Evidence from systematic reviews and meta-analyses for the management of TMD (temporomandibular disorders)

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This aim of this review was to assess the methodological quality of published systematic reviews in the management of temporomandibular disorders (TMD).

Medline, the Cochrane Library and Bandolier were searched for systematic reviews that focused on TMD management published in English, Swedish, or German. Two investigators evaluated the methodological quality of each identified systematic review using two measurement tools, AMSTAR and level of research design (LRD) scoring.

Thirty-eight systematic reviews met inclusion criteria and 30 were analysed (23 qualitative, 7 meta-analyses). Ten of these reviews were related to occlusal appliances, occlusal adjustment or bruxism; eight to physical therapy; seven to pharmacologic treatment; four to TMJ and maxillofacial surgery; and six to behavioural therapy and multimodal treatment.

The median AMSTAR score was 6 (range 2–11). Eighteen of the systematic reviews were based on randomised clinical trials (RCTs), three were based on case–control studies, and nine were a mix of RCTs and case series.

They concluded:

  • There is some evidence that occlusal appliances, acupuncture, behavioural therapy, jaw exercises, postural training, and some pharmacological treatments can be effective in alleviating pain in patients with TMD.
  • Evidence is insufficient for the effect of electrophysical modalities and surgery.
  • Occlusal adjustment seems to have no effect according to the available evidence.
  • One limitation of most of the SRs reviewed was that the considerable variation in methodology between the primary studies made definitive conclusions impossible.

List T, Axelsson S. Management of TMD: evidence from systematic reviews and meta-analyses. J Oral Rehabil. 2010 May;37(6):430-51. [PubMed abstract]

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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