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Running head: THE USE OF ACUPUNTURE IN THE MANAGEMENT OF TEMPOROMANDIBULAR JOINT PAIN 1

The Use of Acupuncture in the Management of Temporomandibular Joint Pain

The Use of Acupuncture in the Management of Temporomandibular Joint Pain

Introduction

Temporomandibular disorder (TMD) is a common condition in dentistry. This multifactorial disorder presents various symptoms that impact the patient’s health and well-being. In addition, due to its multifactorial nature and undefined etiology, the condition is challenging to treat and manage. Western medicine uses different therapeutic approaches such as pharmacological management using NSAIDS and Tricyclic antidepressants to manage the symptoms (Gauer & Semidey, 2015). Other management strategies include biofeedback, physical therapy, and acupuncture (Gauer & Semidey, 2015; Wu et al., 2017). Traditional Chinese medicine uses acupuncture to manage acute and chronic pain. This technique has been adopted to relieve pain and other symptoms of various disorders (Zhu et al., 2019). Some studies have shown that acupuncture is effective as short-term analgesia for patients with painful TMD symptoms. However, there is still inconclusive evidence to support the effectiveness of acupuncture in managing temporomandibular joint (TMJ) pain. This research paper aims to evaluate the mechanism of action of acupuncture in managing temporomandibular joint (TMJ) pain. In addition, the paper will assess the effectiveness of acupuncture in treating patients with TMD.

Background

Temporomandibular disorder refers to non-specific diagnoses characterized by pain and dysfunction of the temporomandibular joint (TMJ) and the muscles of mastication. Epidemiological studies show that approximately 10% of the global population suffers from this condition. The condition peaks at around 20 to 40 years old but is more prevalent in women above 30 years old (Wu et al., 2017; Gauer & Semidey, 2015). Temporomandibular joint is classified as extra-articular and intra-articular, or soft-tissue and hard joint tissue disorders (Gauer & Semidey, 2015; Zhu et al., 2019). Although the etiology of TMD is hard to identify, some studies posit that it is multifactorial, meaning that it involves different factors. These include myofascial pain syndrome (the leading cause), psychological stress, occlusal abnormalities, poor nutrition and oral health, joint laxity, and orthodontic treatment (Gauer & Semidey, 2015). Patients with TMD present with TMJ clicking, acute or chronic myofascial pain, tenderness and pain of the mastication muscles, and abnormal jaw movements (Zhu et al., 2019). Other symptoms include pain when chewing, tinnitus, headache, neck pain, and impairments in hearing and balance. The TMJ clicking signifies a problem with the joint, which rarely happens (Zhu et al., 2019). All symptoms that last for more than a week should be evaluated by a dentist, who identifies the cause and recommends the appropriate management.

There is no agreement on the appropriate management for TMJ pain since TMD has a multifactorial nature. Most common treatment strategies include pharmacotherapy, physical therapy, psychological and cognitive-behavioral therapies, surgical procedures, occlusal therapy, biofeedback, and acupuncture (Wu et al., 2017; Gauer & Semidey, 2015). The management of TMJ pain targets muscle relaxation, joint massage, resting, and removal of causes of increased joint burden (Zhu et al., 2019). Acupuncture has been used in traditional Chinese medicine to achieve muscle relaxation, treat TMJ lesions, and relieve TMJ pain. Acupuncture involves inserting acupuncture needles on acupuncture points at appropriate depths to stimulate blood flow and energies around the meridians (Zhu et al., 2019). The sessions last from 15 to 30 minutes, and the average required number is six to eight (Gauer & Semidey, 2015). However, the response to therapy depends on the history and presentation of the disease. For instance, acute pain requires a shorter duration to manage, unlike chronic cases (Zhu et al., 2019). Traditional Chinese medicine posits that toothaches occur when the essential energy in the meridians of the stomach and intestines remain inactive. This stagnation inhibits the energy from flowing directly to the lower and upper plates. Acupuncture pins are pushed around the ear and jaw or other painful areas. The pins can also be inserted near the elbows, big toe, and knees since they share common paths between the meridians. Balancing the energy in the meridians helps relieve stress and other factors that may cause TMJ discomfort (Zhu et al., 2019).

Discussion

This research is a systemic review of four articles discussing the use of acupuncture in the management of TMJ pain. In a meta-analysis conducted by Wu and colleagues (2017), the researchers found that acupuncture was a definitive therapy for managing TMJ pain and TMD symptoms. In addition, penetrating sham acupuncture used in the technique have more analgesic effects than non-penetrating shams. Hence, one vital strategy to increase the effectiveness of acupuncture is to ensure the needles penetrate the skin. Additionally, the authors found out that the therapist’s techniques influence the effectiveness of Acupuncture. These techniques include the depth and location of the needles. According to Chidembaranathan (2021), Acupuncture works by stimulating the nerve endings to release serotonin, acetylcholine, and endorphins associated with the central nervous system. This technique also relieves TMJ pain by acting as a noxious stimulus. Regardless of the mechanism of action, Acupuncture is effective since it uses the body’s mechanism to produce analgesic effects. Inserting the acupuncture needles deep into the acupoints initiates the release of the neurotransmitters named above. The neurotransmitters then flood the afferent interneurons and block the noxious stimulus.

According to Zhu et al. (2019), acupuncture functions by removing external pathogens from wind and cold. Due to the body’s blood and Qi weakness, wind and cold invade the human system and cause backlog and blockage on the face. As a result, blood circulation is impeded, and poor Qi is produced in the face, hindering nourishment for joints and muscles. These factors result in pain, joint clicking, and unfavorable joint opening. Stimulating different acupoints alleviates the obstructions of the collaterals and meridians. This stimulation also balances the yin and Yang of the patient’s spiritual, physical, and emotional factors. As a result, these activities facilitate energy flow and dispel the free flow of Qi, which eliminates pain.

According to Liu et al. (2021), warm needle acupuncture, which combines moxibustion (a traditional Chinese therapeutic treatment that involves burning of moxa, a herb, that is thought to facilitate healing process) and acupuncture, promotes blood circulation, improves joint relaxation, relieves muscle spasms, eliminates other TMD symptoms, and improves the functional activities of joint capsules, condyles, and ligaments. Additionally, the warm needles achieve the analgesic effects of Acupuncture by inhibiting sensory nerves and reducing their excitability. Lastly, acupuncture helps relieve TMJ pain by inhibiting pain sensitization and regulating inflammatory factors. acupuncture has anti-inflammatory and analgesic effects (Liu et al., 2021; Zhung et al., 2019). It helps increase the body’s threshold for pain, release toxins, and improves immunity.

Conclusion

Temporomandibular disorder (TMD) is a common condition prevalent in women above 30 years old. The disorder presents with different symptoms and signs, including TMJ pain and clicking. Clinicians have identified various methods to manage the condition. Traditional Chinese medicine uses acupuncture to achieve pain relief for many diseases. The research paper analyzed different studies on the effectiveness of acupuncture as an analgesic for TMJ pain. Acupuncture helps achieve good oral hygiene by increasing blood circulation and eliciting quick and effective pain relief for TMJ pain. It also reduces pain sensitization and inflammation.

References

Chidembaranathan, S. (2021). Management of temporomandibular joint disorders using Acupuncture: A case report. Scientific Dental Journal, 5(2), 97. https://doi.org/10.4103/sdj.sdj_70_21

Gauer, R., & Semidey, M. J. (2015). Diagnosis and treatment of temporomandibular disorders. American Family Physician, 91(6), 378–386. https://www.aafp.org/afp/2015/0315/p378.html

Liu, G.-F., Gao, Z., Liu, Z.-N., Yang, M., Zhang, S., & Tan, T.-P. (2021). Effects of warm needle acupuncture on temporomandibular joint disorders: A systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2021, 1–10. https://doi.org/10.1155/2021/6868625

Wu, J.-Y., Zhang, C., Xu, Y.-P., Yu, Y.-Y., Peng, L., Leng, W.-D., Niu, Y.-M., & Deng, M.-H. (2017). Acupuncture therapy in the management of the clinical outcomes for temporomandibular disorders. Medicine, 96(9). https://doi.org/10.1097/MD.0000000000006064

Zhu, J., Arsovska, B., & Kozosvka, K. (2019). Acupuncture treatment in temporomandibular joint pain after tooth. http://eprints.ugd.edu.mk/22275/1/Acupuncture%20treatment%20in%20temporomandibular%20joint%20pain%20after%20tooth%20extraction.pdf