Hyaluronate for temporomandibular joint disorders

Shi Z, Guo C, Awad M

Published Online:

January 21, 2009

There is insufficient evidence to either support or refute the use of hyaluronate for treating patients with temporomandibular joint disorders.
When the joint between lower jaw and the base of the skull is not working well it can led to movement problems, noises (clicking or grating), muscle spasms or pain (temporomandibular joint disorders (TMD)). Arthritis can also affect the joint. A range of treatment options are available including the injection of substances such as glucocorticoids or hyaluronate into the joint. Hyaluronate is sometimes used for osteoarthritis of the knees or hips. The review found that there is not enough evidence to judge whether hyaluronate injections into the joint are helpful for people with TMD. Reported side-effects were mild and transient. No data on quality of life were reported.

Abstract (click to read)

Background:

Temporomandibular joint disorders (TMD) refer to a group of heterogeneous pain and dysfunction conditions involving the masticatory system, reducing life quality of the sufferers. Intra-articular injection of hyaluronate for TMD has been used for nearly 2 decades but the clinical effectiveness of the agent has not been summarized in the form of a systematic review.

Objectives:

To assess the effectiveness of intra-articular injection of hyaluronate both alone and in combination with other remedies on temporomandibular joint disorders.

Search strategy:

Intensive electronic and handsearches were carried out. The Cochrane Oral Health Group's Trials Register (September 2001), CENTRAL (The Cochrane Library 2001, Issue 3), MEDLINE (1966 to May 2001), PubMed (up to March 2002), EMBASE (1980 to August 2001), SIGLE (1980 to December 2001), CBMdisc (1983 to July 2001, in Chinese) and Chinese Medical Library were searched. All the Chinese professional journals in the oral health field were handsearched and conference proceedings consulted. There was no language restriction.

Selection criteria:

Randomized or quasi-randomized controlled trials (RCTs), with single or double blind design, testing the effectiveness of hyaluronate for patients with temporomandibular joint disorders.

Data collection and analysis:

Two review authors independently extracted data, and three review authors independently assessed the quality of included studies. The first authors of the selected articles were contacted for additional information.

Main results:

Seven studies were included in the review. Three studies, including 109 patients with temporomandibular disorders, compared hyaluronate with placebo. Long term effects (3 months or longer) are in favour of hyaluronate for the improvement of clinical signs/overall improvement of TMD (RR = 1.71, 95% CI: 1.05, 2.77) from two of the studies (n = 71). However, this conclusion was not stable enough at sensitivity analysis.

Three studies provided data from 124 patients for the comparison of hyaluronate with glucocorticoids (one study also included a placebo group). Hyaluronate had the same short term and long term effects on the improvement of symptoms, clinical signs or overall conditions of the disorders as glucocorticoids.

When comparing the effect of arthroscopy or arthrocentesis with and without hyaluronate, results were inconsistent. Hyaluronate had a potential in improving arthroscopic evaluation scores.

Mild and transient adverse reactions such as discomfort or pain at the injection site were reported in the hyaluronate groups. No quality of life data were reported

Authors' conclusions:

There is insufficient, consistent evidence to either support or refute the use of hyaluronate for treating patients with TMD. Further high quality RCTs of hyaluronate need to be conducted before firm conclusions with regard to its effectiveness can be drawn.

This record should be cited as:

Shi Z, Guo C, Awad M. Hyaluronate for temporomandibular joint disorders. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002970. DOI: 10.1002/14651858.CD002970

Assessed as up to date:

November 14, 2002

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Oral pain

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Hyaluronate for temporomandibular joint disorders

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