Dr. Adams' Alabama Headache Blog

This study was designed to compare the effects of two types of appliance, flat plane (FP) and anterior repostioning (AR) on selected subjective and objective dimensions from Research Diagnistic Criteria. Twenty patients visiting the Gelb Craniomandibular/Orofacial Pain Center were selected in order of appearance and assigned randomly to two groups. The age range was 18-45 years. One group was fitted with a FP and the other an AR. Prior to insertion, a 10-pt visual analoogue scale (VAS) was administered to rate headache, joint clicking, and joint pain and ear stiffness. Patients were then tested for 1) unassisted maximum interincisal opening, 20 excursions, 3) opening click and 4)joint sounds on excursion. After 2 months, the VAS was readministered and the patients retested. Two-factor, mixed factorial ANOVAS were performed on all testes except click opening and joint sounds on excursion. Headache, subjective rating of clicking, and joint pain reduced significantly in both FP and AR. Ear stuffiness did not change. In contrast, the mean of the AR increased significantly (33.35 mm to 41.6 mm) for interincisal opening while FP did not. Also, for excursions, there was a significant main effect for sequence and group sequence interaction. Mean FP increased 1.125 mm while mean AR increased 3.5 mm. While joint sounds on excursion did not differ, click on opening decreased significantly to zero for AR patients. While both appliances significantly reduced subjective symptoms, AR was more effective in reducing Axis-1 objective measures.