***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The outcome of different treatment modalities after 7 years was investigated in a selected group of 50 patients with craniom and ibular disorders of muscular origin . To minimize the possible effects of selection on the clinical material , the selected treatment group was compared to a consecutive group of patients in terms of age , gender , intensity/ duration of pain , and socioeconomic profile . Both groups were comparable in most respects , but the selected group had a longer duration and a higher intensity of pain at baseline . There were more men in the consecutive group than in the selected group . A combined treatment approach result ed in a better outcome than single treatments . Sixty-five percent of all patients in the selected group reported improvement at the 7-year follow-up . All of the 19 patients who received counseling combined with different occlusal treatments improved . Forty-three percent of the patients treated otherwise showed improvement . Patients who were aware of stress responded better to treatment A double-blind pilot study was undertaken to test the administration of low doses of the long-acting benzodiazepine drug clonazepam in the management of chronic intractable temporom and ibular disorder/myofascial pain patients who were not responsive to occlusal splint , behavioral , and physical therapy .  Clonazepam was selected for its long duration and its cholinergic/GABA-ergic/serotonergic , anxiolytic , muscle relaxant , and sedative properties .  Clonazepam appears to be effective when compared to a placebo . However , caution must be observed with long-term administration of clonazepam because of potential side effects such as depression and liver dysfunction . Indiscriminate administration of clonazepam may be harmful to the patient The hypothesis that the response to conventional physical therapy of patients suffering from chronic cervicobrachial pain and /or headache can be improved by adjusting dental occlusion , was tested . Forty patients seeking treatment were interviewed and examined prior to treatment , and 6 weeks , 12 months and 60 months after treatment . All patients underwent routine physical therapies . They were pairwise matched for age , gender and type of dental occlusion , and r and omly allocated to a true occlusal adjustment group or to a mock adjustment group . The patients and the examiners were unaware of the type of dental treatment given . The outcome variables included subjective pain and discomfort , cervical spine mobility and pain on movement , and comparison of relative EMG activities . The short-term response to therapy was good in both groups . In the long-term , however , the response was significantly better in the patients who had undergone occlusal adjustment than in the mock-adjusted controls The aim of this study was to evaluate the therapeutic effect of occlusal adjustment on symptoms and signs of craniom and ibular disorders ( CMD )  , including  headaches  , after 3 and 6 months . Fifty patients were selected and r and omly assigned to a treatment ( T ) or a control ( C ) group . All patients in the treatment group were subjected to occlusal adjustment , whereas the controls were comforted only . Pre- and post-treatment assessment of subjective symptoms and clinical signs was made by a dentist not performing the occlusal adjustment . There was significant improvement in overall subjective symptoms within the T group at the 3- and 6-month follow-up visits , but a statistically significant difference between groups was found at the 3-month follow-up only . With regard to changes in frequency of facial pain a significant deterioration was reported within the C group , which result ed in a significant difference between groups at the 6-month follow-up . No other significant differences were found within or between groups at the follow-ups with regard to the variables investigated . In conclusion , the results from this study that occlusal adjustment is a treatment modality with a statistically significant short-term effect on symptoms of CMD of muscular origin and superior to counseling Sixty-two dental students judged not to be in need of treatment for craniom and ibular disorder ( CMD ) were r and omly divided into two groups , one receiving occlusal adjustment and the other mock adjustment . A double-blind study design was applied . After 2 years of education in dentistry , including courses in stomatognathic physiology , the increase in the subjective symptoms of CMD was significantly greater in the placebo control group than in the treatment group . The difference between the groups in the increase of sites tender to palpation was less clear , showing only a trend . However , the increase was statistically significant within the placebo group but not within the treatment group . Prophylactic occlusal adjustment thus appears to be effective in reducing the occurrence of symptoms of CMD , and possibly also the occurrence of clinical signs The aim of this study was to evaluate the effect of occlusal adjustment in a prospect i ve longitudinal study . Fifty selected patients with craniom and ibular disorders ( CMD ) including headaches were r and omly assigned to a treatment ( T ) or a control ( C ) group . Both groups received counselling and occlusal adjustment was performed in T group . Subjective symptoms and clinical findings were registered before and 2 years after treatment . At a follow-up 48 % in the T group and 84 % in the C group had dem and ed rescue treatment .  Eleven patients in the T group ( 48 % ) and 3 patients in the C group ( 13 % ) without rescue treatment , reported overall subjective improvement . No difference was found between the groups regarding overall intensity of pain expressed by the visual analogue scale . When all kinds of treatment were taken into account , 70 % and 79 % of the patients in the T and C group reported overall subjective improvement at follow-up . The conclusions from this study were that in a two-year perspective only single patients improved from counselling alone . A few more patients improved if one more kind of treatment , for example occlusal adjustment , was added to the initial counselling , but the majority of the patients required a comprehensive treatment program The aim of this study was to assess the short-term effect of occlusal adjustment on craniom and ibular disorders . Fifty patients were r and omly selected and divided into a  treatment ( T ) and a  control ( C ) group . The initial clinical examination and the follow-up were made by one observer and the occlusal adjustment by another . There were no significant differences between groups with regard to frequency of headaches , facial pain , pain on m and ibular function , or duration of headaches and facial pain . Fifty-two percent of the patients in the treatment group and 20 % of the patients in the control group reported reduced subjective symptoms overall at follow-up examination . The improvement was statistically significant within the T group and significantly greater than in the C group . There was no significant change within or between groups with regard to frequency of headaches , facial pain , or pain on m and ibular movements . There was an almost significant difference between groups after treatment with regard to changes in the number of tender muscles . The results of this study indicate that occlusal adjustment provides a general subjective improvement of craniom and ibular disorders In a double-blind study , 22 patients with typical globus symptoms were investigated by both otolaryngological and odontological methods . All the patients underwent thorough hematological , endoscopic and radiological examinations . They were r and omly divided into a treatment group and a placebo group and underwent either simple occlusal adjust or mock adjustment , respectively . The result of occlusal adjustment was assessed immediately after completion of treatment . The effect of treatment on globus symptoms was assessed 2 to 3 months later in a double-blind study . Binomial tests showed that there was a significant association between the success of occlusal adjustment and disappearance of the globus symptom . A new name for this disease is proposed : the globus syndrome STATEMENT OF PROBLEM Contrary to clinical opinion , the structural risk from dental occlusion in temporom and ibular disorders has been question ed or considered to be insignificant in clinical practice . PURPOSE This study tested the effect of elimination of occlusal interference through occlusal adjustment , on the incidence of temporom and ibular disorders . MATERIAL AND METHODS In a controlled clinical trial of 146 healthy children and adolescents , half of the subjects underwent occlusal adjustment aim ed at elimination of the presumed structural risk , and the other half underwent mock adjustment . Adjustments were repeated every 6 months over a period of 4 years . The outcome variable was the incidence of temporom and ibular disorders , operatively defined as request for treatment of symptoms characteristic of the disorders with presence of clinical signs demonstrated in the muscles of mastication and /or jaw joint . RESULTS The cumulative incidence rate was 9/67 in the mock adjustment group and 1/60 in the real adjustment group , for a relative risk of 8.06 . The difference between groups was statistically significant ( p = 0.019 ) . CONCLUSIONS Elimination of the presumed structural risk from the dental occlusion appeared to significantly reduce the incidence of temporom and ibular disorders in a select group of young subjects Twenty-two patients seeking treatment for the globus symptom were examined for the presence of symptoms and signs of TMJ dysfunction .  They were r and omly divided into a  treatment group ( N = 13 ) and a  placebo group ( N = 9 ) and underwent either simple occlusal adjustment or mock adjustment , respectively . The result of occlusal adjustment was assessed immediately after completion of treatment . The effect of treatment on the globus symptom was assessed 2 to 3 months later in a double-blind study design . Binomial tests showed that there was a significant association between the success of occlusal adjustment and disappearance of the globus symptom . Three patients in the placebo group subsequently received occlusal adjustment and splint therapy . When all patients were interviewed 20 to 44 months later , only two of them reported no improvement . Both had unstable occlusion when the treatment was terminated Recommendations about the need for occlusal adjustment after malocclusion therapy are inconclusive . A total of 123 orthodontically treated healthy adolescents ( 88 girls , 35 boys ; 14.8 + /- 1.7 years old ) agreed to participate in the present study . The subjects were interviewed and examined for signs and symptoms related to temporom and ibular disorder ( TMD ) and were r and omly allocated to intervention ( n = 63 ) and control ( n = 60 ) groups . At base line , occlusal adjustment was carried out for the intervention group and repeated every 6 months thereafter as needed . Mock adjustments were performed for the control group . At the end of the 3rd year 118 subjects ( 96 % ) turned up for re-examination . The number of subjects with palpatory pain of the masticatory muscles , and with occlusal centric slides decreased significantly in the intervention group but not in the control group ( P < 0.001 ) . In conclusion , occlusal adjustment therapy may prevent the occurrence of TMD signs in orthodontically treated healthy adolescents Fifty-one patients with craniom and ibular disorders were divided in two groups . One group underwent mock occlusal adjustment , the other was treated with adjustments to remove significant slides and non-working side interferences . Both groups received identical counseling . The results show that there was no significant difference in the improvements on the signs and symptoms obtained by real or mock adjustments after the first treatment session A group of headache patients who also had many signs and symptoms of m and ibular dysfunction were r and omly assigned to treatment and placebo groups . All 48 patients in the treatment group received occlusal adjustment and 19 of them also splint therapy . In the  placebo group all 43 patients received mock adjustment . The changes in symptoms and signs of m and ibular dysfunction were evaluated after 8 months in the treatment group and after 4 months in the placebo group , in a double-blind design . Placebo treatment and real treatment were equally effective in relieving symptoms of m and ibular dysfunction , but there was significantly more reduction in signs of dysfunction in the treatment group than in the placebo group . When tested statistically , this reduction appeared to be independent of the use of splints as an aid to treatment . It can be concluded that the elimination of occlusal disturbances was an effective treatment for m and ibular dysfunction The purpose of this study is to assess what impact shortening disclusion time to less than .5 seconds during right and left m and ibular excursions has on myofascial pain(s ) symptoms present in a dental student population . Twenty-five dental students , who exhibited symptomatology consistent with myofascial pains patient , were divided into a treatment , control , and an untreated group . They participated in an occlusal adjustment study which measured changes in disclusion time , as well as , myofascial pains muscular symptom remissions result ant from treatment . The treated group of ten subjects received ICAGD occlusal adjustments to shorten their disclusion time to less than .5 seconds per m and ibular excursion . The goal of this therapy was to totally disclude the posterior teeth in a measurable time frame of .5 seconds or less . The control group of eight subjects received mock ICAGD with tooth polishing . The goal of this therapy was to simulate ICAGD adjustments for possible placebo effect on symptom remissions . The untreated group had their disclusion times measured but received no treatment to adjust , or to simulate adjustment to their occlusion . The goal of analyzing an untreated group was to attempt to show that mock treatment ( performed on the control subjects ) , or no treatment ( performed on the untreated subjects ) , result ed in no measurable change in the disclusion time in either of these two subject groups . Each subject was recalled for disclusion time measurement four to five times in a one-year period of observation , at which time , they were required to report their myofascial pains symptom status by answering an ordinal scale question naire . The results suggest that shortening disclusion time to less than .5 seconds per m and ibular excursion can induce remissions of many muscular myofascial pains symptoms . Additionally , mock ICAGD occlusal adjustments did not appear to be a factor in the control subjects treatment response , as this group showed no statistically significant symptom remissions Thirty patients with craniom and ibular disorders and headache were r and omly divided into two groups . One received occlusal equilibration ( O group ) and the 
    Output:
    
REVIEW ER 'S CONCLUSIONS There is an absence of evidence , from RCTs , that occlusal adjustment treats or prevents TMD .
Occlusal adjustment can not be recommended for the management or prevention of TMD .