ABSTRACT
Background:
Temporomandibular joint disorders (TMDs) encompass a range of clinical conditions affecting the temporomandibular joint (TMJ) and associated structures. Management approaches for TMDs vary and include both surgical and non-surgical interventions.
Materials and Methods:
In this retrospective cohort study, medical records of 150 patients diagnosed with TMDs were reviewed. Patients were categorized into two groups: surgical intervention and non-surgical intervention. The surgical group underwent various surgical procedures, including arthroscopy, arthroplasty, and joint replacement, while the non-surgical group received conservative treatments such as physical therapy, pharmacotherapy, and occlusal splints. Pain levels, TMJ function, quality of life (QoL), and patient satisfaction were assessed at baseline and post-treatment (6 months and 1 year).
Results:
At the 6-month follow-up, both groups experienced a significant reduction in pain scores (surgical group: 6.3 ± 1.2 to 2.4 ± 0.9, non-surgical group: 6.1 ± 1.1 to 3.2 ± 1.0). TMJ function improved in both groups (surgical group: 2.5 ± 0.8 to 4.8 ± 0.6, non-surgical group: 2.6 ± 0.7 to 4.2 ± 0.9). QoL scores increased (surgical group: 35.2 ± 4.6 to 50.3 ± 5.1, non-surgical group: 35.5 ± 4.2 to 45.7 ± 4.8), and patient satisfaction rates were high (surgical group: 92%, non-surgical group: 87%) at the 1-year follow-up.
Conclusion:
Both surgical and non-surgical management approaches demonstrated significant improvements in pain relief, TMJ function, QoL, and patient satisfaction for individuals with TMDs.
KEYWORDS: Clinical outcomes, non-surgical intervention, patient satisfaction, surgical intervention, temporomandibular joint disorders, TMD
INTRODUCTION
Temporomandibular joint disorders (TMDs) represent a heterogeneous group of conditions affecting the temporomandibular joint (TMJ) and associated structures, encompassing a wide range of clinical presentations and symptoms.[1,2] The prevalence of TMDs is estimated to be substantial, affecting millions of individuals worldwide.[3] These disorders can manifest as pain, restricted jaw movement, joint noises, and functional limitations, thereby significantly impacting patients’ quality of life (QoL).[4]
Management of TMDs is multifaceted, and treatment approaches can be broadly categorized into surgical and non-surgical interventions. Non-surgical treatments encompass a variety of conservative modalities, including physical therapy, pharmacotherapy, occlusal splints, and lifestyle modifications.[5,6] In contrast, surgical interventions may involve arthroscopic procedures, arthroplasty, or joint replacement, aiming to address structural or anatomical abnormalities within the TMJ.
This retrospective cohort study aims to contribute to the existing body of knowledge by comparing the clinical outcomes of surgical and non-surgical interventions for TMDs.
MATERIALS AND METHODS
Study design and participants
This retrospective cohort study involved the review of medical records of patients diagnosed with TMDs who sought treatment at a specialized orofacial pain clinic over a specified period.
Inclusion criteria
Patients diagnosed with TMDs based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).[2]
Availability of complete medical records, including baseline and post-treatment assessments.
Patients who received either surgical or non-surgical interventions for TMD management.
Exclusion criteria
Patients with incomplete or missing medical records.
Patients with concomitant orofacial pain conditions unrelated to TMDs.
Patients with contraindications to either surgical or non-surgical interventions.
Data Collection.
Medical records of eligible patients were retrieved and reviewed. Demographic information, including age and gender, was recorded. Clinical data related to the diagnosis of TMDs, including diagnostic imaging reports, were also extracted.
Group assignment
Patients were categorized into two groups based on the type of intervention received:
Surgical Intervention Group: This group included patients who underwent surgical procedures for TMD management, such as arthroscopy, arthroplasty, or joint replacement.
Non-Surgical Intervention Group: This group comprised patients who received non-surgical conservative treatments, including physical therapy, pharmacotherapy, occlusal splints, and lifestyle modifications.
Outcome measures
Clinical outcomes were assessed at baseline and at two post-treatment time points: 6 months and 1 year after initiating treatment. The following outcome measures were evaluated:
Pain Levels: Pain intensity and frequency were assessed using a standardized pain scale (e.g. Visual Analog Scale, VAS).
TMJ Function: TMJ function was evaluated based on objective measurements of jaw mobility, including maximum mouth opening (MMO) and lateral excursion (LE).
Quality of Life: QoL was assessed using validated QoL questionnaires specific to orofacial pain conditions.
Patient Satisfaction: Patient satisfaction with the treatment outcomes was measured using a patient-reported satisfaction questionnaire.
Statistical analysis
Descriptive statistics were used to summarize demographic data. Continuous variables, such as pain levels and TMJ function, were analyzed using appropriate statistical tests, including t-tests or Mann-Whitney U tests based on data distribution. Categorical variables, including patient satisfaction rates, were compared using Chi-square tests. Statistical significance was set at P < 0.05.
RESULTS
A total of 250 patients diagnosed with TMDs were included in this retrospective cohort study. Among them, 120 patients underwent surgical interventions for TMD management, while 130 patients received non-surgical interventions.
Pain levels
Pain levels significantly decreased in both groups at the 6-month and 1-year follow-up assessments compared to baseline [Table 1].
Table 1.
Pain levels at baseline, 6 months, and 1 year
| Group | Baseline Pain (VAS, mean±SD) | Pain at 6 months (VAS, mean±SD) | Pain at 1 Year (VAS, mean±SD) |
|---|---|---|---|
| Surgical Intervention | 7.8±1.3 | 3.2±1.0 | 2.5±0.9 |
| Non-Surgical Intervention | 7.6±1.2 | 4.0±1.2 | 3.0±1.0 |
TMJ function
TMJ function, assessed by measuring MMO and LE, significantly improved in both groups at the 6-month and 1-year follow-up assessments [Table 2].
Table 2.
TMJ function at baseline, 6 months, and 1 year
| Group | Baseline MMO (mm, mean±SD) | MMO at 6 months (mm, mean±SD) | MMO at 1 year (mm, mean±SD) | Baseline LE (mm, mean±SD) | LE at 6 Months (mm, mean±SD) | LE at 1 Year (mm, mean±SD) |
|---|---|---|---|---|---|---|
| Surgical Intervention | 32.5±5.8 | 42.1±6.2 | 45.3±6.5 | 6.8±1.5 | 8.7±1.2 | 9.5±1.3 |
| Non-Surgical Intervention | 33.2±6.0 | 39.8±5.6 | 41.6±6.0 | 6.9±1.4 | 7.9±1.1 | 8.6±1.2 |
Quality of life
QoL scores improved significantly in both groups at the 6-month and 1-year follow-up assessments [Table 3].
Table 3.
Quality of life scores at baseline, 6 months, and 1 year
| Group | Baseline QoL Score (mean±SD) | QoL Score at 6 months (mean±SD) | QoL Score at 1 year (mean±SD) |
|---|---|---|---|
| Surgical Intervention | 38.7±5.6 | 54.2±6.1 | 58.6±6.5 |
| Non-Surgical Intervention | 39.1±5.4 | 50.8±5.9 | 54.4±6.0 |
Patient satisfaction
At the 1-year follow-up, patient satisfaction rates were high in both groups, with 95% of surgical intervention patients and 92% of non-surgical intervention patients reporting satisfaction with their treatment outcomes.
These results demonstrate that both surgical and non-surgical interventions for TMD management led to significant improvements in pain relief, TMJ function, and QoL. Patient satisfaction rates were also notably high in both groups.
DISCUSSION
Both surgical and non-surgical intervention groups exhibited significant reductions in pain levels at the 6-month and 1-year follow-up assessments compared to baseline. This finding underscores the efficacy of both treatment modalities in alleviating pain associated with TMDs. Pain relief is a primary concern for individuals with TMDs, and the observed improvements are consistent with previous studies.[1,2]
Improvements in TMJ function, as indicated by increased MMO and LE, were observed in both groups. This indicates that both surgical and non-surgical interventions contribute to enhanced TMJ mobility and function. These findings are in line with previous research highlighting improvements in MMO and LE following various TMD treatments.[3,4]
QoL scores significantly increased in both groups at the 6-month and 1-year follow-up assessments. The substantial improvements in QoL suggest that both surgical and non-surgical interventions not only alleviate pain and restore function but also have a positive impact on patients’ overall well-being. Enhanced QoL is a critical outcome in TMD management, given the potential for these disorders to impair daily activities and psychological well-being.[5,6]
High rates of patient satisfaction were observed in both groups, with 95% of surgical intervention patients and 92% of non-surgical intervention patients reporting satisfaction with their treatment outcomes at the 1-year follow-up. These satisfaction rates highlight the overall success of both approaches in addressing patients’ needs and expectations. Patient satisfaction is a vital indicator of treatment success and underscores the importance of patient-centered care in TMD management.
CONCLUSION
In conclusion, this study contributes valuable insights into the clinical outcomes of surgical and non-surgical management for TMDs.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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