Scoping review of systematic review abstracts about temporomandibular disorders: Comparison of search years 2004 and 2017

Critical Appraisal of Clinical Trials Evaluating Physical Therapy Treatments for Temporomandibular Disorders: A Scoping Review

BACKGROUND

Physical therapy seems the most promising treatment for temporomandibular disorders (TMD), although their effectiveness is controversial in general, due to high heterogeneity regarding study designs, applied treatments and outcomes measures.

OBJECTIVES

The aim of this scoping review is to analyse the methodological characteristics of clinical trials evaluating physical therapy treatments in subjects with TMD.

METHODS

A systematic search was conducted in Medline/PubMed, SPORTDiscus, Scopus, Web of Science, SciELO, Cochrane, ScienceDirect and EMBASE databases on 31 October 2023. Clinical trials evaluating physical therapy interventions in patients older than 18 years with TMD, published in English or Spanish languages. Data regarding content reporting of study designs, sample characteristics, interventions and outcome measures was extracted. Descriptive summary statistics were reported.

RESULTS

The search retrieved 15 322 records, and 136 were included. There were 107 randomised clinical trials, 5 non-randomised controlled trials and 24 non-controlled trials. Most studies had moderate to high risk of bias, small sample sizes (median, 44 subjects) and short follow-up periods (1-3 months). The most common diagnostic criteria used was the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) (48.9%). The most reported experimental interventions were manual therapy (40.4%), exercise (30.2%) and electrotherapy modalities (27.2%), and the most common outcome measure domains were pain (83.8%), range of movement (61.8%), disability (45.6%) and mechanosensitivity (29.4%). There was poor content reporting of experimental interventions.

CONCLUSIONS

Current literature of clinical trials of physical therapy interventions for TMD has moderate to high risk of bias, poor content reporting, small sample size and short-term follow-ups which limit internal and external validity, as well as applicability into clinical practice.

Nurses' responsibilities and tasks in pharmaceutical care: A scoping review

AIM

To provide an overview of responsibilities and tasks of nurses in pharmaceutical care.

DESIGN

Scoping review.

METHODS

Two databases were systematically searched (MEDLINE and Scopus) for recent original research papers concerning nurses' responsibilities and tasks in pharmaceutical care. The definition of responsibility was based on literature, moral and ethical discussions. Existing responsibilities and tasks beyond preparation and administration of medication were collected and synthesized. This main study outcome was extracted from titles and abstracts only. Results were reported in accordance with PRISMA-ScR guidelines.

RESULTS

Of the 3,805 titles and abstracts reviewed, 453 abstracts were included. A total of seven responsibilities were identified: (a) management of therapeutic and adverse effects of medication, (b) management of medication adherence, (c) management of patient medication self-management, (d) management of patient education and information about medication, (e) prescription management, (f) medication safety management and (g) (transition of) care coordination. Within these responsibilities, all tasks performed by nurses were described.

Case Report: Capacity to Objectively Monitor the Response of a Chronic Pain Patient to Treatment

Response to pain therapy is currently by patient self-report. We demonstrate that by evaluating the neurochemistry of a patient, using two-dimensional Correlated SpectroscopY (2D COSY) in a 3T MRI scanner, response to therapy can be recorded. A chronic temporomandibular joint (TMJ) pain patient was evaluated by a pain physician specializing in temporomandibular disorders (TMD), and by 2D COSY, before, and 6 days after treatment with Botulinum Toxin A. Prior to treatment the self-reported pain score was 8/10 and reduced to 0/10 within 24 h of treatment. The neurochemistry of the patient prior to treatment was typical of chronic pain. In particular, the Fuc-α(1-2) glycans were affected. Following treatment, the substrates, α-L Fucose, were elevated and the Fuc-α(1-2) glycans repopulated. The depletion of the molecule assigned the glutathione cysteine moiety, with chronic pain, is indicative of a Glutathione redox imbalance linked to neurodegeneration. This new approach to monitor pain could help discriminate the relative contributions in the complex interplay of the sensory and affective (emotional suffering) components of pain leading to appropriate individualized pharmaceutical drug regimens.

Management of temporomandibular disorders: a rapid review of systematic reviews and guidelines

Temporomandibular disorders (TMD) impact a significant proportion of the population. Given the range of management strategies, contemporary care should be evidence-informed for different TMD types. A knowledge-to-action rapid review of systematic reviews published in the past 5 years and guidelines published in the past 10 years concerning the management of TMD was conducted. The Cochrane, Embase, MEDLINE, PEDro, and PubMed databases were searched. A qualitative data analysis was undertaken, with quality assessment completed using the AMSTAR 2 checklist. In total, 62 systematic reviews and nine guidelines considering a range of treatment modalities were included. In concordance with current guidelines, moderate evidence supports a multi-modal conservative approach towards initial management. Contrary to existing guidelines, occlusal splint therapy is not recommended due to a lack of supporting evidence. The evidence surrounding oral and topical pharmacotherapeutics for chronic TMD is low, whilst the evidence supporting injected pharmacotherapeutics is low to moderate. In concordance with current guidelines, moderate quality evidence supports the use of arthrocentesis or arthroscopy for arthrogenous TMD insufficiently managed by conservative measures, and open joint surgery for severe arthrogenous disease. Based on this, a management pathway showing escalation of treatment from conservative to invasive is proposed.

Affective relationships as predictors of TMD symptoms in young adults

Abstract Introduction Orofacial pain is a critical TMD symptom that can influence physical and social capacity. Objective To evaluate the association of temporomandibular disorders (TMD) symptoms with affective relationships and demographic variables in young adults. Material and method A cross-sectional study involving 395 young adults was developed. Diagnostic Criteria for TMD, anxiety, and depression were collected from questionnaires. The Dental Health Component of the Index of Orthodontic Treatment Need measures the orthodontic treatment need. Questionnaires also contained questions related to the previous orthodontic treatment. Logistic regression models were adjusted, estimating crude odds ratio with the 95% confidence intervals. The variables with p<0.20 in the analyses were assessed in a multiple logistic regression model, remaining with p≤0.10. Result There was no significant association of TMD symptoms with sex, age, medication use for pain, previous orthodontic treatment, orthodontic treatment need, anxiety, and depression (p>0.05). Individuals without an affective relationship are 1.78 (95%CI: 0.99-3.17) times more likely to report TMD symptoms. Conclusion Affective relationships showed an association with TMD symptoms in young adults.

Effectiveness of physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: protocol of a randomised controlled trial

INTRODUCTION

Temporomandibular disorders (TMDs) are considered a collection of musculoskeletal conditions involving the masticatory muscles, the temporomandibular joint and associated structures. The myogenous group appears to represent the most frequently diagnosed category. In the context of a multimodal approach, splint therapy and musculoskeletal physiotherapy are often considered as a preferred therapy. The purpose of this study will be to investigate the effects of musculoskeletal physiotherapy combined with occlusal splint and education versus occlusal splint and education alone in the treatment of chronic myogenous TMD on pain and mandibular range of motion.

METHODS AND ANALYSIS

All consecutive adults complaining of TMDs presented to the Department of Biomedical and Neuromotor Sciences of the University of Bologna will be considered eligible. Inclusion criteria shall be based on the presence of myogenous TMDs, as diagnosed through clinical examination in reference to the international diagnostic criteria of TMDs. Randomisation, concealed allocation, blinded assessment and intention-to-treat analysis will be employed. The splint therapy will consist of the use of the splint every night and concurrent delivery of an educational programme; the protocol shall have a duration of three consecutive months. The combined musculoskeletal physiotherapy, splint therapy and education will additionally consist of manual therapy techniques and exercise; such protocol shall consist of a duration of three consecutive months, inclusive of 10 sessions for the enhanced elements. All outcome measures will be collected at baseline, after treatment and at a 6 months follow-up.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Independent Ethic Committee in Clinical Research of AUSL Bologna-Italy (47/2018/SPER/AUSLBO). Pursuant to applicable rules,we will obtain informed consent from each participant and collect data anonymously to maintain privacy. Results will be disseminated to clinicians and researchers through peer-reviewed publications and conferences.

TRIAL REGISTRATION NUMBER

NCT03726060.

Systematic review versus structured critical analysis

Objective: This analysis discusses common problems with systematic reviews (SRs) and presents a novel solution, the structured critical analysis (SCA) that can be incorporated into a SR or used as an alternative literature review design.Methods: A cross-sectional survey of current SRs related to interdisciplinary restorative dentistry was obtained by evaluating 100 current SRs for their self-reported methodological quality and its effect on scientific validity.Results: The preferred reporting items for systematic reviews and meta-analyses protocol (PRISMA) was used in 99/100 SRs, but only 8/100 reported a low risk of bias. High statistical heterogeneity precluding meta-analysis was found in 44/100 SRs. Only 94 paragraphs/100 SRs provided critical analysis.Discussion: Significant problems were found with current SRs that can compromise their reliability as the premier level of evidence for clinical science research. The reader must be aware of these deficiencies to correctly interpret the SR and cannot rely on the format alone.