Efficacy of Conservative Interventions Targeting Temporomandibular Disorders for Adults With Headache Disorders: A Systematic Review and Meta-Analysis

IF 3.1 3区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of oral rehabilitation Pub Date : 2025-05-01 DOI:10.1111/joor.13994

Anthony Demont, Leila Benaissa, Laurent Pitance

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引用次数: 0

Abstract

Background

The efficacy of conservative interventions targeting temporomandibular disorders (TMDs) in patients diagnosed with headaches has not been systematically reviewed.

Objective

To appraise the efficacy of conservative interventions targeting TMDs for adults with primary or secondary headaches.

Methods

Bibliographic searches were conducted up to September 2024 for randomised controlled trials in five databases: CINAHL, Cochrane CENTRAL, Embase, PEDro and PubMed. Outcomes collected were frequency, intensity and duration of headache episodes, and disability. Version 2 of the Cochrane Risk-of-Bias Tool and the GRADE approach were used for assessing the methodological quality and grading evidence. Results from trials with similar interventions and with similar outcome measures were pooled into separate meta-analyses.

Results

Five trials were included. Low-certainty evidence suggests that the occlusal stabilisation appliance did not reduce headache frequency (SMD episode/week: −1.57; 95% CI: −2.86 to −0.28; 3 RCTs; n = 145) and intensity (SMD VAS: −0.24 points out of 10; 95% CI: −0.67 to 0.20; 2 RCTs; n = 85) compared to non-specific appliance therapy or no treatment at 1–3 months post-intervention. At 4–9 months post-intervention, low-certainty evidence indicates that the occlusal stabilisation appliance therapy reduced headache frequency (SMD episode/week: 1.21; 95% CI: 0.06 to 2.36; 3 RCTs; n = 145), but not headache intensity (SMD VAS: −0.51 point out of 10; 95% CI: −1.01 to −0.02; 2 RCTs; n = 85). Very low-certainty evidence suggests that overall physiotherapy interventions reduced headache intensity compared to non-specific exercises at 1–3 months post-intervention (SMD NPRS: 4.44 points out of 10; 95% CI: −0.46 to 9.34; 2 RCTs; n = 67) and at 4–9 months post-intervention (SMD NPRS: 3.92 points out of 10; 95% CI: 0.75 to 7.09; 2 RCTs; n = 67).

Conclusion

Our results suggest that clinicians may consider combining orofacial stabilisation appliance therapy and physiotherapy interventions without certainty of their effects for the criteria assessed. The heterogeneity of the interventions assessed and the populations studied means that caution must be exercised when interpreting the results obtained.

Trial Registration

#CRD42023389507

查看原文本刊更多论文

针对成人头痛疾病颞下颌疾病的保守干预的疗效：系统回顾和荟萃分析。

背景：针对诊断为头痛患者的颞下颌紊乱（TMDs）的保守干预的疗效尚未系统回顾。目的：评价针对成人原发性或继发性头痛的tmd保守干预的疗效。方法：对截至2024年9月的五个数据库中的随机对照试验进行书目检索：CINAHL、Cochrane CENTRAL、Embase、PEDro和PubMed。收集的结果包括头痛发作的频率、强度和持续时间以及残疾。使用Cochrane风险偏倚工具第2版和GRADE方法评估方法学质量和证据分级。具有类似干预措施和类似结果测量的试验结果被合并到单独的荟萃分析中。结果：纳入5项试验。低确定性证据表明，咬合稳定器并没有减少头痛频率(SMD发作次数/周：-1.57；95% CI: -2.86 ~ -0.28；3相关;n = 145)和强度(SMD VAS: -0.24分/ 10；95% CI: -0.67 ~ 0.20；2相关的;N = 85)，与干预后1-3个月非特异性矫治或不治疗相比。干预后4-9个月，低确定性证据表明，咬合稳定矫治器治疗降低了头痛频率(SMD发作次数/周：1.21次；95% CI: 0.06 ~ 2.36；3相关;n = 145)，但与头痛强度无关(SMD VAS: -0.51分/ 10；95% CI: -1.01 ~ -0.02；2相关的;n = 85)。非常低确定性的证据表明，在干预后1-3个月，与非特异性运动相比，整体物理治疗干预可降低头痛强度(SMD NPRS: 4.44分（满分10分）；95% CI: -0.46 ~ 9.34；2相关的;n = 67)和干预后4-9个月(SMD NPRS: 3.92分（满分10分）；95% CI: 0.75 ~ 7.09；2相关的;n = 67)。结论：我们的研究结果表明，临床医生可能会考虑将口腔面部稳定矫治器治疗和物理治疗干预相结合，而不确定它们对评估标准的影响。评估的干预措施和研究人群的异质性意味着在解释所获得的结果时必须谨慎。试验注册：#CRD42023389507。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of oral rehabilitation 医学-牙科与口腔外科

CiteScore

5.60

自引率

10.30%

发文量

116

审稿时长

4-8 weeks

期刊介绍： Journal of Oral Rehabilitation aims to be the most prestigious journal of dental research within all aspects of oral rehabilitation and applied oral physiology. It covers all diagnostic and clinical management aspects necessary to re-establish a subjective and objective harmonious oral function. Oral rehabilitation may become necessary as a result of developmental or acquired disturbances in the orofacial region, orofacial traumas, or a variety of dental and oral diseases (primarily dental caries and periodontal diseases) and orofacial pain conditions. As such, oral rehabilitation in the twenty-first century is a matter of skilful diagnosis and minimal, appropriate intervention, the nature of which is intimately linked to a profound knowledge of oral physiology, oral biology, and dental and oral pathology. The scientific content of the journal therefore strives to reflect the best of evidence-based clinical dentistry. Modern clinical management should be based on solid scientific evidence gathered about diagnostic procedures and the properties and efficacy of the chosen intervention (e.g. material science, biological, toxicological, pharmacological or psychological aspects). The content of the journal also reflects documentation of the possible side-effects of rehabilitation, and includes prognostic perspectives of the treatment modalities chosen.