Supporting Research

Furlan RM, Giovanardi RS, Britto AT, Oliveira e Britto DB. The use of superficial heat for treatment of temporomandibular disorders: an integrative review. Codas. 2015 Mar-Apr;27(2):207-212. DOI: 10.1590/2317-1782/20152014148. PMID: 26107088.

Examines various techniques for applying superficial heat to treat TMJ disorders. The review found that moist heat is the most commonly used method, typically applied for at least 20 minutes once a day. The heat treatment was shown to significantly relieve pain, reduce muscle tension, improve mandibular function, and increase mouth opening. Most studies recommended applying heat to the facial and cervical regions.

myTMJ Pen can help you integrate heat into your TMJ physical therapy. If you prefer moist heat, you can apply a light layer of a water based gel such as aloe vera to the skin.

Poindexter, R. H., Wright, E. F., & Murchison, D. F. (2002).Comparison of Moist and Dry Heat Penetration Through Orofacial Tissues.Cranio - Journal of Craniomandibular Practice,20(1), 28-33.https://doi.org/10.1080/08869634.2002.11746187

Dry and moist heat applications were equally effective in both maximum tissue temperature rise and the rate of thermal transfer (p > 0.05). However, in a small number of subjects moist heat was preferred. As there seems to be little difference between using moist rather than dry heat, patients may be counseled to employ the superficial heating option that: 1. is an individual's personal preference or 2. improves convenience and optimizes compliance.

Even though application of heat has positive effects in at home symptom management of TMJ Disorders, the fact that moist heat works better is actually a misconception. It is true that at the same temperature, moist heat will transfer heat better, however there is no reason to compare them at the same temperature. You may just use dry heat at a slightly higher temperature to achieve the same effect. And it won't be any more uncomfortable, because our body "feels" heat transfer not temperature. I.e. think about how our body feels cold air vs same temperature air with wind.

However, most studies suggest the most important thing is to apply whichever method is most convenient and comfortable for the user. If you would like to apply moist heat with myTMJ Pen, just apply a little water based gel like aloe vera to the skin.

Zanoli G, Albarova-Corral I, Ancona M, Grattagliano I, Hotfiel T, Iolascon G, Krüger K, Rodríguez Maruri G. Current Indications and Future Direction in Heat Therapy for Musculoskeletal Pain: A Narrative Review.Muscles. 2024; 3(3):212-223. https://doi.org/10.3390/muscles3030019

"Musculoskeletal pain is a non-negligible multifaceted condition affecting more than 30% of the global population. Superficial heat therapy (HT), through increasing tissue temperatures, plays a role in increasing local metabolism and function and relieving pain. [...] HT has been shown to be a potentially beneficial and safe option in the management of several conditions including KP (Knee Pain) and sports. The key in the application of superficial HT is a multimodal and multidisciplinary approach."

Another key point is that heat therapy offers localized pain relief by stimulating temperature sensitive nerve endings which block the processing of pain signals in the spinal cord.

Thilo Hotfiel, Pablo Fanlo-Mazas, Miguel Malo-Urries, Ema Paulino, Luis Sequeira de Medeiros, Massimo Blondett, Mario Vetrano, Juergen Freiwald,
Importance of heat therapy in the treatment of pain in the daily clinical practice,
Journal of Bodywork and Movement Therapies

• Heat Therapy (HT) is widely recommended for MSK (musculoskeletal) pain. LBP (Lower Back Pain) (92%) and NP (Neck Pain) (84%) were most frequently treated with HT.
• 86.5 % of experts recommend heat therapy due to its effects and safety profile.
• Patients should be informed about how value HT is as a self-management therapy option as well as its limitations.
• HT is primarily chosen due to its relaxation effect, high safety profile and enhancement of tissue perfusion.

While this paper does not directly mention TMJ Disorders, this is most likely due to its low profile compared to other chronic pain syndromes such as lower back pain, knee pain, neck pain, etc. TMJD is a musculoskeletal pain condition as well and many of the findings are applicable.

Jiro Nakano, Cristiane Yamabayashi, Alex Scott, W. Darlene Reid,
The effect of heat applied with stretch to increase range of motion: A systematic review,
Physical Therapy in Sport, Volume 13, Issue 3, 2012, Pages 180-188, ISSN 1466-853X, https://doi.org/10.1016/j.ptsp.2011.11.003.

The current review demonstrates that the application of heat potentiates the effect of stretching on improving ROM of a variety of muscle groups. Heating provided a beneficial influence both on the acute gain of ROM, and on sustained gain of ROM evident after multiple treatments in healthy people.

Chabal, C., Dunbar, P. J., Painter, I., Young, D., & Chabal, D. C. (2020). Properties of Thermal Analgesia in a Human Chronic Low Back Pain Model.Journal of pain research,13, 2083–2092. https://doi.org/10.2147/JPR.S260967

"High-level pulsed heat (45°C) produced significantly more analgesia as compared to steady heat at 37°C at the primary end point and for an additional 2 hours after treatment. The onset of analgesia was rapid, <5 minutes of treatment. The results of this trial provide insight into the mechanisms and properties of thermal analgesia that are not well understood in a chronic low back pain model."

Analgesia is a term for pain reduction. And this study is one of many that looks at its effectiveness in lower back pain (another chronic pain syndrome). Specifically it showed higher temperature levels at shorter bursts is more effective than constant application of lower heat. But both show significant improvement compared to normal.

Kazi, R., Govas, P., Slaugenhaupt, R. M., & Carroll, B. T. (2020). Differential Analgesia From Vibratory Stimulation During Local Injection of Anesthetic: A Randomized Clinical Trial.Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.],46(10), 1286–1293. https://doi.org/10.1097/DSS.0000000000002314

This study found statistically significant reduction in pain (>57%) during injection when using vibration compared to normal.

Hollins, M., McDermott, K., & Harper, D. (2014). How does vibration reduce pain?.Perception,43(1), 70–84. https://doi.org/10.1068/p7637

"Cutaneous vibration is able to reduce both clinical and experimental pain, an effect called vibratory analgesia"

Essentially it was found that vibration at the skin level is able to inhibit pain signals at the spinal cord level, and nothing to do with "distraction."

https://www.nidcr.nih.gov/health-info/tmd#treatment

"Apply heat or cold to the face in combination with exercises to gently stretch and strengthen the jaw muscles."

Listed as one of the top methods for nonsurgical treatments of TMJ Disorders.

https://tmj.org/hot-and-cold-packs-most-effective-therapy/

"In a survey the TMJA conducted of TMJ patients, the most frequently used intervention (65% of respondents) was thermal therapy (hot or cold compresses) to the jaw;these were also found by 74% of the respondents to result in a reduction of symptoms."

"Among a wide array of treatments used (46 listed), the most effective relief for most affected individuals (91%) was the use of thermal therapies—hot/cold packs to the jaw area or hot baths."

Herrera-Valencia A, Ruiz-Muñoz M, Martin-Martin J, Cuesta-Vargas A, González-Sánchez M. Effcacy of Manual Therapy in TemporomandibularJoint Disorders and Its Medium-and Long-TermEffects on Pain and Maximum Mouth Opening:A Systematic Review and Meta-Analysis. J Clin Med. 2020 Oct 23;9(11):3404. doi: 10.3390/jcm9113404. PMID: 33114236; PMCID: PMC7690916.

The study analyzed data from randomized controlled trials and found that manual therapy significantly improved pain and mouth opening compared to baseline. While the benefits of manual therapy alone appeared to diminish over time, combining it with therapeutic exercise showed sustained improvements in the long term. This highlights the importance of incorporating therapeutic exercise alongside manual therapy for better long-term outcomes in TMJ disorder treatment.

While myTMJ Pen is not interchangeable with manual therapy or therapeutic exercise, it does offer a tool to assist in these modalities, make them more comfortable, and overall increase the likelihood of consistent therapeutic best practices.

Minervini G, Franco R, Marrapodi MM, Crimi S, Badnjević A, Cervino G, Bianchi A, Cicciù M. Correlation between Temporomandibular Disorders (TMD) and Posture Evaluated trough the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): A Systematic Review with Meta-Analysis. J Clin Med. 2023 Apr 2;12(7):2652. doi: 10.3390/jcm12072652. PMID: 37048735; PMCID: PMC10095000.

Explores the relationship between posture and TMD. The study analyzed data from multiple sources and found a significant correlation between poor posture and the occurrence of TMD. The findings suggest that addressing postural issues may help in the management and prevention of TMD symptoms.

While myTMJ Pen cannot directly impact posture, we do include several resources in myTMJ Tutorials explaining changes you can make and why they matter. Additionally, postural changes often come with muscle pain and tension as you work on developing those weaker muscles - which can be mitigated through myTMJ Pen use.

Ropero Peláez,Francisco Javier,Taniguchi,Shirley,The Gate Theory of Pain Revisited: Modeling Different Pain Conditions with a Parsimonious Neurocomputational Model,Neural Plasticity,2016, 4131395, 14 pages,2016.https://doi.org/10.1155/2016/4131395

This paper is one of many describing the gate control theory of pain, which is a leading theory of understanding why applying forces to the outside of the body tends to block pain signals to the brain.

Castro-Sánchez, A. M., Matarán-Peñarrocha, G. A., Granero-Molina, J., Aguilera-Manrique, G., Quesada-Rubio, J. M., & Moreno-Lorenzo, C. (2011). Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia.Evidence-based complementary and alternative medicine : eCAM,2011, 561753. https://doi.org/10.1155/2011/561753

Bialosky, J. E., Bishop, M. D., Price, D. D., Robinson, M. E., & George, S. Z. (2009). The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model.Manual therapy,14(5), 531–538. https://doi.org/10.1016/j.math.2008.09.001

Wagner Rodrigues Martins, Juscelino Castro Blasczyk, Micaele Aparecida Furlan de Oliveira, Karina Ferreira Lagôa Gonçalves, Ana Clara Bonini-Rocha, Pierre-Michel Dugailly, Ricardo Jacó de Oliveira,
Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis,
Manual Therapy,
Volume 21,
2016,
Pages 10-17,
ISSN 1356-689X,
https://doi.org/10.1016/j.math.2015.06.009.
(https://www.sciencedirect.com/science/article/pii/S1356689X15001381)

"Musculoskeletal manual approaches are effective for treating TMD. In the short term, there is a larger effect regarding the latter when compared to other conservative treatments for TMD."

Especially for increasing maximum opening and decreasing pain while opening.

YaoL,SadeghiradB,LiM,LiJ,WangQ,CrandonH Net al.Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trialsBMJ2023;383:e076226doi:10.1136/bmj-2023-076226

"interventions that promote coping and encourage movement and activity were found to be most effective for reducing chronic TMD pain."

This included jaw mobilization (with instruction or assistance from a therapist) and manual trigger point therapy.

https://tmj.org/hope-in-research/landmark-studies/national-academy-of-medicine/

https://www.ncbi.nlm.nih.gov/books/NBK551612/

Sahebi, S., Moazami, F., Afsa, M., & Nabavi Zade, M. R. (2010). Effect of lengthy root canal therapy sessions on temporomandibular joint and masticatory muscles.Journal of dental research, dental clinics, dental prospects,4(3), 95–97. https://doi.org/10.5681/joddd.2010.024

"Lengthy dental treatments can harm TMJ and masticatory muscles and wide opening of the mouth during such appointments can worsen the situation."

https://www.pennmedicine.org/updates/blogs/health-and-wellness/2020/september/tmj-pain-relief-8-best-practices-to-help-manage-tmd

This is simply an example of the dozens of clinical suggestions for management of TMJ Disorders.

Note, almost all of which warn against things like prolonged and strained mouth opening. And almost all promote thermal therapy and manual therapy as at non surgical treatment options.

https://www.instituteforchronicpain.org/understanding-chronic-pain/what-is-chronic-pain/neuromatrix-of-pain

and

Melzack, R. & Loeser, J. D. (1978). Phantom body parts in paraplegics: Evidence for a central ‘pattern generating mechanism’ for pain. Pain, 4, 195-210.

Chung Man-Kyo , Wang Sheng , Alshanqiti Ishraq , Hu Jiaxin , Ro Jin Y. - The degeneration-pain relationship in the temporomandibular joint: Current understandings and rodent models - Frontiers in Pain Research - VOLUME=4 - YEAR=2023 - URL=https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2023.1038808

https://today.duke.edu/2017/11/why-head-and-face-pain-causes-more-suffering?utm_source=TMJ+News+Bites+Issue+6+2017&utm_campaign=TMJ+News+Bites+2017+Issue+6&utm_medium=email