Cochrane · intervention · CD007261

Interventions for managing temporomandibular joint osteoarthritis

de Souza, RF, Lovato da Silva, CH, Nasser, M, et al. · Cochrane Database of Systematic Reviews · 2012 · Cochrane Library

Oral Health Oral and maxillofacial surgery Temporomandibular disorders and sleep2 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

21

current version

GRADE rated

0

No studies

6

Included studies

3

as reported

No studies 6 · 28.6%Ungraded 15 · 71.4%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Adults over the age of 18 with clinical and/or radiological diagnosis of TMJ osteoarthritis (TMJ OA) according to the RDC/TMD guideline; trials compatible with the RDC/TMD diagnosis also considered; studies with two or more types of TMD included only if separate TMJ OA data were provided; people with polyarthropathies excluded	Adults (>18 years) with TMJ OA per RDC/TMD or compatible criteria; 114 participants across three trials, all recruited in university clinics (n=114)
Intervention	Any form of non-surgical or surgical therapy for TMJ osteoarthritis	Intra-articular sodium hyaluronate (n=1 study); Diclofenac sodium (n=1 study); Glucosamine sulfate (n=1 study)
Comparison	Each other; Placebo; No therapy	Intra-articular corticosteroids/betamethasone (n=1 study); Occlusal splint therapy (n=1 study); Ibuprofen (n=1 study)
Outcomes	Pain/tenderness/discomfort in the TMJs or jaw muscles (validated pain scale); Extent of mandibular movement (maximum jaw opening, lateral movement, protrusion); Subjective TMJ sounds; Quality of life or patient satisfaction (validated questionnaire); Morphological changes of the TMJs (imaging); TMJ sounds by auscultation; Number of visits; Number of days absent from work; Mean operating time and duration of hospital admission; Adverse events; Direct costs of therapy and hospital bed	Reported pain/tenderness of the TMJ and masticatory muscles (n=3 studies); Extent of mandibular movement (n=2 studies with extractable data); Presence of TMJ sounds (n=1 study); Adverse effects/complications (n=3 studies); Morphological changes by CT (n=1 study, not extractable)
Study designs	Randomised controlled trials (RCTs)	RCT (n=3 studies)
Timing	Not specified	Follow-up 14 days to 6 months (Bjornland 2007); 1 week to 3 months (Mejersjo 2008); 90 days (Thie 2001)

Search date: 2011-09. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (Ovid); Embase (Ovid); Physiotherapy Evidence Database (PEDro)

Questions and results

Current version only

Intra-articular injection of sodium hyaluronate vs Intra-articular injection of corticosteroids (betamethasone)

Population: Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

CD007261.PUB2 (current) · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Pain on palpation of the affected/contralateral TMJ and masticatory muscles 14 days to 6 months same question in other reviews	Pain on palpation of the affected and contralateral TMJ and masticatory muscles presented similar frequencies regardless of the time (Analyses 1.4-1.12); no statistically significant differences reported. Point…	1 study · 40 participants	Ungraded
Extent of mandibular movement (maximum jaw opening, lateral and contralateral movement, jaw protrusion) 14 days to 6 months same question in other reviews	None of the mean differences between interventions for the measures of jaw movements (maximum jaw opening, lateral movement to affected side, contralateral movement, jaw protrusion; Analyses 1.16-1.27) showed…	1 study · 40 participants	Ungraded
Presence of TMJ sounds 14 days same question in other reviews	RR 0.59 [0.37, 0.95]	1 study · 40 participants	Ungraded
Complications (adverse effects) same question in other reviews	RR 1.20 [0.44, 3.30]	1 study · 40 participants	Ungraded
Reported pain (mm on VAS) 6 months same question in other reviews	MD -17.00 [-32.60, -1.40]	1 study · 40 participants	Ungraded

Diclofenac sodium (oral NSAID) vs Occlusal splint therapy

Population: Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

CD007261.PUB2 (current) · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Complications (adverse effects) same question in other reviews	RR 1.07 [0.50, 2.28]	1 study · 29 participants	Ungraded
Morphological changes of the TMJs (assessed by CT) same question in other reviews	The study reports morphological changes assessed by CT for the entire sample without distinction of group, so extraction was not possible.	1 study	Ungraded
Pain (on movement and on palpation of the affected TMJ) 1 week and 3 months same question in other reviews	Data for pain on movement or pain on palpation of the affected TMJ (both at 1 week and 3 months) could not be extracted, as they are described as percentages of an unclear total number. Narratively, diclofenac sodium…	1 study	Ungraded

Glucosamine sulfate (oral) vs Ibuprofen (oral)

Population: Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

CD007261.PUB2 (current) · 7 questions

Outcome	Effect	Evidence	Status / GRADE
Maximum voluntary jaw opening (mm), change from baseline 90 days same question in other reviews	MD 3.08 [-0.97, 7.13]	1 study · 45 participants	Ungraded
Reported pain (mm on VAS), change from baseline 90 days same question in other reviews	MD -4.57 [-9.91, 0.77]	1 study · 45 participants	Ungraded
Brief Pain Inventory (BPI) - pain intensity, change from baseline 90 days same question in other reviews	MD -2.69 [-7.38, 2.00]	1 study · 45 participants	Ungraded
Extraoral masticatory muscle tenderness (number of tender sites), change from baseline 90 days same question in other reviews	MD 0.38 [-2.30, 3.06]	1 study · 45 participants	Ungraded
Pain-free maximum jaw opening (mm), change from baseline 90 days same question in other reviews	MD 1.75 [-4.10, 7.60]	1 study · 45 participants	Ungraded
Brief Pain Inventory (BPI) - pain interference, change from baseline 90 days same question in other reviews	MD -6.74 [-14.70, 1.22]	1 study · 45 participants	Ungraded
Pain during function (proportion without significant improvement) 90 days same question in other reviews	Six participants in the glucosamine group did not experience significant improvement in TMJ pain compared with seven in the ibuprofen group (Analysis 3.1); Fisher's exact test P = 0.73 (not significant, per the authors).	1 study · 45 participants	Ungraded

Reassurance / behavioral management (control of contributory factors)

Population: Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

CD007261.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	The review noted the noticeable absence of evidence for reassurance among interventions for TMJ OA; no eligible RCT evaluated it (Discussion).	0 studies	No studies

Physiotherapy modalities (physiotherapy, short-wave diathermy, ultrasound)

Population: Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

CD007261.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	The review noted the noticeable absence of evidence for physiotherapy, short-wave diathermy and ultrasound; no eligible RCT evaluated these (Discussion).	0 studies	No studies

Iontophoretically applied corticosteroids

Population: Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

CD007261.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	The review noted the noticeable absence of evidence for iontophoretically applied corticosteroids; no eligible RCT evaluated it (Discussion).	0 studies	No studies

Laser therapy

Population: Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

CD007261.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	The review noted the noticeable absence of evidence for laser therapy; no eligible RCT evaluated it (Discussion).	0 studies	No studies

Open TMJ surgery (arthroplasty / total joint replacement)

Population: Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

CD007261.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	No study evaluated open surgery for TMJ OA, which should be explored in future trials (Research recommendations Table 1; Discussion).	0 studies	No studies

Arthrocentesis

Population: Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

CD007261.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	No study evaluated arthrocentesis for TMJ OA, which should be explored in future trials (Research recommendations Table 1).	0 studies	No studies

Any non-surgical or surgical therapy for TMJ OA vs Another therapy, placebo, or no treatment

Population: Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

CD007261 · 11 questions

Outcome	Effect	Evidence	Status / GRADE
Pain/tenderness/discomfort in the TMJs or jaw muscles (validated pain scale)	Planned outcome specified in the protocol; no included studies at protocol stage (protocol published 2008).	0 studies	No studies
Quality of life or patient satisfaction (validated questionnaire)	Planned outcome specified in the protocol; no included studies at protocol stage (protocol published 2008).	0 studies	No studies
Extent of mandibular movement (maximum jaw opening, lateral movement, protrusion)	Planned outcome specified in the protocol; no included studies at protocol stage (protocol published 2008).	0 studies	No studies
Morphological changes of the TMJs (assessed by imaging)	Planned outcome specified in the protocol; no included studies at protocol stage (protocol published 2008).	0 studies	No studies
Number of visits	Planned outcome specified in the protocol; no included studies at protocol stage (protocol published 2008).	0 studies	No studies
Adverse events / complications	Planned outcome specified in the protocol; no included studies at protocol stage (protocol published 2008).	0 studies	No studies
Subjective TMJ sounds (as perceived by patients)	Planned outcome specified in the protocol; no included studies at protocol stage (protocol published 2008).	0 studies	No studies
Costs (direct costs of therapy and hospital bed)	Planned outcome specified in the protocol; no included studies at protocol stage (protocol published 2008).	0 studies	No studies
Number of days absent from work	Planned outcome specified in the protocol; no included studies at protocol stage (protocol published 2008).	0 studies	No studies
TMJ sounds assessed by auscultation	Planned outcome specified in the protocol; no included studies at protocol stage (protocol published 2008).	0 studies	No studies
Mean operating time and duration of hospital admission (surgical studies)	Planned outcome specified in the protocol; no included studies at protocol stage (protocol published 2008).	0 studies	No studies