THE LONG-TERM EFFECT OF OCCLUSAL THERAPY ON SELF-ADMINISTERED TREATMENT OUTCOMES OF TMD

Because of a lack of substantial scientific data, the efficacy of occl usal therapy for the management of temporomandibular disorders (TMD) i s still controversial. Of a total of 1405 consecutive TMD patients exa mined over the last 10 years, 369 (26.3%) were determined to have comp leted treatment at least 1 year before the present survey. A sample qu estionnaire was mailed to each patient in this sample population. The questionnaire failed to reach 46 patients; of the 323 patients who rec eived the questionnaire, 260 (80.5%) responded. The mean duration of t ime between their last visit and this survey was 3.7 years. The questi onnaire elicited information on treatment outcomes, present treatment needs, and current signs and symptoms. Participants were divined into two treatment groups: (a) those who underwent some occlusal therapies (Phase II) following successful reversible therapies (Phase I) (20 men and 114 women); and (b) those who underwent reversible therapy only ( 33 men and 93 women). Participants were further differentially diagnos ed into five diagnostic subgroups of TMD, based on the clinical examin ation at the initial visit, tomography, and for some patients, magneti c resonance imaging. The subgroups included myalgia, arthralgia, anter ior disc displacement with and without reduction, and osteoarthritis/o steoarthrosis. Only 12.3 % of the total population surveyed recovered lack of improvement to an acceptable level and further need for treatm ent. The remaining patients reported satisfactory results in the reduc tion of TMD symptomatology and no further need for treatment, because their symptoms had either disappeared or improved to an acceptable lev el. Regardless of treatment groups and diagnostic subgroups, the curre nt subjective signs and symptoms were negligible in most patients, and mean mouth openings were in the normal range. No particular diagnosti c subgroups seemed to have significantly better outcome following Phas e II occlusal therapy. These results suggest that the majority of TMD signs and symptoms improvement to an acceptable level with only revers ible therapy, and the long-term value of additional occlusal therapy f ollowing reversible therapy is minimal. Therefore, permanent occlusion -changing therapies apparently are not generally needed to maintain TM D symptom reduction over time.