Effect of comprehensive physical therapy on mental health and jaw function of patients with temporomandibular disorder

doi:10.19439/j.sjos.2026.05.005

Abstract

Abstract: PURPOSE: To explore the effect of comprehensive physical therapy on improving mental health and mandibular function in patients with temporomandibular disorders (TMD). METHODS: A total of 57 TMD patients were recruited from the Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from November 2021 to February 2022. All patients received comprehensive physical therapy, including ultrasonic therapy, low-intensity laser therapy, low-frequency pulsed electrical therapy, and manual therapy. Before and after treatment, the pain levels at rest, at the end of mouth opening, and during chewing, as well as the maximum active mouth opening, were evaluated. Meanwhile, the mandibular function and mental state were assessed using the Jaw Functional Limitation Scale (JFLS), Patient Health Questionnaire-15 (PHQ-15), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). RESULTS: After treatment, the pain score at the end of mouth opening decreased from 2 (4) points to 1 (1) points (P<0.05), the pain scores during chewing decreased from 2 (3) points to 0 (0) points (P<0.05), and the maximum active mouth opening increased from (28.49±6.49) mm to 38.00 (4.50) mm (P<0.05). The JFLS score for mandibular function significantly decreased (P<0.05). The scores of PHQ-15, PHQ-9, and GAD-7 all significantly decreased (P<0.05); the proportions of patients with mild or higher levels of anxiety, depression, and somatization symptoms significantly reduced (P<0.05). CONCLUSIONS: Comprehensive physical therapy can effectively improve physical symptoms such as pain and mouth opening function in TMD patients, and also have a positive impact on mental health issues such as anxiety and depression. Moreover, the improvement of mental state is correlated with the recovery of physical functions.

Key words: Temporomandibular disorders, Mental health, Jaw function, Physical therapy

CLC Number:

R782.6

Yao Yuan, Xu Lili, Liu Shasha, Zeng Hong, Jin Lei, Cai Bin, Fang Zhongyi. Effect of comprehensive physical therapy on mental health and jaw function of patients with temporomandibular disorder[J]. Shanghai Journal of Stomatology, 2026, 35(5): 475-480.

References

[1] 傅开元, 胡敏, 余强, 等. 颞下颌关节常规 MRI 检查规范及关节盘移位诊断标准的专家共识[J]. 中华口腔医学杂志, 2020, 55(9): 608-612.
[2] Calixtre LB, Moreira RF, Franchini GH, et al.Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials[J]. J Oral Rehabil, 2015, 42(11): 847-861.
[3] Chellappa D, Thirupathy M.Comparative efficacy of low-Level laser and TENS in the symptomatic relief of temporomandibular joint disorders: a randomized clinical trial[J]. Indian J Dent Res, 2020, 31(1): 42-47.
[4] Ba S, Zhou P, Yu M.Ultrasound is effective to treat temporomandibular joint disorder[J]. J Pain Res, 2021, 14: 1667-1673.
[5] 方仲毅, 范帅, 蔡斌, 等. 256例慢性颞下颌关节盘不可复性前移位综合物理治疗远期疗效评价[J]. 上海口腔医学, 2018, 27(3): 289-292.
[6] Fillingim RB, Ohrbach R, Greenspan JD, et al.Potential psychosocial risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case-control study[J]. J Pain, 2011, 12(11 Suppl): T46-T60.
[7] Ferreira DMAO, Costa YM, Bonjardim LR, et al.Effects of acute mental stress on conditioned pain modulation in temporomandibular disorders patients and healthy individuals[J]. J Appl Oral Sci, 2021, 29: e20200952.
[8] Yeung E, Abou-Foul A, Matcham F, et al.Integration of mental health screening in the management of patients with temporomandibular disorders[J]. Br J Oral Maxillofac Surg, 2017, 55(6): 594-599.
[9] Dos Santos EA, Peinado BRR, Frazão DR, et al.Association between temporomandibular disorders and anxiety: a systematic review[J]. Front Psychiatry, 2022, 13: 990430.
[10] Fillingim RB, Ohrbach R, Greenspan JD, et al.Psychological factors associated with development of TMD: the OPPERA prospective cohort study[J]. J Pain, 2013, 14(12 Suppl): T75-T90.
[11] 李苏娜, 宋文尚, 刘子略, 等. 义齿咬合板联合综合物理疗法对颞下颌关节盘不可复性前移位的疗效评价[J]. 上海口腔医学, 2024, 33(3): 273-278.
[12] 刘丽琨, 斌蔡, 方仲毅, 等. 关节腔注射透明质酸与物理疗法治疗颞下颌关节不可复性盘前移位的临床疗效对比[J]. 口腔医学, 2021, 41(9): 820-824.
[13] Miernik M, Wieckiewicz M, Paradowska A, et al.Massage therapy in myofascial TMD pain management[J]. Adv Clin Exp Med, 2012, 21(5): 681-585.
[14] Walker N, Bohannon RW, Cameron D.Discriminant validity of temporomandibular joint range of motion measurements obtained with a ruler[J]. J Orthop Sports Phys Ther, 2000, 30(8): 484-492.
[15] Behrend CJ, Schönbach EM, Vaccaro AR, et al.Maximum pain on visual analog scales in spinal disorders[J]. Spine J, 2017, 17(8): 1061-1065.
[16] Xu L, Cai B, Fang Z.Translation and validation of a Chinese version of the Mandibular Function Impairment Questionnaire[J]. J Oral Rehabil, 2016, 43(8): 608-614.
[17] Kroenke K, Spitzer RL, Williams JB.The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms[J]. Psychosom Med, 2002, 64(2): 258-266.
[18] Levis B, Benedetti A, Thombs BD, et al.Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis[J]. BMJ, 2019, 365: l1476.
[19] Toussaint A, Hüsing P, Gumz A, et al.Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7)[J]. J Affect Disord, 2020, 265: 395-401.
[20] Xu GZ, Jia J, Jin L, et al.Low-level laser therapy for temporomandibular disorders: a systematic review with meta-analysis[J]. Pain Res Manag, 2018: 4230583.
[21] 徐丽丽, 蔡斌, 方仲毅, 等. 个体化综合物理疗法治疗颞下颌关节紊乱病的疗效观察[J]. 中华物理医学与康复杂志, 2014, 36(5): 329-332.
[22] Nagata K, Hori S, Mizuhashi R, et al.Efficacy of mandibular manipulation technique for temporomandibular disorders patients with mouth opening limitation: a randomized controlled trial for comparison with improved multimodal therapy[J]. J Prosthodont Res, 2019, 63(2): 202-209.
[23] Gauer RL, Semidey MJ.Diagnosis and treatment of temporomandibular disorders[J]. Am Fam Physician, 2015, 91(6): 378-386.
[24] 胡欣欣, 朱耀旻, 何柳婷, 等. 109例颞下颌关节紊乱病相关因素分析[J]. 上海口腔医学, 2017, 26(2): 213-216.
[25] Wieckiewicz M, Boening K, Wiland P, et al.Reported concepts for the treatment modalities and pain management of temporomandibular disorders[J]. J Headache Pain, 2015, 16: 106-118.
[26] Sójka A, Stelcer B, Roy M, et al.Is there a relationship between psychological factors and TMD?[J]. Brain Behav, 2019, 9(9): e01360.
[27] 刘法鑫, 黄磊, 蒋立坚. 颞下颌关节紊乱病患者心理状态的研究分析[J]. 广州医药, 2015, 46(1): 48-52.
[28] Dworkin RH, Turk DC, Wyrwich KW, et al.Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations[J]. J Pain, 2008, 9(2): 105-121.