3 questions regarding physical functioning. The mean of the 3 questions regarding provide us with the characteristic pain intensity while the mean of the physical functgioning questions together with sick leave (from work/school) provide us with information about how pain affects physical functioning. Characteristic pain intensity ranges from 0-100 while physical functioning is graded from 0-IV. The lower, the better outcome for all subscales. GCPS is a stanrd tool in the Diagnostic Criteria for temporomandibular disorders (DC/TMD) and part of Axis II which also the questionnaires for the emotional status in Oiutcome 3 are. |
1-6 months
|
Change in emotional status
Time Frame: 1-6 months
|
Changed scores in questionnaires from Axis II in DC/TMD, including stress using the Perceived Stress Scale-4 (PSS-4), anxiety/depression using the Patient Health Questionnaire-4 (PHQ-4) and the psychosocial situation using the Youth Self-report (YSR) Lower scores in these questionnair represent a better outcome The PSS and PHQ-scales are not combained and ranges from 0-4 for each questions.
The YSR is based on several subscales, including the DCM-IV.
|
1-6 months
|
Daily activities
Time Frame: 1-6 months
|
This outcome is based on a daily question of school attendance as well as free-time activities.
The question is did you attend at school today or did you stay at home due to your orofacial pain.
Question 2. Did you do your free-time activity or did you stay at hom due to your orofacial pain
|
1-6 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Nikolaos Christidis, PhD, Karolinska Institutet, Department of Dental Medicine
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Nervous System Diseases
- Pain
- Neurologic Manifestations
- Joint Diseases
- Musculoskeletal Diseases
- Muscular Diseases
- Neuromuscular Diseases
- Musculoskeletal Pain
- Stomatognathic Diseases
- Jaw Diseases
- Craniomandibular Disorders
- Mandibular Diseases
- Myofascial Pain Syndromes
- Arthralgia
- Myalgia
- Temporomandibular Joint Disorders
- Temporomandibular Joint Dysfunction Syndrome
- Anti-Infective Agents
- Dermatologic Agents
- Antifungal Agents
- Keratolytic Agents
- Salicylic Acid
Other Study ID Numbers
- BettfysPed
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Myalgia
-
Assiut UniversityCompleted
-
Assiut UniversityCompleted
-
Creighton UniversityTerminatedStatin-associated MyalgiaUnited States
-
Universidade Federal do Rio Grande do NorteCompletedMyalgia [C05.651.542]
-
Riphah International UniversityCompleted
-
Hadassah Medical OrganizationCompletedStatin Induced MyalgiaIsrael
-
Universidad Nacional Andres BelloCompletedMyalgia of Mastication MuscleChile
-
State University of New York at BuffaloCompletedAdult Females | Bilateral Masseter MyalgiaUnited States
-
Dr. Horst Schmidt Klinik GmbHCompletedIntubating Conditions | Performance With Respiratory Exercise Device | Postoperative MyalgiaGermany
-
Universidad Nacional Andres BelloCompletedMyalgia of Mastication Muscle
Clinical Trials on Soft occlusal appliance
-
Medical University of SilesiaUnknownCannabis | Myofascial Pain | Temporomandibular Disorder | CBD | Electromyography | Occlusal AppliancePoland
-
Josip Juraj Strossmayer University of OsijekRecruitingTemporomandibular Joint DisordersCroatia
-
University Medicine GreifswaldCompletedChronic Disease | Temporomandibular Disorders | Craniomandibular Disorders | Arthromyalgia | Occlusal Appliance
-
Lithuanian University of Health SciencesCompletedTemporomandibular Joint DisordersLithuania
-
Université de MontréalSt. Justine's HospitalTerminatedObstructive Sleep ApneaCanada
-
Patra-cia Rocha CoelhoFederal University of Juiz de ForaUnknownMusculoskeletal Diseases | Temporomandibular Disorders | Stress PsychologicalBrazil
-
Universidad Nacional Andres BelloCompletedMyalgia of Mastication MuscleChile
-
University of RijekaActive, not recruiting
-
University of Santiago de CompostelaCompletedTemporomandibular Joint Disorders | Orofacial PainSpain
-
Cairo UniversityUnknown