|Year : 2021 | Volume
| Issue : 2 | Page : 97-99
Management of temporomandibular joint disorders using acupuncture: A case report
Ahila Singaravel Chidembaranathan
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
|Date of Submission||24-Feb-2021|
|Date of Decision||28-Apr-2021|
|Date of Acceptance||17-May-2021|
|Date of Web Publication||23-Jun-2021|
Ahila Singaravel Chidembaranathan
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai 600089, Tamil Nadu.
Source of Support: None, Conflict of Interest: None
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|| |
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)., 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.,,
Diagnosing and treating TMD can be a difficult and daunting task because of the complexity of their causes. 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.
Acupuncture is an alternative treatment therapy for dental pain, facial pain, and postoperative pain., This clinical report describes a patient with muscular TMD who was treated successfully with acupuncture.
| Case Report|| |
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.
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|| |
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., TMDs cause discomfort and decrease people’s abilities because, in addition to pain, functional jaw limitations cause significant problems in performing daily activities.
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. Acupoints GB2, SI 19, TW 21, GB 20, DU 20, and LI4 are the most commonly used to treat pain in the TMJ area. 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|| |
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
Conflicts of interest
The authors declared that there is no conflict of interest.
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[Figure 1], [Figure 2], [Figure 3]