A Comparison of Cervical Region Position Sensation, Masticatory Muscle Pain Threshold, and the Craniovertebral Angle in Individuals With Temporomandibular Joint Dysfunction and Healthy Individuals
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 30
- 试验地点
- 1
- 主要终点
- pain threshold
研究概览
简要总结
Temporomandibular disorder (TMD) is a group of conditions involving the masticatory muscles, temporomandibular joint (TMJ), and associated structures of the head, neck, and cervical region. TMD may cause pain in the ear region and over the masseter muscle, restricted mandibular movement, and clicking or crepitus sounds in the temporomandibular joint. It may also be accompanied by cervical dysfunction, limited range of motion, pain, and postural abnormalities. Due to the close anatomical and functional relationship between the cervical region and the TMJ, disorders affecting one region are likely to influence the other. Alterations in the TMJ may lead to changes in the cervical spine and consequently affect proprioception. Head posture can be evaluated using the craniovertebral angle. Increases or decreases in this angle may reflect changes in anterior head tilt. Cervical impairments associated with TMD may also result in alterations in the craniovertebral angle. Therefore, the aim of this study is to compare cervical joint position sense, pressure pain threshold of the masticatory muscles, and craniovertebral angle values between individuals with TMD and healthy controls.
详细描述
Temporomandibular disorder (TMD) is a condition affecting the temporomandibular joint (TMJ), masticatory muscles, and associated structures. Patients with TMD may present with a variety of symptoms, including pain, headache, joint locking, limited mouth opening, and joint sounds. Because the cervical vertebrae are anatomically and functionally connected to the cranium and masticatory structures through neurovascular components, muscles, and joints, alterations in one region may influence the other. Shortening of the cervical extensor muscles and the sternocleidomastoid muscle may contribute to the development of a forward head posture, which is associated with increased cervical lordosis. The primary clinical manifestation of TMD is pain related to mandibular movement limitation and joint sounds during function. In addition, TMD-related pain has been reported to be associated with increased psychological distress, autonomic dysfunction, motor impairments, balance deficits, and sleep disturbances. The craniovertebral angle is defined as the angle formed between a horizontal line and a line connecting the tragus of the ear to the spinous process of the seventh cervical vertebra . It is widely used to assess head posture. In a study evaluating cranio-cervical posture using lateral radiographs, Joy et al. reported that individuals with TMD had significantly greater craniovertebral angles than healthy individuals. Proprioception is the ability to perceive joint position and movement without visual input and plays an essential role in maintaining postural balance. Proprioceptors are particularly abundant in the cervical region. Damage or dysfunction affecting the cervical spine may disrupt proprioceptive input, leading to altered head and body position, impaired postural reflexes, and deficits in balance and gait. Based on the current literature, no previous study has simultaneously compared cervical joint position sense, craniovertebral angle, and the pressure pain threshold of the masticatory muscles between individuals with TMD and healthy controls. Therefore, this study was designed to investigate these parameters comprehensively and to contribute to the existing literature.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Cross Sectional
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Temporomandibular dysfunction group:
- •Volunteering to take part in the study
- •Scoring over 15 on the Fonseca scale
- •Being aged 18 or over
- •Healthy group:
- •Willingness to participate in the study, Fonseca score of 15 or below
- •Being aged 18 or over.
排除标准
- •Temporomandibular dysfunction group:
- •Having undergone any medical treatment or physiotherapy for the temporomandibular joint within the last 6 months
- •A history of spinal surgery
- •Neuropathy involving the cervical region
- •A herniated disc and additional conditions that may cause pain
- •Having any neurological or rheumatological condition
- •Healthy group:
- •A history of spinal surgery
- •Cervical spine pathologies
- •Having any neurological or rheumatological condition
研究组 & 干预措施
temporomandibular dysfunction group
The study sample will consist of individuals with temporomandibular disorder and healthy controls from the Faculty of Health Sciences at Ankara Yıldırım Beyazıt University. Individuals who voluntarily agree to participate will be included in the study.
Healthy group
The study sample will consist of individuals with temporomandibular disorder and healthy controls from the Faculty of Health Sciences at Ankara Yıldırım Beyazıt University. Individuals who voluntarily agree to participate will be included in the study.
结局指标
主要结局
pain threshold
时间窗: Participants will be assessed in a single session upon joining the study. This session lasts an average of 10 minutes.
Pressure pain threshold (PPT) of the temporalis and masseter muscles will be assessed using a digital algometer (J-Tech Commander Algometer, Preston Co., USA), an objective measurement device. Participants will be instructed to lie comfortably in the supine position. To familiarize them with the sensation of pressure, pressure will first be applied to an area that is not included in the assessment. During the evaluation, participants will be instructed to raise one hand when the applied pressure first becomes uncomfortable or painful. The algometer will then be applied perpendicularly to the predetermined assessment points: bilaterally over the masseter muscle (1 cm superior and 2 cm anterior to the mandibular angle) and bilaterally over the temporalis muscle (2 cm superior to the zygomatic arch, between the lateral canthus of the eye and the anterior aspect of the ear). The value displayed on the algometer at the moment the participant reports pain will be recorded in kg/cm². A one-m
pain intensity
时间窗: Participants will be assessed in a single session upon joining the study. This session lasts an average of 5 minutes.
Pain associated with TMD will be assessed using the Visual Analog Scale (VAS). Participants will be asked to indicate the intensity of pain perceived in both temporomandibular joints (TMJs). The VAS, developed by Max Freyd, is one of the most widely used methods for pain assessment. It consists of a 100-mm horizontal line with two anchor points representing the extremes of the parameter being measured. Participants will be instructed to mark the point on the line that best reflects their perceived pain intensity. They will be informed that 0 cm represents "no pain" and 10 cm represents "the worst imaginable pain."
sense of joint position in the cervical region
时间窗: Participants will be assessed once they join the study. It takes an average of 20 minutes.
Joint position sense (JPS) will be assessed using an Acumar Dual Digital Inclinometer® (Acu360, Acumar, Lafayette, IN, USA). Cervical joint position sense will be evaluated during flexion, extension, right and left lateral flexion, and right and left rotation at a target angle of 30°. This target angle was selected based on the normal range of cervical motion to minimize the influence of soft tissue tension surrounding the joint on joint position sense. First, the examiner will position the participant at the target angle, where the position will be maintained for 2 seconds to allow the participant to memorize it. The participant will then be passively returned to the neutral position and instructed to actively reproduce the target angle. Each movement will be performed three times with the participant's eyes closed, and the mean value of the three trials will be used for analysis.
pain threshold
时间窗: Day 1
Pressure pain threshold (PPT) of the temporalis and masseter muscles will be assessed using a digital algometer (J-Tech Commander Algometer, Preston Co., USA), an objective measurement device. Participants will be instructed to lie comfortably in the supine position. To familiarize them with the sensation of pressure, pressure will first be applied to an area that is not included in the assessment. During the evaluation, participants will be instructed to raise one hand when the applied pressure first becomes uncomfortable or painful. The algometer will then be applied perpendicularly to the predetermined assessment points: bilaterally over the masseter muscle (1 cm superior and 2 cm anterior to the mandibular angle) and bilaterally over the temporalis muscle (2 cm superior to the zygomatic arch, between the lateral canthus of the eye and the anterior aspect of the ear). The value displayed on the algometer at the moment the participant reports pain will be recorded in kg/cm². A one-m
pain intensity
时间窗: Day 1
Pain associated with TMD will be assessed using the Visual Analog Scale (VAS). Participants will be asked to indicate the intensity of pain perceived in both temporomandibular joints (TMJs). The VAS, developed by Max Freyd, is one of the most widely used methods for pain assessment. It consists of a 100-mm horizontal line with two anchor points representing the extremes of the parameter being measured. Participants will be instructed to mark the point on the line that best reflects their perceived pain intensity. They will be informed that 0 cm represents "no pain" and 10 cm represents "the worst imaginable pain."
sense of joint position in the cervical region
时间窗: Day 1
Joint position sense (JPS) will be assessed using an Acumar Dual Digital Inclinometer® (Acu360, Acumar, Lafayette, IN, USA). Cervical joint position sense will be evaluated during flexion, extension, right and left lateral flexion, and right and left rotation at a target angle of 30°. This target angle was selected based on the normal range of cervical motion to minimize the influence of soft tissue tension surrounding the joint on joint position sense. First, the examiner will position the participant at the target angle, where the position will be maintained for 2 seconds to allow the participant to memorize it. The participant will then be passively returned to the neutral position and instructed to actively reproduce the target angle. Each movement will be performed three times with the participant's eyes closed, and the mean value of the three trials will be used for analysis.
次要结局
- craniovertebral angle(Participants will be assessed once they join the study. It takes an average of 5 minutes)
- craniovertebral angle(Day 1)