Occlusal Adjustment as Treatment for Chronic Orofacial Pain

Primary Outcome Measures:

• Visual Analogic Scale for Pain Intensity (0-10) [ Time Frame: Baseline, immediately after therapy, 3 months and 6 months after therapy ]
  The primary outcome was self-reported pain intensity on a 0 to 10 cm visual analog scale considering the temporomandibular disorder side, being 0="No pain" and 10="Worst imaginable pain"
  
  

Secondary Outcome Measures:

• Symptom Checklist-90-Revised (SCL-90-R®) [ Time Frame: Before and 6 months after therapy ]
  Scale name: Global Severity Index. Scale graded from 0 to 4. Scores increases as the symptoms severity increases.
  
  
• Preferred Chewing Side [ Time Frame: Before and 6 months after therapy ]
  The change in the habitual chewing side of each participant across the study
  
  
• Maximum Mouth Opening (mm) [ Time Frame: 6 months (before and after therapy) including 4 assessment points: pre-treatment, post-treatment, 3- and 6-month follow up ]
  Maximum voluntary unassisted mouth opening
  
  
• Condylar Path Angles [ Time Frame: Baseline ]
  Parasagittal plane condylar path angles tracings in relation to the Frankfort line were made following the Gysi extraoral method.
  
  

Temporomandibular disorders (TMD) are very common disorders in daily dentistry and oral and maxillofacial practice. The key symptoms are jaw joint pain and limited mouth opening. Other than trauma, the causes remain unknown; consequently, there are no treatments based on specific etiologies. In our experience, patients can usually receive beneficial occlusal adjustments if these are carefully planned and performed in two steps: (1) elimination of premature contacts, which reduces loads in the temporomandibular joints, and (2) individualized remodeling of lateral anterior guidance to facilitate unilateral alternate chewing. The study will use stratified blocking randomization to blindly assign patients to the real or placebo treatment groups in order to evaluate the null hypothesis (H0) that "Occlusal adjustment of sufficient quality has no effect on chronic pain and/or limited mouth opening in TMD patients."