***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 
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    Input: BACKGROUND Many practitioners have found that posture training has a positive impact on temporom and ibular , or TMD , symptoms . The authors conducted a study to evaluate its effectiveness . METHODS Sixty patients with TMD and a primary muscle disorder were r and omized into two groups : one group received posture training and TMD self-management instructions while the control group received TMD self-management instructions only . Four weeks after the study began , the authors reexamined the subjects for changes in symptoms , pain-free opening and pressure algometer pain thresholds . In addition , pretreatment and posttreatment posture measurements were recorded for subjects in the treatment group . RESULTS Statistically significant improvement was demonstrated by the modified symptom severity index , maximum pain-free opening and pressure algometer threshold measurements , as well as by the subjects ' perceived TMD and neck symptoms . Subjects in the treatment group reported having experienced a mean reduction in TMD and neck symptoms of 41.9 and 38.2 percent , respectively , while subjects in the control group reported a mean reduction in these symptoms of 8.1 and 9.3 percent . Within the treatment group , the authors found significant correlations between improvements in TMD symptoms and improvements in neck symptoms ( P < .005 ) as well as between TMD symptom improvement and the difference between head and shoulder posture measurements at the outset of treatment ( P < .05 ) . CONCLUSIONS Posture training and TMD self-management instructions are significantly more effective than TMD self-management instructions alone for patients with TMD who have a primary muscle disorder . PRACTICE IMPLICATION S Patients with TMD who hold their heads farther forward relative to the shoulders have a high probability of experiencing symptom improvement as a result of posture training and being provided with selfmanagement instructions BACKGROUND Treatment recommendations for patients with painful temporom and ibular disorders ( TMDs ) range from conservative treatments such as physiotherapy to aggressive and irreversible treatments such as restorative reconstruction and joint surgery . METHODS The authors r and omized 200 subjects diagnosed with TMD into three groups : usual conservative , dentist-prescribed self-care treatment without any intraoral splint appliance ( UT ) ; UT plus a conventional flat-plane hard acrylic splint ( HS ) ; and UT plus a soft vinyl ( a low-cost athletic mouth guard ) splint ( SS ) . Subjects completed question naires and clinical examinations at three , six and 12 months . RESULTS The authors observed no significant differences among the groups in TMD-related pain levels or other common signs and symptoms of TMD at baseline ( BL ) or at any follow-up . The changes from BL were comparable for all three groups . The authors did not note any significant differences at any follow-up for compliance with study protocol s or for occurrences of adverse effects from either splint type . For HS versus SS , there were significant differences in rates of splint use , but these differences were not accompanied by differences in either self-reported symptoms or in clinical findings . CONCLUSIONS All patients improved over time , and traditional splint therapy offered no benefit over the SS splint therapy . Neither splint therapy provided a greater benefit than did self-care treatment without splint therapy . CLINICAL IMPLICATION S These findings suggest that clinicians who treat patients with TMD should consider prescribing low-cost nonsplint self-care therapy for most patients OBJECTIVES The Temporo-M and ibular Disorders ( TMD ) are a set of dysfunctional patterns concerning the temporo-m and ibular joints ( TMJ ) and the masticatory muscles ; its main symptom is pain , probably caused by inflammatory changes in the synovial membrane , alterations in the bone marrow of the m and ibular condyle and impingement and compression . The aim of this preliminary study was to investigate the effectiveness in the TMD pain reduction of a new laser device recently proposed by the commerce that , due to its reduced dimensions and to be a class I laser according the ANSI classification , may be used at home by the patient himself . MATERIAL AND METHODS Twenty-four patients with TMD were r and omly selected : the inclusion criteria for the sample was the diagnosis of mono- or bi-lateral TMD , with acute pain restricted to the joint area , associated with the absence of any muscle tenderness during palpation . The patients were r and omly assigned to two groups : Group 1 ( 12 patients ): patients receiving real LLLT  ( experimental group ) . Group 2 ( 12 patients ): patients receiving inactive laser ( placebo group ) . The treatment was performed once a day for two weeks with an 808 nm diode laser by the patient himself with irradiation of the cutaneous zone corresponding to the TMJ for 15 minutes each side . Each patient was instructed to express its pain in a visual analogue scale ( VAS ) making a perpendicular line between the two extremes representing the felt pain level . Statistical analysis was realized with GraphPad Instat Software , where P<0.05 was considered significant and P<0.01 very significant . RESULTS The patient 's pain evaluation was expressed in the two study groups before the treatment , 1 week and two weeks after the treatment . The differences between the two groups result extremely significant with p<0.0001 for the comparison of VAS value after 1 and 2 weeks . CONCLUSION This study , even if it may be considered such a pilot study , investigated a new way to control the pain in the temporo-m and ibular diseases by an at home self administered laser device . RESULTS are encouraging but they will have to be confirmed by greater studies Introduction Painful temporom and ibular disorders ( TMDs ) are usually treated with physiotherapy , self-exercises , medication-based therapy and splint therapy . For splint therapy different types of splints are available . Therefore this r and omized controlled study compared the effectiveness of a semi-finished occlusal appliance ( SB ) with a laboratory-made occlusal appliance ( SS ) in myofascial pain patients . Method The trial subjects allocated to the experimental groups with the ( SB ) occlusal appliance and those provided with a laboratory-made occlusal appliance ( SS ) did , in addition , receive conservative treatment ( self-exercises , drug-based and manual therapy ) . The control group was given conservative therapy ( CO ) only . Overall , a total of 63 patients participated in the study with each group consisting of 21 subjects . Results When the first follow-up examination took place ( 14 days after splint insertion ) mouth opening within the SB group was significantly enlarged . When the second examination was conducted ( 2.5 months after splint insertion ) mouth opening was significantly enlarged in both splint groups when compared with the initial value . In the control group , no significant enlargement of mouth opening was detected . At no point there was a significant reduction in the number of pressure-sensitive areas of the TMJ . On palpation of the masticatory muscles however , a significant reduction in the number of pressure-sensitive areas could be observed within the CO group and the SS group after 2.5 months . When comparing pain reduction ( muscle/joint pain ) and mouth opening , no significant differences could be detected between the treatments . Conclusion The results suggest that TMD should be treated conservatively . In cases of restricted mouth opening , the additional use of occlusal appliances can eliminate the patient ’s discomfort more quickly . In this context , the tested , semi-finished occlusal appliance appears to offer an immediately available , temporary alternative to laboratory-made splints The aim of this triple-blind full-r and omized clinical trial was to quantify analgesia in masticatory muscles and temporom and ibular joints after  occlusal splint therapy associated with the adjuvant administration of nonsteroidal anti-inflammatory drugs ( NSAID ) isolated or associated with other therapeutic agents . Pain relief was also recorded . Eighteen volunteers who had been suffering from chronic pain in masticatory muscles due to temporom and ibular disorders were selected after anamnesis and assessment using RDC/TMD translated to Portuguese . The 3 proposed treatments were NSAID ( sodium diclofenac ) , panacea ( sodium diclofenac + carisoprodol + acetaminophen + caffeine ) , and a placebo . The total treatment duration was 10 days , preceded and succeeded by patients ' pain assessment . A washout interval of 11 days was established between each therapy . All participants received all treatments in different moments , in a full r and omized crossover methodology . The assessment of drug therapies was performed using visual analogue scale for pain on palpation followed by 11-point numerical scale to quantify pain during treatment . Statistical analysis has shown that , after 10 days of treatment , all therapies were effective for pain relief .  NSAID therapy promoted analgesia on the third day , while placebo only promoted analgesia in the eighth day . It has been concluded that sodium diclofenac used as splint adjuvant therapy , promotes significant analgesia in a shorter time PURPOSE To evaluate the effects of botulinum toxin-A in the treatment of patients who have myofascial pain with or without functional disc displacement . PATIENTS AND METHODS Twenty-four participants were r and omly assigned to the study by using Research Diagnostic Criteria for Temporom and ibular Disorders . All patients were informed about botulinum toxin-A , and were required to give informed consent . Before the injections , patients were asked to fill out a Biobehavioral Question naire to evaluate their pain and psychological status , and afterward , electromyography of the right and left masseter and anterior temporal muscles was recorded . Saline was injected into the masseter and anterior temporal muscles in the placebo group , and botulinum toxin-A was used in the study group . On days 14 and 28 , patients were asked to fill out a Biobehavioral Question naire again , and electromyography of the right and left masseter and anterior temporal muscles was recorded again . RESULTS The study group showed improvement in pain and psychological status . Although a decrease in the action potentials of the masseter muscles on day 14 was followed by an increase on day 28 , the reduction of pain scores and improvement in psychological status continued on day 28 . CONCLUSIONS The injection of botulinum toxin-A decreases the muscle action potential in 14 days . The patients also show improvement in pain and psychological status Fifty-five patients ( 46 women and 9 men ) with craniom and ibular disorders and a history of pain of at least 6 months ' duration participated in this trial . The patients were r and omly assigned to three groups : one group to receive acupuncture ; one group to receive occlusal splint therapy ; and one group to act as controls .  Pressure pain threshold , clinical dysfunction score , and visual analog scale measures were used to evaluate patients before , immediately after , and 6 months after treatment . A moderate , but statistically significant , correlation was found between pressure pain threshold and the number of tender spots in the masticatory muscles ( tau = -.43 ; P < .001 ) , degree of tenderness in the masticatory muscles ( tau = -.43 ; P < .001 ) , clinical dysfunction score ( tau = .32 ; P < .001 ) , and the visual analog scale ( tau = -.25 ; P < .01 ) . The short-term results showed a statistically significant improvement in all evaluations for both treatment groups . No significant differences were found in the control group . The improvements result ed in significant differences between the control and each treatment group immediately after treatment . At the 6-month follow-up , no significant differences in pressure pain threshold or clinical dysfunction score were found in the two treatment groups compared with the short-term results OBJECTIVE The effectiveness of nonsteroidal anti-inflammatory drugs ( NSAIDs ) and physical therapy for disk displacement without reduction is unknown . This study compared this treatment method with nontreatment controls . METHODS Sixty patients with painful disk displacement without reduction and without osseous changes were r and omly divided in 2 groups , consisting of NSAID and physical therapy and a nontreated control group . Both groups were observed at 2 weeks and , for those patients who did not show any improvement , again at 4 weeks . RESULTS There was 60 % improvement in the treatment group compared with 33 % in the control group during the entire 4 weeks of the study . The number needed to treat for benefit was 3.75 , with a 95 % CI 2.103 to 65.935 . CONCLUSIONS A combination of NSAID and physical therapy for 4 weeks is effective as a primary treatment of patients with disk displacement without reduction and without osseous changes AIMS To compare the short-term efficacy of patient education only versus the combination of patient education and home exercises for the treatment of myofascial pain of the jaw muscles . MATERIAL S AND METHODS Seventy myogenous temporom and ibular disorder patients were assigned to 2 treatment groups . One group received patient education supplemented by general information about self-care of the jaw musculature . The other group received both education and a home physical therapy program . Treatment contrast , calculated from the mean normalized relative changes in anamnestic and clinical scores , was used to determine treatment success . Clinical outcome measures included pressure pain threshold ( PPT ) of the masseter , anterior temporalis , and Achilles tendon ; pain-free maximal jaw opening ; and pain on chewing , spontaneous muscle pain , and headache as rated on visual analog scales . RESULTS After 3 months the success rate was 57 % for the group that received education only and 77 % for the group that received both education and home physical therapy ( P = .157 ) . The patients were then redivided into 2 groups : successfully treated patients and unsuccessfully treated patients . In the unsuccessfully treated group , pain-free maximal jaw opening increased significantly more among those who had been in the education and physical therapy group than among those who had been in the education-only group ( P = .019 ) . The change in PPT was significantly greater in successfully treated patients than in unsuccessfully treated patients ( .009 < P < .039 ) , independent of the treatment modality , with higher PPTs among successful patients . There were no significant differences between the successfully and unsuccessfully treated groups or between treatment modal 
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Conclusion Our results suggest that the simplest , cost-effective nonsurgical treatments have a positive therapeutic effect on the initial management of TMJ disorders .