Occlusal adjustment for treating and preventing temporomandibular joint disorders

Koh H, Robinson P

Published Online:

January 21, 2009

No strong evidence of benefit from occlusal adjustment (adjusting the teeth's biting surfaces) for problems associated with the joint between the lower jaw and skull.
When the joint between the lower jaw and the base of the skull is not working well (temporomandibular disorders (TMD)), it can lead to abnormal jaw movement or locking, noises (clicking or grating), muscle spasms, tenderness or pain. TMD is very common, and might be caused by occlusion (the way the teeth bite), trauma or stress. Treatments include occlusal adjustment, splints, physiotherapy and surgery. Occlusal adjustment involves adjusting the biting surface of teeth by grinding the enamel (outer layer of the tooth). The review found there is no evidence from trials to show that occlusal adjustment can prevent or relieve temporomandibular disorders.

Abstract (click to read)

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.

Objectives:

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

Search strategy:

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 Unpublished reports or abstracts were considered from the SIGLE database.

Selection criteria:

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.

Data collection and analysis:

Data were independently extracted, in duplicate, by two review authors (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 Collaboration's statistical guidelines were followed and risk ratios calculated using random-effects models where significant heterogeneity was detected (P < 0.1).

Main 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 groups.

Authors' 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.

This record should be cited as:

Koh H, Robinson P. Occlusal adjustment for treating and preventing temporomandibular joint disorders. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003812. DOI: 10.1002/14651858.CD003812

Assessed as up to date:

November 13, 2002

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Craniofacial anomalies > Orthodontic treatment

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Occlusal adjustment for treating and preventing temporomandibular joint disorders

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