OBJECTIVE:To conduct the cross-cultural adaptation and psychometric validation of the OHIP-TMDs for Portuguese-speaking populations, developing a unified version that encompasses both European and Brazilian Portuguese variants. METHODS:A bicentric observational study was conducted according to Beaton's guidelines and COSMIN standards. The instrument underwent translation, expert review, and pre-testing. Psychometric validation included 211 individuals with TMD (Portugal: n=98; Brazil: n=113). Internal consistency (Cronbach's α, McDonald's ω), test-retest reliability (ICC), structural validity (CFA), convergent validity (Fonseca Anamnestic Index), and known-groups validity were assessed separately for each country. RESULTS:The OHIP-TMDs-PT demonstrated excellent internal consistency (α=0.98 PT; α=0.96 BR) and reliability (ICC=0.96 PT; ICC=0.94 BR). CFA supported a unidimensional structure in Portugal and a second-order model in Brazil. Strong convergent validity and significant known-groups differences were observed. CONCLUSION:The OHIP-TMDs-PT is a reliable and valid instrument for assessing oral health-related quality of life in individuals with TMD across Lusophone populations.

Background/Objectives: This study aimed to explore the functional implications of occlusal changes during clear aligner treatment (CAT) to (a) analyze occlusal changes throughout CAT and the extent of post-treatment occlusal recovery; (b) assess the relationship between post-treatment occlusion and masticatory performance; (c) investigate whether case complexity, facial biotype, and type of malocclusion influence occlusal adaptation and functional outcomes; and (d) evaluate the presence and progression of signs or symptoms of TMDs in patients undergoing CAT. Methods: This longitudinal cohort pilot study included 42 individuals who underwent CAT. Occlusion was evaluated at three timepoints: before treatment (T0), at treatment completion (T1), and three months after with night-only aligner use (T2). Masticatory performance was assessed using a two-colored chewing gum test analyzed through colorimetric software. TMD signs/symptoms were assessed using the Diagnostic Criteria for TMD [DC/TMD]. Statistical analysis used non-parametric tests. Results: A significant decrease in occlusal contact area was observed during active CAT [p = 0.016], which partially recovered at follow-up. Individuals with normal facial proportions (normodivergent) showed more anterior contacts at T1 compared to hyperdivergent individuals [p = 0.013]. Masticatory performance remained stable between T1 and T2 [p = 0.528]. A weak negative correlation was found between posterior contact number and performance score at T1 [r = -0.378, p < 0.05], suggesting that more contacts may be linked to better chewing. No TMD signs or symptoms were detected at any timepoint. Conclusions: Although CAT temporarily reduces occlusal contact area, it does not negatively impact chewing efficiency or trigger TMD symptoms. These findings support the functional safety of CAT when treatment is properly planned and monitored.

Arthrogenic muscle inhibition (AMI) following ACL injury or reconstruction is a common issue that affects muscle activation and functional recovery. Thus, the objective of this study was to systematize the literature on the effects of physiotherapy interventions in the rehabilitation of AMI after ACL injury or reconstruction. A systematic review was conducted following the PRISMA guidelines. The risk of bias was evaluated using the PEDro scale and the Cochrane risk of bias tool. Searches were performed in the PubMed, Google Scholar, Cochrane Library, and EMBASE databases. Randomized controlled trials involving patients with ACL injuries or ACL reconstruction were included. Twenty studies were included. Fifteen evaluated the effects of exercise, showing significant improvement. Seven studies examined electrotherapy, with neuromuscular electrical stimulation and high-frequency therapy combined with exercise showing improvements in muscle strength, pain, and joint range of motion. Nine studies explored interventions like motor imagery, cryotherapy, taping, and vibration. When performed before exercise, motor imagery and cryotherapy improved cortical activity and muscle recovery. Kinesio taping reduced edema and pain better than exercise alone. Vibration showed inconsistent results across three studies. Methodological quality varied between 5 and 8 on the PEDro scale, with moderate-to-low risk of bias. Structured exercise should be the first-line intervention, but combining it with other therapies enhances rehabilitation. The study protocol was registered in the PROSPERO database (CRD42023425510).

Background: Clear aligners (CA) are used 22 h daily, creating a bite-block effect. This work aims to (i) analyze occlusal changes before the beginning of treatment, after the first set of CA and after the use of additional aligners; (ii) compare planned occlusal contacts with the ones obtained after the first set of CA; (iii) analyze the occlusal changes occurred after reaching the orthodontic goals after 3 months of using CA only at night; (iv) evaluate and characterize which tooth movements did not allow the treatment to be completed at the end of the first set of aligners, and finally (v) verify the possible relation between the changes in occlusal contact and areas and parameters such as case complexity and facial biotype. Materials and Methods: A quantitative, comparative, and observational longitudinal cohort study design was implemented to evaluate the clinical data and the complexity levels of cases receiving CA. A non-probabilistic and convenience sample of 82 individuals was recruited. The orthodontic malocclusion traits were classified as simple, moderate, or complex corrections based on the basis of the Align® recommendations with the Invisalign® evaluation tool. According to the Invisalign® criteria, patients need only one complex problem for their case to be classified as complex. Meshlab® v. 2022.02, ClinCheck® version Pro 6.0, My-Itero® version 2.7.9.601 5d plus, and IBM® SPSS Statistics software (Statistical Program for Social Sciences), version 27.0 for Windows were the software® used. Results: A statistically significant decrease in area and occlusal contacts number were observed from before the start of orthodontic treatment (T0) to the end of treatment (T1). The changes in the occlusal area (from T0 to T1) were statistically different between hyperdivergent (28.24 [15.51–40.91]) and hypodivergent (16.23 [8.11–24.97]) biotypes (p = 0.031). A significant difference between the hyperdivergent (4.0 [2.0–5.0]) and normodivergent (5.5 [4.0–8.0]) group was found in T1 for the anterior contacts (p = 0.044). Anterior contacts obtained were significantly higher than the planned (p = 0.037) Between T1 and T2 statistically significant increases of occlusal areas, posterior and total contacts were observed. Conclusions: Occlusal contact and area were decreased, either at the end of the first set or after the use of additional aligners. Anterior occlusal contacts obtained were higher than planned as opposed to posterior occlusal contacts obtained. The hardest tooth movements to achieve to complete the treatment were distalization, rotation, and posterior extrusion. After completing orthodontic treatment (T1) to 3 months after (T2) using additional aligners only at night, posterior occlusal contacts were significantly increased, which could be due to the natural settling of the teeth in this period.

The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol in the PubMed, Cochrane Library, LILACS, EBSCO, Scielo, between 2012 and 2022. The methodological quality was assessed by using the Newcastle–Ottawa Study Quality Assessment Scale. Mean differences and 95% confidence intervals were calculated and combined in meta-analyses. A total of 1202 participants were included in this systematic review (690 with TMD; 512 without TMD), with 22 articles being included in the qualitative analysis. Only three studies enabled the comparative analysis of the results. Ten articles showed a high methodological quality and a low risk of bias, and twelve had a low methodological quality and an increased risk of bias. The meta-analysis showed that the differences between the intervention and control groups were not statistically significant for the percentage overlapping coefficient of the anterior temporal muscle, for the masseter, and for the torque coefficient. The parameters analyzed with the compound technique for chewing showed altered mandibular functions in individuals with TMD. With the EMG method, it was possible to suggest that TMD in adult individuals causes compensatory muscle behaviors, and several changes in the masticatory function were found.

Objective: The aim of this study was to analyze the intra- and inter-examiner reliability when using the DC/TMD axis 1 and verify the replicability and validity of the data obtained. Methods: The sample comprised 30 volunteers (students) of the Instituto Universitário de Ciências da Saúde Norte (Portugal). The calibration process consisted of a volunteer selection, theoretical and practical training, data collection, and agreement calculation. Examiners received proper previous training. Three dental practitioners applied the questionnaire (T1) and re-examined all the participants one week later (T2). To measure the degree of inter and intra-examiner agreement, multiple Kappa coefficients were obtained when nominal or ordinal variables were involved. When the correspondence between quantifiable variables was assessed, Pearson correlation coefficients and their statistical significance were replicated. Results: Regarding opening patterns, a strong overall agreement was obtained, only showing discrepancies in left-assisted and unassisted maximum openings (from -0.034 to -0.370 and -0.630 to -0.933, respectively). A high level of inter-examiner agreement during TMJ noise during the opening assessment was obtained, only displaying variations in clicks (Kappa -0.423 to 0.757). Protrusion movement showed negative kappa and weaker agreement of all measurements (Kappa between -0.034 and -0037). Small discrepancies were obtained from palpation assessment (left lateral pole- Kappa -0.034). Conclusion: There was no discernible and persistent difference in the amount of agreement among the three examiners, demonstrating that all three examiners were capable of participating in data collecting by employing the DC/TMD questionnaire. The findings indicated nearly perfect intra- and inter-examiner concordance scores. Keywords: DC/TMD; test replicability; validation; examiner calibration.

Abstract Background Health Literacy allows optimizing healthy lifestyles and preventive and health protective behaviors (DGS, 2019). Low literacy can lead to a greater number of hospitalizations, a more frequent use of emergency services and a lower prevalence of preventive attitudes in the field of health. Internet-based interventions could have a positive impact on informal caregivers, reducing the geographical barrier, promoting self-efficacy in managing their own emotions, reducing burden. Aim Contribute to the training of informal caregivers of a primary health care unit in Lisbon, through the promotion of digital health literacy. Methods The Community Intervention project was carried out in the context of a home visit, focusing on 11 informal caregivers, through the presentation of an interactive digital manual. It was based on the methodology of health planning, through the elaboration of a diagnosis of the situation, definition of priorities, setting of objectives, selection of strategies, operational preparation and evaluation (Imperatori & Giraldes, 1993). Results It was found that not all informal caregivers have access to the internet or digital technologies, and it was necessary to deliver the printed manual. Caregivers who accessed the interactive digital manual rated its content as very important, having accessed the suggested links without difficulty. The possibility of forwarding the digital manual to other caregivers was valid for all. Conclusions Digital technologies promote communication in terms of health promotion, contributing to universal access and digital training in health, giving individuals the opportunity to increase care for their own health. The creation of digital health tools must be directed to the characteristics of the population. For individuals with low digital literacy, simple technologies must be created and for those who cannot or do not want to use digital tools, adequate alternatives must be created. Key messages • Primary care health professionals may use digital technologies to promote health literacy. • Vulnerable groups with low digital health literacy need support to increase access to digital technology that can promote health literacy.

Primary headache disorders (PHD), specifically migraine, are strongly associated with temporomandibular disorders (TMD), sharing some patterns of orofacial pain. Both disorders have significant genetic contributions already studied. PRISMA guidelines were followed to conduct this systematic review, which comprehensively summarize and discuss the genetic overlap between TMD and PHD to aid future research in potential therapy targets. This review included eight original articles published between 2015 and 2020, written in English and related to either TMD and/or PHD. The genes simultaneously assessed in PHD and TMD studies were COMT, MTHFR, and ESR1. COMT was proved to play a critical role in TMD pathogenesis, as all studies have concluded about its impact on the occurrence of the disease, although no association with PHD was found. No proof on the impact of MTHFR gene regulation on either TMD or PHD was found. The most robust results are concerning the ESR1 gene, which is present in the genetic profile of both clinical conditions. This novel systematic review highlights not only the need for a clear understanding of the role of ESR1 and COMT genes in pain pathogenesis, but it also evaluates their potential as a promising therapeutic target to treat both pathologies.

Temporomandibular disorders (TMD) and headache are complex. This study aims to assess the association between TMD, headache, and psychological dimensions such as psychological inflexibility and pain acceptance. The sample consisted of 120 participants following a non-probabilistic convenience sampling strategy through a direct invitation to the patients attending our facilities and their relatives (n = 61 diagnosed with headache, n = 34 diagnosed with TMD-headache, n = 25 control group). Diagnostic Criteria for Temporomandibular Disorders (DC-TMD), International Classification of Headache Disorders (ICHD-3 beta version), Chronic Pain Acceptance Questionnaire (CPAQ-8), and Psychological Inflexibility in Pain Scale (PIPS) were used as assessment tools. One-way ANOVA, multiple regression analysis (MRA), and the Johnson-Neyman approach were run by IBM SPSS, version 27 (IBM® Company, Chicago, IL, USA). The significance level was 0.05. One third of our sample presented with headache with TMD. Females were predominant. Males with headache, no systemic disease, less pain severity but higher frequency, living longer with the disease and having sensitive changes, showed higher pain acceptance. When headache occurs with TMD, women with higher education, no headache family history, less pain, and no motor changes showed higher pain acceptance. Patients with both conditions are more liable to have chronic pain and pain inflexibility. Pain intensity and willingness explain 50% of the psychological inflexibility in the headache group. In our sample, individuals suffering from both conditions show greater pain inflexibility, implicating more vivid suffering experiences, leading to altered daily decisions and actions. However, further studies are needed to highlight this possible association.

Orthodontic treatment acts through the application of forces and/or by stimulating and redirecting the functional forces within the craniofacial complex. Considering the interrelationship between craniomandibular and craniocervical systems, this intervention may alter craniocervical posture. Thus, our aim is to (a) compare craniocervical posture, hyoid bone position, and craniofacial morphology before, after, and also in the contention phase at least one year after the orthodontic treatment, in patients with temporomandibular disorders and (b) to verify whether the presence of condylar displacement, the skeletal class, or the facial biotype interferes with the abovementioned outcomes. To do so an observational, analytical, longitudinal, and retrospective design study was carried out. A non-probabilistic convenience sampling method was applied. The sample consisted of clinical records of patients diagnosed with temporomandibular disorders in order to compare pre-orthodontic treatment with post-orthodontic treatment (n = 42) and contention phase data (n = 26). A cephalometric analysis of several variables was performed. The p-value was set as 0.05. When the pre- and post-orthodontic treatment data were analyzed, there were statistically significant changes in variables concerning craniocervical posture (CV angle, C0-C1, and AA-PNS) and also concerning hyoid bone position (C3-Rgn). When pre- and post-orthodontic treatment and contention phase data were analyzed the variables concerning craniocervical posture (C0-C1, CVT/Ver, NSL/OPT, NSL/CVT, NSL/Ver; OPT/CVT, OPT/Ver) and facial biotype had statistically significant changes. This allowed us to conclude that in the sample studied, there were significant differences regarding hyoid bone position (pre- versus post-orthodontic treatment) and craniocervical posture (pre- versus post-orthodontic versus contention), with the craniocervical posture being prone to return to basal values. The presence of condylar displacement was found to significantly increase the H-H1 distance in the three moments of evaluation. Facial biotype was found to significantly increase the NSL/Ver angle on hypodivergent compared to hyperdivergent in the contention phase.

CONTEXT:Deep friction massage (DFM) is often used in the treatment of tendinopathies; however, the pressure applied may vary and interfere with the obtained results. OBJECTIVE:To assess whether the immediate effects of DFM on pain (pain intensity and time to onset of analgesia) and muscle strength are dependent on the pressure applied during the DFM application in athletes with patellar tendinopathy. DESIGN:Randomized, controlled, cross-over trial. SETTING:University research laboratory (institutional). PARTICIPANTS:Ten athletes with diagnosis of unilateral patellar tendinopathy (age 27.90 [5.24] y). INTERVENTIONS:All participants attended 4 sessions, 3 treatment sessions with DFM applied with different pressures (the mean pressure-previously determined for each participant-and the mean pressure ± 25%) and a control session, each of which was separated by 48 hours. MAIN OUTCOME MEASURES:Pain (intensity upon palpation and time to onset of analgesia), and muscle strength of knee extensors were assessed before and immediately after each session. RESULTS:Pain intensity changed significantly over time (F1,9 = 52.364; P < .001; ηp2=.853) and among sessions (F3,27 = 82.588; P < .001; ηp2=.902), with a significant interaction for group × time (F3,27 = 19.841; P < .001; ηp2=.688). The knee extensors strength did not change significantly over time (F1,9 = 2.240; P = .17; ηp2=.199), nor a significant interaction for session × time was observed (F3,27 = 3.276; P = .07; ηp2=.267). Regardless of the pressure applied, the time to onset of analgesia was not significantly different (F2,18 = 1.026; P > .05; ηp2=.102). CONCLUSION:It was shown that DFM induces an immediate reduction in pain intensity upon palpation, regardless of the pressure performed. Notwithstanding, the reader should take into account the small sample size and the caution needed in the results' interpretation.

This study aims to determine if a dose–response relationship exists between the pressure applied during deep friction massage (DFM) and the time to the onset of analgesia in an asymptomatic patellar tendon. For this purpose, pressures applied by physiotherapists during DFM (study 1) were characterized and then, based on these pressures, the effects of different DFM pressures on the time to the onset of analgesia were assessed (study 2). First, the mean pressure applied by 40 physiotherapists during a DFM session was assessed with a pressure sensor through an observational, cross-sectional and analytical study. Next, the effects of different pressure intensities (the median, the percentile 25 (P25), and the percentile 75 (P75) of the mean pressure obtained in study 1) were studied in a crossover trial enrolling 30 participants with an asymptomatic patellar tendon. A pressure sensor was used to register the pressures applied during DFM. Our main results indicated that the physiotherapists applied pressures with a wide variation ((mean pressure: 2.317 kg/cm2 (P25: 1.022 kg/cm2; P75: 4.161 kg/cm2)). It was also shown that higher pressures had shorter times to the onset of analgesia (pressure: 1 kg/m2, time to the onset of analgesia: 67.0 s (P25: 84.5 s; P75: 113.5 s); pressure: 2.3 kg/m2, time to the onset of analgesia: 59.0 s (P25: 73.5 s; P75: 87.3 s); pressure: 4.2 kg/m2, time to the onset of analgesia: 37.8 s (P25: 54.0 s; P75: 62.0 s)) (p ≤ 0.001). In conclusion, the mean DFM pressure obtained by the physiotherapists was 2.3 kg/cm2 (P25: 1.02 kg/cm2; P75: 4.16 kg/cm2). Higher pressures of DFM resulted in shorter times to the onset of analgesia.

Introduction Achilles tendinopathy is considered one of the most frequent injuries in individuals who practice regular physical activity, thus the existence of an instrument that allows the evaluation of the degree of severity of the lesion is important. The VISA-A was developed for English-speaking population to evaluate patients with this condition, and there is a need to adapt this tool to Portuguese (Portugal). Objectives To cross-cultural adapt and validate the VISA-A questionnaire for Portuguese-speaking (Portugal) Achilles tendinopathy patients. Methodology The VISA-A questionnaire was translated and cross-culturally adapted into Portuguese (VISA-A-Por) according to specific guidelines, using six steps: Translation, synthesis, back translation, expert committee review, pretesting (n = 10), and appraisal of the adaptation process. The resulting VISA-A-Por was then subjected to an analysis of the psychometric properties (construct validity, reproducibility [agreement and reliability], internal consistency and floor and ceiling effects) in 57 Achilles tendinopathy patients and 58 asymptomatic people. Participants completed the questionnaire at baseline and after a minimum interval of 48 hours. Results The Visa-A-Por semantic and content validity was considered good by the expert committee and has construct validity shown by the differences between groups (p < 0,001). The questionnaire presented good internal consistency, with a Cronbach α of 0,88. Concerning reproducibility, agreement levels were considered optimal which can be verified in the Bland Altman graph, the standard error measurement (6,49) and the minimally important change (17,99 points), as well as the excellent ICC value (0,88). No ceiling-floor effect was found. Conclusion The VISA-A-Por questionnaire has been shown to be equivalent to the original questionnaire, which indicates that it is a valid and reliable measure for the evaluation of the severity and functional impact of patellar tendinopathy in Portuguese-speaking (Portugal) patients.

Introduction: The purpose of this article was to develop and validate a scale to assess common knowledge about temporomandibular disorders (TMDs) in the general population, evaluate the status of TMDs knowledge in the Portuguese population, quantify the severity and prevalence of TMDs-related symptoms in the general population, and assess the association between TMDs-related symptoms’ severity and demographic, medical and oral associated factors. Materials and Methods: This study was an analytical cross-sectional survey design. The sample consisted of 2165 participants selected through a snowball sampling method. The participants completed an online questionnaire regarding social and demographic characteristics, medical history, oral habits, Fonseca’s Anamnestic Index, a scale about difficulties on impulsiveness control and also the TMDs knowledge scale developed. The psychometric properties of the scale developed was tested on a small number of participants (n = 210). The P value set was 0.05. Results: Concerning psychometric properties all items showed a moderate-to-strong positive association with the loading factor. The Cronbach’s alpha was 0.956, showing good reliability. TMDs knowledge was positive in 1295 participants (59.8%). Multivariate-adjusted odds showed that female gender, diagnosis of tension-type headache, migraine, anxiety, impulsiveness, facial trauma, and parafunctional habits increased the risk of developing TMDs (adjusted odds ratios from 1.84 to 49.38). Conclusion: The scale developed is psychometrically valid and reliable and the participants had an overall positive knowledge about TMDs. A high prevalence of TMDs-related symptoms among the Portuguese population was found and the associated factors were female gender, impulsiveness, tension-type headache, migraine, anxiety, facial trauma, and parafunctional habits.

Introduction: Physiotherapy as a profession has been evolving supported by the growing knowledge from scientific trials. Orofacial pain represents a clinical condition, where the evolution of the knowledge regarding this condition, has substantially changed through the years with a direct impact in the clinical approach to this condition [1 Chichorro JG, Porreca, F, Sessle B. Mechanisms of craniofacial pain. Cephalalgia. 2017;37(7):613–626.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar],2 Ghurye S, McMillan R. Orofacial pain – an update on diagnosis and management. British Dental Journal. 2017;223:639–647.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]], namely the physiotherapy approach [3 Gil-Martínez A, Paris-Alemany A, López-de-Uralde-Villanueva I, et al. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. Journal of Pain Research. 2018;11:571–587. doi:10.2147/JPR.S127950[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]]. There have been several paradigm shifts grounded by the evidence from epidemiology, neurobiology, cognitive sciences and many other fields of knowledge [4 Horswell BB, Sheikh J. Evaluation of Pain Syndromes, Headache, and Temporomandibular Joint Disorders in Children. Oral and Maxillofacial Surgery Clinics. 2018;30(1):11–24. doi:10.1016/j.coms.2017.08.007[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]–6 List T, Jensen RH. Temporomandibular disorders: Old ideas and new concepts. Cephalalgia. 2017;37(7):692–704.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]]. Once orofacial pain disorders are highly prevalent and debilitating conditions, physiotherapy intervention should take into account the complexity of this condition in order to provide the best treatment focused on the individual needs and beliefs of the patient and informed by the best available evidence.

Introduction: Temporomandibular disorders (TMDs) concerns a heterogeneous group of pathologies that manifest in the orofacial region, head and neck [1 Magnusson T, Egermark I, Carlsson GE. A prospective investigation over two decades on signs and symptoms of temporomandibular disorders and associated variables. A final summary. Acta Odontol Scand. 2005;63(2):99–109. doi:10.1080/00016350510019739[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]] and is defined as a group of musculoskeletal and neuromuscular conditions that involve the TMJs, the masticatory muscles and all associated structures in a reciprocal interaction and influence [2 Leeuw R, Klasser GD. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. 5th ed. The American Academy of Orafacial Pain, Quintessence Books; 2013. p. 312. [Google Scholar]]. This disorder results in one or more signs and symptoms: orofacial pain, masticatory muscle pain or a combination of both. Other symptoms include impaired mandibular range of motion, joint noises associated with function, muscle and joint tenderness as well as head and neck pain [3 Suvinen TI, Reade PC, Kemppainen P, et al. Review of aetiological concepts of temporomandibular pain disorders: towards a biopsychosocial model for integration of physical disorder factors with psychological and psychosocial illness impact factors. Eur J Pain. 2005;9(6):613–633. doi:10.1016/j.ejpain.2005.01.012[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]]. Pain represents the main reason for medical seek [4 Gil-Martínez A, Paris-Alemany A, López-de-UraldeVillanueva I, et al. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res. 2018;11:571–587.[Taylor & Francis Online], [Web of Science ®] , [Google Scholar],5 Dickerson S, Weaver J, Boyson A, et al. The effectiveness of exercise therapy for temporomandibular dysfunction: A systematic review and meta-analysis. Clin Rehabil. 2017;31(8):1039–1048. doi:10.1177/0269215516672275[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]] and certain psychological factors, such as pain catastrophizing, fear, and depression can influence pain thresholds and pain tolerance [4 Gil-Martínez A, Paris-Alemany A, López-de-UraldeVillanueva I, et al. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res. 2018;11:571–587.[Taylor & Francis Online], [Web of Science ®] , [Google Scholar],5 Dickerson S, Weaver J, Boyson A, et al. The effectiveness of exercise therapy for temporomandibular dysfunction: A systematic review and meta-analysis. Clin Rehabil. 2017;31(8):1039–1048. doi:10.1177/0269215516672275[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]]. Taking into account that the literature has shown that pain thresholds and pain tolerances have been found to increase following exercise [4 Gil-Martínez A, Paris-Alemany A, López-de-UraldeVillanueva I, et al. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res. 2018;11:571–587.[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]], we have performed a study that aimed to evaluate the immediate effects of therapeutic exercises (TE) in TMDs patients with chronic pain.Material and Methods: A prospective clinical study was conducted having 20 subjects with muscular TMDs diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders with chronic pain. The subjects were assigned to two groups: 10 in the experimental group (G1) and 10 in the control group (G2). The G2 group consisted of subjects on the waiting list who were evaluated at all times in conjunction with the G1 group, but who were not submitted to any intervention. The experiment was conducted approximately 90 min in duration. During the session, participants: 1) completed the Pain Catastrophizing Scale (PCS); 2) had their pressure pain threshold (PPT) measured before, immediately after and 30 min after TE; and 3) had their pain intensity measured before, immediately after and 30 min after TE through numeric pain rating scale (NPRS). The data evaluation was conducted in a SPSS with an exploratory analysis and a two-way mixed ANOVA to assess the difference between groups, with a significance level of 5%. All the assumptions of the Helsinki Declaration have been fulfilled.Results: PPT values increased from T0 to T2 in the G1 (p < 0.001). NPRS values decreased at T2 when compared with the T0 in the G1 (p = 0.001).Discussion/Conclusion: Therapeutic exercises promoted an increase in the PPT values and a decrease in the NPRS value, reinforcing its value in the treatment of muscular TMDs. However, further investigation should be done with an increased sample.

Les troubles temporomandibulaires ou les désordres de l’appareil manducateur (DAM) comportent plusieurs risques et différents facteurs associés avec, par conséquent, des approches thérapeutiques variées. Il est important d’identifier les troubles caractéristiques du patient qui relèvent d’orthodontie, de kinésithérapie, ou d’autres modalités thérapeutiques plus ou moins combinées. Nous présentons trois cas de patients présentant des signes et/ou symptômes communs de troubles temporomandibulaires avec des approches thérapeutiques et des résultats différents ; et notre but est de comprendre ce qui pourrait expliquer les différences de résultats observées et reconnaître les éléments particuliers squelettiques, musculaires, faciaux et occlusaux qui pourraient justifier le bénéfice d’une intervention particulière. Il a été démontré que l’orthodontie joue un rôle important pour résoudre des problèmes occlusaux et modifier la dimension verticale. D’un autre côté, la kinésithérapie s’est avérée efficace dans la gestion et l’amélioration de l’intensité de la douleur, lorsque les changements musculosquelettiques sont clairement constatés. Enfin, il a également été démontré qu’une approche pluridisciplinaire peut s’avérer essentielle : le clinicien doit être conscient de l’intérêt d’une évaluation globale, prenant en compte tous les facteurs associés, en particulier les facteurs psychologiques.