In patients with temporomandibular disorders, do particular interventions influence oral health-related quality of life? A qualitative systematic review of the literature.
OBJECTIVE
The use of patient-based outcomes to measure therapeutic effectiveness is increasing, because a growing number of clinical scientists are attempting to evaluate the impact of therapy on the recipient. There are indications that patients suffering from temporomandibular disorders (TMDs) may also show a reduced oral health-related quality of life (OHQoL). It was the purpose of this paper to answer the question as to whether therapeutic interventions in TMD patients have a positive effect on their OHQoL.


METHODS
A systematic electronic search (Ovid Medline 1966-2006; Science Citation Index 1945-2006) of the literature was carried out to identify pertinent articles of randomized and non-randomized clinical trials. Reports on retrospective and prospective studies that specifically focused on OHQoL changes in TMD patients as a consequence of therapeutic interventions were included. The reference lists of the identified articles were screened to find additional pertinent publications.


RESULTS
The investigation yielded seven relevant contributions from Medline. A quantitative analysis of the seven identified articles was not possible. There was considerable heterogeneity among the investigations with regard to study design, patient characteristics, and provided therapy. Three of the identified articles reported about prospective controlled studies, of which one was an RCT. Four additional investigations were retrospective. According to the results of the only RCT, a 6-week course of the non-selective cyclooxygenase (COX) inhibitor naproxen may lead to slightly better OHQoL in patients with temporomandibular joint (TMJ) arthralgia than the selective COX-2 inhibitor celecoxib. The two other articles reporting of a controlled study showed that selective serotonine uptake inhibitors accompanied by psychological therapy improved OHQoL in individuals with TMJ arthralgia. In contrast, TMJ surgery did not improve OHQoL.


CONCLUSIONS
It appears that all therapeutic interventions reported in the identified publications led to at least some improvement of OHQoL. The only exception were patients with multiple TMJ surgeries.
Türp
Jens C
JC
Clinic for Reconstructive Dentistry and Temporomandibular Disorders, Dental School, University of Basel, Basel, Switzerland. jens.tuerp@unibas.ch
Motschall
Edith
E
Schindler
Hans J
HJ
Heydecke
Guido
G
D006801:Humans; D009909:Oral Health; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013705:Temporomandibular Joint Disorders / Q000628:therapy*; D016896:Treatment Outcome