Temporomandibular Disorders and Balance Performance

Primary outcomes

1. Sociodemographic Data Form

   Time frame: February 2024 and June 2024

   Through this form, fundamental information such as the participants' age, height, body weight, sex, educational status, occupation, and marital status was recorded, along with their medical history, current medication use, past surgical interventions, and whether any treatment or intervention related to the temporomandibular joint (TMJ) had been performed within the last six months.

2. Pressure pain threshold

   Time frame: February 2024 and June 2024

   Pressure pain threshold The pressure pain threshold measurement was conducted on the masseter muscles using an algometer.

3. Numerical Pain Scale (NPS) Assessment

   Time frame: February 2024 and June 2024

   This scale ranges from 0 to 10, where patients indicate their pain level by selecting a number within the range of "0 - no pain" to "10 - worst possible pain" to describe the intensity of their experienced pain.

4. Forward head posture

   Time frame: February 2024 and June 2024

   It was evaluated using the craniovertebral angle (CVA) method. The craniovertebral angle is defined as the angle formed between the horizontal line and the line connecting the tragus of the ear to the spinous process of the seventh cervical vertebra.

5. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)

   Time frame: February 2024 and June 2024

   This form consists of criteria used for the diagnosis of commonly encountered temporomandibular disorders (TMD). Based on the results of the form, participants can be diagnosed with one or more conditions such as myofascial pain, osteoarthritis, arthralgia, disc displacement, and arthritis.

   DC/TMD consists of two main sections. The first section includes criteria for diagnosing disorders related to the masticatory muscles and the temporomandibular joint (TMJ). The second section allows for a comprehensive assessment of pain and the individual's psychosocial status by evaluating factors such as pain intensity, pain-related disabilities, depression, and somatization.

6. Maximum pain-free mouth opening

   Time frame: February 2024 and June 2024

   The maximum pain-free mouth opening was recorded using a 10 cm ruler.

7. Fonseca's Anamnestic Questionnaire

   Time frame: February 2024- June 2024

   Fonseca's Anamnestic Questionnaire (FAQ) was used for TMJ dysfunction. The FAQ has a multi-factor evaluation structure. The questionnaire consists of ten questions about pain in TMJ, head, and joints, with answer options of "No, Sometimes and Yes." A score of 25 and above was accepted as the presence of TMD.

8. Muscle Activation Assessment

   Time frame: February 2024 and June 2024

   In our study, a four-channel Neurotrac MyoPlus Pro 4 surface EMG biofeedback device was used to assess muscle activation. Participants sat in an upright position with standardized posture, and EMG signals were recorded from the bilateral masseter muscles using self-adhesive electrodes. EMG signals were recorded using self-adhesive electrodes measuring 2.5 cm × 2.5 cm. The electrodes were placed bilaterally on the masseter muscles, with an inter-electrode distance of 10 mm. Before normalization, maximum voluntary isometric contraction (MVIC) levels were recorded. Participants performed three five-second maximal clenching trials with one-minute rest intervals. After the MVIC measurement, bilateral masseter muscle activation was recorded again via EMG during balance assessments. Muscle activation during the task was analyzed using Neurotrac PC Software, and the results were reported as mean microvolt values and normalized data (%MVC).

9. Static and Dynamic Balance Assessment

   Time frame: February 2024 and June 2024

   The Korebalance Premier-19 device was used to measure postural imbalances through anterior-posterior and medial-lateral sway. Postural deviations were assessed using a total score, where higher scores indicated poorer balance.

   Static balance was tested with both eyes open and closed, with the device inflated to 6.0 PSI. Participants were instructed to maintain a stable posture and keep the "+" sign centered on the monitor. In the eyes-closed test, they adjusted their balance and position before the measurement began, followed by a five-second countdown, after which they attempted to maintain the same balance and position.

   Dynamic balance was assessed only with eyes open, with the device inflated to 5.0 PSI. Participants tracked a moving target without external support. Each balance assessment lasted 30 seconds per participant.