title: Interventions for the management of temporomandibular joint osteoarthritis.
abstract: BACKGROUND
  Osteoarthritis (OA) is the most common form of arthritis of the temporomandibular joint (TMJ), and can often lead to severe pain in the orofacial region. Management options for TMJ OA include reassurance, occlusal appliances, physical therapy, medication in addition to several surgical modalities.
  
  
  OBJECTIVE
  To investigate the effects of different surgical and non-surgical therapeutic options for the management of TMJ OA in adult patients.
  
  
  METHODS
  We searched the following databases: the Cochrane Oral Health Group Trials Register (to 26 September 2011); CENTRAL (The Cochrane Library 2011, Issue 3); MEDLINE via OVID (1950 to 26 September 2011); EMBASE via OVID (1980 to 26 September 2011); and PEDro (1929 to 26 September 2011). There were no language restrictions.
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing any form of non-surgical or surgical therapy for TMJ OA in adults over the age of 18 with clinical and/or radiological diagnosis of TMJ OA according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guideline or compatible criteria.Primary outcomes considered were pain/tenderness/discomfort in the TMJs or jaw muscles, self assessed range of mandibular movement and TMJ sounds. Secondary outcomes included the measurement of quality of life or patient satisfaction evaluated with a validated questionnaire, morphological changes of the TMJs assessed by imaging, TMJ sounds assessed by auscultation and any adverse effects.
  
  
  METHODS
  Two review authors screened and extracted information and data from, and independently assessed the risk of bias in the included trials.
  
  
  RESULTS
  Although three RCTs were included in this review, pooling of data in a meta-analysis was not possible due to wide clinical diversity between the studies. The reports indicate a not dissimilar degree of effectiveness with intra-articular injections consisting of either sodium hyaluronate or corticosteroid preparations, and an equivalent pain reduction with diclofenac sodium as compared with occlusal splints. Glucosamine appeared to be just as effective as ibuprofen for the management of TMJ OA.
  
  
  CONCLUSIONS
  In view of the paucity of high level evidence for the effectiveness of interventions for the management of TMJ OA, small parallel group RCTs which include participants with a clear diagnosis of TMJ OA should be encouraged and especially studies evaluating some of the possible surgical interventions.
authors.affiliation: Department of Dental Materials and Prosthodontics, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, Brazil.raphaelfs@yahoo.com.br
authors.forename: Raphael Freitas
authors.initials: RF
authors.lastname: de Souza
authors.forename: Claudia H
authors.initials: CH
authors.lastname: Lovato da Silva
authors.forename: Mona
authors.initials: M
authors.lastname: Nasser
authors.forename: Zbys
authors.initials: Z
authors.lastname: Fedorowicz
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Al-Muharraqi
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001623:Betamethasone / Q000008:administration & dosage; D004008:Diclofenac / Q000008:administration & dosage; D005944:Glucosamine / Q000008:administration & dosage; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007052:Ibuprofen / Q000008:administration & dosage; D017090:Occlusal Splints; D010003:Osteoarthritis / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D013705:Temporomandibular Joint Disorders / Q000628:therapy*; D055675:Viscosupplements / Q000008:administration & dosage
chemical_list: D000893:Anti-Inflammatory Agents; D055675:Viscosupplements; D004008:Diclofenac; D006820:Hyaluronic Acid; D001623:Betamethasone; D005944:Glucosamine; D007052:Ibuprofen