A PROSPECTIVE CLINICAL STUDY TO EVALUATE THE EFFECTIVENESS OF ACUPUNCTURE TREATMENT FOR TEMPOROMANDIBULAR JOINT MUSCULAR DISORDER
Ahila Singaravel Chidambaranathan1*, Thulasingam Culathur2
1Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai-89, TamilNadu, India. [email protected]
2Department of Prosthodontics, Tamil Nadu Govt Dental College, Chennai-3, India.
The main purpose of the clinical study was to evaluate the effect of acupuncture treatment for pain due to TMJ muscular disorder. A total of 15 patients between 14 and 50 years with pain around TMJ without radiographic changes were included and acupoints Ting Hui, Ting gong, Ermen, Fengchi, Baihui He Gu, and He Gu were selected in which a sterile 32 gauge ½ inch stainless steel needles were manually inserted to a depth of 3 to 7 mm and stimulated by giving clockwise and counter clockwise motion for 30 seconds for every 10 minutes for 3 sessions, then the needles were removed from the respective acupoints. The treatment was pursued once a week continuously for 6 months and the pain scores were calculated using the Visual Analog Scale. The obtained pain scores were statistically analyzed using repeated ANOVA and Post hoc tests (Bonferroni). The results of this study showed that the pain score was reduced by 2 and 4.13 units after 3 and 6 months of acupuncture treatment for TMJ muscular disorders. TMJ disorder muscular pain had come to a minimum level and also mouth opening has come to near normal after 6 months of acupuncture treatment.
Key words: Acupuncture, Acupoints, Orofacial pain, Masticatory muscles, Temporomandibular joint disorder, Splint therapy.
The routine complaint raised by the patient to the general dental practitioner is temporomandibular joint disorders (TMD). The origin of pain may be due to non-odontogenic in the orofacial region which can refer to masticatory muscles, periauricular region, teeth, and head and ear area with some otologic manifestations such as tinnitus, vertigo, and ear fullness [1, 2].
The data given by an epidemiological study that 30-year-old women are most likely to be affected and approximately 10% of the population by TMD [1, 2]. Psychological tension, occlusal discrepancy, trauma, orthodontic treatment, joint laxity, health problems, malnutrition, and exogenous estrogen are the most contributing factors for TMD disorders [3-5].
Temporomandibular disorder is categorized into intraarticular and extraarticular. Musculoskeletal conditions are the most common cause of TMD, accounting for at least 50% of cases [6-8]. The treatment option to manage the pain of masticatory muscles are therapeutic exercises, drug therapy, splint therapy, injection therapy, surgical procedures, and acupuncture .
Acupuncture is used as an adjunct therapy to local anesthesia and the suggested mode of treatment for TMJ clicking and locking, orofacial pain, trigeminal neuralgia, dental anxiety, xerostomia, gag reflex, and Vitamin B12 deficiency . The idea behind acupuncture treatment is stimulation of specific acupoints using a specially designed needle is in practice apart from the heat, laser, electric stimulation, and suction cups .
Acupoints can be located everywhere on the human body's skin surface when human beings found that diseases could be cured after certain points were accidentally burnt or punched. In internal organs diseases, the bad qi travels through the meridians of the respective organs and reflects on the corresponding acupoints as soreness. The evacuating point of qi on the skin surface is used to pinpoint the disease's origin. It is also the entrance for elements from the external into our body . Hence this study was commenced to evaluate the effect of acupuncture treatment on muscular TMD after 3 and 6 months of acupuncture treatment. A hypothesis was formulated that TMD muscular pain will be reduced after treatment with acupuncture treatment.
Materials and Methods
This prospective study was carried in the patients reported to the outpatient dispersal of Department of Prosthodontics, Tamil Nadu Government Dental College, Chennai, with the complaints of pain on both sides of TMJ for 3 months.
The patients between 14 and 50 years with pain in TMJ for 3 months, deviation of mouth opening, restricted mouth opening, and clicking sound with stable vital signs and without neurological symptoms were included for this study.
Patients with mental sickness, neurological disorder, insulin therapy, severely attrited teeth, oral ulcers due to Bechet’s disease. Also, patients had an abnormality in TMJ  previous TMJ and orthognathic surgery, radiological changes due to TMJ osteoarthrosis, malignancy, condylar resorption, condylar fractures, pregnancy or lactation, current use of corticosteroids, nonsteroidal anti-inflammatory therapy, narcotics, muscle relaxants, or herbal medicines.
After completing the history and clinical examination, the treatment was started after obtaining informed consent from the subject. Patients were provided enough time to deliberate their participation with the written information and the study was started after obtaining institutional ethical committee approval. This research was carried out after obtaining informed consent and ethical approval. (TNDrMGRMU/TNGDCH/2002/PG/001) A total of 15 patients (Male:8 and Female:7) with pain in and around the TMJ region without any radiological changes in TMJ were selected for this study. Acupuncture was performed by a dentist qualified for acupuncture.
Acupoints Ting Hui points GB2 (anterior to the inter-tragic notch at the posterior border of the condylar process of the mandible), Ting gong SI 19 (anterior to the tragus and posterior to the condylar process of the mandible, a depression created while opening the mouth), Er Men TW 21 were identified in front of the ear (Figure 1), Fengchi GB 20 (located on the lower aspect of the occipital bone of the sunken of the mastoid process where the sternocleidomastoid and trapezius muscles attached Baihui DU 20 (vertex of the midline and 5 cm posterior to the anterior hairline of head) (Figure 2), He Gu LI4 (situated on the dorsum of the hand, radial to the midpoint of the second metacarpal bone between index finger and thumb) (Figure 3).
Figure 1. Acupoints GB2,SI 19,TW21