Effect of Diclofenac Gel Phonophoresis on Temporomandibular Joint Disorders: A Prospective Quasi-Experimental Study

Abstract

Background: Temporomandibular disorders (TMD) are a group of pathologies that affect the masticatory muscles, the temporomandibular joint, and related structures and affect more than 25% of the general population. Objectives: This study aimed to demonstrate the effect of ultrasounds (US) plus diclofenac gel 10% (phonophoresis) as a physical therapy available for the management of TMD based on pain amelioration and function recovery. Methods: Prospective quasi-experimental one-group before-after study. Outcome measures consist: (1) pain measured by Visual Analog scale (VAS); and (2) mouth opening by measuring lip to lip distance and interincisal distance in millimeters (mm); evaluated at the beginning/end of treatment. Twenty sessions (1 session per day) of continuous Ultrasound to intensity of 1 W/cm2/1 MHz/5 minutes over the affected joint, with Ultrasound gel (5 mL) and 10% diclofenac gel (5 mL) in a proportion of 1:1 as transducer medium. Results: A total of 50 consecutive patients were analyzed. Phonophoresis protocol was able to improve all outcome measures with a statistical difference. Pain evaluated by VAS was 6.67 ± 0.82 and decreased to 3.48 ± 0.8 points (P = 0.0000). Mouth opening by mean of lip-to-lip distance was 50 ± 8.23 mm that improved to 56 ± 6.2 mm (P = 0.0000) and by mean of interincisal distance was 37.9 ± 7.02 mm and increased to 44 ± 5.5 mm (P = 0.0000). Conclusions: Diclofenac phonophoresis is an effective physical therapy for the management of TMD, evaluated by pain improvement and function recovery.