Two commentaries on interventions for the management of temporomandibular joint osteoarthritis

Abstract

Data sources: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase and PEDro databases were searched with no language restrictions. Handsearching of a number of relevant dental journals and the reference lists of identified articles was also conducted.

Study selection: Randomised controlled trials (RCTs) comparing any form of non-surgical or surgical therapy for TMJ OA in adults were included. Only studies with clinical and/or radiological diagnosis of TMJ OA according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guideline or compatible criteria were considered. Pain/tenderness/discomfort in the TMJs or jaw muscles, self assessed range of mandibular movement and TMJ sounds were the primary outcomes considered. Secondary outcomes included the measurement of quality of life or patient satisfaction, morphological changes of the TMJ and TMJ sounds

Data extraction and synthesis: Study selection, data abstraction and risk of bias assessment were carried out independently by two reviewers. Meta-analysis was not conducted owing to clinical heterogeneity.

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.

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.