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Intervention Review

Hyaluronate for temporomandibular joint disorders

  1. Zongdao Shi1,*,
  2. Chunlan Guo2,
  3. Manal Awad3

Editorial Group: Cochrane Oral Health Group

Published Online: 20 JAN 2003

Assessed as up-to-date: 13 NOV 2002

DOI: 10.1002/14651858.CD002970


How to Cite

Shi Z, Guo C, Awad M. Hyaluronate for temporomandibular joint disorders. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002970. DOI: 10.1002/14651858.CD002970.

Author Information

  1. 1

    West China College of Stomatology, Sichuan University, Department of Oral and Maxillofacial Surgery, Chengdu, Sichuan Province, China

  2. 2

    Peking Union Medical College Hospital, Dentistry Department, Beijing, China

  3. 3

    American University of Sharjah, College of Health Sciences, Sharjah, United Arab Emirates

*Zongdao Shi, Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, No 14, 3rd section, Renmin Nan Road, Chengdu, Sichuan Province, 610041, China. shizd0664@yahoo.com.cn. shizd0664@vip.sina.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JAN 2003

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Temporomandibular joint disorders (TMD) refer to a group of heterogeneous pain and dysfunction conditions involving the masticatory system, reducing life quality of the sufferers. Intra-articular injection of hyaluronate for TMD has been used for nearly 2 decades but the clinical effectiveness of the agent has not been summarized in the form of a systematic review.

Objectives

To assess the effectiveness of intra-articular injection of hyaluronate both alone and in combination with other remedies on temporomandibular joint disorders.

Search methods

Intensive electronic and handsearches were carried out. The Cochrane Oral Health Group's Trials Register (September 2001), CENTRAL (The Cochrane Library 2001, Issue 3), MEDLINE (1966 to May 2001), PubMed (up to March 2002), EMBASE (1980 to August 2001), SIGLE (1980 to December 2001), CBMdisc (1983 to July 2001, in Chinese) and Chinese Medical Library were searched. All the Chinese professional journals in the oral health field were handsearched and conference proceedings consulted. There was no language restriction.

Selection criteria

Randomized or quasi-randomized controlled trials (RCTs), with single or double blind design, testing the effectiveness of hyaluronate for patients with temporomandibular joint disorders.

Data collection and analysis

Two review authors independently extracted data, and three review authors independently assessed the quality of included studies. The first authors of the selected articles were contacted for additional information.

Main results

Seven studies were included in the review. Three studies, including 109 patients with temporomandibular disorders, compared hyaluronate with placebo. Long term effects (3 months or longer) are in favour of hyaluronate for the improvement of clinical signs/overall improvement of TMD (RR = 1.71, 95% CI: 1.05, 2.77) from two of the studies (n = 71). However, this conclusion was not stable enough at sensitivity analysis.

Three studies provided data from 124 patients for the comparison of hyaluronate with glucocorticoids (one study also included a placebo group). Hyaluronate had the same short term and long term effects on the improvement of symptoms, clinical signs or overall conditions of the disorders as glucocorticoids.

When comparing the effect of arthroscopy or arthrocentesis with and without hyaluronate, results were inconsistent. Hyaluronate had a potential in improving arthroscopic evaluation scores.

Mild and transient adverse reactions such as discomfort or pain at the injection site were reported in the hyaluronate groups. No quality of life data were reported

Authors' conclusions

There is insufficient, consistent evidence to either support or refute the use of hyaluronate for treating patients with TMD. Further high quality RCTs of hyaluronate need to be conducted before firm conclusions with regard to its effectiveness can be drawn.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Hyaluronate for temporomandibular joint disorders

There is insufficient evidence to either support or refute the use of hyaluronate for treating patients with temporomandibular joint disorders.
When the joint between lower jaw and the base of the skull is not working well it can led to movement problems, noises (clicking or grating), muscle spasms or pain (temporomandibular joint disorders (TMD)). Arthritis can also affect the joint. A range of treatment options are available including the injection of substances such as glucocorticoids or hyaluronate into the joint. Hyaluronate is sometimes used for osteoarthritis of the knees or hips. The review found that there is not enough evidence to judge whether hyaluronate injections into the joint are helpful for people with TMD. Reported side-effects were mild and transient. No data on quality of life were reported.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

顳顎關節障礙症的玻尿酸治療

顳顎關節障礙症(TMD)是指一咀嚼系統障礙、減少患者生活品質的多種疼痛。關節內注射玻尿酸治療顳顎關節障礙症已發展近20年,但這項藥劑在臨床上的效用尚未有系統性回顧文獻給予結論。

目標

評估僅以關節內注射玻尿酸治療或結合其他療法對於治療顳顎關節障礙症的有效性。

搜尋策略

進階電子搜尋和手動搜尋資料庫。搜尋了The Oral Health Group's Trials Register (September 2001)、The Cochrane Library CENTRAL database (Issue 3, 2001)、MEDLINE (1966~2001.05)、PubMed (2002.03)、EMBASE (1974~2001.08), SIGLE (1980 – 2001.12), CBMdisc (1983 – 2001.07;中文)和中文醫學圖書資料庫。並手動搜尋所有口腔保健領域的中文專業期刊與相關的研討會議論文集。沒有語言限制。

選擇標準

單一或雙盲的隨機或半隨機對照試驗(RCTs),分析玻尿酸對治療顳顎關節障礙症的有效度。

資料收集與分析

2名評閱者獨立的搜集資料,3名評閱者獨立的審核所納入試驗的品質。並與所篩選出文獻的第一作者聯繫,取得更進一步的資訊。

主要結論

回顧性文獻篩選取得7篇研究。其中3篇研究含109位顳顎關節障礙症患者,為玻尿酸治療和安慰劑的比較。在2篇研究中,評估長期效果時(3個月或更長時間), 顯示玻尿酸有助於改善顳顎關節障礙症的臨床徵候/全面改善。(RR = 1.71, 95%CI: 1.05, 2.77)(n = 71)。然而,此結論對於敏感度分析而言還不夠穩定。有3篇研究提供124位患者來比較玻尿酸與糖化皮質類固醇的效果。(其中一篇研究甚至包含安慰劑群組)。對於改善症狀、臨床徵候或障礙症的整體狀況,玻尿酸的短期和長期效果都與糖化皮質類固醇相似。當比較有無玻尿酸合併治療的關節內視鏡檢查或關節穿刺時,其結果並不一致。玻尿酸治療能改善關節鏡的評估指標。玻尿酸群組在注射區域會有輕度和短暫不良反應,如不舒服或疼痛。無文獻提供有關生活品質的資料。

作者結論

沒有足夠的、一致的證據支持或反駁使用玻尿酸治療顳顎關節障礙症。在得到玻尿酸是否有效的確切結論前,需進一步導入高品質的隨機對照試驗。

翻譯人

本摘要由臺灣大學附設醫院王東美翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有足夠的證據支持或反駁以玻尿酸治療顳顎關節障礙症的患者。當下顎和顱底間的關節運作不良,將導致運動問題、聲音(彈響或摩擦聲),肌肉痙攣或疼痛(顳顎關節障礙症(TMD))。關節炎也可能影響顳顎關節。一系列的治療選擇可包括藥物注射,如注射糖化皮質類固醇或玻尿酸至關節。玻尿酸有時用於治療膝蓋或髖關節的退化性關節炎。此篇回顧性文獻發現沒有足夠證據來判斷關節內注射玻尿酸是否有助於顳顎關節障礙的患者。副作用是輕微的、短暫的。沒有針對生活品質是否改善的報告。