Paucity of evidence for the effectiveness of treatments for temporomandibular joint osteoarthritis

The Dental Elf, 2012

Paucity of evidence for the effectiveness of treatments for temporomandibular joint osteoarthritis » The Dental Elf
The temporomandibular joint (TMJ) as with many of the other joints, can be affected by osteoarthritis (OA).
 This is characterized by progressive destruction of the internal surfaces of the joint which can result in debilitating pain and joint noises.
 Osteoarthritis (OA) is the most common form of arthritis affecting the TMJ.  The aim of this Cochrane Review was to investigate the effects of different surgical and non-surgical therapeutic options for the management of TMJ OA in adult patients.
Detailed search strategies were conducted in Cochrane Oral Health Group Trials Register, The Cochrane Central Database , Medline, Embase and PEDro databases  to identify 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.  There  were  no language restrictions
The main outcomes considered were pain/tenderness/discomfort in the TMJs or jaw muscles, mandibular movement and TMJ sounds.
 Secondary outcomes included quality of life measures, patient satisfaction, morphological changes of the TMJs and any adverse effects.
Three RCTs were included in this review, However 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.
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.
The authors also highlight issues regarding the classification of TMJ disease and the use of recognized criteria to allow comparisons.