825 final Effec&veness of Behavioral and Lifestyle Changes in Reducing TMD Symptoms: Evidence from a Structured Interven&on Vol 13 No 1 (2025) DOI 10.5195/d3000.2025.825 h#p://den*stry3000.pi#.edu Effectiveness of Behavioral and Lifestyle Changes in Reducing TMD Symptoms: Evidence from a Structured Intervention Dunya Malhan Hanweet, Karar Abdulzahra Mahdi, Ansam Mahdi Khalel, Salah M. Ibrahim Faculty of Dentistry, Kufa University, Najaf, Iraq Abstract Objec>ve: To assess the effec+veness of behavioral measures in managing TMDs with an emphasis on pain, joint mobility and psychosocial status. Methods: Forty-eight subjects with TMDs were enrolled based on the RDC/TMD criteria. Stress management, ergonomics training, dietary changes and stretching exercises were recommended as individualized lifestyle plans. The clinical, psychosocial and func+onal evalua+ons were done before and aGer three months of interven+on. Results: The frequency of myofascial pain without limited mouth opening was 45. 8% which was reduced to 20. The percentage of subjects with right and leG TMJ arthralgia was also seen to have reduced significantly (70. 8% to 43. 7%, p = 0. 0133; 75% to 41. 6%, p = 0. 001). Right TMJ osteoarthrosis and osteoarthri+s showed a considerable improvement (p < 0. 05) while the changes in the leG TMJ were not significant. Disc displacement with reduc+on on the right and without reduc+on on the leG side was also found to have improved markedly (p = 0. 036; p = 0. 041). Depression severity was also found to have reduced significantly with the normal levels increasing from 45. 8% to 83. 3% (p < 0. 05). Pain intensity as measured by VAS also reduced from 4. 72 ± 1. 44 to 3. 43 ± 1. 38 (p = 0. 001). There was also an enhancement in the non-specific physical symptoms but the differences were not sta+s+cally significant. Conclusions: The present study demonstrated that the implementa+on of lifestyle modifica+ons helps in decreasing the symptoms of TMD, increases the joint func+on and has a posi+ve effect on the psychosocial status of the pa+ents and therefore should be considered as the first- line treatment in the management of TMD. Keywords: Stress management; Ergonomics; Dietary changes; Stretching exercises. Cita9on: Hanweet DM, et al. (2025) Effec9veness of Behavioral and Lifestyle Changes in Reducing TMD Symptoms: Evidence from a Structured Interven9on. Den9stry 3000. 1:a001 doi:10.5195/d3000.2025.825 Received: January 12, 2025 Accepted: February 11, 2025 Published: February 14, 2025 Copyright: ©2025 Hanweet DM, et al. This is an open access ar9cle licensed under a Crea9ve Commons AZribu9on Work 4.0 United States License. Email: Salahm.abrahem@uokufa.edu.iq Introduction Temporomandibular disorders, or TMDs, are a group of diseases that affect the temporomandibular joint, masticatory muscles, and the other structures around it. TMDs are defined by pain, limited functionality, and auditory manifestations, including clicking or crepitus [1]. They are common in the international community with important consequences for oral health, quality of life, and health care expenses. Causes of TMD include occlusal irregularities, parafunctional habits, stress, and some systemic diseases [2]. However, non- invasive treatments are still the mainstay of managing these disorders even with the new pharmacological and surgical management [3]. Lifestyle changes have been identified as a way of managing TMDs, as they help manage the variables that can be altered [4]. Changes in behavior that include stress management, proper posture, changes in diet, and regular exercise have been seen to decrease muscle tension and Effec&veness of Behavioral and Lifestyle Changes in Reducing TMD Symptoms: Evidence from a Structured Interven&on Vol 13 No 1 (2025) DOI 10.5195/d3000.2025.825 h#p://den*stry3000.pi#.edu improve the joint’s flexibility, thus improving the overall health of patients [5]. These include relaxation techniques, ergonomic measures, and certain stretching and strengthening exercises for the TMJ and surrounding muscles that may be helpful in the management of symptoms in the long term [6]. This paper highlights the need to adopt a holistic view when managing TMDs, as evidenced by the relationship between lifestyle and TMJ health. Knowing which lifestyle factors may aggravate or reduce TMD symptoms will help patients and healthcare providers find the right direction for a noninvasive treatment. This research therefore seeks to assess the effectiveness of lifestyle alterations on TMJ health and their efficacy in decreasing TMD symptoms to suggest best practice for their application in the clinical setting. To enable individuals with TMDs to be more involved in the management of their condition and enhance their quality of life, this study seeks to encourage and support the implementation of cost-efficient measures. Material and Methods Study Design A prospective interventional study was used to determine the efficacy of lifestyle changes in managing TMD. The study design involved 62 participants who were followed up for three months during which the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used to determine the diagnosis and intensity of the symptoms of the participants before and after the lifestyle changes. At the end of the assessment period, only 48 patients committed to the instructions, and all other uncommitted participants were excluded. The inclusion criteria were as follows: adults between the ages of 18-60 years with primary TMD as per RDC/TMD, reporting at least one of the symptoms which include pain, joint sounds or limited jaw function. The history of TMJ surgery, systemic diseases that affect the TMJ including rheumatoid arthritis, or concurrent medication or physical therapy for TMDs was excluded from the study. Baseline Assessment: 1. Clinical Examination: The RDC/TMD Axis 1 protocol [7] involved a trained oral medicine specialist who conducted a structured procedure for assessing pain (through palpation), joint sounds like clicking or crepitus, and the range of motion of the mandible. 2. Symptom Severity: Pain intensity was measured using the Visual Analog Scale (VAS). 3. Psychosocial Assessment: RDC/TMD Axis II criteria were used to assess psychological distress and parafunctional habits. Intervention: All participants were given individualized lifestyle change guidelines that included the following: All participants received a written personalized lifestyle modification plan, including: 1. Stress management measures such as mindfulness, deep breathing, and meditation. 2. Ergonomic training with video record reference to teach participants correct posture. 3. Dietary changes that entail avoiding hard or chewy foods and using small bites during food chewing. 4. Exercises for the neck and TMJ region to be done regularly. 5. Sleep quality improvement. The participants were then reassessed for myofascial pain using the same RDC/TMD criteria and scales three months after the intervention. Effec&veness of Behavioral and Lifestyle Changes in Reducing TMD Symptoms: Evidence from a Structured Interven&on Vol 13 No 1 (2025) DOI 10.5195/d3000.2025.825 h#p://den*stry3000.pi#.edu Chi-square test and Fisher’s exact test were used to test the differences between the records before and after intervention, which was significant at a level of a p-value < 0.05. Results As shown in table 1, iniaally, a large proporaon of paaents had myofascial pain without limited mouth opening (45.8%), which significantly decreased to 20.8% (p=0.0172). A reducaon in number of right TMJ arthralgia cases also was recorded from 70.8% to 43.7% (p=0.0133), while lee TMJ arthralgia decreased from 75% to 41.6% (p=0.001). Similar records were observed for right TMJ osteoarthrosis (68.7% to 45.8%) with significant difference (p<0.05) and right TMJ osteoarthrias, which also was significantly reduced in the second records (P-value <0.05). while the reducaons in lee TMJ osteoarthrosis and osteoarthrias were not staasacally significant (P-value >0.05). Table 1. TMD symptoms (RDC/TMD Axis I for paaents before and aeer 3 months from intervenaon (* Chi-square test. P-value A:er 3 months (n=48) Before intervenDon (n=48) 0.0172* 10(20.8%) 22(45.8%) Myofascial pain without limited mouth opening 0.0133* 21(43.7%) 34(70.8%) Right TMJ Arthralgia 0.001* 20(41.6%) 36(75%) Lee TMJ Arthralgia 0.0107* 22(45.8) 33(68.7) Right TMJ Osteoarthrosis 0.25* 7(14.5%) 12(25%) Lee TMJ Osteoarthrosis 0.022* 6(12.5%) 17(35.4%) Right TMJ Osteoarthrias Effec&veness of Behavioral and Lifestyle Changes in Reducing TMD Symptoms: Evidence from a Structured Interven&on Vol 13 No 1 (2025) DOI 10.5195/d3000.2025.825 h#p://den*stry3000.pi#.edu 0.317* 6(12.5%) 18(37.5%) Lee TMJ Osteoarthrias 0.036* 18(37.5%) 33(68.7) Right disc displacement with reducaon 0.157* 6(12.5%) 12(25%) Right disc displacement without reducaon 0.128* 13(27%) 22(45.8) Lee disc displacement with reducaon 0.041* 9(18.7%) 20(41.6%) Lee disc displacement without reducaon Effec&veness of Behavioral and Lifestyle Changes in Reducing TMD Symptoms: Evidence from a Structured Interven&on Vol 13 No 1 (2025) DOI 10.5195/d3000.2025.825 h#p://den*stry3000.pi#.edu Table 2. RDC/TMD Axis II levels of depression and non-specific physical symptoms for paaents before and aeer 3 months of intervenaon (*Chi-square test, **Fisher’s exact test). Table 3. Visual Analogue Scale before and aeer intervenaon (Paired t-test). . Depression P-value Non-specific physical symptoms P-value Iniaal records n=48 Aeer 3 months n=48 Iniaal records n=48 Aeer 3 months n=48 Normal 22(45.8) 40(83.3%) 0.022* 26 30 0.596* Moderate 16(33.3%) 6(12.5%) 0.033* 13 12 0.841* Severe 10(20.8%) 2(4.2%) 0.016** 9 6 0.439* n VAS Mean (SD) P-value Before treatment 48 4.72 (1.44) 0.001* Aeer treatment 48 3.43 (1.38) Effec&veness of Behavioral and Lifestyle Changes in Reducing TMD Symptoms: Evidence from a Structured Interven&on Vol 13 No 1 (2025) DOI 10.5195/d3000.2025.825 h#p://den*stry3000.pi#.edu For disc displacement condiaons there was a notable change. The number of paaents with right disc displacement with reducaon declined from 68.7% to 37.5% (p=0.036), while the number with lee disc displacement without reducaon decreased significantly too (41.6% to 18.7%, p=0.041). Depression levels also showed improvement, the percentage of paracipants with normal levels increased significantly from 45.8% to 83.3% (P-value < 0.05). Moderate and severe depression raaos showed significant reducaons too (P- value < 0.05). Although there were slight improvements in non-specific physical symptoms, changes were not staasacally significant across severity levels (e.g., severe symptoms reduced slightly from 9 to 6 paracipants, p=0.439) (Table2). As in Table 3, pain intensity measured by VAS scores significantly decreased from a mean of 4.72 (±1.44) before treatment to 3.43 (±1.38) in the final record (p=0.001). Discussion The results of this research also show that there are huge advantages of lifestyle changes in managing symptoms and clinical diagnoses of temporomandibular joint disorder. TMJ disorders are acute and chronic pain, dysfunction and structural changes of the joint which are often complicated for the patient and the healthcare giver. It shows that focusing on the factors that can be changed can help to decrease the symptoms and increase the quality of life of the patient. The best result was the enhancement of TMJ-related diagnosis after the intervention. Some of the diseases that were observed include myofascial pain, arthralgia and osteoarthrosis which revealed a decrease especially on the right side. These changes depict that non-invasive measures can also be used in the management of not only muscular aches but also joint dysfunctions [8]. The reduction in osteoarthritis severity also supports the notion that lifestyle changes may help in lessening degenerative processes which may include reduction of joint stress and inflammation [9]. However, there were no significant changes in some of the conditions on the left side suggesting possibly different responses which could be attributed by factors such as the asymmetry of TMJ loading or differing ability of individuals to adapt to the intervention. About disc displacement conditions, the improvements seen point to the potential of behavioral changes to enhance joint dynamics. Changes in parafunctional habits and mandibular positioning using stress management, posture alignment, and dietary changes may be useful in the restoration of disc positioning and Effec&veness of Behavioral and Lifestyle Changes in Reducing TMD Symptoms: Evidence from a Structured Interven&on Vol 13 No 1 (2025) DOI 10.5195/d3000.2025.825 h#p://den*stry3000.pi#.edu enhancement of joint stability [10]. These results also support the notion that the management of TMJ disorders should encompass the treatment of the biomechanical and behavioral factors that lead to the condition, in an addition to other noninvasive types of management like sleep quality improvement and diet habit correction [11,12]. Pain and psychological well- being were also found to have improved markedly after the intervention. The reduction in pain intensity is very promising especially because pain is a major factor that affects the quality of life of people with TMJ disorders [13]. The decrease in depressive symptoms also supports the link between psychological health and pain. Some of the lifestyle changes that are recommended also help in reducing stress and thus have the potential of improving the physical wellbeing of an individual and the mental health as well. This is an important finding because mood disorders are known to worsen the TMD and may interfere with the treatment process [14]. However, the changes in the non-specific physical symptoms were not statistically significant therefore suggesting that these changes might not have been significant or consistent within the study sample. This shows that there is still a need to explore more about these symptoms and how they are related to TMD. Further research could also examine whether longer durations of intervention or more individualized management plans may produce better results in this regard. The findings of this study support the need to take a systemic approach when managing TMJ disorders. Many surgical and pharmacological strategies were tested in previous research for the management of TMD [15-17]. This paper shows that behavioral, lifestyle and dietary changes can be as effective as pharmacological and surgical interventions but at a cheaper and with no side effects [18-20]. Modifying these behavioral, postural and dietary factors can help manage the various symptoms of TMDs therefore offering a complete management plan [21-23]. This implies that there could be differences in the response rates based on the diagnosis and the symptom profiles hence possibly needing tailored treatment plans to enhance the best results. Conclusion This research shows that implemenang lifestyle changes is an effecave way of enhancing the TMJ and thus reducing the severity of TMDs. The reducaon of pain, psychological distress and the pathologies of the TMJ demonstrates the effecaveness of these intervenaons to Effec&veness of Behavioral and Lifestyle Changes in Reducing TMD Symptoms: Evidence from a Structured Interven&on Vol 13 No 1 (2025) DOI 10.5195/d3000.2025.825 h#p://den*stry3000.pi#.edu improve the quality of life of the sufferers. Further research should also entail the enhancement of these measures, the evaluaaon of their maintenance over ame and the assessment of the results in different people and environments. A ailability o data Data are v e o re e t to t e corres o g t or Financial support and sponsorship No e Con icts o interest ere re o conflict of tere t. References 1. Kapos FP, Exposto FG, Oyarzo JF, Durham J. Temporomandibular disorders: a review of current concepts in eaology, diagnosis and management. Oral Surg. 2020 Nov;13(4):321-34. 2. Matheson EM, Fermo JD, Blackwelder RS. Temporomandibular disorders: rapid evidence review. Am Fam Physician. 2023 Jan;107(1):52- 8. PMID: 36689971. 3. Vaira LA, De Riu G. Temporomandibular joint disorders: funcaonal and conservaave treatment. J Clin Med. 2023 Jul 19;12(14):4772. 4. Tabrizi R, Shourmaej Y, Pourdanesh F, Shafiei S, Moslemi H. Does lifestyle modificaaon (physical exercise and listening to music) improve symptoms in paaents with temporomandibular disorder? A randomized clinical trial. Natl J Maxillofac Surg. 2024 Jan- Apr;15(1):55-8. DOI: 10.4103/njms.njms_23_23. 5. Bianiene D, Zamaliauskiene R, Kubilius R, Leketas M, Gailius T, Smirnovaite K. Quality of life in paaents with temporomandibular disorders: a systemaac review. Stomatologija. 2018;20:3-9. 6. Keefe FJ, Somers TJ, Marare LM. Psychologic intervenaons and lifestyle modificaaons for arthrias pain management. Rheum Dis Clin North Am. 2008;34:351-68. 7. Dworkin SF, LeResche L. Research diagnosac criteria for temporomandibular disorders: review, criteria, examinaaons and specificaaons, criaque. J Craniomandib Disord Facial Oral Pain. 1992;6(4):301-55. PMID: 1298767. 8. Meyer JD, Torres ER, Grabow ML, Zgierska AE, Teng HY, Coe CL, et al. Benefits of 8- week mindfulness-based stress reducaon or aerobic training on seasonal declines in physical acavity. Med Sci Sports Exerc. 2018;50:1850-8. 9. Dahlström L, Carlsson GE. Temporomandibular disorders and oral health- related quality of life: a systemaac review. Acta Odontol Scand. 2010;68:80-5. 10. Mander DK, Beniwal SK, Kam N, Singh H, Sharma A. Conservaave management of temporomandibular joint disorders: a review. J Adv Med Dent Sci Res. 2023 Sep;11(9):50-5. 11. Rener-Sitar K, John MT, Pusalavidyasagar SS, Bandyopadhyay D, Schiffman EL. Sleep quality in temporomandibular disorder cases. Sleep Med. 2016;25:105- 12. 12. Safour W. Understanding the influence of changes to diet on individuals living with temporomandibular disorder (TMD): an interpreave phenomenological study [dissertaaon]. Canada: McGill University; 2018. 13. De Freitas RF, Ferreira MA, Barbosa GA, Calderon PS. Counselling and self- management therapies for temporomandibular disorders: a systemaac review. J Oral Rehabil. 2013 Nov;40(11):864- 74. 14. Qamar Z, Alghamdi AM, Haydarah NK, Balateef AA, Alamoudi AA, Abumismar MA, et al. Impact of temporomandibular disorders on oral health-related quality of life: a systemaac review and meta-analysis. J Oral Rehabil. 2023 Aug;50(8):706-14. Effec&veness of Behavioral and Lifestyle Changes in Reducing TMD Symptoms: Evidence from a Structured Interven&on Vol 13 No 1 (2025) DOI 10.5195/d3000.2025.825 h#p://den*stry3000.pi#.edu 15. Mahdi KA, Al-Mudhafar MH, Hanweet DM. Platelet-rich plasma injecaon modulates inflammatory cytokines in temporomandibular joint disorders: a cross-secaonal study. J Indian Acad Oral Med Radiol. 2024 Oct-Dec;36(4):422- 5. DOI: 10.4103/jiaomr.jiaomr_90_24. 16. Chrisadis N, Al-Moraissi EA, Barjandi G, Svedenlöf J, Jasim H, Chrisadis M, et al. Pharmacological treatments of temporomandibular disorders: a systemaac review including a network meta-analysis. Drugs. 2024 Jan;84(1):59-81. 17. Andre A, Kang J, Dym H. Pharmacologic treatment for temporomandibular and temporomandibular joint disorders. Oral Maxillofac Surg Clin North Am. 2022 Feb;34(1):49-59. 18. Ibrahim SM, Al- Mizraqchi AS. Comparison of the Anabacterial Acavity of Panax Ginseng and Symphytum Officinale with Metronidazole against P. gingivalis: An MIC and MBC Analysis. The Open Denastry Journal. 2024 May 7;18(1). 19. Ibrahim SM, Al- Mizraqchi AS, Haider J. Metronidazole potenaaaon by panax ginseng and Symphytum officinale: A new strategy for P. gingivalis infecaon control. Anabioacs. 2023 Aug 4;12(8):1288. 20. Ibrahim SM, Al-Hmedat SJ, Alsunboli MH. Histological Study to Evaluate the Effect of Local Applicaaon of Myrtus Communis Oil on Alveolar Bone Healing in Rats. The Open Denastry Journal. 2024 May 7;18(1). 21. Khalel AM, Ali MB, Sadiq MA, Ibrahim SM, Ali SH. DMFT and PUFA Indices in First Permanent Molars of Iraqi Children in Najaf City. Denastry 3000. 2024 Nov 22;12(2). 22. Hassan RS, Hanoon ZA, Ibrahim SM, Alhusseini NB. Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs: A Cross-Secaonal Study. Denastry 3000. 2024 Nov 22;12(2). 23. Ibrahim SM, Abdul- Zahra Al-Hmedat SJ. Role of manual and powered tooth brushes in plaque removal and oral health status (a comparaave study). Indian Journal of Public Health Research & Development. 2019 Aug 1;10(8).