Acupuncture And Moxibustion Treatment For Temporomandibular Disorders: A Systematic Review And Meta-analysis

Background Temporomandibular disorder(TMD)is one of the most common oral and maxillofacial diseases,with high incidence but relatively low rate of treatment,and its symptoms seriously affect the quality of life of the patients.There are many clinical reports on the treatment of TMD with acupuncture and moxibustion,but the quality of the research evidence is not high.Therefore,the clinical efficacy and safety of acupuncture and moxibustion for the treatment of TMD are not yet clear.Objective According to the method of Cochrane systematic review,we make the metaanalysis to evaluate the curative effect and safety of acupuncture and moxibusti on treatment for temporomandibular disorders(TMD),to provide evidence and research route for the clinical trial and scientific research of acupuncture and m oxibustion treatment for TMD in future.Methods According to the Cochrane systematic review method,characteristics of each datab ase and the inclusion criteria,we designed a reasonable and effective literature retriev al strategy.Then we searched in Chinese and English databases such as CNKI,CBM,VIP,WF,PubMed,Cochrane library,Springer,ScienceDirect by computer,and manua lly retrieve the related literatures in the library of Chengdu University of Traditional C hinese Medicine.The randomized controlled trials(RCT)of acupuncture and moxibu stion treatment for TMD were included in Chinese or English.After excluding repetiti ve literatures,the literatures were screened and data were extracted by 2 evaluators ac cording to the inclusion and exclusion criteria strictly.After screening all the literature s that met the inclusion criteria,Risk of bias table was used to conduct bias risk assess ment for all the literatures.Then the statistical software Revman5.3 provided by Coch rane Collaboration was used to make statistical and Meta-analysis of all the results in t he literatures.Finally,we used GRADE profiler 3.6 software to grade the quality of ea ch outcome index.Results This study included totally 32 articles,containing 2461 patients.The results of the system evaluation showed: 1.The difference of VAS score of acupuncture therapy was better than that of placebo therapy [SMD=0.53,95% CI[0.16,0.90].2.The effective rate of acupuncture was better than that of conventional therapy [OR=4.36,95% CI [2.48,7.69],P<0.00001],and so was the cure rate[OR=2.31,95% CI [1.67,3.21],P<0.00001].3.The effective rate of acupuncture combined with conventional therapy was better than that of conventional therapy[OR=5.26,95% CI [3.28,8.45],P<0.00001],so wa the cure rate[OR=2.49,95% CI[1.87,3.33],P<0.00001].4.The effective rate of moxibustion was better than that of conventional therapy [OR=5.19,95% CI [2.49,10.85],P<0.0001],so was the cure rate[OR=2.17,95% CI [1.22,3.88],P=0.008].5.The effective rate of moxibustion combined with conventional therapy was better than that of conventional therapy[OR=4.77,95% CI [2.06,11.06],P<0.00001],so was the cure rate[OR=2.73,95% CI[1.79,4.18],P<0.00001],so was the VAS score after treatment[MD=-3.30,95% CI[-3.54,3.05],P<0.00001].The quality of GRADE evidence showed: 1.Acupuncture VS Placebo therapy:the quality of the VAS score was "medium".2.Acupuncture VS Conventional therapy:the quality of evidence of effective rate was "very low",and the quality of evidence was "low" about the cure rate.3.(Acupuncture + Conventional therapy)VS Conventional therapy : the quality of evidence of effective rate was "very low",the quality of evidence of the cure rate was "low".4.Moxibustion VS Conventional therapy: the quality of the evidence of the efficacy was "very low",and the quality of the evidence was "low" about the cure rate.5.(Moxibustion + Conventional therapy)VS Conventional therapy : the quality of evidence of effective rate was "very low",the quality of evidence of the cure rate was "low",the quality of VAS score after treatment was "medium".Only 3 articles included adverse events,while no adverse event was reported.Conclusion 1.The efficacy of common acupuncture treatment of TMD is clear,and it is better t han placebo therapy.The evidence qualities of VAS score is "medium".A small am ount of articles are contained in this group,so that this conclusion should be treat ed carefully,and more clinical trials with large samples and high quality are neede d to be further proved in the treatment.2.The efficacy of common acupuncture and electroacupuncture treatment of TMDis clear,and it is better than conventional therapy.The evidence qualities of the effect ive rate and cure rate are "very low" and "low" respectively.A small amount of articles are contained in this group,so that this conclusion should be treated carefu lly,and more clinical trials with large samples and high quality are needed to be furt her proved in the treatment.3.The efficacy of acupuncture combined with conventional therapy of TMD is obvio us.The evidence qualities of the effective rate and cure rate are "very low" and "low" respectively.Meanwhile,there are a few studies in this group,so we need to take thi s conclusion carefully,and need more clinical trials with large samples and high qual ity to further prove the efficacy.4.The efficacy of warm acupuncture treatment of TMD is better than that of conventi onal therapy.The evidence qualities of the effective rate,cure rate are "very low" an d "low" respectively.Meanwhile,there are a few studies in this group,so we need to t ake this conclusion carefully,and need more clinical trials with large samples and hi gh quality to prove the efficacy further.5.The efficacy of warm acupuncture combined with conventional therapy of TMD i s obvious.The evidence qualities of the effective rate,cure rate and VAS score aft er treatment are "very low","low" and "medium" respectively.Meanwhile,there ar e a few studies in this group,so we need to take this conclusion carefully,and need m ore clinical trials with large samples and high quality to further prove the efficacy.6.The efficacy of thunder-fire moxibustion treatment of TMD is not yet sure.We still expect more supports from clinical trials.7.Because there is little description of the adverse events included in the study,this st udy can not evaluate the safety of acupuncture and moxibustion treatment of TMD ob jectively,and more clinical trials with large samples and high quality are needed to c onfirm it in the future.