Synchronous vs Asynchronous Telerehabilitation for Bruxism

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).

Inclusion criteria

• Diagnosed with clinically-based bruxism
• Aged 18 years or older
• Voluntarily agreed to participate and provided written informed consent

Exclusion criteria

• Prior or concurrent neurological, psychiatric, or systemic diseases
• Ongoing dental treatment
• Currently receiving physical therapy
• Regular use of medications such as analgesics or muscle relaxants
• History of surgery or trauma involving the temporomandibular joint (TMJ) or neck region
• Pregnancy
• Active cancer
• Planned surgical procedures
• Visual, auditory, or cognitive impairments that could potentially confound the study outcomes
• History of receiving treatment for the TMJ within the preceding 3 months