Comparative effectiveness of traditional East Asian medicine treatments for temporomandibular joint disorders: A systematic review and network meta-analysis.

BACKGROUND

Temporomandibular joint disorders (TMDs) cause pain and functional restrictions in the temporomandibular joint that interfere with daily activities. This study aimed to evaluate and compare the effectiveness and safety of various traditional East Asian medicine treatments, including acupuncture, electroacupuncture, moxibustion, and herbal medicine, in the management of TMD.

METHODS

We included searches of MEDLINE, CENTRAL, EMBASE, AMED, CINAHL, OASIS, KISS, RISS, KMbase, KCI, CNKI, and CiNii from inception to November 12, 2023, for randomized controlled trials of traditional East Asian medicine treatments in patients with TMD. A network meta-analysis was performed using frequentist methods, and the Confidence In Network Meta-Analysis methodology were employed to assess evidence quality.

RESULTS

Forty-five studies with 2,211 participants were finally included. Acupotomy (Mean difference (MD) -5.07, 95 % Confidence interval (CI) -7.37 to -2.78) and acupuncture (MD -1.18, 95 % CI -2.28 to -0.09) showed statistically significant superiority in reducing pain intensity compared to sham treatment. According to the SUCRA rankings, acupotomy was considered the most effective treatment, followed by electroacupuncture, acupuncture, manipulation, laser therapy and occlusal splint. A total of 12 studies reported incidence of adverse events, and none were serious adverse events.

CONCLUSION

Acupotomy and acupuncture could be more beneficial than sham treatment in pain relief and might be a better option than occlusal splint. However, future rigorous, well-designed trials are needed to draw clear conclusions.

PROTOCOL REGISTRATION

PROSPERO (CRD42023467340).