Effect of home exercise programs and splints on craniomandibular dysfunction

Abstract

Background: Around 40% of the world’s population is affected by craniomandibular dysfunction (CMD). It manifests as pain, restricted movement, and/or temporomandibular joint (TMJ) noises, and is usually diagnosed and treated at a late stage due to the large variability of symptoms. It is not uncommon for the quality of life of affected persons to be impaired. Physiotherapy and splint fitting play an important role in the treatment of CMD. Objective: The aim of this study is to clarify the effects of home exercise programs and splint therapies on the main symptoms of CMD. It is assessed whether a combination of the two therapies represents an added therapeutic value. Material and methods: Studies were searched for in the PubMed, PEDro and Cochrane databases. After reviewing suitable abstracts, the full texts were summarized and critically discussed. Results: Both home exercise programs and splint therapies lead to an improvement in symptoms and quality of life. In myogenic CMD, home exercise programs show a better therapeutic effect on TMJ mobility. In contrast, no clear therapeutic successes was found for the diagnosis of dislocation with reduction. In none of the analyzed studies did a combination of the two interventions result in an added value. In the analysis of quality of life, comparability was limited due to different and nonoptimal questionnaires. Comparing the results of the interventions regarding the duration, it was found that better results were achieved at the beginning of the therapies than after a longer treatment period. Dropout rates also increased with longer follow-up times. Conclusion: Individual adaptation of home exercise programs promotes compliance and adherence to treatment. Based on the current evidence, both home exercise programs and splint therapy are an appropriate method to reduce pain and TMJ noise, and to improve TMJ mobility and quality of life. For myogenic CMD, home exercise programs are an adequate, cost-effective alternative to splint therapy. Further research is needed to analyze the exact therapeutic effect in the different diagnostic groups. Regarding quality of life, further analyses with appropriate questionnaires are needed.