title: Effects of massage therapy and occlusal splint therapy on electromyographic activity and the intensity of signs and symptoms in individuals with temporomandibular disorder and sleep bruxism: a randomized clinical trial.
abstract: BACKGROUND
  Temporomandibular disorder (TDM) is the most common source of orofacial pain of a non-dental origin. Sleep bruxism is characterized by clenching and/or grinding the teeth during sleep and is involved in the perpetuation of TMD. The aim of the present study was to investigate the effects of massage therapy, conventional occlusal splint therapy and silicone occlusal splint therapy on electromyographic activity in the masseter and anterior temporal muscles and the intensity of signs and symptoms in individuals with severe TMD and sleep bruxism.
  
  
  METHODS
  Sixty individuals with severe TMD and sleep bruxism were randomly distributed into four treatment groups: 1) massage group, 2) conventional occlusal splint group, 3) massage + conventional occlusal splint group and 4) silicone occlusal splint group. Block randomization was employed and sealed opaque envelopes were used to conceal the allocation. Groups 2, 3 and 4 wore an occlusal splint for four weeks. Groups 1 and 3 received three weekly massage sessions for four weeks. All groups were evaluated before and after treatment through electromyographic analysis of the masseter and anterior temporal muscles and the Fonseca Patient History Index. The Wilcoxon test was used to compare the effects of the different treatments and repeated-measures ANOVA was used to determine the intensity of TMD.
  
  
  RESULTS
  The inter-group analysis of variance revealed no statistically significant differences in median frequency among the groups prior to treatment. In the intra-group analysis, no statistically significant differences were found between pre-treatment and post-treatment evaluations in any of the groups. Group 3 demonstrated a greater improvement in the intensity of TMD in comparison to the other groups.
  
  
  CONCLUSIONS
  Massage therapy and the use of an occlusal splint had no significant influence on electromyographic activity of the masseter or anterior temporal muscles. However, the combination of therapies led to a reduction in the intensity of signs and symptoms among individuals with severe TMD and sleep bruxism.
  
  
  BACKGROUND
  This study is registered in August, 2014 in the ClinicalTrials.gov (NCT01874041).
authors.affiliation: Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil ; Department of Physical Therapy, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil.
authors.forename: Cid André Fidelis de Paula
authors.initials: CA
authors.lastname: Gomes
authors.affiliation: Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil ; Department of Physical Therapy, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: El Hage
authors.affiliation: Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Amaral
authors.affiliation: Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil ; Department of Physical Therapy, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil.
authors.forename: Fabiano
authors.initials: F
authors.lastname: Politti
authors.affiliation: Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil ; Department of Physical Therapy, Universidade Nove de Julho (UNINOVE), Av. Dr. Adolfo Pinto,109, Água Branca, 05001-100 São Paulo, SP Brazil.
authors.forename: Daniela Aparecida
authors.initials: DA
authors.lastname: Biasotto-Gonzalez
keywords: Massage therapy; Occlusal splint; Physical therapy modalities; Temporomandibular joint disorders