Acupuncture in the treatment of patients with craniomandibular disorders. Comparative, longitudinal and methodological studies.

The aim of the thesis was to compare the short- and long-term effects of acupuncture and occlusal splint therapy in patients with craniomandibular disorders (CMD). One hundred and ten patients, 23 males and 87 females, participated in the study. All patients exhibited moderate or severe signs and symptoms of CMD and had had pain for more than six months. The participants were randomly assigned to three groups: acupuncture, occlusal splint therapy or control. Ten different subjective and/or clinical assessment variables were used in the evaluation of the treatment effect. Immediately after treatment, acupuncture and occlusal splint therapy had reduced the symptoms as compared with the control group which remained essentially unchanged. Acupuncture gave better subjective results than occlusal splint in the short-term. In the 12-month long-term follow-up, 57% of the patients who received acupuncture and 68% of the patients who received occlusal splints benefitted subjectively and clinically from the treatment. There were no statistically significant differences between the two groups in any of the assessment variables. Those patients who received various additional therapies following acupuncture and/or occlusal splints rarely responded favorably to additional treatment. No serious adverse events or complications were observed in the study. Acupuncture seems to have adverse events of a more general nature whereas adverse events of the occlusal splint seem to be more related to the orofacial region. The majority of the patients responded positively to the comfort of both treatment modes. In order to measure tenderness (pressure pain threshold, PPT) more objectively, the usefulness of an algometer was evaluated. A good reliability and validity was found for the algometer in recording the PPT in the masticatory muscles. The reliability was further improved by connection of a stopwatch to the algometer so that the pressure rate could be kept within acceptable limits. A moderate but statistically significant correlation was found between PPT and clinical and subjective variables. The algometer was sensitive enough to detect pre- and post-treatment changes. A statistically significant reduction in tenderness was found immediately after and at the 6-month follow-up for both treatment modes. This series of studies showed that acupuncture gave positive results similar to those of occlusal splint therapy in patients with primarily myogenic CMD symptoms over a 1-year period.