title: Effect of jaw-opening exercise on prevention of temporomandibular disorders pain associated with oral appliance therapy in obstructive sleep apnea patients: A randomized, double-blind, placebo-controlled trial.
abstract: OBJECTIVE
  There are no studies on the prevention of temporomandibular joint and/or masticatory muscle pain (TMD pain) associated with oral appliance (OA) therapy in patients with obstructive sleep apnea (OSA). The aim of this study was to determine the effect of jaw-opening exercise on TMD pain associated with OA therapy in OSA patients.
  
  
  METHODS
  Twenty-five OSA patients without pain-related TMD were consecutively enrolled into a two-arm, randomized, double-blind, placebo-controlled trial. One group performed jaw-opening exercise (JE, n=13), and the other group performed placebo exercise (PE, n=12) for 1-month, and had started 2-weeks prior to insertion of an adjustable OA. TMD sign using the Research Diagnostic Criteria for Temporomandibular Disorders and TMD pain intensity using a visual analog scale (VAS) in the morning and daytime were evaluated at baseline (pre-exercise) and at 2-weeks, 1-month, and 3-months after OA insertion.
  
  
  RESULTS
  Pain-related TMD was not observed in the JE-group at all evaluation periods, although one subject in the PE-group was diagnosed with arthralgia at the 1-month evaluation. The JE-group showed lower morning and daytime VAS scores than the those of the PE-group at all evaluation periods, and significant group differences were found in terms of chewing pain and jaw-opening pain in the morning at the 1-month evaluation, and of jaw-opening pain during daytime at the 3-month evaluation (P<0.05).
  
  
  CONCLUSIONS
  Within the limitations of the study, jaw-opening exercise prior to OA therapy reduced the risk of TMD pain associated with OA use. Therefore, jaw-opening exercise may contribute to the prevention of TMD pain.
authors.affiliation: Orofacial Pain Management, Department of Oral Health Sciences Graduate School, Tokyo Medical and Dental University, Tokyo, Japan; Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ishiyama
authors.affiliation: Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo, Japan; Removable Partial Prosthodontics, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: shu.inukai.rpro@tmd.ac.jp.
authors.forename: Shusuke
authors.initials: S
authors.lastname: Inukai
authors.affiliation: Orofacial Pain Management, Department of Oral Health Sciences Graduate School, Tokyo Medical and Dental University, Tokyo, Japan; Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Nishiyama
authors.affiliation: Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hideshima
authors.affiliation: Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Sleep Modulatory Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Meiyo
authors.initials: M
authors.lastname: Tamaoka
authors.affiliation: Health Administration Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: Removable Partial Prosthodontics, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Fueki
authors.affiliation: Removable Partial Prosthodontics, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Wakabayashi
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007568:Jaw / Q000502:physiology*; D008297:Male; D008410:Masticatory Muscles; D008875:Middle Aged; D017090:Occlusal Splints; D010146:Pain / Q000517:prevention & control*; D015990:Placebo Effect; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D013704:Temporomandibular Joint; D013705:Temporomandibular Joint Disorders / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Compliance; Jaw-opening exercise; Obstructive sleep apnea; Oral appliance; Temporomandibular disorders