Clinical Research Directory

Spinal Mobility, Rigidity, and Kinesiophobia in PD and TMD

Axial rigidity and loss of spinal mobility commonly observed in Parkinson's disease (PD) lead to postural deformities and substantial reductions in trunk flexibility. This condition can impair the biomechanics of the craniocervical and lumbopelvic kinetic chain, potentially exerting a negative impact on temporomandibular joint (TMJ) functions. In this context, the planned study aims to determine whether differences exist in spinal mobility, axial rigidity, and kinesiophobia levels between individuals with PD with and without Temporomandibular Disorders (TMD), and to investigate whether a biomechanical relationship exists between TMD and spinal mobility, axial rigidity, and kinesiophobia levels in this population. The study will be conducted face-to-face at the Neurology Outpatient Clinic of Hatay Mustafa Kemal University Research and Training Hospital. Individuals aged 40-75 years, diagnosed with PD, staged between 1.5 and 4 according to the Hoehn and Yahr Scale, with a Mini-Mental State Examination score of 24 or higher (MMSE ≥ 24), and in the "ON" state during the evaluation will be included. Individuals with a history of cervical, lumbar, maxillofacial, or TMJ surgery that could directly affect spinal mobility and posture; acute orthopedic or rheumatologic disorders that would preclude testing (e.g., advanced Ankylosing Spondylitis); comorbid neurological conditions (e.g., stroke, multiple sclerosis); complete edentulism or severe disruption of oral anatomy; active toothache; pregnancy or suspected pregnancy; and severe psychiatric disorders will be excluded. Written informed consent will be obtained from all participants, and the study will be conducted on a voluntary basis. All data will remain confidential and be utilized solely for scientific purposes. In this cross-sectional study, evaluations will be carried out in a single session for each participant. Following the recording of demographic and clinical characteristics, the presence of TMD will be assessed using the Fonseca Anamnestic Index, jaw range of motion with a millimeter ruler, and spinal mobility using the modified-modified Schober test, tragus-to-wall distance, intermalleolar distance, and occiput-to-wall distance measurements. Axial rigidity will be evaluated using item 3.3 (Rigidity) of the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), posture will be assessed using MDS-UPDRS item 3.13 (Posture) alongside craniovertebral angle measurement, and kinesiophobia will be assessed via the Tampa Scale for Kinesiophobia. The resulting findings are expected to contribute to understanding the impact of spinal mobility, axial rigidity, and kinesiophobia on the temporomandibular system in PD, offering valuable clinical guidance for assessment, physiotherapy, and multidisciplinary neurological rehabilitation pathways.

Effects of Orofascial Myofunctional Therapy and Cervical Stabilization Exercises on Temporomandibular Dysfunction

Temporomandibular disorders (TMDs) are among the most common musculoskeletal conditions affecting the craniofacial region and are characterized by pain, joint sounds, restricted movement, and functional limitations. Anterior disc displacement is one of the most frequently observed temporomandibular joint (TMJ) disorders and is classified as anterior disc displacement with reduction (ADDwR) or without reduction (ADDwoR). In ADDwR, the articular disc becomes displaced during mandibular movement but returns to its normal position during opening, commonly producing a clicking sound. Although disc displacement can occur in asymptomatic individuals, repeated episodes may interfere with normal joint mechanics, alter mandibular movement, and contribute to maladaptive muscular activity. In some patients, ADDwR may progress to disc displacement without reduction, resulting in limited mouth opening, restricted lateral movement, minimal condylar translation, and deviation of the mandible toward the affected side. TMDs have a multifactorial etiology involving trauma, parafunctional activities such as clenching and bruxism, emotional stress, anxiety, depression, sleep disturbances, abnormal muscle recruitment, occlusal characteristics, and disc or bony morphology. Epidemiological evidence indicates that TMDs are particularly common among adults aged 18-60 years, with a consistent female predominance. Individuals exposed to repetitive masticatory activities and high-stress occupations may also be at increased risk. Normal orofacial function depends on coordinated activation of the jaw, tongue, lips, cheeks, palate, pharyngeal, and laryngeal muscles. Orofacial Myofunctional Therapy (OMT) consists of individualized oral and peri-oral exercises designed to retrain muscle function and improve the coordination of the stomatognathic system. OMT may promote appropriate tongue posture, nasal breathing, lip seal, swallowing, mastication, and jaw-muscle coordination. Although OMT has demonstrated benefits in several orofacial conditions, its specific role in TMD, particularly ADDwR, remains insufficiently explored. The TMJ also has a close anatomical and neurophysiological relationship with the cervical spine. Cervical muscles contribute to head stabilization during chewing, swallowing, speaking, and breathing, while convergence between trigeminal and cervical sensory pathways can facilitate pain referral between the neck and craniofacial region. Consequently, cervical postural abnormalities, instability, and impaired neuromuscular control may contribute to mandibular dysfunction and TMJ-related pain. Cervical stabilization exercises (CSE) may therefore complement OMT by improving deep cervical muscle activation, reducing excessive superficial muscle activity, and enhancing overall neuromuscular control. Current research suggests that OMT may improve pain, oral function, muscle activity, and other functional outcomes; however, the evidence remains inconclusive because many studies involve heterogeneous TMD populations, small samples, methodological limitations, combined interventions, and potential placebo effects. Most previous research has also failed to focus specifically on joint-level characteristics such as disc position, reduction mechanics, and condylar-disc coordination. Therefore, a diagnostically precise investigation of patients with ADDwR is warranted. Examining OMT combined with cervical stabilization may provide a more comprehensive rehabilitation approach by addressing both local orofacial dysfunction and associated cervical impairments. Such an integrated intervention could improve mandibular function, muscle coordination, pain, and overall TMJ-related disability. Further high-quality research is therefore needed to establish the effectiveness of combined OMT and cervical stabilization specifically in patients with ADDwR and to guide evidence-based, outcome-oriented management of this common condition.

Effects of Vagus Nerve Stimulation on Temporomandibular Disorders.

The study aims to examine the effects of transcutaneous non-invasive vagus nerve stimulation (nVNS) on symptoms and brain mechanisms in premenopausal women with temporomandibular disorders (TMD). Non-invasive vagus nerve stimulation (nVNS) is the most well researched and possibly the most effective non-invasive neuromodulation treatment for chronic pain conditions that targets the brain-gut-microbiome (BGM) axis. Participants will be asked to come in for 2 in-clinic visits, at baseline and post treatment. Participants will also be asked to come in 2x/week for 8 consecutive weeks to receive the nVNS treatment. The in-clinic visits will include physical measures, blood draw, saliva sample, and brain MRI. Participants will be asked to collect a stool sample at home and answer online questionnaires regarding, mood, pain, and health behaviors at home, prior to the in-clinic appointments.

Peloid Therapy in Temporomandibular Joint Dysfunction

This prospective, single-group clinical study will evaluate whether local peloid therapy improves pain and jaw function in adults with temporomandibular joint dysfunction. Participants will receive peloid therapy applied to the temporomandibular joint region and masticatory muscles for 20 minutes per session, 5 days per week, for 2 weeks. Pain and functional outcomes will be measured at baseline and at the end of treatment using validated clinical scales, including the Jaw Functional Limitation Scale-8, visual analog scale pain scores, Fonseca index, maximum mouth opening, and secondary otalgia assessment.

Investigation of the Effects of Different Treatment Approaches in Jaw (Temporomandibular) Joint Disorders

Temporomandibular joint disorders (TMD) are common conditions that may cause jaw pain, limited jaw movement, and reduced quality of life. Individuals with TMD can also experience neck-related problems, balance impairments, emotional changes, and sleep disturbances. This interventional study aims to investigate the effects of a combined physiotherapy and rehabilitation program in individuals with temporomandibular joint dysfunction. The intervention consists of conventional manual therapy techniques applied to the temporomandibular joint and cervical region, combined with specific manual therapy techniques targeting the limbic system, along with therapeutic exercise applications. The study will evaluate the effects of this combined treatment approach on pain, jaw range of motion, joint position sense, balance, emotional status, patient satisfaction, and quality of life and sleep in individuals with TMD.

Effects of Cervical Manual Therapy for Temporomandibular Disorders With Myalgia

Background: Temporomandibular disorders (TMDs) are the leading cause of non-odontogenic orofacial pain interfering with daily activities. TMDs consist of a group of conditions affecting the masticatory muscles, the temporomandibular joint (TMJ), or the associated structures. Previous studies showed alterations in TMJ kinematics, cortical excitability, electromyographic (EMG) activity of the masticatory muscles, and tongue pressure in individuals with TMDs compared to healthy controls. Furthermore, several studies have demonstrated that manual therapy applied to the cervical joint could reduce pain and improve jaw function in individuals with TMDs. However, the effects of upper cervical mobilization on TMJ kinematics, cortical excitability, tongue pressure, and EMG of masticatory muscles during mouth opening in individuals with myogenous TMDs remain unknown. Purpose: This study aims to investigate the immediate effects of upper cervical mobilization on TMJ kinematics, EMG of masticatory system muscles, cortical excitability, and tongue pressure in individuals with myogenous TMDs. Methods: A randomized controlled trial will be conducted with a total sample size of 48 participants. Individuals diagnosed with myogenous TMDs, defined as chronic myalgia (lasting \>3 months continuously or \> 6 months intermittently) according to the Diagnostic Criteria for Temporomandibular Disorders, will be recruited for this study. Participants will be randomly assigned to either the experimental or the control group, stratified by age and sex. The experimental group will receive a single session of upper cervical mobilization, while the control group will receive a placebo maneuver. The primary outcomes will include TMJ kinematics and EMG activity of the masseter and suprahyoid muscles, while the secondary outcomes will include cortical excitability, tongue pressure, pain intensity, and upper cervical mobility. All measurements will be taken before and immediately after the intervention. Statistical analysis: The continuous and categorical variables of clinical and demographic characteristics will be analyzed by an independent t test/Mann-Whitney U test and a Chi-square test, respectively. A 2×2 mixed-model analysis of variance (ANOVA) will be used to analyze the outcome measures and to test the main effects and interactions between time and group. If there is a significant interaction effect, post hoc pairwise comparisons with Bonferroni correction will be used. The alpha level is set at 0.05.

Hard Splint Vs Conservative Therapy for TMJ Pain Management

The purpose of this study is to compare the efficacy of a hard occlusal splint versus conservative therapy (using topical Ibuprofen gel and counseling) in the management of patients with temporomandibular (TMJ) joint disorders. The study aims to determine which treatment is more effective at reducing pain, measured by Visual Analogue Scale (VAS), at 1 week and 4 weeks post therapy.

Diagnostic Study Accuracy of Jaw Motion Analyzer(JMA) Versus Research Diagnostic Criteria(RDC/TMD) and Magnetic Resonance Imaging(MRI) for Temporomandibular Disorders Among Patients With Chronic Orofacial Pain.

The goal of this diagnostic accuracy study is to determine the diagnostic accuracy of jaw motion analyzer(JMA) in terms of sensitivity and specificity with target cut of points used by valid reference standards which will be the research diagnostic criteria(RDC/TMD) and magnetic resonance imaging(MRI) for Temporomandibular disorders(TMDs). The main questions the study aim to answer are : * Does the actual precision of JMA which will achieve the target cut off diagnostic values in diagnosing TMDs ? * How much accuracy values to be achieved by JMA compared to RDC/TMD and MRI as reference standards ? Researchers will determine the precision values of JMA for patients with chronic orofacial pain for targeting TMDs and compare with valid diagnostic reference standards which are the RDC/TMD and MRI. Participants with chronic orofacial pain will undergo through two diagnostic interventions in two separate visits with one week interval; first visit will be intraoral scan(IOS) for both upper and lower dental arches with bite registration followed with IOS import in JMA (WINJAW+3.0, Zebris GmbH Germany) to measure the trajectory of mandibular movements and condylar path tracking and accordingly both functional and EPA reports will be extracted to obtain both graph tracing records of both mandibular and condylar path trajectories. On the second visit, participants will be examined by the RDC/TMD clinical examination based algorithms to diagnose TMDs and MRI will be used as confirmative approach.

Comparing the Effectiveness of Online vs. Face-to-face Physiotherapy for Treating Temporomandibular Disorders

Dentists and physiotherapists have two options for treating these conditions: splint therapy and physiotherapy. Right now, the gold standard is individual physiotherapy, which contains manual therapy and active exercises too. Since not many dentists and physiotherapists are experts in this area, patients have to wait for months or even years to get their treatment. Thanks to social media, patients can find many information about their condition while they are waiting, but it's our responsibility to provide safe and effective information. In view of this situation, our aim is to find out if online or group physiotherapy is as effective as individual physiotherapy.

ePROPP - eHealth for Preventing and Reducing Orofacial Pain in the Population

Pain in the orofacial region has a 10% prevalence in the general population and health care providers are therefore expected to encounter these patients on a daily basis. Chronic orofacial pain often presents as jaw pain related to overload of the jaw muscles and temporomandibular joints. The aim of this study is to evaluate the effectiveness of a smartphone-based behavioural intervention (Ecological Momentary Intervention, EMI) grounded in Cognitive Behavioural Therapy (CBT), compared to standard treatment with an occlusal splint and a waiting list control group.

Quality of Life and Sleep in Patients With Temporomandibular Disorders

The aim of this study is to evaluate and compare the effects of two physiotherapeutic intervention programs on the quality of life in patients with Temporomandibular Disorders (TMD). Study design: Randomized, longitudinal, and prospective clinical trial with two intervention groups. Population: Subjects aged 18-65 years with subacute temporomandibular disorders.