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. 2012 Apr 18;2012(4):CD007261.
doi: 10.1002/14651858.CD007261.pub2.

Interventions for the management of temporomandibular joint osteoarthritis

Raphael Freitas de Souza  1 , Claudia H Lovato da Silva, Mona Nasser, Zbys Fedorowicz, Mohammed A Al-Muharraqi
Affiliations

Interventions for the management of temporomandibular joint osteoarthritis

Raphael Freitas de Souza et al. Cochrane Database Syst Rev. .

Abstract

Background: Osteoarthritis (OA) is the most common form of arthritis of the temporomandibular joint (TMJ), and can often lead to severe pain in the orofacial region. Management options for TMJ OA include reassurance, occlusal appliances, physical therapy, medication in addition to several surgical modalities.

Objectives: To investigate the effects of different surgical and non-surgical therapeutic options for the management of TMJ OA in adult patients.

Search methods: We searched the following databases: the Cochrane Oral Health Group Trials Register (to 26 September 2011); CENTRAL (The Cochrane Library 2011, Issue 3); MEDLINE via OVID (1950 to 26 September 2011); EMBASE via OVID (1980 to 26 September 2011); and PEDro (1929 to 26 September 2011). There were no language restrictions.

Selection criteria: Randomised controlled trials (RCTs) comparing any form of non-surgical or surgical therapy for TMJ OA in adults over the age of 18 with clinical and/or radiological diagnosis of TMJ OA according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guideline or compatible criteria.Primary outcomes considered were pain/tenderness/discomfort in the TMJs or jaw muscles, self assessed range of mandibular movement and TMJ sounds. Secondary outcomes included the measurement of quality of life or patient satisfaction evaluated with a validated questionnaire, morphological changes of the TMJs assessed by imaging, TMJ sounds assessed by auscultation and any adverse effects.

Data collection and analysis: Two review authors screened and extracted information and data from, and independently assessed the risk of bias in the included trials.

Main results: Although three RCTs were included in this review, pooling of data in a meta-analysis was not possible due to wide clinical diversity between the studies. The reports indicate a not dissimilar degree of effectiveness with intra-articular injections consisting of either sodium hyaluronate or corticosteroid preparations, and an equivalent pain reduction with diclofenac sodium as compared with occlusal splints. Glucosamine appeared to be just as effective as ibuprofen for the management of TMJ OA.

Authors' conclusions: In view of the paucity of high level evidence for the effectiveness of interventions for the management of TMJ OA, small parallel group RCTs which include participants with a clear diagnosis of TMJ OA should be encouraged and especially studies evaluating some of the possible surgical interventions.

PubMed Disclaimer

Conflict of interest statement

There are no financial conflicts of interest and the review authors declare that they do not have any associations with any parties who may have vested interests in the results of this review.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 1.3. Reported pain (mm on VAS), 6 months.
5
5
Forest plot of Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 1.6. Pain on palpation of the affected TMJ, after 6 months.
6
6
Forest plot of Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 1.9. Pain on palpation of the contralateral TMJ, after 6 months.
7
7
Forest plot of Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 1.12. Pain on palpation of the masticatory muscles, after 6 months.
8
8
Forest plot of Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 1.18. Maximum jaw opening (mm), 6 months.
9
9
Forest plot of Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 1.21. Lateral movement to affected side (mm), 6 months.
10
10
Forest plot of Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 1.24. Contralateral movement (mm), 6 months.
11
11
Forest plot of Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 1.27. Jaw protrusion (mm), 6 months.
1.1
1.1. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 1 Reported pain (mm on VAS), 14 days.
1.2
1.2. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 2 Reported pain (mm on VAS), 1 month.
1.3
1.3. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 3 Reported pain (mm on VAS), 6 months.
1.4
1.4. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 4 Pain on palpation of the affected TMJ, after 14 days.
1.5
1.5. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 5 Pain on palpation of the affected TMJ, after 1 month.
1.6
1.6. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 6 Pain on palpation of the affected TMJ, after 6 months.
1.7
1.7. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 7 Pain on palpation of the contralateral TMJ, after 14 days.
1.8
1.8. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 8 Pain on palpation of the contralateral TMJ, after 1 month.
1.9
1.9. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 9 Pain on palpation of the contralateral TMJ, after 6 months.
1.10
1.10. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 10 Pain on palpation of the masticatory muscles, after 14 days.
1.11
1.11. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 11 Pain on palpation of the masticatory muscles, after 1 month.
1.12
1.12. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 12 Pain on palpation of the masticatory muscles, after 6 months.
1.13
1.13. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 13 Presence of TMJ sounds, after 14 days.
1.14
1.14. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 14 Presence of TMJ sounds, after 1 month.
1.15
1.15. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 15 Presence of TMJ sounds, after 6 months.
1.16
1.16. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 16 Maximum jaw opening (mm), 14 days.
1.17
1.17. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 17 Maximum jaw opening (mm), 1 month.
1.18
1.18. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 18 Maximum jaw opening (mm), 6 months.
1.19
1.19. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 19 Lateral movement to affected side (mm), 14 days.
1.20
1.20. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 20 Lateral movement to affected side (mm), 1 month.
1.21
1.21. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 21 Lateral movement to affected side (mm), 6 months.
1.22
1.22. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 22 Contralateral movement (mm), 14 days.
1.23
1.23. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 23 Contralateral movement (mm), 1 month.
1.24
1.24. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 24 Contralateral movement (mm), 6 months.
1.25
1.25. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 25 Jaw protrusion (mm), 14 days.
1.26
1.26. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 26 Jaw protrusion (mm), 1 month.
1.27
1.27. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 27 Jaw protrusion (mm), 6 months.
1.28
1.28. Analysis
Comparison 1 Comparison 1. Sodium hyaluronate versus corticosteroids, Outcome 28 Post‐surgical complications.
2.1
2.1. Analysis
Comparison 2 Comparison 2. Diclofenac sodium versus occlusal splint, Outcome 1 Post‐surgical complications.
3.1
3.1. Analysis
Comparison 3 Comparison 3. Glucosamine sulfate versus ibuprofren, Outcome 1 Pain during function, after 90 days.
3.2
3.2. Analysis
Comparison 3 Comparison 3. Glucosamine sulfate versus ibuprofren, Outcome 2 Reported pain (mm on VAS), change from baseline at 90 days.
3.3
3.3. Analysis
Comparison 3 Comparison 3. Glucosamine sulfate versus ibuprofren, Outcome 3 Pain‐free maximum jaw opening (mm), change from baseline at 90 days.
3.4
3.4. Analysis
Comparison 3 Comparison 3. Glucosamine sulfate versus ibuprofren, Outcome 4 Maximum jaw opening (mm), change from baseline at 90 days.
3.5
3.5. Analysis
Comparison 3 Comparison 3. Glucosamine sulfate versus ibuprofren, Outcome 5 BPI questionnaire ‐ pain intensity (VAS), change from baseline at 90 days.
3.6
3.6. Analysis
Comparison 3 Comparison 3. Glucosamine sulfate versus ibuprofren, Outcome 6 BPI questionnaire ‐ pain interference (VAS), change from baseline at 90 days.
3.7
3.7. Analysis
Comparison 3 Comparison 3. Glucosamine sulfate versus ibuprofren, Outcome 7 Masticatory muscle tenderness (= number of tender sites/14), change from baseline at 90 days.
See this image and copyright information in PMC

Comment in

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