Is nonsurgical management effective in temporomandibular joint disorders? – A systematic review and meta‑analysis

Abstract

Background: Various nonsurgical interventions have been used for the management of patients
with temporomandibular joint (TMJ) disorders, but their clinical effectiveness remains unclear.
Hence, the purpose of this systematic review and meta‑analyses was to assess the evidence of the
effectiveness of nonsurgical interventions in the management of TMJ disorders.
Materials and Methods: A literature search on five databases such as PubMed, PubMed Central
Cochrane, TRIP, NGCH databases and hand searching was conducted for a period from October
1995 to 2015. Randomized control trials (RCTs) on the nonsurgical management of TMJ disorders
were included and reported in accordance with Preferred Reporting Items for Systematic Reviews
and Meta‑Analyses guidelines. The quality of the articles was assessed by JADAD scoring. Finally,
out of 23 RCTs, 11 articles having any of the primary outcomes (pain pressure threshold [PPT],
pain, maximal pain‑free mouth opening, and level of dysfunction) were selected. The extracted data
were analyzed using NCSS software.
Results: The results showed the evidence of pain reduction (P = 0.00), maximal pain‑free mouth
opening (P = 0.0138), and decrease in level of dysfunction (P = 0.0007) but no improvement in PPT
to a significant level (P = 0.6600).
Conclusion: Our results suggest that the simplest, cost‑effective nonsurgical treatments have a positive
therapeutic effect on the initial management of TMJ disorders. However, a consistent methodology
recording both the objective and subjective outcomes would be a better choice for added reliability.
Key Words: Managment, meta-analysis, nonsurgical, systematic review, temporomandibular
joint disorders