Temporomandibular disorders and the use of traditional and laser acupuncture: a systematic review

Can ChatGPT-4o provide new systematic review ideas to oral and maxillofacial surgeons?

OBJECTIVE

This study aims to evaluate the capacity of ChatGPT-4o to generate new systematic review ideas in the field of oral and maxillofacial surgery. The data obtained from this study will provide evidence-based information to oral and maxillofacial surgeons regarding the academic use of GPT-4o.

MATERIALS AND METHODS

ChatGPT-4o was asked to provide four previously unpublished systematic review ideas each for the topics of impacted third molars, dental implants, orthognathic surgery, and temporomandibular disorders. A literature search was conducted in the PubMed database to check if the ideas generated by GPT-4o had been previously published, and the search results were compared with the ideas generated by the AI.

RESULTS

The PubMed database search resulted in a total of 871 publications, with 37 publications found to be related to the topics generated by GPT-4o after the first and second screening. Out of the 16 publication ideas generated by GPT-4o, 9 (56.25 %) were determined to be previously unexplored according to the PubMed database search. There was no statistically significant relationship between the presence of ChatGPT's suggestions in PubMed and the subject areas of the studies.

CONCLUSION

ChatGPT-4o has a high potential to be used as a valuable tool for suggesting systematic review topics in oral and maxillofacial surgery. Additionally, this tool can assist researchers not only in proposing publication ideas but also in developing the methodology of the study.

Effectiveness of Laser Acupuncture for Reducing Pain and Increasing Mouth Opening Range in Individuals with Temporomandibular Disorder: A Systematic Review and Network Meta-Analysis

PURPOSE OF REVIEW

Laser acupuncture (LA) demonstrates promising results in the treatment of musculoskeletal disorders. However, its effects on temporomandibular disorder (TMD) are not yet fully understood. Thus, the aim of this systematic review and network meta-analysis was to assess the effectiveness of LA on pain intensity and maximum mouth opening range (MMO) related to TMD. A search was carried out in 11 electronic databases and references of included studies to locate randomized clinical trials (RCTs) that evaluated LA as a primary treatment for TMD. The risk of bias was assessed using the RoB 2 tool. Network meta-analysis was conducted on the MetaInsight platform, considering the pain intensity and counseling (C) as the outcome of reference. The GRADE system was used to assess the certainty of the evidence.

RECENT FINDINGS

Five studies evaluated pain intensity, four with a high risk of bias and one with a low risk. Two studies evaluated pain intensity on palpation (one with high and one with low risk of bias), and one study with high risk of bias evaluated MMO. Laser parameters were: 690-810 nm, 40-150 mW, and 7.5-112.5 J/cm2. Occlusal splint (OS) [- 2.47; CI 95% - 3.64, - 1.30] and Physiotherapy (PT) [-2.64; CI 95% - 3.94, - 1.34] reduced pain intensity compared to C. The ranking of treatments in order of effectiveness was PT > OS > LA > C > CR (craniopuncture). The certainty of the evidence was very low or low. The data do not support the indication of LA for the treatment of TMDs and new placebo-controlled RCTs must be conducted to demonstrate its effectiveness more precisely.

The effectiveness of different types of acupuncture to reduce symptoms and disability for patients with orofacial pain. A systematic review and meta-analysis

PURPOSE

To determine the effectiveness of different types of acupuncture in reducing pain, improving maximum mouth opening and jaw functions in adults with orofacial pain.

METHODS

Six databases were searched until 15 June 2023. The Cochrane risk of bias tool and GRADE were employed to evaluate bias and overall evidence certainty.

RESULTS

Among 52 studies, 86.5% (n = 45) exhibited high risk of bias. Common acupoints, including Hegu LI 4, Jiache ST 6, and Xiaguan ST 7, were used primarily for patients with temporomandibular disorder [TMDs]. Meta-analyses indicated that acupuncture significantly reduced pain intensity in individuals with myogenous TMD (MD = 26.02 mm, I2=89%, p = 0.05), reduced tenderness in the medial pterygoid muscle (standardised mean differences [SMD] = 1.72, I2 = 0%, p < 0.00001) and jaw dysfunction (SMD = 1.62, I2 = 88%, p = 0.010) in mixed TMD when compared to sham/no treatment. However, the overall certainty of the evidence was very low for all outcomes as evaluated by GRADE.

CONCLUSION

The overall results in this review should be interpreted with caution as there was a high risk of bias across the majority of randomized controlled trial (RCTs), and the overall certainty of the evidence was very low. Therefore, future studies with high-quality RCTs are warranted evaluating the use of acupuncture in patients with orofacial pain.

Comparison of therapeutic effects of 940 nm diode laser acupuncture with transcutaneous electrical nerve stimulation in the myofascial pain dysfunction syndrome: a comparative randomized clinical trial

Myofascial pain dysfunction syndrome (MPDS) is one of the most common sources of orofacial pain. There are different types of physical therapy for patients with MPDS, but there is insufficient evidence that any one treatment method is superior. This study aimed to compare the clinical efficacy of transcutaneous electrical nerve stimulation (TENS) and laser acupuncture (LA) using a 940-nm diode on MPDS improvement. In this randomized clinical trial, 22 MPDS patients were randomly assigned to TENS (180 HZ, 300 µs, 20 min) and LA (940 nm, continuous wave, 0. 5 w, 40 s, 105 J/cm2) groups. Data on overall facial pain, tenderness in the masticatory muscles, deviation, joint sound, and maximum mouth opening without pain (MMO) were collected from all patients at baseline, before and after each treatment session, and 1 month after the end session. Data were analyzed using an independent t-test, repeated measures ANOVA, and Fisher's exact test at a significance level of P < 0.05. The decreases in overall facial pain (P = 0.000), muscle tenderness (P = 0.000), and increase in MMO (P = 0.01, P = 0.001) were statistically significant compared to the baseline in the TENS and AL groups. No significant differences were detected between TENS and LA for overall facial pain, muscle tenderness, or MMO at 1 month follow-up (P > 0.05). Both LA and TENS are effective physical therapies with promising effects on sign and symptom improvements in MPDS patients.

Is acupuncture an effective treatment for temporomandibular disorder?: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Acupuncture is used for treating various disorders, but its effects on temporomandibular disorder (TMD) remain unclear. This study aimed to assess the effectiveness and safety of acupuncture for TMD via a systematic review of randomized clinical trials.

METHODS

A total of 11 Korean and worldwide databases were searched to identify acupuncture studies in adults with TMD. A Cochrane risk of bias assessment was performed on all articles; a meta-analysis, which involved the categorization according to the type of control used (inactive control, active control, or add-on), was subsequently performed. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation methodology.

RESULTS

The qualitative analysis of randomized clinical trials with acupuncture as the intervention included 32 articles, 22 of which were included in the quantitative analysis (471 participants). Acupuncture significantly improved outcomes (effect rate, relative risk [RR]: 7.00, 95% confidence interval [CI]: 1.91, 25, 62; visual analog scale, standardized mean difference: 0.49, 95% CI: 0.24, 0.73) versus active controls (effect rate, RR: 1.19; 95% CI: 1.12, 1.27). In the analysis of add-ons, acupuncture significantly improved the effect rate and pain intensity (effect rate, RR: 1.36; 95% CI: 1.04, 1.77; visual analog scale, mean difference: -1.23; 95% CI -1.79, -0.67). However, the quality of evidence was determined to range from low to very low.

CONCLUSION

Acupuncture in TMD significantly improved outcomes versus active controls and when add-on treatments were applied. However, as the quality of evidence was determined to be low, well-designed clinical trials should be conducted in the future.

Is bruxism associated with temporomandibular joint disorders? A systematic review and meta-analysis

OBJECTIVES

The aim of this review is to examine and quantify the association between bruxism and temporomandibular joint disorders in a systematic review and meta-analysis.

METHODS

Electronic searches were performed in PubMed/Medline, Embase, Cochrane, Wiley, ProQuest, Web of Science, and Scopus databases for articles published up to March 2022. Two independent reviewers assessed the quality of the studies using the Newcastle-Ottawa Scale. A random-effects model was used to estimate the pooled odds ratio (OR) and its corresponding 95% confidence interval (CI) for each study.

RESULTS

The search retrieved 1651 studies, and 20 studies were eligible for meta-analysis. The results of the study showed that there is a significant relationship between bruxism and TMD, with the presence of bruxism increasing the odds of TMD by 2.25 times (OR = 2.25, 95% CI (1.94-2.56)). Based on the type of bruxism, awake bruxism was found to increase the odds of TMD by 2.51 times (OR = 2.51, 95% CI: (2.02-2.99)), while sleep bruxism increased the odds of TMD by 2.06 times (OR = 2.06, 95% CI: (1.82-2.30)). Analysis of the results from studies that reported both types of bruxism showed that bruxism increases the odds of TMD by 2.17 times (OR = 2.17, 95% CI: (2.30-3.05)).

CONCLUSION

The available data demonstrate a positive relationship between bruxism and TMD, with the presence of bruxism increasing the likelihood of developing TMD in the future.

The Effect of Lifting-and-Thrusting Laser Acupuncture on Electrodermal Activity of Acupoints, Pulse Characteristics, and Brainwave

Acupuncture has been shown as an effective traditional Chinese medicine treatment method, especially for pain relief. Recently, laser acupuncture is becoming increasingly popular, thanks to its noninvasive and painless nature and effectiveness in treating diseases, proven by many studies (for example, some previous studies showed that low-power laser stimulation is able to increase the power of alpha rhythms and theta waves). In our prior work, we developed a novel laser acupuncture model that emulates lifting-and-thrusting operation commonly used in traditional needle acupuncture and showed its benefit in improving cardiac output and peripheral circulation. By extending our previous studies, in this work, we perform extensive experiments to understand the effect of such a system on electrodermal activity (EDA) of acupoints, pulse characteristics, and brainwave, to further verify its efficacy. In particular, we found that laser stimulation could cause significant changes in EDA of acupoints, pulse amplitude, pulse-rate-variability (PRV), and acupoint conductance, as a function of laser power and stimulation time. In addition, laser acupuncture with the lifting-and-thrusting operation has more significant effect on increasing the power of alpha and theta frequency bands as compared to laser acupuncture without the lifting-and-thrusting operation. Finally, given sufficient stimulation time (e.g., > 20 min), the performance of a low-powered laser acupuncture with the lifting-and-thrusting operation could be comparable to that of traditional needle acupuncture.

Short-Term Effect of Scalp Acupuncture on Pain, Sleep Disorders, and Quality of Life in Patients with Temporomandibular Disorders: A A Randomized Clinical Trial

OBJETIVE

To evaluate the effects of Chinese scalp acupuncture in patients diagnosed with temporomandibular disorders (TMD) on pain, sleep, and quality of life (QOL), and compare these results with the results from traditional therapies.

METHODS

Sixty patients diagnosed with TMD using the research diagnostic criteria for temporomandibular disorders (RDC/TMD) were allocated into four treatment groups: counseling (C = 15), occlusal splint (OS = 15), scalp acupuncture (SA = 15), and manual therapy (MT = 15). Participants were re-evaluated within 1 month. Three questionnaires were used to access sleep disorders, QOL, and pain: The Pittsburgh Sleep Quality Index (PSQI), World Health Organization Quality of Life (WHOQOL-bref), and the Visual Analogue Scale (VAS), respectively. The data obtained were analyzed using the Statistical Package for the Social Science program (SPSS 22.0).

RESULTS

The SA group significantly improved pain (P = .015), as well as the OS (P = .01) and MT groups (P = .014). Only the OS (P = .002) and MT (P = .029) groups improved sleep. MT group significantly improved QOL in terms of the physical domain of the WHOQOL-bref (P = .011) and the OS group in the psychological domain (P = .012).

CONCLUSIONS

The scalp acupuncture proved to be another alternative for pain relief in patients with TMD, demonstrating positive results in the short term. However, it was not as effective in improving quality of life and sleep.