Effects of massage therapy and occlusal splint therapy on electromyographic activity and the intensity of signs and symptoms in individuals with temporomandibular disorder and sleep bruxism: a randomized clinical trial

Cid André Fidelis de Paula Gomes, Yasmin El Hage, Ana Paula Amaral, Fabiano Politti, Daniela Aparecida Biasotto-Gonzalez, Cid André Fidelis de Paula Gomes, Yasmin El Hage, Ana Paula Amaral, Fabiano Politti, Daniela Aparecida Biasotto-Gonzalez

Abstract

Introduction: Temporomandibular disorder (TDM) is the most common source of orofacial pain of a non-dental origin. Sleep bruxism is characterized by clenching and/or grinding the teeth during sleep and is involved in the perpetuation of TMD. The aim of the present study was to investigate the effects of massage therapy, conventional occlusal splint therapy and silicone occlusal splint therapy on electromyographic activity in the masseter and anterior temporal muscles and the intensity of signs and symptoms in individuals with severe TMD and sleep bruxism.

Methods: Sixty individuals with severe TMD and sleep bruxism were randomly distributed into four treatment groups: 1) massage group, 2) conventional occlusal splint group, 3) massage + conventional occlusal splint group and 4) silicone occlusal splint group. Block randomization was employed and sealed opaque envelopes were used to conceal the allocation. Groups 2, 3 and 4 wore an occlusal splint for four weeks. Groups 1 and 3 received three weekly massage sessions for four weeks. All groups were evaluated before and after treatment through electromyographic analysis of the masseter and anterior temporal muscles and the Fonseca Patient History Index. The Wilcoxon test was used to compare the effects of the different treatments and repeated-measures ANOVA was used to determine the intensity of TMD.

Results: The inter-group analysis of variance revealed no statistically significant differences in median frequency among the groups prior to treatment. In the intra-group analysis, no statistically significant differences were found between pre-treatment and post-treatment evaluations in any of the groups. Group 3 demonstrated a greater improvement in the intensity of TMD in comparison to the other groups.

Conclusion: Massage therapy and the use of an occlusal splint had no significant influence on electromyographic activity of the masseter or anterior temporal muscles. However, the combination of therapies led to a reduction in the intensity of signs and symptoms among individuals with severe TMD and sleep bruxism.

Trial registration: This study is registered in August, 2014 in the ClinicalTrials.gov (NCT01874041).

Keywords: Massage therapy; Occlusal splint; Physical therapy modalities; Temporomandibular joint disorders.

Figures

Figure 1
Figure 1
Median (25% and 75% quartile) of median frequency (Hz) in right and left anterior temporal and masseter muscles during maximum voluntary clenching in each group (non-significant differences,p> 0.05; Kruskal-Wallis test).

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