TMD painTo complement the Research Reports in the May 2015 issue of MASSAGE Magazine. Summary: Research subjects who received occlusal splint therapy combined with massage therapy experienced improvements in the symptoms of temporomandibular disorder (TMD) and sleep bruxism, even though each therapy used by itself did not result in symptom improvement.

Researchers in Brazil found the combination of massage therapy and the use of an occlusal splint to decrease the severity of symptoms associated with TMD and sleep bruxism, the latter of which involves clenching or grinding the teeth during sleep and is linked to prolonged TMD.

Subjects and methodology

The study, “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,” included 60 people diagnosed with severe TMD and sleep bruxism.

Subjects in the study were randomly assigned to one of four groups: massage; conventional occlusal splint; massage and conventional occlusal splint; or silicone occlusal splint. Participants assigned to the three occlusal splint groups wore the splint for four weeks. Those in the groups involving massage received three massages per week for four weeks.

Each massage session lasted 30 minutes and comprised sliding and kneading techniques to address the masseter and anterior temporal muscles, with the degree of pressure altered to suit each subject’s needs and preferences. A massage cream for the face was used to provide lubrication.

“Sliding consisted of a unidirectional movement in which part of the therapist’s hand (mainly the fingertips) was used, moving from the proximal to the distal portion of the face with constant, progressive pressure compatible with the status of each tissue,” stated the study’s authors. “Kneading consisted of a gripping maneuver of a muscle group or portion of a muscle, with intermittent movements of compression and decompression. The therapist performed circular movements with the fingertips such that the skin and subcutaneous tissues were moved over the subjacent structures.”

In the research groups that involved occlusal splints, subjects were instructed to wear the splint during sleep. These bite plates are used in an effort to induce relaxation of the masticatory muscles, guard the teeth and jaws from the effects of clenching and grinding, and promote better alignment of the condyles and jaws, among other potential benefits.

How massage and splint therapy affected TMD

The main outcome measures for this study were electromyographic (EMG) activity in the masseter and anterior temporal muscles, along with the intensity of the signs and symptoms associated with severe TMD and sleep bruxism. EMG activity of the right and left masseter and anterior temporal muscles was measured before and after the intervention in all groups, using surface EMG. The Fonseca Patient History Index was used before and after the intervention to assess the severity of TMD.

Results of the research found no significant improvements in the signs and symptoms of TMD and sleep bruxism among the occlusal splint therapy groups or the massage-only group. However, subjects assigned to receive both massage therapy and occlusal splint therapy demonstrated reductions in the intensity of symptoms associated with severe TMD and sleep bruxism. 

About the Authors

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

Sources: Postgraduate Program in Biophotonics Applied to Health Sciences, Department of Physical Therapy and Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil. Originally published online in 2014 in Chiropractic & Manual Therapies, 22(43).