A meta-analysis of Clinical Effects of Low-level Laser Therapy on Temporomandibular Joint Pain

Study Title: A meta-analysis of Clinical Effects of Low-level Laser Therapy on Temporomandibular Joint Pain

Study Type: Systematic Review with Meta-analysis

Level of Evidence: Level 1

Clinical Summary: The researchers pooled the results (n=216) from 6 high quality RCTs (peDRO score >/= 7/11), and found a moderate treatment effect size of 0.6 (95% CI 0.47 to 0.73). Outcomes looked at were primarily pain assessed by VAS. Results were both statistically and clinically significant.

Overall Quality: High- Further research very unlikely to change our confidence in the estimate of effect

Why: Inclusion criteria clearly stated, only high quality studies were included, meta-analysis included.

Apply This: Though the optimal parameters and dosage of LLLT for TMJ have not been clearly established, the 780-830 nm range seems to have the largest effect size. Effective therapeutic dosage seems to be between 6.3-105 J/cm^2. Power output of between 30-500 mW was used. In the studies reviewed, between 4 and 10 treatment sessions demonstrated a moderate to large treatment effect size.

Study Author(s): Wen-Dien Chang PhD, Chia-Lun Lee PhD, Hung-Yu Lin PhD, Yung-Chun Hsu MS, Chung-Jieh Wang PhD, Ping-Tung Lai BS

Publication Date: 2/16/2014

Published in: J. Phys. Ther. Sci Vol.26, No. 8, 2014

 

Interventions for the management of temporomandibular joint osteoarthritis

Study Title:Interventions for the management of temporomandibular joint osteoarthritis (Review)

Study Type: Systematic Review

Level of Evidence: Level 1

Clinical Summary:Injections of hyaluronic acid or corticosteroids seem to be equally effective for pain at 6 months, VAS SMD: -17.00 (95%CI: -32.6 to -1.4) No measures of jaw movements had significant results in the first study. Night splints appear to be as effective as diclofenac sodium, but pain scores were reported as percentages and could not be extracted. Diclofenac sodium was associated with more severe side effects. Glucosamine Sulfate appeared to be as effective as ibuprofen at improving pain and function over a 90-day period: VAS SMD -6.74 (-14.70, 1.22).

Overall Quality: Moderate- Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Why:The quality of the review is excellent, however the studies themselves lack homogeneity and specifics in some cases, and there were very few that met the inclusion criteria used by the reviewers. For these reasons, the weight of the evidence is relatively minor, and further research is needed in each area.

Apply This:The glucosamine protocol used was as follows: glucosamine sulfate 500 mg PO TID for 90 days.

Study Author(s):de Souza RF, Lovato da Silva CH, Nasser M, Fedorowicz Z, Al-Muharraqi MA

Publication Date:2012

Published in:The Cochrane Library

Mandibular Manipulation for the Treatment of Temporomandibular Disorder

Study Title: Mandibular Manipulation for the Treatment of Temporomandibular Disorder         

Study Type: Systematic Review

Level of Evidence: Level 1

Clinical Summary:Only 2 studies met the inclusion criteria, and both showed no evidence for therapeutic benefit. This does not demonstrate a lack of benefit from manipulative therapy so much as a lack of quality studies on the subject. This study specifically looked at patients with confirmed disc displacement without reduction.

Overall Quality: Moderate- Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Why:Only 2 studies were included, thus total evidence reviewed is too limited to draw hard conclusions. Methodology in this review is sound, however, and both studies reviewed were of high quality and their results were in agreement. A lack of a priori power calculations in both studies reviewed raises questions about the statistical power to detect changes.

Apply This:For TMJ pain related to disc displacement without reduction, there may be some benefit to some patients from mandibular manipulation, and no adverse events were reported.

Study Author(s):Betania Mara Franco Alves, MD, Cristiane Rufino Macedo, MD, Eduardo Januzzi, MD, Eduardo Grossmann, MD, Alvaro Nagib Atallah, MD, Stella Peccin, MD

Publication Date:3/1/2013

Published in: The Journal of Craniofacial Surgery