Article Text

Muscular diagnostics and the feasibility of microsystem acupuncture as a potential adjunct in the treatment of painful temporomandibular disorders: results of a retrospective cohort study
  1. Irmgard Simma1,2,
  2. Leopold Simma3,
  3. Johannes Fleckenstein4,5
  1. 1 CAM in Dentistry, ÖGZMK Association, Bregenz, Austria
  2. 2 Clinic for Medical and Dental Medicine and Oral Health, University of Graz, Graz, Austria
  3. 3 Children’s Hospital Lucerne, Luzern, Switzerland
  4. 4 Department of TCM/Acupuncture, Institute of Complementary Medicine, University of Bern, Bern, Switzerland
  5. 5 Department of Sports Medicine, Institute of Sports Sciences, Goethe University, Frankfurt, Germany
  1. Correspondence to Dr Johannes Fleckenstein, Department of TCM/Acupuncture, Institute of Complementary Medicine, University of Bern, Bern 3010, Switzerland; johannes.fleckenstein{at}


Aims To investigate the effect of microsystem acupuncture on painful temporomandibular disorders (TMD).

Methods We retrospectively analysed 887 treatments in 407 TMD-patients (mean age 45±1.5 years), who received microsystem acupuncture (mouth, scalp or fingers) with a focus on oral acupuncture. All patients systematically underwent palpation of specific muscular tender points and their pain rating was assessed on a four-point Likert scale (no pain to strong pain) before and after treatment. In 42 cases, the pain intensity was determined using a visual analogue scale (0–100 mm). As the data were normally distributed, analysis was performed with unpaired t-tests.

Results The pterygoid muscles were most painful to palpation, with the lateral pterygoid rated moderate to strong by 76% of patients and the medial pterygoid by 48% of patients. The palpation of microsystem acupuncture points revealed the strongest sensitivity (moderate or strong pain) of the oral retromolar points at the upper jaw (83%). After treatment, the pain intensity of all tender points had significantly decreased (P<0.001). The proportion of moderate to strong pain ratings was below 3% at most tender points. Overall pain intensity of the subjects (n=42) before treatment was 55.5±19.7 mm on the VAS scale and was significantly reduced to 29.6±20.9 mm (P<0.001) post-treatment.

Conclusions This analysis suggests microsystem acupuncture could reduce the pain intensity of TMD in the short term. Considering the increased local muscular tenderness, further investigations regarding the key role of myofascial trigger points in the occurrence of TMDs are warranted and could lead to new comprehensive treatment strategies.

  • auricular acupuncture
  • pain management
  • dental surgery
  • otolaryngology
  • pain management

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  • Contributors All authors substantially contributed to the conception and design of the study. JF analysed data and wrote the first draft of the manuscript. IS and LS participated in the conduct of the study and critically revised the manuscript for important intellectual content. All authors discussed the results, commented on, read and approved the final version of the manuscript accepted for publication.

  • Competing interests JF is the Deputy Head of the Scientific Chapter of the German medical acupuncture society DAEGfA. He has received honoraria for academic teaching and counselling.

  • Patient consent Obtained.

  • Ethics approval Cantonal Ethics Committee, Bern, Switzerland (reference no. 2016-01206).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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