The joint is complex, with gliding and hinge movements. It is made up structurally of the glenoid fossa, articular eminence of the temporal bones, and mandibular condyle. The articular surfaces of the TMJ are coated with fibrocartilage, in contrast to typical synovial joints [1,2]. The term "temporomandibular joint dysfunction" describes a range of conditions marked by mouth and facial discomfort, abnormalities in the lower jaw's mobility, and other associated symptoms. Different names for these disorders have been given them over time, reflecting differing opinions on what causes them. Research has shown that there is a significant range in the occurrence of temporomandibular joint (TMJ) problems, with rates believed to be anywhere between 17% and 70%. Headaches are a common symptom and are more common in women than in men. A clinical examination, a subjective assessment, and the patient's stated symptoms are used to make the diagnosis[3-5].  It may also be necessary to employ extra instruments like electromyography and imaging methods like CT and MRI scans. Conservative therapy is the primary approach for treating TMJ problems. It does this by addressing the underlying causes and symptoms without the need for invasive surgeries. In the early phases of dysfunction, bite plane therapy and the use of splints are commonly used to elicit muscular relaxation, collect diagnostic data, and protect teeth. However, complicated conditions could call for more invasive measures[5-7].

In selecting and modifying occlusal appliances, physicians must have a thorough understanding of the constantly evolving masticatory system. In addition, it is critical to consider the medical history of the patient because TMJ abnormalities may be associated with systemic illnesses. The purpose of the study was to determine how splints affected patients with TMJ dysfunction syndrome in terms of their ability to chew, namely their masseter and temporalis muscles [7,8].

The investigation was conducted at Department of Dentistry, Government Medical College and Hospital, Siddipet between March 2024 to February 2025. The protocol for this investigation was approved by the institutional review board (IRB). Twenty patients, aged 18 to 60, with an untreated diagnosis of TMJ dysfunction made up the study sample. The following are the inclusion and exclusion criteria:

Inclusion criteria

• Individuals diagnosed with stage I and II of Wilke's classification of internal derangement
• TMJ region pain and tenderness
• Masticatory muscle pain and discomfort
• Occasional TMJ locking
• Audible joint sounds
• Patients aged 18-60 years

Exclusion criteria

• Patients classified as stage III, IV, or V according to Wilke's classification of internal derangement.
• Patients experiencing cognitive impairment.
• Patients with missing teeth resulting in loss of posterior occlusion.
• Patients with other systemic illnesses including osteoporosis, rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, and a previous history of trauma.
• Individuals who have received orthognathic surgery, a surgical procedure for the correction of jaw abnormalities.
• Individuals who are taking medications such as anti-psychotics and anti-depressants.

Table 1: Study subjects categorised based on age and gender.

Table 2:  Subject distribution categorised by Angle's malocclusion.

Table 3: Study subjects categorised based on Wilke's staging of internal derangement and the type of splint utilised for distribution purposes.

Table 4: Study subjects categorised based on the Fonseca's anamnestic index.

This medical condition can manifest with a range of symptoms, such as oral pain, facial pain, restricted mouth opening, audible popping or clicking in the jaw joint with or without pain, deviation of the jaw to one side during opening, and discomfort or sensitivity in the jaw joint, facial muscles, and associated structures. TMJ disorders have a multifactorial aetiology that encompasses various components. The aetiology of temporomandibular dysfunction (TMD) encompasses various variables including as trauma, recurring infections, and predisposing factors such as parafunctional behaviours, stress, anxiety, depression, inappropriate occlusion, and poor oral hygiene. Temporomandibular disorders (TMDs) have significant physiological and psychological repercussions that greatly diminish an individual's quality of life. In their comprehensive analysis of 320 studies, Bitiniene et al. (2018) identified a robust association between abnormalities of the temporomandibular joint (TMJ) and the overall quality of life. The statistical research revealed that temporomandibular disorders (TMD) have a direct impact on psychological and social well-being, resulting in a decreased quality of life. Out of the 20 participants in this study, 33.3% were male and 66.7% were female. The findings, which demonstrate a greater influence on women compared to males, align with a previous study conducted by Bora Bagis et al. in 2012. In that study, out of the total of 243 participants, 171 were female, making up around 70.6% of the whole study group. A study conducted by Manfredini et al. in 2017 included 433 patients, with females comprising around 73.2% of the sample group. This outcome aligns with the previously made observations [8,9]. Sex hormones, particularly oestrogen, have a substantial impact on the development of temporomandibular dysfunction (TMD) and pain sensitivity, specifically in the chewing muscles. The threshold and tolerance for pain can vary depending on the stage of the menstrual cycle. Oestrogen is a recognised risk factor for temporomandibular dysfunction (TMD) and the concomitant craniofacial discomfort concerns. Studies conducted on both humans and animals have demonstrated that oestrogen has the ability to regulate pain through both peripheral and central mechanisms. Research has shown that sexual hormones, particularly oestrogen receptors, govern the responsiveness of trigeminal neurons and impact the pain pathways of the trigeminal nerve. The study included individuals with TMJ dysfunction, whose ages varied from 27 to 35 years old, constituting 47% of the whole population. The mean age of these patients was 30.86 years. Previous research did not provide evidence to support the concept that there are age-related changes in the overall frequency and presence of TMJ dysfunction, or in the occurrence of specific joint sounds. Prior research has indicated that there are no notable disparities in the occurrence of headaches, pain, joint problems, and discomfort or pain in interconnected body parts among various age demographics. Recent research indicate that older individuals are more prone to experiencing objective symptoms, such as joint noises, compared to younger individuals who are more inclined to report subjective symptoms, such as pain, prompting them to seek medical intervention[10-13].

Guaradanardini et al (2011) found that those above the age of 52 are more likely to have advanced stages of illnesses. The average age range for discussing muscular incoordination and disc displacement is often between 30 and 40 years old.55% of the individuals in the sample population had affected third molars. There has been a persistent suggestion that third molars may act as precipitating factors for TMJ disorders. The decision to extract third molars as a prophylactic treatment remains uncertain due to the potential risks associated with the surgical procedure. This study supports the proactive extraction of impacted third molars, unless they are in a state of normal alignment. The results of our investigation indicated that there was no deterioration in the patients' functioning following the extraction of their third molars, which is consistent with our initial hypotheses. In 2008, Huang and colleagues conducted a retrospective study on 2217 pairs of third molars in patients who had undergone tooth extraction. The study did not find any statistically significant association between the extraction of third molars, the level of impaction, and the occurrence of TMJ problems following the removal. Nevertheless, among patients below the age of 21 who underwent the extraction of all four third molars in a single session, there was a 23% higher probability of developing temporomandibular disorders (TMDs). Our study did not involve performing bilateral extractions or surgical procedures. However, we did remove third molars that were not in occlusion[14,15].

The Fonseca Anamnestic Index (FAI) is a patient-reported outcome measure that relies on the replies provided by the evaluated individual. The RDC/TMD, while widely acknowledged and standardised as a diagnostic instrument for TMD, presents challenges in its administration due to its extensive nature and the requirement for assessor training. On the other hand, the FAI is simple to administer and does not necessitate assessor training, yet it maintains a notable degree of sensitivity, efficacy, and accuracy. Among the 20 patients included in this study, the FAI score ranged from a minimum of 25 to a maximum of 65. Thus, all individuals involved in this research were exclusively in the mild to moderate phase of TMD and did not require intrusive treatment. Juliana Alvares et colleagues conducted a study including 700 Brazilian women to evaluate the severity of TMD's concept using the FAI scale. The study determined that the FAI possesses adequate validity and reliability. The Visual Analogue Scale (VAS) is a subjective assessment instrument utilised to evaluate the subjective qualities of a patient's pain that cannot be physically measured. The psychometric response scale is commonly used in many questionnaires. The Visual Analogue Scale (VAS) was assessed at two time points: initially, when the complaint was first reported, and one month after conservative therapy. The study documented a substantial decline in the mean score of the 20 participants, from 6.2 to 2.06[16-18]. This suggests that the medication successfully alleviated discomfort and pain in the participants of the trial. The VAS score showed a link with both FAI levels and Wilke's staging of TMD.

Patients at the intermediate phases of temporomandibular dysfunction (TMD) showed increased visual analogue scale (VAS) scores at the initial evaluation. Furthermore, these patients exhibited an elevated functional activity index (FAI) score. This study utilised a muscular force transducer to evaluate the muscle activity in people diagnosed with temporomandibular disorder (TMD) before and after receiving conservative therapy. The temporalis muscle exhibited a peak value of 21.2 and a trough value of 8.8 at T0, with an average value of 10.327. At T0, the masseter muscle had a peak value of 12.6 and a trough value of 6.1, with an average value of 6.46. Patients diagnosed with intermediate stages of temporomandibular disorder (TMD) (Wilke's II) exhibited higher values upon initial presentation of symptoms, whereas patients with milder stages of TMD (Wilke's I) displayed lower values. This can be linked to the fact that pain usually occurs in the later stages of an illness, when there is a progression of muscular incoordination. However, in the initial stages, muscle activity is not significantly hindered. Nevertheless, it is noteworthy to state that even during the early stages of TMD, there was a discernible elevation in muscle activity that above the usual range. Thus, it may be inferred that even during the early phases of temporomandibular disorder (TMD), all individuals may display a subclinical increase in muscle activity. The temporalis muscle had higher levels of activity in comparison to the masseter muscle, which aligns with the patients' reports of headaches or pain in the temple area, as well as other symptoms associated with temporomandibular disorders (TMDs)[18,19].

A study conducted in 2018 by Schmitter et al revealed a correlation between chronic stress and increased levels of temporalis muscle activation during sleep. This conclusion was derived from an electromyography investigation including 45 female volunteers. Stress is acknowledged as a primary factor that initiates temporomandibular disorders (TMDs), and it may also be the primary reason for the increased levels of temporalis muscle activity. The temporalis muscle had a peak value of 14.8 and a minimum value of 8.4 at T1, with an average value of 8.76. The masseter muscle exhibited a peak value of 8.5 and a minimum value of 4.8 at T1, with an average value of 5.413. The T1 values of both the temporalis and masseter muscle showed the most notable change after splint therapy, indicating the effectiveness of the treatment for temporomandibular disorder (TMD). All patients, except for one, showed a notable improvement in their condition after splint therapy was started, independent of the type of splint used. The results of this study are consistent with the findings of Alajbeg et al. (2003), who conducted a study using electromyography to investigate the effects of occlusal splints on the muscles involved in chewing. Their study revealed enhanced muscle activation after occlusal splint therapy. According to Carlson et al. (1979), Sheikholeslam et al. (1980), and Holmgren et al. (1985), the temporalis muscles show reduced activity when at rest and during maximum clenching after the use of a stabilisation splint. Nevertheless, their conclusions are in direct opposition to one another. The user's input consists of a solitary letter "S". Canay et al's 1998 study found that the muscular activity variations after splint therapy were considered to be insignificant [19].

Based on the gathered findings, it can be inferred that conservative care can be a successful therapy for temporomandibular disorders (TMDs) if correctly recognised and administered at the proper moment. The impact of splints is most evident within the first month of usage, but they should not be discontinued even in the absence of clinical results, as there are continuing subclinical effects, while slight, that endure. It is advisable to maintain the usage of splints until muscular activities have fully recovered. The muscle force transducer is a versatile and practical device that has a wide range of uses. The device not only quantifies the magnitude of muscle activation in temporomandibular disorders (TMDs), but also aids in determining the most effective duration for splint therapy. Moreover, it functions as an instructional instrument for patients, allowing them to gain a deeper understanding of the current condition. The study was limited by a small sample size, which prevented the achievement of a uniform distribution. Nevertheless, the outcomes were still deemed satisfactory. It is important to mention that utilising a 3T MRI would have yielded more precise data in contrast to the 1.5T MRI employed in this investigation, hence diminishing the likelihood of misdiagnosis. Furthermore, performing electromyography during the activity could have provided more precise data on muscle activity. Nevertheless, the chair-side equipment utilised in this investigation effectively collected information on muscle activation and proved to be more convenient than an electromyogram [19,20].

Temporomandibular joint disorders are a common cause of pain in the face and mouth. These illnesses have a higher incidence in females and are commonly seen in adults in their middle age. Functional habits, psychological factors, and impacted third molars are commonly identified as predisposing, precipitating, or initiating components of temporomandibular disorders (TMDs). Temporomandibular disorders (TMDs) are highly correlated with individuals who have an Angle's Class II malocclusion. Magnetic resonance imaging (MRI) is the most dependable technique for identifying internal abnormalities of the temporomandibular joint (TMJ). The transducer is an exceptionally efficient, user-friendly, and portable device that can be employed as a diagnostic tool. Furthermore, it allows the practitioner to evaluate the duration of conservative treatment. Furthermore, it empowers the patient to acquire knowledge regarding the nature of their ailment and the duration required to get a favourable treatment outcome. Based on this study, occlusal splints have a notable impact on the muscles associated with chewing, which are closely linked to the temporomandibular joint (TMJ). Thus, occlusal splints remain the foremost therapy choice for conservative management of patients in the initial phases of temporomandibular disorder (TMD).

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