A three-dimensional Oral health-related quality of life framework for temporomandibular joint disorders: A structural analysis of the Oral Health Impact Profile-14.

OBJECTIVES: the objective is to analyze the structure and relationship between the components of the Oral health-related quality of life using the Oral Health Impact Profile-14 (OHIP-14) for patients with temporomandibular joint disorders (TMJD). METHODS: two studies were examinated by means of factor analysis, multidimensional scaling and their spatial display in a cross-sectional design (n = 153). RESULTS: three-dimensional solutions with an adequate fit were found: residual distribution, root mean square of residuals (RMSR) = 0.04, Goodness of Fit Index (GFI) = 0.96, and Adjusted Goodness of Fit Index (AGFI) = 0.93; and Stress I = 0.023, respectively. The overall ordinal alpha coefficient was 0.92 (CI=0.90 to 0.94). The ordinal alpha coefficients for functional impact, psychosocial impact and psychological impact factors were 0.87 (CI=0.84 to 0.90), 0.88 (CI=0.84 to 0.91) and 0.78 (CI= 0.72 to 0.83), respectively. Item 9 was the most central, followed by 7 and 11. Items 1 and 2 had minor associations. There was no evidence of differences between centers: edge weight differences (M = 0.226, p = 0.94), global strength invariance test (S = 1.88, p = 0.1), centrality invariance test (p >0.05), edge invariance test (p >0.05). CONCLUSIONS: the links between the dimensions and the items seem to involve psychological components. Oral health-related quality of life emerged as a three-dimensional structure (Functional Impact, Psychosocial Impact and Psychological Impact) of functional and psychosocial elements in which physical, psychological, and social disability were essential, while theoretical functional limitation was least important. CLINICAL SIGNIFICANCE: the three-dimensional OHRQoL system for temporomandibular disorders (TMD) is a worthwhile alternative to interpret psychological and psychosocial aspects.

Long term oral health related quality of life after TMJ arthrocentesis with hyaluronic acid. A retrospective cohort study.

The purpose of the study was to assess the long-term oral health-related quality of life (oQoL) in patients with temporomandibular joint (TMJ) internal derangement (ID) after TMJ arthrocentesis plus hyaluronic acid (HA). Patients were analysed at different follow-up times using an analytical observational design. The Oral Health Impact Profile-14 (OHIP-14) score was evaluated according to age, sex, disc position, presence of degenerative joint disease (DJD), joint pain, maximum mouth opening and follow-up time. A total of 60 participants were enrolled, 88% female, with a mean age of 38 years (SD = 13.48). In an average follow-up of 25.02 months (SD = 5.32), the OHIP-14 total score decreased 8.67 (95% confidence interval [CI]: -11.21 to -6.11) after the intervention (Cohen's d = 1.22; 95% CI = 0.81 to 1.64). All OHIP-14 domain scores decreased (p < 0.05) except for the Functional limitation domain (p = 0.378). The oQoL after the intervention worsened in female patients (p = 0.039) and with a higher level of pain at baseline (p = 0.002). Self-perceived QoL improvement should be considered stable long term after temporomandibular joint arthrocentesis plus HA, regardless of concurrence with DJD or ID subtype. QoL should be used as clinical assessment measure of ID patients, with special attention to those with higher levels of pain.

TMJ arthroscopy with hyaluronic acid: A 12-month randomized clinical trial.

OBJECTIVES: To determine the effects of hyaluronic acid (HA) as an adjunct to temporomandibular joint (TMJ) arthroscopy, relative to standard TMJ arthroscopy, in Wilkes stage-III and stage-IV patients. METHODS: A randomized clinical trial design was utilized (ClinicalTrials.gov NCT04110587). 51 patients were allocated to a TMJ arthroscopy (n = 25) or a TMJ arthroscopy plus HA (n = 26) group. Visual analog scale joint pain scores, maximum mouth opening (MMO), and muscle pain were measured at baseline, and at 3, 6, 9, and 12 months. Disk position on magnetic resonance imaging was evaluated at baseline and 12 months. Oral health-related quality of life (OHRQoL) was assessed at baseline, and at 6 and 12 months. RESULTS: No group differences were observed in clinical or radiographic measurements (p ≥ .05). The results do not indicate any benefit of HA as an adjuvant therapy to arthroscopy during follow-up months 3-12. TMJ arthroscopy improved OHRQoL at 6 and 12 months (Oral Health Impact Profile-14 questionnaire scores of -14.59 and -14.27, 95% confidence intervals = -17.55 to -11.63 and -17.27 to -11.27) respectively, as well as pain and MMO, at all follow-up time points (p < .001). CONCLUSIONS: A beneficial effect of HA injection during TMJ arthroscopy after the 3-month follow-up was not observed.

Estado actual de la viscosuplementación con ácido hialurónico en el tratamiento de los trastornos temporomandibulares: revisión sistemática / Current status of viscosupplementation with hyaluronic acid in the treatment of temporomandibular disorders: a systematic review

Los trastornos temporomandibulares comprenden un conjunto de alteraciones relacionadas con factores biológicos, psicológicos y sociales. La cirugía mínimamente invasiva de la articulación temporomandibular constituye un tratamiento efectivo que junto con el uso del ácido hialurónico es usado para disminuir los signos y síntomas de los pacientes con trastornos temporomandibulares. Objetivo. Evaluar el beneficio clínico adicional de la infiltración del ácido hialurónico como único tratamiento o como coadyuvante a la cirugía mínimamente invasiva de la articulación temporomandibular. Material y método. Se ha realizado una búsqueda electrónica en las bases de datos Medline (PubMed) y Cochrane Central Register of Controlled Trials (CENTRAL) utilizando los términos: temporomandibular joint, temporomandibular disorders, hyaluronic acid y sodium hyaluronate. El criterio de selección fue: ensayos clínicos aleatorizados controlados o cuasi-aleatorizados que evalúan la infiltración de ácido hialurónico como único procedimiento o junto con cirugía mínimamente invasiva de la articulación temporomandibular. Resultados. Se incluyeron 8 estudios en la revisión. Cuatro estudios compararon la infiltración de ácido hialurónico con placebo. Dos estudios compararon la artroscopia más ácido hialurónico con artroscopia sin ácido hialurónico. Dos estudios compararon la artrocentesis con la artrocentesis más ácido hialurónico. Los resultados en las variables clínicas favorecen al ácido hialurónico frente al placebo a corto plazo. Conclusiones. Debido al riesgo de sesgo elevado son necesarios estudios con un mejor diseño metodológico que aporten datos más fiables para la cirugía mínimamente invasiva de la articulación temporomandibular más ácido hialurónico (AU)

Temporomandibular disorders are a set of related biological, psychological and social factors. Minimally invasive surgery of the temporomandibular joint is an effective treatment, and together with the use of hyaluronic acid this may reduce the signs and symptoms of patients with temporomandibular disorders. Objective. To evaluate the additional clinical benefit of an injection of hyaluronic acid as single treatment or as an adjunct to minimally invasive surgery of the temporomandibular joint. Material and methods. An electronic search of databases Medline (PubMed) and the Cochrane Central Register of Controlled Trials (CENTRAL) was made using the terms "temporomandibular joint", "temporomandibular disorders", "hyaluronic acid" and "sodium hyaluronate". The selection criteria were: randomised controlled or quasi-randomised clinical trials evaluating the injecting of hyaluronic acid as a single procedure or with minimally invasive surgery of the temporomandibular joint. Results. A total of 8 studies were included in this review. Four of them compared the injection of hyaluronic acid with placebo. Two studies compared arthroscopy with hyaluronic acid versus arthroscopy without hyaluronic acid. Two studies compared arthrocentesis versus arthrocentesis with hyaluronic acid. The results using the clinical variables showed hyaluronic acid to be superior to placebo in the short term. Conclusions. Due to the high risk of bias, more studies with better methodological design are needed in order to provide more reliable data for minimally invasive surgery of the temporomandibular joint with hyaluronic acid (AU)