title: Treating temporomandibular disorders in adolescents: a randomized, controlled, sequential comparison of relaxation training and occlusal appliance therapy.
abstract: OBJECTIVE
  To compare the effects of occlusal appliance therapy (OA) and therapist-guided relaxation training (RT) on temporomandibular disorder (TMD) pain in adolescents, thereby replicating a previous randomized controlled trial, and to explore whether additional therapy administered in a crossover sequential design improves treatment outcomes.
  
  
  METHODS
  The study involved 64 adolescents, aged 12 to 19 years, experiencing TMD pain at least once a week and diagnosed with myofascial pain in accordance with the Research Diagnostic Criteria for TMD. For phase 1 of the study, subjects were randomly assigned to OA or RT; nonresponders were offered the other treatment in phase 2. Self-reports of TMD pain and clinical assessments were performed before and after treatment in each phase and 6 months after the last treatment phase. Differences in outcomes between treatment groups across the different phases were analyzed by analysis of covariance (ANCOVA), and for differences in proportions, the chi-square test was used.
  
  
  RESULTS
  After phase 1, a significantly higher proportion of adolescents treated with OA (62.1%) than those treated with RT (17.9%) responded to treatment, defined as a subjective report of "Completely well/Very much improved" or "Much improved." Similar differences in self- report of treatment effect occurred after phase 2. About two-thirds of all adolescents in both phases reported such an improvement level at the 6-month follow-up, including a somewhat higher proportion of phase 1 responders (79.2%) than phase 1 nonresponders (60%).
  
  
  CONCLUSIONS
  The findings suggest that, for adolescents with TMD pain, use of standardized clinical treatment with OA is more effective than RT on self-evaluation of treatment improvement. For nonresponders, subsequent crossover treatment might be useful to improve subjective TMD pain.
authors: Kerstin
authors: K
authors: Wahlund
authors: Ing-Marie
authors: IM
authors: Nilsson
authors: Bo
authors: B
authors: Larsson
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D001294:Attitude to Health; D001945:Breathing Exercises; D002648:Child; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008499:Medical Records; D009042:Motivation; D009119:Muscle Contraction / Q000502:physiology; D017090:Occlusal Splints; D010147:Pain Measurement; D010349:Patient Compliance; D017060:Patient Satisfaction; D016059:Range of Motion, Articular / Q000502:physiology; D012063:Relaxation; D012064:Relaxation Therapy / Q000379:methods*; D057566:Self Report; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics