OBJECTIVE
The aim of this systematic review with meta-analysis was to evaluate the efficacy of conservative interventions in pain relief in patients with intracapsular temporomandibular disorders (TMD).


METHODS
PubMed, Scopus, and Web of Science were systematically searched until January 1st, 2022 to identify randomized controlled trials (RCTs) presenting patients with diagnosis of intracapsular TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), conservative approaches as interventions, and pain intensity as outcome.


RESULTS
Out of 3372 papers, 13 RCTs were included, with 844 study participants. Most of them (n = 7) investigated the efficacy of splint appliance. Meta-analysis revealed that rehabilitative interventions had a significant overall effect size of 0.75 [0.17, 1.34], reporting splint appliance and laser therapy as significantly effective treatments.


CONCLUSION
Findings of this systematic review with network meta-analysis suggested that conservative approaches might be effective in pain relief of intracapsular TMD patients.

Efficacy of conservative approaches on pain relief in patients with temporomandibular joint disorders: a systematic review with network meta-analysis.

BACKGROUND
The management of temporomandibular disorders (TMDs) requires a comprehensive approach that considers multiple factors, including the impact of oral health-related quality of life (OHRQoL). Through this investigation we aim to assess the impact of OHRQoL played in a TMD-afflicted individual.


METHODS
Using keywords relevant to our research, such as "Oral health related quality of life," "Oral hygiene," "Temporomandibular joint" and "Temporomandibular disorders," a comprehensive search across multiple online databases was carried out, yielding a total of 632 studies at the preliminary stage of the review. Modified New Castle Ottawa scale was used to assess the quality of studies included.


RESULTS
Eight studies were included in the review, out of which six were eligible for further meta-analysis. The studies included in this review employed various OHRQoL measures, including the Oral Health Impact Profile - 14(OHIP - 14), the Short-Form 36 Health Survey (SF-36), and the OHIP -49. All the studies demonstrated significant effect of TMDs on the OHRQoL of the target population under study.


CONCLUSION
The impact of OHRQoL on the management of TMD was deemed to be significant. The comprehensive management of TMD should consider the impact of the condition on the individual's daily life and incorporate interventions that address both the physical and psychological aspects of the condition. By improving OqL, individuals with TMD can experience improved overall well-being and quality of life.

Impact of temporomandibular disorders on Oral Health Related Quality of Life: A systematic review and meta-analysis.

OBJECTIVE
Fractures of the mandibular condyle are the most common jaw fractures. There are several treatment approaches. There is the nonsurgical and surgical approach. The purpose of this systematic literature review is to evaluate the indications and contraindications of either method to help the clinician make the best treatment choice.


MATERIALS AND METHODS
Pubmed, Web of Science and Lilacs were systematically searched until 20/05/2023. Clinical trials were selected to compare the two treatments for condyle fracture and evaluate indications and contraindications.


RESULTS
Out of 2515 papers, four studies were included. The surgical approach allows faster functional recovery and decreases patient discomfort. The study analyzes under what circumstances a surgical procedure is more practical than a nonsurgical one.


CONCLUSION
There is no evidence regarding the reliability of either method. Both have superimposable results. However, age, type of occlusion and other factors direct the clinician toward a surgical choice.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/joor.13497

Conservative treatment of Temporomandibular Joint condylar fractures: A systematic Review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions.

BACKGROUND
Over the past few years, researchers have investigated whether varying menstrual statuses and estrogen levels could affect the likelihood of temporomandibular disorders (TMDs), with conflicting results. While some studies suggest a potential link between increased estrogen levels and higher TMD risk, others have found no correlation. It is worth noting that estrogen levels can impact the structure and function of the temporomandibular joint (TMJ). In light of these findings, our study seeks to investigate the prevalence of TMDs among pregnant women.


METHODS
We searched in PubMed, Web of Science and Lilacs for articles published from the inception until January 20, 2023. We applied the Population, Exposure, Comparator, and Outcomes (PECO) model to assess the document eligibility: P) Participants: female human subjects. E) Exposure: pregnancy. C) Comparison: pregnant women compared to non-pregnant women in the childbearing age. O) Outcome: TMDs diagnosis. Only study providing data about the prevalence in both group (pregnant and non-pregnant) were included. We set the following exclusion criteria: 1) diagnosis of rheumatic diseases or chronic inflammatory disorders (e.g., rheumatoid arthritis, juvenile, idiopathic arthritis, psoriatic arthritis); 2) diagnosis of fibromyalgia; 3) congenital abnormality or neoplastic conditions in the TMJ region; 4) studies including subjects undergoing arthrocentesis or intra-articular infiltrations; 5) studies including local pressure pain assessment; 6) studies including women in menopause in the control group 7) cross-over study design; 8) language different from English; 8) full- text unavailability (i.e., posters and conference abstracts); 9) studies involving animals; 10) review (topical or systematic) article; 11) case reports/series; 12) studies evaluating TMDs prevalence in subjects not pregnant. The software Review Manager version 5.2.8 (Cochrane Collaboration, Copenhagen, Denmark; 2014) was used to perform the pooled analysis. We measured the risk ratio (RR) between the two group (pregnant and non-pregnant).


RESULTS
The included subjects in this review were 440. Among them, 244 were pregnant while the remaining 196 were age matched non-pregnant women. Among those pregnant 102 presented sign/symptoms of TMD or TMD diagnosis (41,8 %) whereas 80 of those not pregnant were diagnosed with (40,8%). The overall effect showed that there was no difference in TMD prevalence between pregnant and non-pregnant women in childbearing age (RR 1.12; 95% CI: 0.65- 1.93), suggesting that pregnant is neither a risk factor nor a protective factor for TMD.


CONCLUSIONS
Overall, we did not find an association between TMD and pregnancy, neither positive nor negative. Further studies on larger samples are needed to clarify our results.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/joor.13458

Prevalence of temporomandibular disorders (TMD) in pregnancy: a systematic review with metanalysis.

Temporomandibular disorders (TMDs) are common and affect the temporomandibular joint (TMJ) and surrounding musculoskeletal tissues. Although traditional rehabilitative treatments such as physiotherapy, occlusal splints, orthodontics, and electrotherapy effectively manage TMDs, chiropractic therapy is emerging as a promising non-invasive treatment option. We report a 39-year-old female patient with TMD who underwent chiropractic therapy, including spinal adjustments, soft tissue therapy, and exercise rehabilitation. After four weeks of treatment, the patient reported a complete resolution of symptoms and an improved quality of life score. Thereafter, the patient continued chiropractic treatment monthly for six months, during which she reported no symptoms and demonstrated improvements in her spinal range of motion, open-mouth anatomy, and cervical lordosis. This case study highlights the efficacy of applying an interdisciplinary approach to treating TMD and the potential of chiropractic therapy as a valuable treatment option for managing TMD.

/pdf/temporomandibular-disorder-treated-with-chiropractic-therapy-27txdam8.pdf

Temporomandibular Disorder Treated With Chiropractic Therapy

Within physical therapy, manual therapy is known to be effective for managing temporomandibular disorders (TMDs). However, manual therapy is a broad term including different approaches applied to different body regions.This is the first systematic review that aims to evaluate the effectiveness of manual therapy applied specifically to the craniomandibular structures (Cranio-Mandibular Manual Therapy [CMMT]) on pain and maximum mouth opening in people with TMD.This systematic review was developed based on a pre-determined published protocol which was prospectively registered with PROSPERO (CRD42019160213). A search of MEDLINE, Embase, CINAHL, ZETOC, Web of Science, SCOPUS, PEDro, PubMed, Cochrane Library and Best Evidence, EBM reviews-Cochrane Central Register of Controlled Trials, Index to Chiropractic Literature ChiroAccess and Google Scholar databases was conducted from inception until October 2020. Randomised controlled trials comparing the effect of CMMT on pain and maximum mouth opening versus other types of treatment in TMDs were included. Two reviewers independently screened articles for inclusion, extracted data, assessed risk of bias with the revised Cochrane risk of bias tool for randomised trials and evaluated the overall quality of evidence with the Grading of Recommendations, Assessment, Development and Evaluations.A total of 2720 records were screened, of which only 6 (293 participants) satisfied the inclusion criteria. All studies showed some concerns in risk of bias, except for one, which was high risk of bias. The overall quality of evidence was very low for all outcomes because of high heterogeneity and small sample sizes. All studies showed a significant improvement in pain and maximum mouth opening for CMMT from baseline in the mid-term, but only two showed superiority compared to other interventions. Given the high heterogeneity and small sample sizes of the included studies, a quantitative synthesis was not performed.There is the need for future high methodology research investigating different manual therapy techniques applied to different regions and different populations (e.g., chronic versus acute TMD) to determine what is most effective for pain and maximum mouth opening in patients with TMDs. 

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/joor.13299

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Papers

Effectiveness of manual therapy applied to craniomandibular structures in temporomandibular disorders: A systematic review