Occlusal adjustment for treating and preventing temporomandibular joint disorders.
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.


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


METHODS
We searched the Cochrane Oral Health Group's Trials Register (April 2002); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2002); 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 Unpublished reports or abstracts were considered from the SIGLE database.


METHODS
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.


METHODS
Data were independently extracted, in duplicate, by two reviewers, 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 Oral Health Group's statistical guidelines were followed and relative risk values calculated using random effects models where significant heterogeneity was detected (P<0.1).


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 group.


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.
Koh
H
H
Department of Dental Public Health & Community Dental Education, Guy's, King's and St. Thomas' School of Dentistry, King's College London, London, UK, SE5 8AN. holykoh@dr.com
Robinson
P G
PG
D000328:Adult; D006801:Humans; D019558:Occlusal Adjustment; D016032:Randomized Controlled Trials as Topic; D013705:Temporomandibular Joint Disorders / Q000517:prevention & control / Q000628:therapy*