Arthrocentesis and lavage for treating temporomandibular joint disorders

Guo C, Shi Z, Revington P

Published Online:

October 7, 2009

When the joint between the lower jaw and the base of the skull is not working well, the signs and symptoms such as movement problems, noises (clicking or grating), muscle spasms or pain could take place. It is so-called temporomandibular joint disorders. A range of treatment options for treating temporomandibular joint disorders are available such as arthrocentesis and arthroscopy. The review found that there is no enough evidence to judge whether arthrocentesis is more helpful for people with temporomandibular joint disorders than arthroscopy. Reported side effects were mild and transient.

Abstract (click to read)

Background:

Temporomandibular joint disorders are important oral health problems, reducing the quality of life of sufferers. It has been estimated that approximately 20% to 30% of the adult population will experience temporomandibular joint dysfunction. Arthrocentesis and lavage has been used to treat temporomandibular joint disorders for about 10 years, but the clinical effectiveness of the therapy has not been summarized in the form of a systematic review.

Objectives:

To assess the effectiveness and complications of arthrocentesis and lavage for the treatment of temporomandibular joint disorders compared with controlled interventions.

Search strategy:

The Cochrane Oral Health Group's Trials Register (to August 2009), CENTRAL (The Cochrane Library 2009, Issue 3), MEDLINE (1950 to August 2009), EMBASE (1980 to August 2009), OpenSIGLE (to August 2009), CBMdisc (1981 to 2007 (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:

All randomised controlled trials (RCTs) (including quasi-randomised clinical trials) aiming to test the therapeutic effects of arthrocentesis and lavage for treating temporomandibular joint disorders.

Data collection and analysis:

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

Main results:

Two trials, at unclear to high risk of bias, were included in the review. The two trials, including 81 patients with temporomandibular joint disorders, compared arthrocentesis with arthroscopy. No statistically significant difference was found between the interventions in terms of pain. However, a statistically significant difference in favour of arthroscopy was found in maximum incisal opening (MIO) (weighted mean difference of -5.28 (95% confidence interval (CI) -7.10 to -3.46)).

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

Authors' conclusions:

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

This record should be cited as:

Guo C, Shi Z, Revington P. Arthrocentesis and lavage for treating temporomandibular joint disorders. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD004973. DOI: 10.1002/14651858.CD004973.pub2

Assessed as up to date:

August 4, 2009

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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

Arthrocentesis and lavage for treating temporomandibular joint disorders

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