Synchronous vs Asynchronous Telerehabilitation for Bruxism

Overview

The goal of this clinical trial was to learn if online exercise and self-massage programs could lower pain and improve jaw movement in adults with bruxism (teeth grinding or clenching). The main questions it aimed to answer were: Did live video exercise guided by a physical therapist lower jaw pain more than an independent video exercise program? Did live video exercise guided by a physical therapist improve mouth opening more than an independent video exercise program? Researchers compared live video sessions to independent video exercises to see which approach worked better for improving jaw function, sleep quality, and daily life. Participants: Completed an 8-session exercise and self-massage program over 4 weeks (2 times each week). Either practiced live with a physical therapist over video calls or followed recorded video exercises on their own at home. Answered surveys about pain, sleep quality, and oral health before and after the 4-week program. Had their mouth opening, jaw muscle sensitivity, and muscle activity tested before and after the program.

Bruxism is characterized by repetitive masticatory muscle activity leading to masticatory muscle pain, restricted mandibular range of motion, and impaired oral health-related quality of life. Telerehabilitation represents a promising alternative to conventional face-to-face physiotherapy to overcome accessibility barriers. In this prospective, randomized, two-arm parallel-group controlled trial, individuals diagnosed with clinically-based bruxism were randomly assigned to either the Synchronous Telerehabilitation Group (S-TRG) or the Asynchronous Telerehabilitation Group (A-TRG). Both groups completed an 8-session intervention protocol over 4 weeks (2 sessions per week). The intervention protocol comprised: Breathing training protocol (deep diaphragmatic breathing), Cervical region stretching and chin-tuck exercises, Temporomandibular joint range of motion and stretching exercises, Bilateral self-massage techniques (sliding, kneading, friction, and ischemic compression to masseter and temporalis muscles), Scapular stabilization exercises (W, T, and Y exercises). In the S-TRG, sessions were conducted in real time under the direct supervision of a physiotherapist via live video calls. In the A-TRG, participants were taught the exercises in an initial recorded live video session and subsequently performed the protocol independently using their personalized instructional video recordings, with weekly phone/text check-ins to monitor adherence and screen for adverse events. Additionally, all participants received a standardized patient education brochure on TMJ care and behavioral modifications. Outcome assessments were conducted at baseline and immediately following the 4-week intervention period. Evaluated parameters included: Pain intensity assessed using the 0-10 Numeric Rating Scale (NRS) at rest, during the night, in the morning, and during activity, Maximum mouth opening (MMO) measured with a caliper, Pressure pain threshold (PPT) and pressure pain tolerance (PPTol) of the masseter and temporalis anterior muscles assessed using a digital algometer, Masticatory muscle activation during maximum voluntary isometric contraction and clenching tasks assessed via surface electromyography (sEMG), Oral health-related quality of life evaluated using the 14-item Oral Health Impact Profile (OHIP-14), Subjective sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI).