Effects of Physiotherapy on Pain and Mouth Opening in Temporomandibular Disorders: An Umbrella and Mapping Systematic Review with Meta-Meta-Analysis

Abstract

The aim of this meta-meta-analysis was to assess the current evidence regarding the effect of physical therapy (PT) interventions on pain and functional variables in temporomandibular disorders (TMD). We conducted an umbrella systematic review (SR) and four meta-meta-analyses (MMA) and created an evidence map to determine the effectiveness of PT on pain intensity and maximum mouth opening in patients with TMD. The quality of the included SR was assessed with the AMSTAR 2, and the risk of bias with ROBIS. Of the 31 SR included in the umbrella SR, only 10 were included in the MMA. The MMA showed moderate effects for manual therapy and therapeutic exercise, and large effects for low-level laser therapy on improving pain intensity and maximum mouth opening in patients with TMD, with a limited to moderate quality of evidence. The overlapping analyses showed only a slight overlap for all the MMA according to the corrected covered area (range from 0.07 to 0.2), 23.1% to 41.6%. This umbrella SR showed that manual therapy and exercise interventions, as well as low-level laser therapy interventions, are effective in the reduction in pain intensity and improvement of maximum mouth opening in TMD. This article presents a synthesis of the available evidence related to the various physical therapy interventions used in patients presenting with temporomandibular disorders. These results could help clinicians to select the optimal intervention for their patients and to reject those that are less useful.

Correlation between Temporomandibular Disorders (TMD) and Posture Evaluated trough the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): A Systematic Review with Meta-Analysis

“…An attempt at postural readjustment can be concluded from the findings of the use of an occlusal splint and therapeutic exercise guidelines in subjects with TMD over the course of 12 weeks, which included an increase in the velocity of center gravity recovery. It is possible to interpret the acceleration of the postural sway as an increase in the frequency of postural balance corrections made by the individuals [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. The adjustment of the head and neck posture carried on using the occlusal splint may have caused this increase in the frequency of corrections.…”

Comparison of low‐level laser therapy and standard treatment for temporomandibular disorders: An assessment of therapeutic and placebo effects

“…However, an optimal approach would be a multimodal, biopsychosocial, behaviour-based, and multidisciplinary approach. [4][5][6][7] Physical therapy is a noninvasive and reversible treatment option LLLT's effectiveness for TMD treatment has been debated in previous studies. 6,9,13,15,16,26,27 These studies were limited by several drawbacks, including a high risk of bias, uncertainty regarding the randomization and blinding methods, small sample sizes, and unclear criteria for patient selection and treatment protocols.…”

“…2,3 While conservative treatment protocols such as physiotherapy and elimination of parafunctional habits exist, they rely heavily on patient cooperation. 4,5 In recent years, newer treatment methods with greater and faster effectiveness have emerged. [6][7][8][9][10][11] Laser manufacturing companies have extensively advertised the effectiveness of low-power lasers on head and face pains, particularly TMD problems, leading to an increased willingness among dentists to purchase and use this technology.…”

“…While conservative treatment protocols such as physiotherapy and elimination of parafunctional habits exist, they rely heavily on patient cooperation 4,5 . In recent years, newer treatment methods with greater and faster effectiveness have emerged 6–11 .…”

“…Physical therapy focuses on reducing pain, muscle relaxation, reducing muscular hyperactivity, and re-establishing muscle function and joint mobility. Self-care management and patient responsibility are also emphasised in physical therapy to help improve treatment outcomes [4][5][6][7].…”