Comparative effectiveness of therapeutic ultrasound and pharmacotherapy in the management of muscular temporomandibular disorders: a randomized clinical trial.

INTRODUCTION: Temporomandibular disorders (TMDs) of muscular origin are a common cause of chronic orofacial pain and functional limitation. Conservative management includes pharmacotherapy and physiotherapeutic modalities such as therapeutic ultrasound. However, evidence directly comparing their effectiveness remains limited. This randomized clinical trial compared therapeutic ultrasound and pharmacotherapy in reducing pain intensity and improving mandibular function in patients with muscular TMDs. MATERIALS AND METHODS: A prospective, parallel-group randomized clinical trial was conducted among 36 patients diagnosed with muscular TMDs according to Group I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Following ethical approval (YEC-1/2024/038) and CTRI registration (CTRI/2024/12/077788), participants were randomly allocated into two groups (n = 18). Group A received ibuprofen (400 mg), paracetamol (325 mg), and chlorzoxazone (250 mg) twice daily for seven days. Group B received therapeutic ultrasound (1 MHz, 1.0 W/cm², continuous mode) for 10 min daily for seven days. Pain intensity was assessed using the Numerical Rating Scale (NRS), and maximum mouth opening was measured using a Vernier calliper. Data were analysed using paired and independent Student's t-tests (p < 0.05). RESULTS: All participants completed the study. Both groups showed significant reductions in pain intensity and improvements in maximum mouth opening (p < 0.05). Mean NRS scores decreased from 6.31 ± 1.35 to 2.94 ± 1.06 in the pharmacotherapy group and from 5.56 ± 1.97 to 1.69 ± 1.08 in the therapeutic ultrasound group. Mean mouth opening increased from 40.31 ± 3.63 mm to 41.44 ± 2.94 mm and from 40.75 ± 3.55 mm to 43.63 ± 2.55 mm, respectively. Therapeutic ultrasound achieved significantly greater pain reduction (p = 0.002) and greater improvement in mouth opening (p = 0.032). No adverse events were reported. CONCLUSION: Both treatments were effective for muscular temporomandibular disorders; however, therapeutic ultrasound was associated with greater short-term improvements in pain intensity and maximum mouth opening than pharmacotherapy under the conditions of this study. CLINICAL TRIAL REGISTRATION: https://ctri.nic.in/Clinicaltrials/login.php, identifier CTRI/2024/12/077788.