Introduction
Methods
Study design and ethical approval
Research question
Inclusion and exclusion criteria
Search strategy
Database searched | Search strategy and terms | Articles retrieved |
---|---|---|
Pubmed/medline* | ("Temporomandibular Joint Disorders"[Mesh] or “Temporomandibular joint disorder” or “Disorder, Temporomandibular Joint” or “Disorders, Temporomandibular Joint” or “Joint Disorder, Temporomandibular” or “Joint Disorders, Temporomandibular” or “Temporomandibular Joint Disorder” or “TMJ Disorders” or “Disorder, TMJ” or “Disorders, TMJ” or “TMJ Disorder” or “Temporomandibular Disorders” or “Disorder, Temporomandibular” or “Disorders, Temporomandibular” or “Temporomandibular Disorder” or “Temporomandibular Joint Diseases” or “Disease, Temporomandibular Joint” or “Diseases, Temporomandibular Joint” or “Joint Disease, Temporomandibular” or “Joint Diseases, Temporomandibular” or “Temporomandibular Joint Disease” or “TMJ Diseases” or “Disease, TMJ” or “Diseases, TMJ” or “TMJ Disease” or “Temporomandibular joint dysfunction syndrome” or “Temporomandibular joint pain” or “Temporomandibular pain” or “Craniomandibular Disorders” or “Craniomandibular Disorder” or “Disorder, Craniomandibular” or “Disorders, Craniomandibular” or “Craniomandibular Diseases” or “Craniomandibular Disease” or “Disease, Craniomandibular” or “Diseases, Craniomandibular” or “Chronic orofacial pain” or “Orofacial Pain” or “Craniofacial pain” or “Chronic craniofacial pain”) AND ("Quality of Life"[Mesh] or “Quality of life” or “Quality of lives” or “Life Quality” or “Health-Related Quality Of Life” or “Health Related Quality Of Life” or “Life Style” or “Karnofsky Performance Status” or “Sickness Impact Profile” or “Value of Life” or “Oral Health-related Quality of life” or “Oral Health Impact Profile” or “World Health Organization Quality of Life” or “Social Dental Indicators” or “General Oral Health Assessment Index” or “General quality of life” or “The Dental Impact Profile” or “Subjective Oral Health-Related Quality of Life Measure” or “The Dental Impact Daily Living” or “Oral Impacts on Daily Performances”) | 491 |
EMBASE† | (“Temporomandibular joint disorder” or “Disorder, Temporomandibular Joint” or “Disorders, Temporomandibular Joint” or “Joint Disorder, Temporomandibular” or “Joint Disorders, Temporomandibular” or “Temporomandibular Joint Disorder” or “TMJ Disorders” or “Disorder, TMJ” or “Disorders, TMJ” or “TMJ Disorder” or “Temporomandibular Disorders” or “Disorder, Temporomandibular” or “Disorders, Temporomandibular” or “Temporomandibular Disorder” or “Temporomandibular Joint Diseases” or “Disease, Temporomandibular Joint” or “Diseases, Temporomandibular Joint” or “Joint Disease, Temporomandibular” or “Joint Diseases, Temporomandibular” or “Temporomandibular Joint Disease” or “TMJ Diseases” or “Disease, TMJ” or “Diseases, TMJ” or “TMJ Disease” or “Temporomandibular joint dysfunction syndrome” or “Temporomandibular joint pain” or “Temporomandibular pain” or “Craniomandibular Disorders” or “Craniomandibular Disorder” or “Disorder, Craniomandibular” or “Disorders, Craniomandibular” or “Craniomandibular Diseases” or “Craniomandibular Disease” or “Disease, Craniomandibular” or “Diseases, Craniomandibular” or “Chronic orofacial pain” or “Orofacial Pain” or “Craniofacial pain” or “Chronic craniofacial pain”) AND (“Quality of life” or “Quality of lives” or “Life Quality” or “Health-Related Quality Of Life” or “Health Related Quality Of Life” or “Life Style” or “Karnofsky Performance Status” or “Sickness Impact Profile” or “Value of Life” or “Oral Health-related Quality of life” or “Oral Health Impact Profile” or “World Health Organization Quality of Life” or “Social Dental Indicators” or “General Oral Health Assessment Index” or “General quality of life” or “The Dental Impact Profile” or “Subjective Oral Health-Related Quality of Life Measure” or “The Dental Impact Daily Living” or “Oral Impacts on Daily Performances”) | 564 |
LILACS‡ | (“Temporomandibular joint disorder(s)” or “Craniomandibular disorder(s)” or “Temporomandibular joint dysfunction syndrome” or “Temporomandibulares disorder(s)” or “Temporomandibular disorders” or “Temporomandibular joint” or “Temporomandibular joint pain” or “Chronic orofacial pain” or “Orofacial pain” or “Craniofacial pain” or “Chronic craniofacial pain”) AND ("Quality of Life" or “Quality of life” or “Quality of lives” or “Life Quality” or “Health-Related Quality Of Life” or “Health Related Quality Of Life” or “Life Style” or “Karnofsky Performance Status” or “Sickness Impact Profile” or “Value of Life” or “Oral Health-related Quality of life” or “Oral Health Impact Profile” or “World Health Organization Quality of Life” or “Social Dental Indicators” or “General Oral Health Assessment Index” or “General quality of life” or “The Dental Impact Profile” or “Subjetive Oral Helth-Related Quality of Life Measure” or “The Dental Impact Daily Living” or “Oral Impacts on Daily Performances”) | 128 |
Study selection and extraction of data
Data analysis and quality evaluation
Results
Systematic review
Author (year) | Title | Journal | Country | Diagnostic criteria used | Measurement of Qual. of life | Method of data collection | Number and qualification of the examiner | Case selection method | Control selection method |
---|---|---|---|---|---|---|---|---|---|
Ahn et al [18] | Objective and subjective assessment of masticatory function in patients with temporomandibular disorder in Korea | J Oral Rehabil | South Korea | RDC/TMD (did not report axes) in cases and controls | OHIP (no version informed) | Interview, CE andRx | A single specialist examiner | Patients seeking treatment at the dental clinic | Dental Students |
Almoznino et al. [19] | Oral Health Related Quality of Life in Temporomandibular disorder patients | J Oral Facial Pain and Headache | Israel | DC/TMD and RDC/TMDaxis I in cases | OHIP-14 | Interview, CE | Not informed | Patients seeking treatmentat the dental clinic | Patients from the integrated clinic without TMD |
Bayat et al [6] | Oral health-related quality of life in patients with temporomandibular disorders: A case–control study considering psychological aspects | Int J Dent Hygiene | Iran | RDC/TMD axes I and II in cases | OHIP-14 | Interview, CE | A single calibrated specialist examiner | Patients seeking treatmentat the dental clinic | Returning patients for maintenance |
Karacayli et al [14] | The effects of chronic pain on oral healthrelated quality of life in patients with anterior disc displacement with reduction | Community Dental Health | Turkey | RDC/TMD (did not report axes) in cases | OHIP-14 | Interview, CE and MRI | A single calibrated specialist examiner | Patients seeking treatmentat the dental clinic | Random sample from healthy patients |
Miettinen. Lahti, Sipilä [15] | Psychosocial aspects of temporomandibular disorders and oral health-related quality-of-life | Acta Odontol Scand | Finland | RDC/TMD axis I in cases | OHIP-14 | Interview, CE | Not informed | Patients seeking treatmentat the dental clinic | University students without TMD |
Schierz et al [28] | Comparison of perceived oral health in patients with temporomandibular disorders and dental anxiety using oral health-related quality of life profiles | Qual Life Res | Germany | RDC/TMD (does not report axes) in cases | OHIP-14 | Interview, CE | Severalexperiencedexaminers | Patients seeking treatmentat the dental clinic | Probabilistic sample from the general population |
John et al [20] | Oral health-related quality of life in patients with temporomandibular disorders | J Orofac Pain | Germany | RDC/TMD axes I and II in cases | OHIP-49 | Interview, CE | Small number of experienced dentists | Patients seeking treatment at the dental clinic | Probabilistic sample from the general population |
Moufti et al [29] | The Oral Health Impact Profile: ranking of items for temporomandibular disorders | Europe J Oral Sci | Ukraine | RDC/TMD axes I and II in cases | OHIP-49 | Interview, CE | Not informed | Patients from the health care system | Accompanying other patients who did not have TMD |
Reissmann et al [21] | Functional and psychosocial impact related to specific temporomandibular disorder diagnoses | J Dent | Germany | RDC/TMD axes I and II in cases and controls | OHIP-49 | Interview, CE | Small group of specialists | Patients seeking treatmentat the dental clinic | Probabilistic sample from the general population evaluated by the Helkimo-index without TMD |
Rener-Sitar et al [22] | Oral health related quality of life in Slovenian patients with craniomandibular disorders | Coll Antropol | Slovenia | RDC/TMD axis I in cases and controls | OHIP-49 | Interview, CE | Not informed | Patients seeking treatmentat the dental clinic | Randomized sample fromthegeneral urban population |
Rener-Sitar et al [23] | Factors related to oral health related quality of life in TMD patients | Coll Antropol | Slovenia | RDC/TMD axis I in cases and controls | OHIP-49 | Interview, CE | Not informed | Patients seeking treatmentat the dental clinic | Randomized sample from the general urban population |
Barros et al [24] | The impact of orofacial pain on the quality of life of patients with temporomandibular disorder | J Orofac Pain | Brazil | RDC/TMD axis I | OHIP-14 (modified) | Interview, CE | Three calibrated examiners (did not report qualification) | Patients seeking treatmentat the dental clinic | Not informed |
Blanco-Aguilera et al [16] | Application of an oral health-related quality of life questionnaire in primary care patients with orofacial pain and temporomandibular disorders | Med Oral Patol Cir Bucal | Spain | RDC/TMD (did not report axes) | OHIP-14 | Interview, CE | A single calibrated specialist examiner | Sample of the population of the Public Health System | Not informed |
Su et al [4] | Correlation between oral health-related quality of life and clinical dysfunction index in patients with temporomandibular joint osteoarthritis | J Oral Sci | China | RDC/TMD axis I | OHIP-14 | Interview, CE | A single calibrated specialist examiner | Patients seeking treatmentat the dental clinic | Not informed |
Tjakkes et al [25] | TMD pain: The effect on health related quality of life and the influence of pain duration | Health Qual Life Outcomes | Netherlands | RDC/TMD axes I and II | SF-36 | Interview, CE | Not informed | Patients seeking treatmentat the dental clinic | Not informed |
Resende et al [5] | Quality of life and general health in patients with temporomandibular disorders | Braz Oral Res | Brazil | RDC/TMD axes I and II | WHOQOL-Brev | Interview, CE | Not informed | Patients seeking treatmentat the dental clinic | Not informed |
Portella, Smith, Guimarães [31] | Qualidade de vida em pacientes com disfunção temporomandibular: avaliação através do questionário SF-36 | CAPES BDTD | Brazil | RDC/TMD axis I in cases | SF-36 | Interview, CE | Many dentists | Patients seeking treatmentat the dental clinic | Patients seeking treatmentat the dental clinic |
Trize, Marta [32] | Disfunção temporomandibular e sua associação com qualidade de vida | CAPES BDTD | Brazil | RDC/TMD axis I in cases and controls | SF-36 | Interview, CE | A single calibrated examiner (did not inform qualification) | Patients seeking treatmentat the dental clinic | Patients seeking treatmentat the dental clinic |
Castanharo, Junior [34] | Estudo da qualidade de vida em pacientes com disfunção temporomandibular e cefaleias primárias | CAPES BDTD | Brazil | RDC/TMD axis I in cases and controls | SF-36 | Interview, CE | Several trained and calibrated researchers (did not report qualification) | Patients seeking treatmentat the dental clinic | Patients seeking treatmentat the dental clinic |
Gui et al [33] | Quality of life in temporomandibular disorders patientes with localized and widespread pain | Braz J Oral Sci | Brazil | RDC/TMD axis I in cases | SF-36 | Interview, CE | Calibrated examiners (did not report numbers) | Not informed | Not informed |
Pigozzi et al [26] | Prevalence of quality of life in patients with temporomandibular disorders in an adult population-based case–control study in Southern-Brazil | Int J Prosthodont | Brazil | RDC/TMD axes I and II in cases and controls | WHOQOL-Brev | Interview, CE | A single calibrated and PhD student examiner | Randomized, representative sample from the population | Randomized, representative sample from the population |
Da Silva, Barbosa [35] | Relação entre aspectos sociodemográficos, ansiedade e qualidade de vida com disfunção temporomandibular | CAPES BDTD | Brazil | RDC/TMD axis I in the cases and controls | WHOQOL-Brev | Interview, CE | A single calibrated examiner (did not report qualification) | Notinformed | Not informed |
Lucena, Da Costa, De Góes [17] | O impacto da disfunção temporromandibular na qualidade de vida relacionada à saúde bucal | CAPES BDTD | Brazil | RDC/TMD axis I and II | OHIP-14 | Interview, CE | A single calibrated and PhD student examiner | Patients seeking treatment at the dental clinic | Not informed |
Rodrigues, Mazzatto [27] | Impacto da dor e do ruído articular na qualidade e no custo de vida de indivíduos com disfunção temporomandibular | CAPES BDTD | Brazil | RDC/TMD axis I | OHIP-14 | Interview, CE | A single examiner (did not report qualification) | Patients referred from the Public Health System | Not informed |
Author (year) | Measurement Quality of life | n (n woman)/ mean age (SD) | Total number of controls (n woman)/mean age (SD) | Results / conclusions |
---|---|---|---|---|
Ahn et al [18] | OHIP (does not report version) | 51(32)/26.2(8.8) | 20(5)/26.5(9.1) | OHIP scores were worse in the TMD group than in controls. The pain group presented the domains of physical pain (2.05), physical disability (2.15) and psychological incapacity (1.81), greater than the control group. There was no significant difference with MAI, but there was a higher correlation with FIA than with VAS. The FIA showed correlation with the 5 domains of OHIP, mainly physical incapacity and pain |
Almoznino et al. [19] | OHIP-14 | 187(111)/21.12(3.83) | 200(90)/20.93(3.74) | In TMD group, there were statistical differences for the following OHIP domains as compared to controls: physical pain, physical incapacity, psychological discomfort, and psychological incapacity. The groups with the worst results were: muscular and articular pain, followed by muscular only and articular only groups, but with no statistical difference between the last two groups. There was no difference in relation to the sociodemographic profile. There was an inverse relationship between pain and quality of life, mainly due to limitation of mouth opening, forced opening of the mouth, pain during opening, and limitation of lateral movements |
Bayat et al [6] | OHIP-14 | 75(64)/34.3(12.3) | 75(55)/29.1(6.1) | The TMD group had a statistically worse quality of life than controls, positively correlated with TMD severity, mainly related to duration of pain and the GCPS scale. There was no statistical difference regarding ageand gender in relation toquality of life prevalence, but severity was higher in women.The prevalence and severity of OHIP was 6 and 2 times higher respectively in the TMD group, and the factor that influenced the most was the psychological incapacity |
Karacayli et al [14] | OHIP-14 | 37(23)/29(**) | 37(23)/30(**) | In the OHIP, patients with disc displacement had worse quality of life than the control group, mainly inbothworse pain in the last 6 months and average intensity of pain in the last 6 months. In addition, a worse OHIP-14 score was observed in patients who had problems with smiling/laughing, teeth/face cleaning, swallowing, and talking. OHIP was significantly worse when pain intensity was also higher |
Miettinen. Lahti, Sipilä [15] | OHIP-14 | 79(61)/43.5(13.1) | 70(47)/25.3(6.5) | OHIP was worse in all RDC/TMD groups relative to controls, and it was also directly related to pain intensity. Women had an OHIP worse than men in all sub-items and also in relation to severity. OHIP was 3 times worse in the TMD than in the non-TMD group. Psychosocial factors were associated with TMD and impaired quality of life |
Schierz et al [28] | OHIP-14 | 416(329)/37.4(16.2) | 2026(1054)/43.3(16.2) | Patients with TMD had a statistically worse OHIP scores than both patients with anxiety and the general population, the last with the best quality of life |
John et al [20] | OHIP-49 | 416(329)/37.4(16.2) | 2026(1054)/43.3(16.2) | For OHIP, on the RDC/TMD axis I, there was better quality of life in patients with disc displacement without reduction as compared to the other two groups. However, they were statistically worse than the control group. Women had worse scores, but with no statistical difference. Regarding axis II, mandibular dysfunction had worse OHIP scores. There was greater somatization in the TMD group, with worse OHIP scores, as opposed to depression. However, both were higher than the general population |
Moufti et al [29] | OHIP-49 | 110(92)/39(**) | 110 (92)/38(**) | The study demonstrated statistical differences between patients with and without TMD in OHIP scores. The impact of pain and physical disability was substantial. The study also appeared to show a worse outcome on the impact of the overall oral health in quality of life among TMD patients, with worse scores reported in all items |
Reissmann et al [21] | OHIP-49 | 471(358)/38.6(15.6) | 35(16)/36.1(10.7) | The population with TMD had significantly worse OHIP scores than controls. Within the TMD groups, the worst OHIP score was for myofascial pain without limited opening, and the best OHIP score was for disc displacement group with reduction. Patients with DD without reduction had a significantlyworse OHIP scores than with reduction. Within group III, there was no significant statistical difference among arthralgia, arthritis and arthrosis. In the 3 TMD groups, group II had the best OHIP scores, differing statistically from groupsI (the worst) and group III. Groups I and III did not differ between themselves |
Rener-Sitar et al [22] | OHIP-49 | 68(58)/36.54(13.76) | 400(270)/41.38(12.66) | OHIP scores wereworse in the TMD population than in the controls. The best OHIP scores were in disc displacement with reduction, and the worst were in disc displacement without reduction with limited opening. There was no significant difference between genders |
Rener-Sitar et al [23] | OHIP-49 | 81(65)/36.1(13.4) | 400(291)/41.38(12.66) | Similar results were reported in relation to the previous study by the same authors; however, the worst OHIP scores were found inboth osteoarthritis and disc displacement without reduction with limited opening |
Barros et al [24] | OHIP-14 (modif.) | 83(69)/36.5(13.5) | – | Women presented worse impact in the functional limitation; in the other domains, there was no significant difference. There was statistical difference between groups I and III, but not against group II; and group III had the worst result. The severity of TMD was directly related to poorer quality of life |
Blanco-Aguilera et al [16] | OHIP-14 | 407(364)/♀42.15(14.66) and ♂41.48(17.28) | – | Women had a worse OHIP scores than men. OHIP still showed a significant and positive association between patients with both high intensity of pain without disability and poor perception of quality of life in relation to oral health. They also presented higher OHIP values for physical pain and psychological discomfort. The duration of pain over 1 year also interfered in OHIP by 6.5 points in relation to the group with less pain duration. Age and marital status were not significant |
Su et al [4] | OHIP-14 | 541(407)/38.59(15.52) | – | Muscle sensitivity during palpation was related to worse OHIP scores in all domains. An increase in TMJ pain scores on palpation in HDI was significantly associated with worse OHIP total score and domains, with the exception of functional limitation |
Tjakkes et al [25] | SF-36 | 95(90)/40.3(13.1) | – | There was statistical difference for SF-36 in RDC/TMD groups I and III in the following areas: physical functionality and pain in the body. But there was no significant difference between groups II and III. The other scores did not differ statistically amonggroups. Regarding TMD duration, patients with less than 1 year with diagnosed TMD presented better scores in physical functionality. However, those who had TMD for more than 1 years had an impact mainly on social commitment |
Resende et al [5] | WHOQOL-Bref | 43(43)/36.48(**) | – | The WHOQOL was worse for group II in the social aspect for the disc displacement with reduction. In the physical aspect, there was a significant association with all TMD groups, and it was directly related to pain severity. The worst WHOQOL scores were in the group with associated muscular and articular dysfunction |
Portella, Smith, Guimarães [31] | SF-36 | 45(45)/32(10) | 58(58)/33(10) | The TMD group presented SF-36 scores significantly worse than those in the control group in the following domains: functional capacity, physical appearance, pain, general health status, vitality, social aspects, emotional aspects and mental health |
Trize, Marta [32] | SF-36 | 51(*)/** | 51(*)/** | The TMD group showed worse quality of life than the group without TMD, in all absolute values, but it was statistically significant only for pain and mental health |
Castanharo, Junior [34] | SF-36 | 228(200)/** | 34(19)/** | There was a statistical difference for all domains between general TMD and controls. Regarding pain, the control group differed from the other threeRDC/TMD axis I groups. The TMD + headache group differed from both the TMD groupandthe headache group alone. For mental health, emotional and social aspect, and general health, the TMD + headache group had significantly worse scores than both the control group and headache group alone |
Gui et al [33] | SF-36 | 76(76)/** | 40(40)/50.93(12.34) | Patients in the TMD group with diffuse pain differed significantly in all components as compared to controls. In the TMD with localized pain, the emotional factor did not differ among subgroups. The domains of general health, mental, physical and psychological function did not differ between TMD with localized pain and controls |
Pigozzi et al [26] | WHOQOL-Bref | 584(*)/** | 1048(*)/** | There was a significantly worse quality of life in all domains in both RDC/TMD axis I and II versus controls. Group I (muscle disorders), group III (arthralgia) and group III (osteoarthritis) had statistically significant difference in all domains as compared to controls. For group II (disc displacement), this difference was not observed in any domain. For group III with osteoarthrosis, there was no significant difference for the psychological, social and environmental domains, butonly for the physical domain. Pain intensity/severity was related to lower quality of life scores |
Da Silva, Barbosa [35] | WHOQOL-Bref | 60(*)/** | 60(*)/** | In all domains, subjects without TMD showedsignificantlybetterquality of life and compared to TMD patients. In the WHOQOL-General, the subjects without TMD showed also significantbetterscores of quality of life. There were 9.2 times more chances of individuals with low quality of life of having TMD than those with medium to high quality of life scores |
Lucena, Da Costa, De Góes [17] | OHIP-14 | 155(138)/37.3(12.9) | – | Pain interfered negatively in the quality of life, with greater impairment in the performance of the daily activities related to the physical domain, followed by the psychological and, with less impact, in the social activities. Psychological factors, such as depression, somatization, psychosocial incapacity, and pain intensity were significantly associated with quality of life impairment |
Rodrigues, Mazzatto [27] | OHIP-14 | 80(70)/32.71(**) | – | TMD interfered in the quality of life in all three RDC/TMD axis I groups. Disc displacement with muscle pain had the worstquality of life, while the best was only for disc displacement. The severity of pain was also directly related to the worst quality of life scores |
Meta-analysis
Publication bias
Quality of the studies
Study | Selection | Comparability | Outcome | Total | |
---|---|---|---|---|---|
Ahn et al [18] | ★ 1C, 2C, 3A | ★★ | ★ 1D, 2A | 4★ | |
Almoznino et al [19] | ★★ 1C, 2A, 3A | ★★ | ★ 1D, 2A | 5★ | |
Bayat et al [6] | ★★ 1C, 2A, 3A | ★★ | ★ 1D, 2A | 5★ | |
Karacayli et al [14] | ★★ 1C, 2A, 3A | ★★ | ★ 1D, 2A | 5★ | |
Miettinen. Lahti, Sipilä [15] | ★ 1C, 2B, 3A | ★★ | ★ 1D, 2A | 4★ | |
Schierz et al [28] | ★★★ 1B, 2A, 3A | ★★ | ★ 1D, 2A | 6★ | |
John et al [20] | ★★★ 1B, 2A, 3A | ★★ | ★ 1D, 2A | 5★ | |
Moufti et al [29] | ★★ 1C, 2A, 3A | ★ | ★ 1D, 2A | 4★ | |
Reissmann et al [21] | ★★★ 1B, 2A, 3A | ★★ | ★ 1D, 2A | 6★ | |
Rener-Sitar et al [22] | ★★ 1C, 2A, 3A | ★★ | ★ 1D, 2A | 4★ | |
Rener-Sitar et al [23] | ★★ 1C, 2A, 3A | ★★ | ★ 1D, 2A | 4★ | |
Barros et al [24] | ★ 1C, 2A, 3B | 0 | ★ 1D, 2A | 2★ | |
Blanco-Aguilera et al [16] | ★★★ 1B, 2A, 3B | 0 | ★ 1D, 2A | 4★ | |
Su et al [4] | ★ 1C, 2B, 3A | ★★ | ★ 1D, 2A | 4★ | |
Tjakkes et al [25] | ★ 1C, 2B, 3A | 0 | ★ 1D, 2A | 2★ | |
Resende et al [5] | ★ 1C, 2B, 3A | 0 | ★ 1D, 2A | 2★ |