Effect of Temporomandibular Joint Mobilization versus home exercise program on maximal mouth opening in subjects with Oral sub mucosal fibrosis

Introduction: Oral Sub Mucous Fibrosis (OSMF) is a chronic, complex potential potent pre-cancerous condition characterized by juxta-epithelial inflammatory reaction and progressive fibrosis of the sub mucosa (lamina propria and deeper connective tissues). As the disease progresses it leads to disorders of the temporo mandibular joint (TMJ) causing various combinations of limitation of movement of the jaw, pain, locking or clicking sounds and difficulty in opening mouth ,usually treated by maxillofacial surgeries or medical approaches. Objective: To study the effect of TMJ mobilization on maximal mouth opening in subjects with OSMF. Method: A quasi-experimental study was conducted at college of physiotherapy, Ahmadabad. Twelve participants of OSMF with history of tobacco chewing since last 6 months and willing to participate in the study were included and those who underwent any surgery for OSMF or any injections for pain relief were excluded from the study. The subjects were divided into two groups (A and B). Group A (control group) was given home exercise programme in form of stick exercises. Group B (experimental group) was given TMJ mobilization and stick exercises. Both the groups received treatment for 4 weeks. Maximal mouth opening (MMO) was measured. For MMO, distance from edge of upper incisor teeth to edge of lower incisor teeth was measured using calibrated fibre ruler on first day and after four weeks of intervention. Level of significance was kept at 5%.Results: Pre intervention MMO in group A was 1.9+0.81 and in group B was1.7+0.79. Post intervention MMO in group A was 3.13+0.58 and in group B was 4.43+0.71. Within group analysis using Wilcoxon test showed statistically significant difference in both the groups A and B (Z=2.37, p=0.028and Z=2.21, p=0.018 respectively). Between group analysis using Mann Whitney U test showed statistically significant difference between both group (U=0.2, p=0.01).Conclusion: Both Temporo mandibular joint mobilization and home exercise programme are beneficial but TM joint mobilization has more effect on maximal mouth opening than home exercise program in subjects with Oral sub mucosal fibrosis.