Management of TMD: evidence from systematic reviews and meta-analyses

Abstract

This systematic review (SR) synthesises recent evidence and assesses the methodological quality of published SRs in the management of temporomandibular disorders (TMD). A systematic literature search was conducted in the PubMed, Cochrane Library, and Bandolier databases for 1987 to September 2009. Two investigators evaluated the methodological quality of each identified SR using two measurement tools: the assessment of multiple systematic reviews (AMSTAR) and level of research design scoring. Thirty-eight SRs met inclusion criteria and 30 were analysed: 23 qualitative SRs and seven meta-analyses. Ten SRs 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 SRs were based on randomised clinical trials (RCTs), three were based on case-control studies, and nine were a mix of RCTs and case series. Most SRs had pain and clinical measures as primary outcome variables, while few SRs reported psychological status, daily activities, or quality of life. There is some evidence that the following can be effective in alleviating TMD pain: occlusal appliances, acupuncture, behavioural therapy, jaw exercises, postural training, and some pharmacological treatments. Evidence for the effect of electrophysical modalities and surgery is insufficient, and occlusal adjustment seems to have no effect. One limitation of most of the reviewed SRs was that the considerable variation in methodology between the primary studies made definitive conclusions impossible.

Treatment of temporomandibular disorders – knowledge, attitudes and clinical experience among general practising dentists in Sweden

“…[9] Occlusal adjustment has been questioned as a TMD therapy for many years. [19,20] To perform reversible TMD treatments is the predominant treatment concept in Scandinavia. [2] These two facts might have influenced and reduced the frequency of occlusal adjustment performed and thereby also the selfreported frequency of good clinical routine and confidence for this treatment.…”

Multimodal physiotherapeutic approach: effects on the temporomandibular disorder diagnosis and severity

“…In addition, instructions for self-care, patients education, clarification of risk factors and home exercises afford gains of psychological and behavioral order in the clinical picture of TMD patients, once they may decrease anxiety (16,17).…”

Managing temporomandibular disorders (TMD) by integrating exercise therapy into therapeutic patient educational programs: why, when, how?

“…In a search of Medline [4] we found several systematic reviews dealing with maxillo-facial re-education in which the conclusions of the most recent were similar 22,[25][26][27][28][29]43 : -the results of the systematic reviews should be interpreted prudently because of a number of methodological problems that vitiate their reliability; -maxillo-facial re-education, advice on behavior, passive mobilization, and relaxation techniques seem to be effective in ameliorating TMD symptoms; -the integration of behavioral advice into TMD treatment is desirable, even though no proof of its longterm effectiveness has as yet been demonstrated.…”