The Journal of prosthetic dentistry · 2026
A prospective single arm study of salivary cortisol changes in muscular temporomandibular disorders patients following computer-guided occlusal adjustments.
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Goud Sushmitha S, Thumathi Prafulla, Poovani Shwetha Kumari, Radke John, Kerstein Robert B
Аннотация
STATEMENT OF PROBLEM: The relationship between occlusomuscular temporomandibular disorders (TMD) and stress measured by salivary cortisol and the effect that disclusion time reduction (DTR) therapy may have on cortisol levels remains unclear. Objective evidence is lacking as to whether modifying the occlusal dynamics with DTR therapy will objectively reduce stress responses in affected patients.
PURPOSE: The purpose of this clinical study was to evaluate the stress levels among patients with occlusomuscular TMD by measuring salivary cortisol levels before and after DTR therapy.
MATERIAL AND METHODS: Thirty patients diagnosed with occlusomuscular TMD had salivary cortisol level samples collected and assayed by passive drool at baseline and 1-month after DTR therapy with enzyme-linked immunosorbent assay (ELISA). All 30 participants were treated with the T-Scan 10 Novus digital occlusion analyzer synchronized with temporalis and masseter surface electromyography (sEMG) to achieve disclusion times of less than 0.5 seconds during left and right lateral excursive movements. The Kolmogorov-Smirnov tested normality and the Student's paired t test evaluated pre-and posttreatment cortisol levels, the disclusion times, and muscular comparisons (P<.05), with 95% confidence levels reported.
RESULTS: Mean salivary cortisol levels significantly decreased from 11.43 ±1.48 ng/mL before DTR to 6.57 ±1.20 ng/mL after DTR, which equaled a 4.85 ng/mL reduction (P<.001). DTR significantly reduced the left mean disclusion time from 2.32 ±1.25 seconds to 0.28 ±0.06 seconds (mean difference=2.04 seconds, P<.001) and the right mean disclusion time from 2.60 ±1.97 seconds to 0.28 ±0.05 seconds (mean difference=2.32 seconds, P<.001). The average EMG muscle activities of the bilateral masseter and temporalis muscles increased significantly from pretreatment to 1 month after DTR (P<.001).
CONCLUSIONS: DTR therapy significantly reduced salivary cortisol levels in patients with occlusomuscular TMD. Stress reduction was achieved with high precision, time-based computer-guided occlusal adjustments that controlled the participants' occlusal neurophysiology responsible for their elevated cortisol production.
PURPOSE: The purpose of this clinical study was to evaluate the stress levels among patients with occlusomuscular TMD by measuring salivary cortisol levels before and after DTR therapy.
MATERIAL AND METHODS: Thirty patients diagnosed with occlusomuscular TMD had salivary cortisol level samples collected and assayed by passive drool at baseline and 1-month after DTR therapy with enzyme-linked immunosorbent assay (ELISA). All 30 participants were treated with the T-Scan 10 Novus digital occlusion analyzer synchronized with temporalis and masseter surface electromyography (sEMG) to achieve disclusion times of less than 0.5 seconds during left and right lateral excursive movements. The Kolmogorov-Smirnov tested normality and the Student's paired t test evaluated pre-and posttreatment cortisol levels, the disclusion times, and muscular comparisons (P<.05), with 95% confidence levels reported.
RESULTS: Mean salivary cortisol levels significantly decreased from 11.43 ±1.48 ng/mL before DTR to 6.57 ±1.20 ng/mL after DTR, which equaled a 4.85 ng/mL reduction (P<.001). DTR significantly reduced the left mean disclusion time from 2.32 ±1.25 seconds to 0.28 ±0.06 seconds (mean difference=2.04 seconds, P<.001) and the right mean disclusion time from 2.60 ±1.97 seconds to 0.28 ±0.05 seconds (mean difference=2.32 seconds, P<.001). The average EMG muscle activities of the bilateral masseter and temporalis muscles increased significantly from pretreatment to 1 month after DTR (P<.001).
CONCLUSIONS: DTR therapy significantly reduced salivary cortisol levels in patients with occlusomuscular TMD. Stress reduction was achieved with high precision, time-based computer-guided occlusal adjustments that controlled the participants' occlusal neurophysiology responsible for their elevated cortisol production.