Oral acupuncture in the therapy of craniomandibular dysfunction syndrome -- a randomized controlled trial.
CONTEXT: Patients with disorders of the stomatognathic system describe pain and clicking phenomena as primary symptoms. Rapid improvement of the pain is required to ensure and maintain adequate patient compliance. OBJECTIVE: The study was intended to assess the effects of acupuncture in patients with temporomandibular disorders as compared to placebo therapy (sham laser); the primary target parameter was the subjective pain sensation. DESIGN: Randomized, placebo-controlled trial. PATIENTS AND METHODS: 23 patients were enrolled and randomly assigned to one of the two groups. One group received acupuncture treatment according to the very-point technique, the other group received sham laser treatment. The following observer-blinded findings were evaluated before and after treatment: subjective pain, mouth opening, and muscular tenderness and pain on pressure. In addition, mandibular joint movement pathways were recorded using electronic axiography. OUTCOMES: Improvements in pain scores (scale, 0-100) in the acupuncture group (19.1 +/- 11.9) were significant (p = 0.03) versus those in the placebo group (6.2 +/- 14.8). Mouth opening showed an insignificant trend towards improvement (p > 0.1) in the acupuncture (5.0 +/- 6.2 mm) versus the placebo group (1.0 +/- 4.7 mm), differences in tenderness and pain on pressure in neck and masticatory muscles were significant (p < 0,05) for most of the muscles having shown pretreatment tenderness or pain. The axiographic tracings were assessed for quality, symmetry and curve characteristics. Recordings of the opening and closing movement in the acupuncture group showed an increased frequency of improvements of curve characteristics as compared to the placebo group. The acupuncture group also showed an increased frequency of improvement in protrusion and retrusion movements, though no statistical significance could be obtained. CONCLUSION: On the basis of the results of the present study, acupuncture may be recommended as acute treatment of craniomandibular disorders, but studies with larger numbers of patients as well as about long-term treatment outcomes should be conducted.