Pain in masticatory muscles is one of the most frequent symptoms in patients with temporomandibular disorders (TMD) and can lead to changes in the patterns of neuromuscular activity of masticatory muscles and decrease in bite force. This study assesses the effects of three eight-week exercise programs on pain intensity, neuromuscular activation, and bite force of masticatory muscles in patients with TMD. Forty-five patients were divided into three groups: a therapeutic exercise program (G1), a therapeutic and aerobic exercise program (G2), and an aerobic exercise program (G3). The masticatory muscles’ pain was evaluated using the numeric pain rating scale (NPRS), surface electromyographic (sEMG) activity of the masseter was recorded during maximum voluntary contraction and at rest, and bite force was evaluated using a dynamometer. These parameters were evaluated twice at baseline (A01/A02), at the end of the eight-week intervention period (A1), and 8–12 weeks after the end of the intervention (A2). After intervention, G2 showed the best results, with a significantly decrease in masticatory muscles’ pain and increase in bite force. These results suggest that interventions to reduce pain in patients with TMD should be multimodal.

To assess the effects of three 8-week exercise programs on the frequency, intensity, and impact of headaches in patients with headache attributed to temporomandibular disorder (TMD). Thirty-six patients diagnosed with headache attributed to TMD participated in the study and were divided into three groups of 12 patients: a therapeutic exercise program (G1, mean age: 26.3±5.6 years), a therapeutic and aerobic exercise program (G2, mean age: 26.0±4.6 years), and an aerobic exercise program (G3, 25.8±2.94 years). Headache frequency and intensity were evaluated using a headache diary, and the adverse headache impact was evaluated using the Headache Impact Test (HIT-6). The intensity was reported using the numerical pain rating scale. These parameters were evaluated twice at baseline (A01/A02), at the end of the 8-week intervention period (A1), and 8–12 weeks after the end of the intervention (A2). At A1, none of the G2 patients reported having headaches, in G1, only two patients reported headaches, and in G3, ten patients reported headache. The headache intensity scores (0.3 [95% CI: -0.401, 1.068]), (0.0 [95% CI: -0.734, 0.734]) and HIT-6 (50.7 [95% CI: 38.008, 63.459]), (49.5 [95% CI: 36.808, 62.259]), significantly decreased in G1 and G2 at A1. At A2 headache intensity scores (0.5 [95% CI: -0.256, 1.256]), (0.0 [95% CI: -0.756, 0.756]) and HIT-6 (55.1 [95% CI: 42.998, 67.268]), (51.7 [95% CI: 39.532, 63.802]) in G1 and G2 haven’t change significantly. The effects obtained immediately after the completion of the intervention programs were maintained until the final follow-up in all groups. The programs conducted by G1 (therapeutic exercises) and G2 (therapeutic and aerobic exercise) had significant results at A1 and A2.

The temporomandibular disorders (TMD) are one of the main concerns regarding orofacial pathologies and there are an ascending number of cases. They are characterised as a group of pathological conditions that may affect the temporomandibular joint (TMJ), the masticatory musculature and/or other adjacent anatomical structures, leading to pain and dysfunction [ 1 Cuccia AM , Caradonna C , Bruschetta D , et al. Imaging of temporomandibular joint: approach by direct volume rendering. J Clin Diagn Res. 2014;8(11):ZC105–9. [PubMed] , [Google Scholar] ]. The multifactorial aetiology of TMD affects a relatively large number of the world population and requires a multidisciplinary evaluation and diagnosis by the clinical team [ 2 Okeson JP. Management of temporomandibular disorders and occlusion. 7th ed. Mosby-St Louis (MO): Elsevier; 2013. [Google Scholar] ]. Among the various elements that constitute the multidisciplinary team we highlight the dentist and the physiotherapist. The dentist as a first-line professional, most of the time is responsible for the identification of patients potentially at risk and for the follow-up of those who already present the disease [ 3 Kogawa E , Kato M , Santos C , et al. Evaluation of the efficacy of low- level laser therapy (LLLT) and the microelectric neurostimulation (MENS) in the treatment of myogenic temporomandibular disorders: a randomized clinical trial. J Appl Oral Sci. 2005;13(3):280–285. [Crossref], [PubMed] , [Google Scholar] ]. On the other hand, the physiotherapist aims to reduce musculoskeletal pain, promote muscle relaxation, reduce muscle hyperactivity, improve function by restoring the quality and quantity of mandibular movements and maximise joint mobility [ 4 Armijo Olivo S , Magee D , Parfitt M , et al. The association between cervical spine, the stomatognathic system and orofacial pain: a critical review. J Orofacial Pain. 2006;20(4):271–287. [PubMed] , [Google Scholar] ]. A 24-year-old female patient with a history of temporomandibular disorder and bruxism she presented an non-assisted mouth opening (UMO) of 28 mm and an assisted mouth opening with pain in the masseter and TMJ bilaterally of 29 mm, after the clinical assessment with the DC/TMD protocol we arrived at a diagnosis of disc displacement without reduction (DDwR) with limited opening, degenerative joint disease in the left TMJ, arthralgia (II), myofascial pain (III) in the masseter with pain referred to other anatomical regions. All the assumptions of the Helsinki Declaration have been fulfilled and an informed consent for clinical case of Clinica Dentária Egas Moniz approved by the ethic commission of Instituto Universitário Egas Moniz. The treatment plan consisted of cognitive behavioural therapy (CBT), prescription of muscle relaxants, occlusal splint especially for reduction of overload due to bruxism, infiltration with 1 ml of hyaluronic acid of high molecular weight in the TMJ bilaterally followed by articular mobilisation techniques and neuromuscular and myofascial techniques. The patient was instructed to continue with the physiotherapy. The follow up was made 2 months after with 8 sessions of physiotherapy and 1 more hyaluronic acid infiltration bilaterally as protocoled session, we could observe an absence of temporomandibular joint pain, UMO of 42 mm, decreased crepitation, decreased intensity of myofascial pain (I) and (DDwR) without limited opening. The multidisciplinary dentist-physiotherapist team combines inputs from different professions with the aim of promoting the best patient care and represents an added value for the management of the signs/symptoms of patients with temporomandibular dysfunction.

Study objectives: Obstructive sleep apnea (OSA) has a high prevalence in the global population and is a significant sleep disorder. One of the non-invasive options to treat obstructive sleep apnea is the mandibular advancement device. 2 methods can help predict the success of mandibular advancement devices, and they are Neck computed tomography (CT) and Drug-induced Sleep endoscopy (DISE). The objective of this study was to determine which method is better at predicting the success of a mandibular advancement device in the treatment of obstructive sleep apnea. Methods: PubMed, Embase and Web of Science Core Collection databases were comprehensively searched. A total of 1809 was obtained through the extensive search of the three databases mentioned above (Embase = 952; PubMed = 508; Web of Science = 349). The exclusion criteria were studies lacking clear and replicable methodologies; research involving pediatric and adolescent participants, as well as individuals with craniofacial malformations; and Animal studies, conference abstracts, editorials, case reports, book chapters, and review articles. Results: Based on the inclusion criteria, mainly because of the lack of direct comparison between CT and DISE for the prediction of MAD success, two articles were selected for this systematic review. The conflicting findings between the two studies underscore the complexity of OSA management and challenges associated with predicting treatment outcomes using different diagnostic modalities. Conclusions: Although CT offers detailed anatomical information regarding airway morphology, DISE provides dynamic visualization of upper airway collapse during sleep, which may better simulate real-life conditions and MAD responses.

Obstructive sleep apnea is a sleep disorder with a high prevalence in the world population. The mandibular advancement device is one of the options for treating obstructive sleep apnea. Neck computed tomography and drug-induced sleep endoscopy are complementary diagnostic tests that may help predict the effectiveness of mandibular advancement devices. This study aims to analyze the best method for predicting the effectiveness of mandibular advancement devices in the therapeutic approach to obstructive sleep apnea. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science Core Collection databases will be comprehensively searched. We will include randomized clinical trials, non-randomized prospective or retrospective clinical studies, case controls, cohort studies, and case series. Two authors will independently conduct data extraction and assess the literature quality of the studies. The analysis of the included literature will be conducted by Revman 5.3 software. The outcomes that will be analyzed are craniofacial characteristics, cephalometric assessments, site and type of obstruction of the upper airway, mean values of the apnea–hypopnea index, and SaO₂ verified in the initial and follow-up polysomnography. This study will provide reliable, evidence-based support for the clinical application of mandibular advancement devices for obstructive sleep apnea.

Background: Physiotherapy is one of the most referenced and effective conservative strategies for treating patients with temporomandibular disorders (TMD). This study aimed to characterize and analyze the self-knowledge of TMD of Portuguese physiotherapists. Methods: an online questionnaire was carried out, and the data collected were descriptively analyzed. Results: A total of 338 physiotherapists participated, of which only 142 treated patients with TMD. Seventy-six percent of the physiotherapists reported that they had not received training in the TMD area during the physiotherapy degree course. Only 11% of the physiotherapists reported that treating patients with TMD adequately identified all symptoms of TMD. Conclusions: the present study showed that it is necessary to integrate TMD-related content into the basic training of physiotherapists and promote an increase in evidence-based training.