Occlusal adjustment and pain mitigation in temporomandibular disorders: A meta-analysis of randomized clinical trials

Abstract

Statement of problem: The role of occlusal adjustment in treating temporomandibular disorders remains highly debatable. Purpose: The purpose of this systematic review and meta-analysis was to determine the effectiveness of occlusal adjustment in the treatment of facial pain, jaw pain, and headache as a result of temporomandibular disorders. Material and methods: MEDLINE, Embase, Conference Proceedings Citation Index- Science, Open Access Theses and Dissertations (OATD), the 5 regional databases of the World Health Organization, and the reference lists of included studies and related narrative reviews were searched. The risk of bias in the studies was determined using the RoB-2 tool. Heterogeneity and publication bias were assessed, and sensitivity analyses were conducted. Results: A total of 784 articles were initially identified, of which 11 met the inclusion criteria and were included in the meta-analysis. The pooled Odds Ratio (OR) for any pain indicated that occlusal adjustment was associated with higher odds of pain mitigation than mock or placebo treatments (OR 0.67; 95%CI: 0.51–0.88), with low heterogeneity. The effect was stronger for facial pain (OR: 0.36, 95%CI: 0.14–0.94) and jaw pain (OR: 0.47, 95%CI: 0.24–0.92). Conclusions: Occlusal adjustment represents a suitable option for the control of pain in temporomandibular disorders. The high potential of bias of several studies included in this meta-analysis should be considered. Future studies with sufficiently large sample sizes and which use dichotomous outcomes instead of continuous measures, such as means and medians, should shed more light on the effectiveness of this technique.