Temporomandibular disorders (TMD) are a group of disorders with symptoms that include pain, clicking, grating in the jaw joint and/or problems chewing or opening the jaw.   It has been estimated that around 75% of the population have at least one sign of TMD.  The aim of this review was to assess the effectiveness of counselling strategies and self-management in reducing signs and symptoms of TMD and compare its results with others treatment approaches.

The PubMed and Cochrane Library electronic databases were searched together with handsearching of  The Journal of the American Dental Association, Journal of Orofacial Pain, and Journal of Oral Rehabilitation. Controlled clinical trials for treatment of temporomandibular disorders that included at least one group with counselling or self-management techniques published in Portuguese, Spanish or English were considered.

• Seven studies (all randomised controlled trials) involving 489 patients in total were included.
• Follow-up periods ranged from 4 weeks to 12 months.
• A qualitative summary of the studies was presented.
• The selected articles analysed revealed that counselling was able to improve tenderness upon masticatory muscle palpation and maximum mouth opening with and without pain in patients with TMD, with similar results to those of interocclusal appliances approaches.

The authors concluded

Although counselling- and self-management-based therapies could be a conservative low-cost and beneficial treatment alternative for treating TMD with good results for the relief and control of TMD signs and symptoms by improving psychological domains and potentially reducing harmful behaviours, the evidence remains unclear due the reduced number of controlled and randomized well-designed clinical trials. Thus, further studies with higher level of evidence and more representative samples should be conducted to validate the performance of this treatment modality.

Comment

A range of interventions and outcome measures are used in the included studies, which pose challenges for summarising the evidence.  The studies included were not assessed for quality and are relatively small.   A related Cochrane review by Aggarawl et al published in 2011 looked at psychosocial interventions for chronic orofacial pain. They found 17 trials and concluded that there was weak evidence to support the use of psychosocial interventions for chronic orofacial pain, although the included studies were considered to be at high risk of bias.

Links

de Freitas, R. F. C. P., Ferreira, M. Â. F., Barbosa, G. A. S. and Calderon, P. S. (2013), Counselling and self-management therapies for temporomandibular disorders: a systematic review. Journal of Oral Rehabilitation. doi: 10.1111/joor.12098

Aggarwal VR, Lovell K, Peters S, Javidi H, Joughin A, Goldthorpe J. Psychosocial interventions for the management of chronic orofacial pain. Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD008456. DOI: 10.1002/14651858.CD008456.pub2.