Physical Agents in Temperomandibular Disorders

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Dr. Deepak Anap Off. Asso. Prof. COPT,PIMS Physical Agents in Temperomandibular Disorders

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Micro-currents Electrical Nerve Stimulation (MENS) Study Cheng et al (1982) : At 500 microampere, ATP generation increased about 500% and amino acid transport was increased by 30 to 40 % above control levels using 100 to 500 microampere. Higher milliampere currents inhibit healing whereas the lower microampere currents promote healing. Effective modality for treating myofascial and Temperomandibular disorders – Dupont P ain decrease could by opioid mechanisms MENS placebo - Paulo Renato Junqueira

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Shockwave Therapy Ingrowth of  Neovascularization Reversal of Chronic Inflammation: releasing of pro-inflammatory compounds -chemokines and cytokines Dispersion of Pain Mediator “Substance P”

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LASER Use of mid-laser treatment (904 nm, 27 W, applied for 9 minutes, 3 treatments per week for 3 weeks) & LLLT treatment (HeNe, continuous wave, 632.8 nm, 30 mW) may be beneficial for reducing pain severity in TMJ Possible mechanism: changes on the cellular level with increased ATP production by the mitochondria, increased serotonin and endorphins improved local blood circulation.

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Therapeutic Ultrasound Relieves soreness and improves mobility. Reduce muscle spasms Increased tissue extensibility Significant pain relief.

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Phonophoresis Phonophoresis of Diclofenac sodium Hydrocortisone, Glucosaminoglycan in the treatment of temporomandibular joint

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Heat and Cold Help to reduce tension in the muscles and spasms Ice packs or cold compress on the affected area helps reduce swelling and relieve the pain.

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TENS Stimulate large, fast, myelinated, non-nociceptive neurons in the painful area, “closing the central gate” Activation of an endogenous opioid system

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Interferential Currents Decrease recurrent jaw pain and to increase maximum vertical jaw opening Relieve pain by three methods: 1) blocking pain in the neural pathway ; 2) Suppressing sympathetic nervous system activity, thereby producing vasodilatation of blood vessels and allowing for the removal of noxious substances that irritate nociceptive nerve endings, 3) inducing a placebo effect.

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Iontophoresis Alternative to local anesthetic injections for the treatment of TMJ dysfunction Less discomfort than IM injection and fewer side effects than systemic medications L idocaine hydrochloride (+ Ion) and dexamethasone sodium phosphate (-ve ion) (Lark & Gangarosa).

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Thank you