Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania 'Luigi Vanvitelli', Naples, Italy.
Department of Woman, Child and General and Specialist Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy.
J Oral Rehabil. 2023 Dec;50(12):1535-1543. doi: 10.1111/joor.13572. Epub 2023 Aug 29.
Haemophilia A, B and von Willebrand disease are the most common bleeding disorders. There is an increased tendency of spontaneous bleeding into joints resulting in intra-articular infection. It is believed that Temporomandibular Joint (TMJ) can be affected in a similar manner which can further lead to limited mouth opening and ankylosis. The association between bleeding disorders (BD) and development of temporomandibular disorders (TMD) is poorly understood. This systematic review intends to evaluate the association of TMD in individuals with inherited bleeding disorders as compared to healthy controls.
PubMed, Ovid SP and Google Scholar were searched for articles published between the times of inception to 1 May 2023. All the articles were subjected to Population, Exposure, Comparison and Outcome model (PECO) based on which inclusion and exclusion criteria were applied. Participants (P) is children, adults or adolescents; Exposure (E) is children, adults or adolescents with a diagnosis of Haemophilia or bleeding disorder (BD); Comparator (C) is age and gender-matched healthy controls who do not have Haemophilia or bleeding disorder; Outcome (O) is prevalence of any signs or symptoms (clinical, radiographic) that is suggestive of temporomandibular disorder (TMD). Studies showing the prevalence of TMD are included for qualitative analysis. Only the studies which provided data of the prevalence of TMD in both the groups (BD and healthy controls) were included in the quantitative analysis. TMD diagnosis can be by clinical signs and symptoms, radiographic criteria, Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) or any other imaging criteria (MRI). We have set the exclusion criteria as articles without a control group, diagnostic sensitivity studies, case reports and systematic reviews and narrative reviews. The software Review Manager version 5.4 (Cochrane Collaboration) was used to perform the pooled analysis. We measured the risk ratio (RR) between the two groups (BD and healthy controls) for the outcome TMD.
A total of seven studies are included for qualitative analysis of data. The age of the population (BD and control) in the included studies ranged between 2 and 57 years. The prevalence of TMD in individual studies varied from 2% to 77%, and controls in the individual studies varied from 2% to 14%. Among the included studies, only clinical signs, symptoms and history were taken into consideration in four studies. Four studies were included for meta-analysis, the pooled result of the four studies suggests there is no significant difference in the prevalence of TMD in BD and control group (p value = .11, RR 2.19; 95% CI [0.84, 5.73]).
This systematic review and meta-analysis elicits no association between bleeding disorders and increased prevalence of TMD.
血友病 A、B 和血管性血友病是最常见的出血性疾病。关节内自发性出血的倾向增加，导致关节内感染。人们认为，颞下颌关节 (TMJ) 也可能以类似的方式受到影响，从而导致张口受限和关节强直。出血性疾病 (BD) 与颞下颌关节紊乱 (TMD) 之间的关联尚未得到充分理解。本系统评价旨在评估与健康对照组相比，遗传性出血性疾病患者的 TMD 发病情况。
在 PubMed、Ovid SP 和 Google Scholar 上检索了从成立时间到 2023 年 5 月 1 日发表的文章。所有文章均基于人群、暴露、比较和结局模型 (PECO) 进行了评估，根据该模型确定了纳入和排除标准。参与者 (P) 为儿童、成人或青少年；暴露 (E) 为患有血友病或出血性疾病 (BD) 的儿童、成人或青少年；对照组 (C) 为年龄和性别匹配的无血友病或出血性疾病的健康对照者；结局 (O) 为任何提示颞下颌关节紊乱 (TMD) 的体征或症状 (临床、影像学) 的患病率。包括显示 TMD 患病率的研究进行定性分析。仅纳入在两组 (BD 和健康对照组) 中均提供 TMD 患病率数据的研究进行定量分析。TMD 诊断可以通过临床体征和症状、影像学标准、颞下颌关节紊乱诊断标准 (DC/TMD)、颞下颌关节紊乱研究诊断标准 (RDC/TMD) 或任何其他影像学标准 (MRI) 进行。我们设定的排除标准为无对照组的文章、诊断敏感性研究、病例报告以及系统评价和叙述性综述。使用 Review Manager 版本 5.4 (Cochrane 协作网) 软件进行汇总分析。我们测量了两组 (BD 和健康对照组) 之间 TMD 结局的风险比 (RR)。
共纳入 7 项研究进行数据定性分析。纳入研究中人群 (BD 和对照) 的年龄范围为 2 至 57 岁。个别研究中 TMD 的患病率从 2%到 77%不等，个别研究中对照组的患病率从 2%到 14%不等。在纳入的研究中，只有 4 项研究同时考虑了临床体征、症状和病史。有 4 项研究纳入了荟萃分析，这 4 项研究的汇总结果表明，BD 和对照组 TMD 的患病率无显著差异 (p 值 =.11，RR 2.19；95%CI [0.84, 5.73])。
本系统评价和荟萃分析未发现出血性疾病与 TMD 患病率增加之间存在关联。
