Effektivität von Heilgymnastik in der Behandlung der Kiefergelenkdysfunktion: Langzeitergebnisse

Kurzfassung

Ziel: Die Wirksamkeit von Physiotherapie in der Behandlung der Kiefergelenkdysfunktion konnte in einer kontrollierten Studie gezeigt werden. Da es sich hierbei um Kurzzeitergebnisse handelte, war das Ziel dieser Studie zu überprüfen, ob die Therapie auch langfristig wirkt. Methode: 20 Patienten wurden nachuntersucht. Alle Patienten waren in einer früheren Studie erfolgreich behandelt worden und litten beim Einschluss in die vorhergehende Studie an Kiefergelenkknacken und Schmerzen im Kiefergelenk. Parameter: Ruheschmerz. Maximalschmerz. Beeinträchtigung im täglichen Leben. Mundöffnung. Kiefergelenkknackintensität. Ergebnisse: Der Nachbeobachtungszeitraum betrug durchschnittlich 2,2 Jahre. 90 % der Patienten waren weiterhin nicht behandlungsbedürftig. Die Schmerzintensität, subjektive Beeinträchtigung und Mundöffnung waren im Vergleich zu vor Therapiebeginn signifikant verbessert (Wilcoxon-Test: p < 0,005). 60 % der Patienten waren vollkommen schmerzfrei (Fisher's Exact Test: p = 0,001), weitere 30 % hatten nur mehr belastungsabhängige Schmerzen (Fisher's Exact Test: p = 0,003). Lediglich ein Patient wies eine eingeschränkte Mundöffnung auf (Fisher's Exact Test: p = 0,004). Eine Reduktion des Kiefergelenkknackens wurde in 35 % erreicht. Bei keinem Patienten kam es zum Auftreten einer Mundöffnungssperre. Schlussfolgerungen: Physiotherapie kann als langfristig wirksame Methode zur Behandlung der Kiefergelenkdysfunktion angesehen werden.

Effectiveness of exercise therapy in craniomandibular disorders: a long-term follow-up

Objective: The relative effectiveness of physiotherapy has been shown in a controlled trial. Since only short time results have been reported, this study aimed to assess the long-term follow-up data of these patients. Methods: 20 patients were evaluated. All patients had been successfully treated in a previous trial, and suffered from temporomandibular joint clicking, and pain in the temporomandibular joint at baseline. Parameter: Pain at rest and at stress, impairment in daily life, mouth opening, joint clicking. Results: After a mean follow-up time of 2.2 years, 90 % of the patients were successfully treated. Pain, impairment and mouth opening were improved when compared to baseline (Wilcoxon Test: p < 0,005). 60 % of the patients experienced no pain at all (Fisher's Exact Test: p = 0.001), another 30 % had only pain during stress (Fisher's Exact Test: p = 0.003). Only one patient had a reduced mouth opening (Fisher's Exact Test: p = 0.004). A reduction of joint clicking occurred in 35 %. No patient developed a closed lock. Conclusions: Exercise therapy can be expected to help patients also in the long-term.

Schlüsselwörter

Physiotherapie - Heilgymnastik - Kiefergelenkdysfunktion - Schmerz - Langzeitresultate

Key words

Exercise therapy - physiotherapy - temporomandibular disorders - pain - long-term follow-up

Literatur

• 1 Ciancaglini R, Testa M, Radaelli G. Association of neck pain with symptoms of temporomandibular dysfunction in the general adult population.  Scand J Rehabil Med. 1999;  31 17-22
• 2 Wanman A. Longitudinal course of symptoms of craniomandibular disorders in men and women. A 10-year follow-up study of an epidemiologic sample.  Acta Odontol Scand. 1996;  54 337-342
• 3 Conti P C, Ferreira P M, Pegoraro L F, Conti J V, Salvador M C. A cross-sectional study of prevalence and etiology of signs and symptoms of temporomandibular disorders in high school and university students.  J Orofac Pain. 1996;  10 254-262
• 4 Goulet J P, Lavigne G J, Lund J P. Jaw pain prevalence among French-speaking Canadians in Quebec and related symptoms of temporomandibular disorders.  J Dent Res. 1995;  74 1738-1744
• 5 Onizawa K, Yoshida H. Longitudinal changes of symptoms of temporomandibular disorders in Japanese young adults.  J Orofac Pain. 1996;  10 151-156
• 6 Hupfauf L. Funktionsstörungen des Kauorgans.  Praxis der Zahnheilkunde. 1989;  Band 8, 2. Auflage 1
• 7 Eversole L R, Machado L. Temporomandibular joint internal derangements and associated neuromuscular disorders.  J Am Dent Assoc. 1985;  110 69-79
• 8 Eriksson L, Westesson P L. Clinical and radiological study of patients with anterior disc displacement of the temporomandibular joint.  Swed Dent J. 1983;  7 55-64
• 9 Olsson M, Lindqvist B. Mandibular function before orthodontic treatment.  Eur J Orthod. 1992;  14 61-68
• 10 Gervais R O, Fitzsimmons G W, Thomas N R. Masseter and temporalis etectromyographic activity in asymptomatic, subclinical, and temporomandibular joint dysfunction patients.  Cranio. 1989;  7 52-57
• 11 Cooper B C, Cooper D L. Multidisciplinary approach to the differential diagnosis of facial, head and neck pain.  J Prosihet Dent. 1991;  66 72-78
• 12 Flor H, Birbaumer N, Schulte W, Roos R. Stress-related electromyographic responses in patients with chronic temporomandibular pain.  Pain. 1991;  46 145-152
• 13 Rocabado M, Johnston B EJ, Blakney M G. Physical therapy and dentistry: an overview.  J Craniomandibular Pract. 1982;  1 46-49
• 14 Nicolakis P, Nicolakis M, Piehslinger E, Ebenbichler G, Vachuda M, Kirtley C, Fialka-Moser V. Relationship Between Craniomandibular Disorders and Poor Posture.  Cranio. 2000;  18, Number 2 106-112
• 15 Nicolakis P, Erdogmus B, Kopf A, Djaber-Ansari A, Piehslinger E, Fialka-Moser V. Exercise therapy for craniomandibular disorders.  Arch Phys Med Rehabil. 2000;  81 1137-1143
• 16 Schiffman E, Anderson G, Fricton J, Burton K, Schellhas K. Diagnostic criteria for intraarticular T.M. disorders.  Community Dent Oral Epidemiol. 1989;  17 252-257
• 17 Piehslinger E, Celar A G, Celar R M, Slavicek R. Computerized axiography: principles and methods.  Cranio. 1991;  9 344-355
• 18 Kropmans T J, Dijkstra P U, Stegenga B. The smallest detectable difference of mandibular function impairment in patients with a painfully restricted temporomandibular joint.  J Dent Res. 1999;  78 1445-1449
• 19 Schiffman E L, Fricton J R, Haley D P, Shapiro B L. The prevalence and treatment needs of subjects with temporomandibular disorders.  J Am Dent Assoc. 1990;  120 295-303
• 20 Helkimo M. Studies on function and dysfunction of the masticatory system. II. Index for anamnestic and clinical dysfunction and occlusal state.  Sven Tandlak Tidskr. 1974;  67 101-121
• 21 Fricton J R, Schiffman E L. The craniomandibular index: validity.  J Prosthet Dent. 1987;  58 222-228
• 22 Scott J, Huskisson E C. Graphic representation of pain.  Pain. 1976;  2 175-184
• 23 Lundh H, Westesson P L, Kopp S. A three-year follow-up of patients with reciprocal temporomandibular joint clicking (see comments).  Oral Surg Oral Med Oral Pathol. 1987;  63 530-533
• 24 Davies S J, Gray R J. The pattern of splint usage in the management of two common temporomandibular disorders. Part 1: The anterior repositioning splint in the treatment of disc displacement with reduction.  Br Dent J. 1997a;  183 199-203
• 25 Montgomery M T, Van Sickels J, Harms S E. Success of temporomandibular joint arthroscopy in disk displacement with and without reduction.  Oral Surg Oral Med Oral Pathol. 1991;  71 651-659
• 26 Lundh H, Westesson P L. Long-term follow-up after occlusal treatment to correct abnormal temporomandibular joint disk position.  Oral Surg Oral Med Oral Pathol. 1989;  67 2-10
• 27 Greene C S, Laskin D M. Long-term status of TMJ clicking in patients with myofascial pain and dysfunction (published erratum appears in J Am Dent Assoc 1988 Oct. 117 (5): 558) (see comments).  J Am Dent Assoc. 1988;  117 461-465
• 28 Kozeniauskas J J, Ralph W J. Bilateral arthrographic evaluation of unilateral temporomandibular joint pain and dysfunction.  J Prosthet Dent. 1988;  60 98-105
• 29 De Leeuw J, Boering G, Van der Kuijl B, Stegenga B. Hard and soft tissue imaging of the temporomandibular joint 30 years after diagnosis of osteoarthrosis and internal derangement.  J Oral Maxillofac Surg. 1996;  54 1270-1280
• 30 Dao T T, Lavigne G J, Charbonneau A, Feine J S, Lund J P. The efficacy of oral splints in the treatment of myofascial pain of the jaw muscles: a controlled clinical trial.  Pain. 1994;  56 85-94
• 31 Davies S J, Gray R J. The pattern of splint usage in the management of two common temporomandibular disorders. Part III: Long-term follow-up in an assessment of splint therapy in the management of disc displacement with reduction and pain dysfunction syndrome.  Br Dent J. 1997b;  183 279-283
• 32 Ekberg E C, Vallon D, Nilner M. Occlusal appliance therapy in patients with temporomandibular disorders. A double-blind controlled study in a short-term perspective.  Acta Odontol Scand. 1998;  56 122-128
• 33 Vallerand W P, Hall M B. Improvement in myofascial pain and headaches following TMJ surgery.  J Craniomandib Disord. 1991;  5 197-204
• 34 Wexler G B, McKinney M W. Temporomandibular treatment outcomes within five diagnostic categories.  Cranio. 1999;  17 30-37
• 35 Horne R, Rugh J. The effects of jaw exercises on jaw closure patterns. AADR abs no 906.  J Dent Res. 1980;  59 494
• 36 Lewit K, Simons D G. Myofascial pain: relief by post-isometric relaxation.  Arch Phys Med Rehabil. 1984;  65 452-456
• 37 De Wijer A, Steenks M H, De Leeuw J, Bosman F, Helders P J. Symptoms of the cervical spine in temporomandibular and cervical spine disorders.  J Oral Rehabil. 1996;  23 742-750
• 38 Goldstein D F, Kraus S L, Williams W B, Glasheen W M. Influence of cervical posture on mandibular movement.  J Prosthet Dent. 1984;  52 421-426
• 39 Boyd C H, Slagle W F, Boyd C M, Bryant R W, Wiygul J P. The effect of head position on electromyographic evaluations of representative mandibular positioning muscle groups.  Cranio. 1987;  5 50-54
• 40 Makofsky H W, Sexton T R, Diamond D Z, Sexton M T. The effect of head posture on muscle contact position using the T-Scan system of occlusal analysis.  Cranio. 1991;  9 316-321