The aim of this narrative review was to present research investigating chitosan, including its general characteristics, properties, and medical and dental applications, and finally to present the current state of knowledge regarding the efficacy of chitosan in the treatment of temporomandibular disorders (TMDs) based on the literature. The PICO approach was used for the literature search strategy. The PubMed database was analyzed with the following keywords: (“chitosan”[MeSH Terms] OR “chitosan”[All Fields] OR “chitosans”[All Fields] OR “chitosan s”[All Fields] OR “chitosane”[All Fields]) AND (“temporomandibular joint”[MeSH Terms] OR (“tem-poromandibular”[All Fields] AND “joint”[All Fields]) OR “temporomandibular joint”[All Fields] OR (“temporomandibular”[All Fields] AND “joints”[All Fields]) OR “temporo-mandibular joints”[All Fields]). After screening 8 results, 5 studies were included in this review. Chitosan presents many biological properties and therefore it can be widely used in several branches of medicine and dentistry. Chitosan promotes wound healing, helps to control bleeding, and is used in wound dressings, such as sutures and artificial skin. Apart from its antibacterial property, chitosan has many other properties, such as antifungal, mucoadhesive, anti-inflammatory, analgesic, antioxidant, antihyperglycemic, and antitumoral properties. Further clinical studies assessing the efficacy of chitosan in the treatment of TMD are required. According to only one clinical study, chitosan was effective in the treatment of TMD; however, better clinical results were obtained with platelet-rich plasma.
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Introduction
Temporomandibular disorders (TMDs) is a broad term encompassing dysfunction of the temporomandibular joints (TMJs) and/or the masticatory musculature. The most important feature of TMD is pain, followed by restricted or limited jaw movement, and joint noises during jaw movement [1]. Pain-related TMD, including, among others, myalgia and arthralgia, and intra-articular TMD, including different types of disc displacements, degenerative joint disease, and subluxation [1], exist.
The overall prevalence of TMD was found to be approximately 31% for adults/elderly and 11% for children/adolescents, and the most common type of TMD is disc displacement with reduction [2]. Persistent and recurrent pain in the area of TMJs may lead to psychological discomfort, physical disability, and functional limitations, and therefore may reduce oral health-related quality of life [3,4,5,6].
The etiology of TMD is multifactorial [7]. One of the most important potential causes of TMD is mechanical overloading. Excessive intraarticular forces may cause temporary hypoxia in vascular-supplied structures. When the load is reduced and the intraarticular pressure decreases, blood is reperfused into the capillaries that supply the joint structures. Repeatable cycles of hypoxia and reperfusion lead to the release of free radicals into the synovial fluid. Free radicals have been found to inhibit biosynthesis of hyaluronic acid, and break down already existing chains of hyaluronic acid. Hyaluronic acid protects the phospholipids that line the surfaces of the joints and provide important hydration [8,9,10,11,12,13,14,15,16,17]. Without phospholipids, articular surfaces wear off, which leads to TMJs’ destruction and so-called “sticking” [18,19,20]. Afterwards, non-inflammatory osseocartilaginous pathology, known as chondromalacia, develops [21,22]. Chondromalacia is reversible in its early stages. However, if the mechanical loading exceeds the capacity of the articular tissues, irreversible changes occur within the TMJs. This may lead to sticking of the articular surfaces (adherences), and eventually to disc displacements [22,23]. Figure 1 presents the schematic changes that occur within the TMJs due to mechanical overloading based on the literature.
Different treatment modalities for TMD have been discussed, including conservative methods of treatment (physiotherapy, occlusal splint therapy, pharmacotherapy), less invasive surgical procedures (arthrocentesis, intraarticular injections), and invasive surgical procedures (arthroscopy, open joint surgery) [
24,
25]. The choice of an adequate treatment option depends on the initial diagnosis, history of previous treatment, and intensity of reported symptoms [24,25].
Minimally invasive surgical procedures, including arthrocentesis and intraarticular injections, are very effective in TMJs’ pain reduction and therefore can be recommended either additionally to conservative therapy or even as a first-line therapy [25]. Arthrocentesis can be performed either alone or in combination with intraarticular injections. So far, intraarticular injections of hyaluronic acid (HA), corticosteroids (CS), and platelet-rich plasma (PRP) have been examined. However, the results of intraarticular injections performed after arthrocentesis were not superior to the results obtained with arthrocentesis performed alone.
In case of intraarticular injections performed without previous arthrocentesis, better results were obtained with HA compared to either CS or physiologic saline solution [26].
Although a lot is known about the use of HA, CS, and PRP in the treatment of TMD, none of these substances are considered to unquestionably be the gold standard. Contemporary medicine is looking for new solutions and new biomaterials for tissue regeneration. One of the very interesting materials in terms of tissue regeneration is chitosan, a deacetylated form of chitin, a linear semi-crystalline polymer and the most naturally abundant polysaccharide after cellulose [27,28]. Nowadays, chitosan is one bone tissue engineering scaffold. It has a similar chemical structure to glycosaminoglycans (the main components of connective tissue extracellular matrix, ECM), and it can be shaped to specific bone defects and fabricated as membranes, fibers, nanoparticles, hydrogels, or through 3D printing [29,30,31]. Moreover, chitosan has been found to be effective in the process of cartilage regeneration, and in relieving osteoarthritis [32,33,34,35].
Therefore, chitosan may be an effective agent in the treatment of TMD.
The aim of this narrative review was to present research investigating chitosan, including its general characteristics, properties, and medical and dental applications, and finally to present the current state of knowledge regarding the efficacy of chitosan in the treatment of TMD based on the literature.
Download the research paper as PDF: General Characteristics, Biomedical and Dental Application, and Usage of Chitosan in the Treatment of Temporomandibular Joint Disorders
or continue here with the medical use of chitosan
Derwich, M.; Lassmann, L.; Machut, K.; Zoltowska, A.; Pawlowska, E. General Characteristics, Biomedical and Dental Application, and Usage of Chitosan in the Treatment of Temporomandibular Joint Disorders: A Narrative Review. Pharmaceutics 2022, 14, 305. https://doi.org/10.3390/pharmaceutics14020305
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