Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

153 questions · 168 findings · 14 reviews · Oral and maxillofacial surgery

No studies found 61 · 36.3%GRADE not reported 58 · 34.5%Very low 29 · 17.3%Low 16 · 9.5%Moderate 4 · 2.4%High 0 · 0%

Antifibrinolytic therapy (tranexamic acid or epsilon aminocaproic acid) vs Placebo, no intervention or usual care (with or without placebo)

Side effects or other adverse events · People with haemophilia (A or B) undergoing minor oral surgery or dental extractions

Antifibrinolytic therapy (tranexamic acid or epsilon aminocaproic… showed no clear difference in side effects or other adverse events compared with placebo, no intervention or usual care (with or without placebo) (low certainty).

1 finding from 1 review

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA) mouthwash/solution (SoF eligibility: TXA or EACA; all included trials used topical TXA) vs standard local care

Major bleeding, requiring transfusion of packed red blood cells · People on continuous VKA treatment undergoing minor oral surgery or dental extractions (eligibility included DOACs and all ages; all four…

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA)… showed no clear difference in major bleeding requiring transfusion of packed red blood cells compared with standard care (usual local haemostatic measures: gelatin sponge and…; GRADE not reported.

1 finding from 1 review

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA) mouthwash/solution (SoF eligibility: TXA or EACA; all included trials used topical TXA) vs Placebo mouthwash

Number of thromboembolic complications · People on continuous VKA treatment undergoing minor oral surgery or dental extractions (eligibility included DOACs and all ages; all four…

The review found no eligible studies for this question.

1 finding from 1 review

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA) mouthwash/solution (SoF eligibility: TXA or EACA; all included trials used topical TXA) vs standard local care

Number of participants with postoperative bleedings requiring intervention · People on continuous VKA treatment undergoing minor oral surgery or dental extractions (eligibility included DOACs and all ages; all four…

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA)… showed no clear difference in number of participants with postoperative bleedings requiring… compared with standard care (usual local haemostatic measures: gelatin sponge and… (moderate certainty).

1 finding from 1 review

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA) mouthwash/solution (SoF eligibility: TXA or EACA; all included trials used topical TXA) vs Placebo mouthwash

Number of minor postoperative bleeding episodes · People on continuous VKA treatment undergoing minor oral surgery or dental extractions (eligibility included DOACs and all ages; all four…

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA)… showed no clear difference in number of minor postoperative bleeding episodes compared with placebo (placebo solution/mouthwash); GRADE not reported.

1 finding from 1 review

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA) mouthwash/solution (SoF eligibility: TXA or EACA; all included trials used topical TXA) vs Placebo mouthwash

Bleeding duration (minutes, all types of bleeding, minor and major) · People on continuous VKA treatment undergoing minor oral surgery or dental extractions (eligibility included DOACs and all ages; all four…

The review found no eligible studies for this question.

1 finding from 1 review

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA) mouthwash/solution (SoF eligibility: TXA or EACA; all included trials used topical TXA) vs Placebo mouthwash

Adverse effects requiring withdrawal/discontinuation of study medication · People on continuous VKA treatment undergoing minor oral surgery or dental extractions (eligibility included DOACs and all ages; all four…

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA)… showed no clear difference in side effects or other adverse events requiring withdrawal compared with placebo (placebo solution/mouthwash) (moderate certainty).

1 finding from 1 review

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA) mouthwash/solution (SoF eligibility: TXA or EACA; all included trials used topical TXA) vs Placebo mouthwash

Change in haemoglobin level from baseline · People on continuous VKA treatment undergoing minor oral surgery or dental extractions (eligibility included DOACs and all ages; all four…

The review found no eligible studies for this question.

1 finding from 1 review

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA) mouthwash/solution (SoF eligibility: TXA or EACA; all included trials used topical TXA) vs Placebo mouthwash

Major bleeding, requiring transfusion of packed red blood cells · People on continuous VKA treatment undergoing minor oral surgery or dental extractions (eligibility included DOACs and all ages; all four…

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA)… showed no clear difference in major bleeding requiring transfusion of packed red blood cells compared with placebo (placebo solution/mouthwash); GRADE not reported.

1 finding from 1 review

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA) mouthwash/solution (SoF eligibility: TXA or EACA; all included trials used topical TXA) vs Placebo mouthwash

Number of immediate (less than 24 hours) and delayed (24 hours to 10 days) postoperative bleeding episodes requiring intervention · People on continuous VKA treatment undergoing minor oral surgery or dental extractions (eligibility included DOACs and all ages; all four…

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA)… led to lower number of immediate and delayed postoperative bleeding episodes… compared with placebo (placebo solution/mouthwash); GRADE not reported.

1 finding from 1 review

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA) mouthwash/solution (SoF eligibility: TXA or EACA; all included trials used topical TXA) vs Placebo mouthwash

Any postoperative complication except bleeding (e.g. wound infection) · People on continuous VKA treatment undergoing minor oral surgery or dental extractions (eligibility included DOACs and all ages; all four…

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA)… showed no clear difference in any postoperative complication except bleeding (e.g. wound infection) compared with placebo (placebo solution/mouthwash); GRADE not reported.

1 finding from 1 review

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA) mouthwash/solution (SoF eligibility: TXA or EACA; all included trials used topical TXA) vs Placebo mouthwash

Number of participants with postoperative bleedings requiring intervention · People on continuous VKA treatment undergoing minor oral surgery or dental extractions (eligibility included DOACs and all ages; all four…

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA)… probably leads to lower number of participants with postoperative bleedings requiring… compared with placebo (placebo solution/mouthwash) (moderate certainty).

1 finding from 1 review

Antifibrinolytic therapy - locally-applied tranexamic acid (TXA) mouthwash/solution (SoF eligibility: TXA or EACA; all included trials used topical TXA) vs Placebo mouthwash

Amount of postoperative blood loss (mL) · People on continuous VKA treatment undergoing minor oral surgery or dental extractions (eligibility included DOACs and all ages; all four…

The review found no eligible studies for this question.

1 finding from 1 review

CBT vs alternative treatment

Reduction in pain intensity · People aged 12 years and over with painful TMD lasting 3 months or longer

Cognitive behavioural therapy (CBT) showed no clear difference in pain intensity at treatment completion compared with alternative (active) treatment (e.g. oral splint, medication,… (low certainty).

2 findings from 1 review

CBT vs alternative treatment

Mental distress · People aged 12 years and over with painful TMD lasting 3 months or longer

Cognitive behavioural therapy (CBT) may leads to lower psychological distress at follow-up compared with alternative (active) treatment (e.g. oral splint, medication,… (low certainty).

2 findings from 1 review

CBT vs inactive control (usual care care, attention control, waitlist)

Adverse events · People aged 12 years and over with painful TMD lasting 3 months or longer
1 finding from 1 review
  • Only 1 study reported adverse events as an outcome (Litt 2010): it found worsening symptoms in 13 people treated with an oral splint (as part of standard treatment) and 4 people treated with CBT.
    1 study · 101 participants
    Very low

CBT vs alternative treatment

Additional physical symptoms · People aged 12 years and over with painful TMD lasting 3 months or longer

The review found no eligible studies for this question.

1 finding from 1 review

CBT vs alternative treatment

Disability caused by pain at follow-up · People aged 12 years and over with painful TMD lasting 3 months or longer

Cognitive behavioural therapy (CBT) showed no clear difference in disability caused by pain at treatment completion compared with alternative (active) treatment (e.g. oral splint, medication,… (low certainty).

2 findings from 1 review