Occlusal adjustment for treating and preventing temporomandibular joint disorders

 

Abstract

Background

There has been a long history of using occlusal adjustment in the management of temporomandibular disorders (TMD). It is not clear if occlusal adjustment is effective in treating TMD.

Objectives

To assess the effectiveness of occlusal adjustment for treating TMD in adults and preventing TMD.

Search methods

We searched the Cochrane Oral Health Group's Trials Register (April 2002); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2002, Issue 2); MEDLINE (1966 to 8th April 2002); EMBASE (1980 to 8th April 2002) and handsearched journals of particular importance to this review.

Additional reports were identified from the reference lists of retrieved reports and from review articles of treating TMD. There were no language restrictions. Unpublished reports or abstracts were considered from the SIGLE database.

Selection criteria

All randomised or quasi-randomised controlled trials (RCTs) comparing occlusal adjustment to placebo, reassurance or no treatment in adults with TMD. The outcomes were global measures of symptoms, pain, headache and limitation of movement.

Data collection and analysis

Data were independently extracted, in duplicate, by two review authors (Holy Koh (HK) and Peter G Robinson (PR)). Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Collaboration's statistical guidelines were followed and risk ratios calculated using random-effects models where significant heterogeneity was detected (P < 0.1).

Main results

Over 660 trials were identified by the initial search. Six of these trials, which reported results from a total of 392 patients, were suitable for inclusion in the review. From the data provided in the published reports, symptom-based outcomes were extracted from trials on treatment. Data on incidence of symptoms were extracted from trials on prevention. Neither showed any difference between occlusal adjustment and control groups.

Authors' conclusions

There is an absence of evidence, from RCTs, that occlusal adjustment treats or prevents TMD. Occlusal adjustment cannot be recommended for the management or prevention of TMD. Future trials should use standardised diagnostic criteria and outcome measures when evaluating TMD.

 

Plain language summary

Occlusal adjustment for treating and preventing temporomandibular joint disorders

No strong evidence of benefit from occlusal adjustment (adjusting the teeth's biting surfaces) for problems associated with the joint between the lower jaw and skull.
When the joint between the lower jaw and the base of the skull is not working well (temporomandibular disorders (TMD)), it can lead to abnormal jaw movement or locking, noises (clicking or grating), muscle spasms, tenderness or pain. TMD is very common, and might be caused by occlusion (the way the teeth bite), trauma or stress. Treatments include occlusal adjustment, splints, physiotherapy and surgery. Occlusal adjustment involves adjusting the biting surface of teeth by grinding the enamel (outer layer of the tooth). The review found there is no evidence from trials to show that occlusal adjustment can prevent or relieve temporomandibular disorders.

 

摘要

背景

以咬合調整治療和預防顳顎關節障礙症

利用咬合調整方式治療顳顎關節障礙症(TMD)已有很長的歷史。目前尚不清楚以咬合調整治療顳顎關節障礙症是否有效。

目標

評估咬合調整對於治療和預防成人顳顎關節障礙症的有效性。

搜尋策略

我們檢索了Cochrane Oral Health Group's Trials Register(2002.04)、the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2002)、MEDLINE(1966～2002.4.8)、EMBASE(1980 – 2002.4.8)並手動搜尋和此篇文獻相關的重要期刊。並經由所篩選出的研究與治療顳顎關節障礙症的回顧文獻中的參考文獻取得進一步的報告。沒有語言限制。未出版的報告或摘要視為出自SIGLE database。

選擇標準

所有的隨機或半隨機對照試驗(RCTs)，以咬合調整的治療患有顳顎關節障礙症的成人，並與安慰劑、安心保證或不治療的方式相比較。以全面性的症狀評估、疼痛、頭痛和運動限制作為治療成效。

資料收集與分析

由兩位評閱者：Holy Koh和Peter G Robinson，獨立的取得資料並做成一式兩份的格式。與納入試驗的作者取得聯繫，瞭解隨機細節、統計排除、量化評估。遵循Cochrane Oral Health Group's statistical guidelines， 利用偵測出顯著相異(P<0.1)的隨機效應模型，計算出相對風險值。

主要結論

初始檢索取得超過 660項試驗。適合納入此篇文獻的為6項試驗，總計392位患者。從出版報告所提供的數據，取得了以症狀導向的治療結果。症狀發生率則由有關疾病發生的試驗取得數據。以上兩組資料都無法顯示咬合調整組和對照組有任何差異。

作者結論

從這些隨機對照試驗來看，缺乏佐證證實咬合調整能治療或預防顳顎關節障礙症。咬合調整不能作為治療或預防顳顎關節症的建議。未來的試驗應當在評估顳顎關節症時使用標準化診斷標準與成效評估方法。

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

沒有強有力的證據支持咬合調整(調整牙齒的咬合面)有益於改善下顎和顱骨間的關節問題。當下顎和顱底間的關節運作不良(顳顎關節障礙症)，它會導致異常下顎運動或閉鎖、聲音(彈響或摩擦聲)、肌肉痙攣、壓痛或疼痛。顳顎關節症非常普遍，且可能經由咬合(牙齒對咬方式)、創傷或壓力造成。治療方法包括咬合調整，咬合板，物理治療和手術。咬合調整是以修磨牙齒琺瑯質的方式來調整牙齒咬合面(牙齒外層)。本篇文獻發現沒有證據顯示咬合調整可以預防或減輕顳顎關節障礙症。