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

J Prosthodont Res. 2017 Jul;61(3):259-267. doi: 10.1016/j.jpor.2016.12.001. Epub 2017 Jan 4.


Purpose: 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.

Keywords: Compliance; Jaw-opening exercise; Obstructive sleep apnea; Oral appliance; Temporomandibular disorders.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Double-Blind Method
  • Exercise / physiology*
  • Female
  • Humans
  • Jaw / physiology*
  • Male
  • Masticatory Muscles*
  • Middle Aged
  • Occlusal Splints*
  • Pain / prevention & control*
  • Placebo Effect
  • Sleep Apnea, Obstructive / therapy*
  • Temporomandibular Joint Disorders / prevention & control*
  • Temporomandibular Joint*
  • Treatment Outcome
  • Young Adult