ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Effectiveness of Sodium Hyaluronate Treatment for TMJ Pain
Clinical Question Should injection of sodium hyaluronate be a preferred treatment option for controlling TMJ pain, before invasive surgical procedures are considered?
Clinical Bottom Line Injection of sodium hyaluronate should be a viable treatment option for patients with TMJ pain, before considering invasive surgery. Injection into the joint space reduced pain over a period of 6 months in some patients. (See Comments on the CAT below)
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) 20144496Morey-Mas/201040 patients with MRI confirmed meniscus displacement, Wilkes stage III or IV TMJ disorder, and TMJ joint painDouble blind, randomized controlled trial
Key resultsVAS pain in the test group (treated with 1ml SH after arthroscopic lysis and lavage) diminished from a mean value of 62.0 at the start of the study, to 19.0 at day 168. The control group (given IA Ringer lactate during arthroscopic lysis and lavage) diminished from 47.9 at the start of the study, to 9.6 at day 168 (P < .05).
#2) 20185343Tang/201040 patients with osteoarthritisRandomized Controlled Trial
Key resultsVAS pain score decreased in the test group from 7.4 to 4.5, whereas the control group reported no change (P < .05).
#3) 18940487Oliveras-Moreno/200841 patients with confirmed Wilkes stage II disease with TMJ painRandomized Controlled Trial
Key resultsVAS pain in the test group diminished from 6.8 to 3.5 at day 84, whereas the control group remained unchanged (P < .04). TMJ function, measured by self report, increased in the test group and decreased in the control group (P < .001).
Evidence Search Search (#2) AND #7 AND sodium Limits: Randomized Controlled Trial, published in the last 3 yearsSearch (#2) AND #7 AND sodium Limits: Randomized Controlled Trial Search (#2) AND #7 Limits: Randomized Controlled TrialSearch (#2) AND #7 Limits: Meta-AnalysisSearch "chondroitin sulfate, sodium hyaluronate drug combination" [Supplementary Concept]Search "Injections"[Mesh] OR "Injections, Subcutaneous"[Mesh] OR "Injections, Intradermal"[Mesh]Search "Temporomandibular Joint"[Mesh] OR "Temporomandibular Joint Disorders"[Mesh] OR "Temporomandibular Joint Dysfunction Syndrome"[Mesh]
Comments on
The Evidence
In all instances, the group treated with sodium hyaluronate, reported decreased amounts of pain. The one study in which the control group reported greater pain reduction than the treatment group, received different treatment, not placebo. Additionally, the treatment group in this study (Morey-Mas/2010), started with higher mean and range of pain scores, and ended with a lower range of pain. It would be beneficial to have a true double blind study, in which the administering doctor did not know if the patient was receiving a sodium hyaluronate solution or placebo; a study in which patients with TMJ pain bilaterally, were treated with both sodium hyaluronate and placebo on opposite sides, would also be enlightening.
Applicability From the available evidence, it seems beneficial for a patient not responding to conservative, noninvasive TMJ therapy, to receive an injection of sodium hyaluronate before considering surgical alternatives.
Specialty/Discipline (Public Health) (General Dentistry) (Oral Surgery)
Keywords Temporomandibular Joint, Temporomandibular Disorders, Hyaluronate, Joint Therapy, Reconstructive Surgery, Injections, Subcutaneous, Intradermal, Drug Therapy
ID# 846
Date of submission: 04/08/2011spacer
E-mail grahamwyatt@livemail.uthscsa.edu
Author Travis F. Graham-Wyatt
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward F. Wright, DDS, MS
Faculty mentor/Co-author e-mail WrightE2@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by John P. Hatch (San Antonio, Texas) on 07/08/2014
A 2010 systematic review (PMID 2080673) supports the conclusion that HA injections are superior to placebo injections and probably comparable to corticosteroid injections and oral appliances. No conclusions were drawn relative to surgical intervention.
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