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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 97-99

Management of temporomandibular joint disorders using acupuncture: A case report


Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India

Date of Submission24-Feb-2021
Date of Decision28-Apr-2021
Date of Acceptance17-May-2021
Date of Web Publication23-Jun-2021

Correspondence Address:
Ahila Singaravel Chidembaranathan
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai 600089, Tamil Nadu.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SDJ.SDJ_70_21

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  Abstract 

Background: Temporomandibular joint disorder (TMD) is a term for disease of the TMJ and the muscles attached to it. The symptoms and signs of TMD are clicking, crepitation, headache, and pain in and around the TMJ. Management of TMD includes dental approaches (e.g., splints, bite plates, and jaw exercises) and surgical approaches. Acupuncture is a Chinese medicine that consists of insertion of small solid stainless-steel needles into many acupoints on the body to improve health and relieve pain in the surrounding areas. Case Report: A 34-year-old male patient reported with severe pain in the right and left TMJ region and difficulty in opening of his mouth for the past 6 months. Extra-oral examination revealed tenderness on both sides of the face, deviation of the mouth toward the right side, the mouth opening was two finger breadths, and mild early-opening click. Intra-oral examination revealed the presence of 28 teeth. Orthopantogram did not show any changes in the condyle and articular eminence. The patient was initially treated with palliative therapy and then treated with acupuncture. Conclusion: Acupuncture is an alternative mode of treatment for persons with muscular TMD.

Keywords: Acupuncture, clicking, crepitus, temporomandibular joint pain


How to cite this article:
Singaravel Chidembaranathan A. Management of temporomandibular joint disorders using acupuncture: A case report. Sci Dent J 2021;5:97-9

How to cite this URL:
Singaravel Chidembaranathan A. Management of temporomandibular joint disorders using acupuncture: A case report. Sci Dent J [serial online] 2021 [cited 2021 Jul 31];5:97-9. Available from: https://www.scidentj.com/text.asp?2021/5/2/97/319054




  Background Top


Temporomandibular joint disorders (TMDs) are multifactorial conditions that describe chronic pain and/or dysfunction of the temporomandibular joint (TMJ) masticatory muscles. The syndrome has been classified into disorders of the soft tissue (e.g., disk displacement) and joint hard tissue (e.g., osteoarthritis and osteoarthrosis).[1],[2] The etiology of TMD is multifactorial and involves many anatomical structures, but myofascial pain syndrome is the main cause. The prevalence of TMD is between 40% and 75%, and they are more common in adults between 20 and 50 years of age and in women.[3],[4],[5]

Diagnosing and treating TMD can be a difficult and daunting task because of the complexity of their causes.[6] Symptoms of other entities can exist in the same person, leading to confuse the diagnoses and very demanding treatments. The therapeutic approach requires multidisciplinary knowledge and expertise in managing the disease. Many treatments, which include therapeutic exercises, occlusal splint therapy, physiotherapeutic techniques, oral drug therapy, injectable pharmacotherapy, surgical procedures, and acupuncture, are available for the management of pain in the masticatory muscles.[7]

Acupuncture is an alternative treatment therapy for dental pain, facial pain, and postoperative pain.[8],[9] This clinical report describes a patient with muscular TMD who was treated successfully with acupuncture.


  Case Report Top


A 34-year-old male patient reported to the Department of Prosthodontics, Tamil Nadu Government Dental College and Hospital, Chennai, with severe pain in the right and left TMJ region and difficulty in opening his mouth for the past 6 months. Extra-oral examination revealed tenderness on both sides of the face, deviation of the mouth toward the right side, the mouth opening was two finger breadths, and mild early-opening click. Intra-oral examination revealed the presence of 28 teeth, and the four wisdom teeth were impacted which were surgically removed 3 months ago due to TMD, but the pain persisted after removal of wisdom teeth.

The patient’s TMJ was evaluated with orthopantomograms of both sides, but there were no changes in the condyle and articular eminence. The case was diagnosed as TMD. The patient was initially treated with palliative therapy, such as analgesics and thermal therapy, but the pain was relieved only for a short time, and reported to the hospital again with the same symptoms. As the patient was in middle age, we explained the acupuncture treatment procedure and its pros and cons for orofacial pain. The patient and family members agreed to acupuncture treatment, and the procedure was started after obtaining informed consent.

The acupoints chosen for the patient were the Ting Hui 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 (in front of the ear) [Figure 1], Fengchi GB 20 (located by feeling for the mastoid bone and inferior to the occipital bone in the depression between the sternocleidomastoid muscle and the trapezius muscle, following the groove back to where the neck muscles attach to the skull) [Figure 2], DU 20 Baihui (located at the vertex, on the midline, 5 mm posterior to the anterior hairline on the head), and LI4 He Gu (located on the dorsum of the hand, between the thumb and index fingers, radial to the midpoint of the second metacarpal bone) [Figure 3]. Sterile 32-gage ½ inch stainless steel needles were inserted to a depth of 3–7 mm. The needles were stimulated by giving a clockwise motion for 30 s. After 30 min, the needles were removed from all acupoints.
Figure 1: Acupoints GB2, SI 19, TW 21

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Figure 2: Acupoint GB 20

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Figure 3: Acupoint LI4

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This treatment was continued once a week for 4 weeks. The pain was reduced to a moderate level, and the mouth opening had also started to increase; therefore, the treatment was continued for 3 months. The patient was relieved of the pain and tenderness and able to perform normal mouth opening and carry out his usual duties without any discomfort.


  Discussion Top


TMDs are the cause of most of the common types of orofacial musculoskeletal pain and present as chronic pain that is difficult to control by dentists or other health professionals.[10],[11] TMDs cause discomfort and decrease people’s abilities because, in addition to pain, functional jaw limitations cause significant problems in performing daily activities.[12]

Acupuncture may stimulate the nerve endings to release endorphins, serotonin, and acetylcholine associated with the central nervous system, or it may relieve pain by acting as a noxious stimulus. In any case, acupuncture uses the body’s own mechanisms to reduce pain. Insertion of acupuncture needles into particular acupoints as a pain treatment initiates the release of endogenous opioids (e.g., endorphins and enkephalins), which flood the afferent interneurons, thereby blocking the noxious stimuli.[13] Acupoints GB2, SI 19, TW 21, GB 20, DU 20, and LI4 are the most commonly used to treat pain in the TMJ area.[14] Hence, these points were selected for treating this patient with TMD, and his pain symptoms were relieved after 3 months of treatment.

The advantage of acupuncture treatment is non-surgical and easy to perform. However, the disadvantage is invasive and the result may be unpredictable sometime.


  Conclusion Top


Acupuncture is an alternative mode of treatment for persons with muscular TMD. The treatment should be given once a week for 30 min for six rounds, which is to be followed up to 3 months till the symptoms have subsided.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

The authors declared that there is no conflict of interest.



 
  References Top

1.
Gray R, Davies , Quayle A. A clinical guide to temporomandibular disorders. Br Dent J 1995;176:429-35.  Back to cited text no. 1
    
2.
Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders; review, criteria, examinations and specifications critique. J Craniomandi Disord 1992;6:310-55.  Back to cited text no. 2
    
3.
Leeuw R, Klasser KD. American Academy of Orofacial Pain: Guidelines for Assessment, Diagnosis and Management. 6th ed. Chicago: Quintessence; 2018. p. 129-75.  Back to cited text no. 3
    
4.
Martín-Granizo R, Martín-Granizo LR, Redondo Gonzalez LM, Sanchez Cuellar Y. Manual de Cirugia oral Y maxilofacial. 2nd ed. Madrid: Editorial ENE; 2004. Vol. 2. p. 1465-91.  Back to cited text no. 4
    
5.
McNeill C, American Academy of Craniomandibular Disorders. Craniomandibular Disorders: Guideline for Evaluation, Diagnosis, and Management. Chicago: Quintessence; 1990. p. 54.  Back to cited text no. 5
    
6.
Ravishankar K, Anoop S, Shobhit A, Sweekriti M, Sanober K. Alternative therapies in the treatment of temporomandibular disorders. J Dent Orofac Res 2018;15:78-83.  Back to cited text no. 6
    
7.
Wieckiewicz M, Boening K, Wiland P, Shiau YY, Paradowska-Stolarz A. Reported concepts for the treatment modalities and pain management of temporomandibular disorders. J Headache Pain 2015;16:106.  Back to cited text no. 7
    
8.
World Health Organization. Acupuncture: An Review and Analysis of Reports on Control Clinical Trail. Geneva: World Health Organization; 2003.  Back to cited text no. 8
    
9.
Wong LB. Acupuncture in dentistry; its possible role and application. Proc Singapore Healthc 2012;21:48-56.  Back to cited text no. 9
    
10.
Hong MH. Relationship of stress, oral habits and TMJ symptoms in 20-30 ages adults. J Korean Soc Dent Hyg 2014;14:739-46.  Back to cited text no. 10
    
11.
Branco CA, Fonseca RB, Oliveira TR, Gomes VL, Fernandes Neto AJ. Acupuncture as a complementary treatment option to temporomandibular dysfunction—A review of the literature. Rev Odontol UNESP 2005;34:11-6.  Back to cited text no. 11
    
12.
Alajbeg I. Temporomandibular disorders—The role of neuromuscular dentistry. Med Sci 2010;34:33-41.  Back to cited text no. 12
    
13.
Raphael KG, Klausner JJ, Nayak S, Marbach JJ. Complementary and alternative therapy use by patients with myofascial temporomandibular disorders. J Orofac Pain 2003;17:36-41.  Back to cited text no. 13
    
14.
Wong YK, Cheng J. A case series of temporomandibular disorders treated with acupuncture, occlusal splint and point injection therapy. Acupunct Med 2003;21:138-49.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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