ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Oral Contraception and Estrogen Replacement Therapy Are Not Linked To TMD Severity
Clinical Question In a patient with TMD, do exogenous estrogens exacerbate the severity of TMD signs and symptoms?
Clinical Bottom Line Exogenous estrogens do not put patients with TMD at increased risk for developing more severe signs and symptoms.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 11258088Hatch/2001Postmenopausal women aged 37 to 82Cross-sectional observational study
Key resultsNeither oral contraceptives nor replacement estrogens place patients at increased risk of developing TMD. There was no significant difference in muscle and joint signs and symptoms in women taking estrogen and those who were not.
#2) 18686498Nekora-Azak/2008Postmenopausal women aged 42-72Cross-sectional observational study
Key resultsEstrogen replacement therapy does not increase women’s risk of developing TMD. The p-value was 0.213 and therefore there was no significant difference in TMJ pain in women taking HRT and those who were not.
#3) 15895836Sherman/2005Women with normal menstrual cyclesCross-sectional observational study
Key resultsWomen with TMD who were normal cycling had higher pain intensity at menses and midluteal phases. TMD patients taking oral contraceptives had more stable palpation pain intensity in comparison to normal cycling women during menses, ovulation and midluteal phases, but intensity increased during the late luteal phase. It is evident that pain intensity fluctuates throughout the menstrual cycle in normal cycling women and in women taking oral contraceptives. However, more evidence is needed to support a protective factor from exogenous estrogens.
Evidence Search "Temporomandibular Joint Disorders"[Mesh] AND "Estrogens"[Mesh]
Comments on
The Evidence
Hatch: This cross-sectional observational study had similar groups of women at start who were all post-menopausal. There was more than 80% completion rate and all groups were treated the same. This was not a double-blind trial but there was adequate compliance, no recall bias was likely and no competing interests were evident. Nekora-Azak: This cross-sectional observational study had similar groups of post-menopausal women who were treated the same, and had more than 80% completion rate. The trial was not double-blinded but there was adequate compliance, no recall bias likely and no competing interests evident.Sherman: This cross-sectional observational study was composed of women with normal menstrual cycles at start who were all treated the same. More than 80% completed the trial, and there was adequate compliance. This was not a double-blinded trial, there was no recall bias likely and no competing interests were apparent.
Applicability This is applicable to a patient who currently has TMD signs and symptoms and is either considering taking exogenous estrogens or is currently taking them.
Specialty/Discipline (General Dentistry)
Keywords Estrogen Replacement Therapy, TMD, exogenous estrogens, oral contraceptives
ID# 2192
Date of submission: 04/24/2012spacer
E-mail haml@livemail.uthscsa.edu
Author London Ham
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Rita Renee Parma, DDS
Faculty mentor/Co-author e-mail parma@uthscsa.edu
Basic Science Rationale
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