Comparative Effectiveness of Traditional East Asian Medicine Treatments for Temporomandibular Joint Disorders: A Systematic Review and Network Meta-analysis

Overview

Journal Integr Med Res

Publisher Elsevier

Date 2025 Feb 10

PMID 39926698

Authors

Seojung Ha

Sung-Woo Kang

Sanghoon Lee

Affiliations

Soon will be listed here.

Abstract

Background: Temporomandibular joint disorders (TMDs) cause pain and functional restrictions in the temporomandibular joint that interfere with daily activities. This study aimed to evaluate and compare the effectiveness and safety of various traditional East Asian medicine treatments, including acupuncture, electroacupuncture, moxibustion, and herbal medicine, in the management of TMD.

Methods: We included searches of MEDLINE, CENTRAL, EMBASE, AMED, CINAHL, OASIS, KISS, RISS, KMbase, KCI, CNKI, and CiNii from inception to November 12, 2023, for randomized controlled trials of traditional East Asian medicine treatments in patients with TMD. A network meta-analysis was performed using frequentist methods, and the Confidence In Network Meta-Analysis methodology were employed to assess evidence quality.

Results: Forty-five studies with 2,211 participants were finally included. Acupotomy (Mean difference (MD) -5.07, 95 % Confidence interval (CI) -7.37 to -2.78) and acupuncture (MD -1.18, 95 % CI -2.28 to -0.09) showed statistically significant superiority in reducing pain intensity compared to sham treatment. According to the SUCRA rankings, acupotomy was considered the most effective treatment, followed by electroacupuncture, acupuncture, manipulation, laser therapy and occlusal splint. A total of 12 studies reported incidence of adverse events, and none were serious adverse events.

Conclusion: Acupotomy and acupuncture could be more beneficial than sham treatment in pain relief and might be a better option than occlusal splint. However, future rigorous, well-designed trials are needed to draw clear conclusions.

Protocol Registration: PROSPERO (CRD42023467340).

References

Calixtre L, Oliveira A, Alburquerque-Sendin F, Armijo-Olivo S . What is the minimal important difference of pain intensity, mandibular function, and headache impact in patients with temporomandibular disorders? Clinical significance analysis of a randomized controlled trial. Musculoskelet Sci Pract. 2020; 46:102108. DOI: 10.1016/j.msksp.2020.102108. View

Shousha T, Alayat M, Moustafa I . Effects of low-level laser therapy versus soft occlusive splints on mouth opening and surface electromyography in females with temporomandibular dysfunction: A randomized-controlled study. PLoS One. 2021; 16(10):e0258063. PMC: 8486092. DOI: 10.1371/journal.pone.0258063. View

Maia M, Ribeiro M, Maia L, Stuginski-Barbosa J, Costa Y, Porporatti A . Evaluation of low-level laser therapy effectiveness on the pain and masticatory performance of patients with myofascial pain. Lasers Med Sci. 2012; 29(1):29-35. DOI: 10.1007/s10103-012-1228-7. View

de Salles-Neto F, Paula J, Romero J, Almeida-Leite C . Acupuncture for pain, mandibular function and oral health-related quality of life in patients with masticatory myofascial pain: A randomised controlled trial. J Oral Rehabil. 2020; 47(10):1193-1201. DOI: 10.1111/joor.13055. View

Kalamir A, Graham P, Vitiello A, Bonello R, Pollard H . Intra-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomised, clinical trial. Chiropr Man Therap. 2013; 21:17. PMC: 3706243. DOI: 10.1186/2045-709X-21-17. View

Wewege M, Jones M, Williams S, Kamper S, McAuley J . Rescaling pain intensity measures for meta-analyses of analgesic medicines for low back pain appears justified: an empirical examination from randomised trials. BMC Med Res Methodol. 2022; 22(1):285. PMC: 9636623. DOI: 10.1186/s12874-022-01763-x. View

Al Quran F, Kamal M . Anterior midline point stop device (AMPS) in the treatment of myogenous TMDs: comparison with the stabilization splint and control group. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101(6):741-7. DOI: 10.1016/j.tripleo.2005.04.021. View

Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J . Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. 2014; 28(1):6-27. PMC: 4478082. DOI: 10.11607/jop.1151. View

Calixtre L, Oliveira A, de Sena Rosa L, Armijo-Olivo S, Visscher C, Alburquerque-Sendin F . Effectiveness of mobilisation of the upper cervical region and craniocervical flexor training on orofacial pain, mandibular function and headache in women with TMD. A randomised, controlled trial. J Oral Rehabil. 2018; 46(2):109-119. DOI: 10.1111/joor.12733. View

10.

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

11.

Slade G, Ohrbach R, Greenspan J, Fillingim R, Bair E, Sanders A . Painful Temporomandibular Disorder: Decade of Discovery from OPPERA Studies. J Dent Res. 2016; 95(10):1084-92. PMC: 5004239. DOI: 10.1177/0022034516653743. View

12.

El-Shaheed N, Mostafa A, Aboelez M . Efficacy of stabilisation splint and low-level laser therapy for patients with chronic closed lock from non-reducible displaced temporo-mandibular joint discs: A parallel randomised clinical trial. J Oral Rehabil. 2022; 50(3):177-193. DOI: 10.1111/joor.13405. View

13.

DeVocht J, Goertz C, Hondras M, Long C, Schaeffer W, Thomann L . A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder. J Am Dent Assoc. 2013; 144(10):1154-63. PMC: 4103021. DOI: 10.14219/jada.archive.2013.0034. View

14.

Jung A, Shin B, Lee M, Sim H, Ernst E . Acupuncture for treating temporomandibular joint disorders: a systematic review and meta-analysis of randomized, sham-controlled trials. J Dent. 2011; 39(5):341-50. DOI: 10.1016/j.jdent.2011.02.006. View

15.

Demirkol N, Sari F, Bulbul M, Demirkol M, Simsek I, Usumez A . Effectiveness of occlusal splints and low-level laser therapy on myofascial pain. Lasers Med Sci. 2014; 30(3):1007-12. DOI: 10.1007/s10103-014-1522-7. View

16.

Shim S, Kim S, Lee J, Rucker G . Network meta-analysis: application and practice using R software. Epidemiol Health. 2019; 41:e2019013. PMC: 6635665. DOI: 10.4178/epih.e2019013. View

17.

Gomes C, Politti F, Andrade D, de Sousa D, Herpich C, Dibai-Filho A . Effects of massage therapy and occlusal splint therapy on mandibular range of motion in individuals with temporomandibular disorder: a randomized clinical trial. J Manipulative Physiol Ther. 2014; 37(3):164-9. DOI: 10.1016/j.jmpt.2013.12.007. View

18.

Peixoto K, Bezerra A, Melo R, de Resende C, de Almeida E, Barbosa G . Short-Term Effect of Scalp Acupuncture on Pain, Sleep Disorders, and Quality of Life in Patients with Temporomandibular Disorders: A A Randomized Clinical Trial. Pain Med. 2021; 22(4):905-914. DOI: 10.1093/pm/pnab048. View

19.

Ferrando M, Andreu Y, Galdon M, Dura E, Poveda R, Bagan J . Psychological variables and temporomandibular disorders: distress, coping, and personality. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 98(2):153-60. DOI: 10.1016/j.tripleo.2003.12.030. View

20.

Emam A, Abdel-Gawwad E, Baiomy A, Farhat M, Atito E, Helal M . Efficacy of Occlusal Splints and Low-Level Laser Therapy on the Mandibular Range of Motion in Subjects with Temporomandibular Joint Disc Displacement with Reduction. J Int Soc Prev Community Dent. 2023; 13(3):229-236. PMC: 10411297. DOI: 10.4103/jispcd.JISPCD_159_22. View