Non-invasive therapies for management of temporomandibular disorders: a systematic review

Abstract

Introduction: As a multifactorial disease, temporomandibular disorders (TMD) require a complex therapeutic approach, being noninvasive therapies the first option for most patients. The aim of this study was to perform a systematic review to analyze the most common non-invasive therapies used for TMD management. Methods: The review was done by searching electronic databases to identify controlled clinical trials related to pharmacologic and non-invasive treatments. Of all potential articles found, 35 were included in this review. Results: Low-level laser therapy (LLLT), occlusal splints (OS) and oral exercises/ behavior education (OE/BE) were the most common therapies used. LLLT showed significant results in pain and movement improvement in most studies. OS was usually combined to other therapies and resulted in improvement of pain. OE/BE showed significant results when combined with ultrasound, LLLT, and manual therapy. Conclusions: Non-invasive treatments can provide pain relief and should be prescribed before surgical procedures. LLLT was the therapy with the higher number of studies showing positive results. Based in heterogeneity of treatment protocols, diagnostic and outcomes criteria used, new well-designed randomized controlled trials (RCT) are necessary.

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

“…Fifteen of the included studies were SR [16,17,[20][21][22][45][46][47][48][49][50][51][52][53][54], whereas the other sixteen were SR and meta-analyses [15,18,19,[55][56][57][58][59][60][61][62][63][64][65][66][67]. Table 1 list the characteristics of the included articles, and Table 2 list the characteristics of the interventions analyzed in each SR.…”

“…In terms of the population in the SR, all of them included patients with various diagnoses of TMD: 8 SR (n = 4286) included myalgia TMD [16,21,46,55,58,60,62,66]; 3 SR (n = 684) included intra-articular TMD [47,56,57]; 17 SR (n = 11,571) included any type of TMD [15,[17][18][19]22,45,46,[48][49][50]52,54,59,61,63,64,67]; and 2 SR (n = 850); 2 SR (n = 643) included headache attributed to TMD [58,65] and 2 SR (n = 850) included mixed TMD [20,53].…”

“…Referring to the diagnostic criteria used in the primary studies of the included SR, 18 (57%) SR used the research DC/TMD or the DC/TMD criteria [15,16,21,[45][46][47][48][49][50][51]55,56,59,60,62,63,65,66]. In the remaining 13 SR, the diagnosis was made with non-standardized criteria based on signs and symptoms, such as the Helkimo index or Fonseca's questionnaire, or it was not described [15,[17][18][19]22,[52][53][54]57,58,61,64,67].…”

“…Although it has been shown in various SR that a number of PT approaches are safe and simple interventions that could benefit patients with TMD, there remain controversies around the quality of evidence from these studies [15][16][17][18][19][20][21][22][23]. On the other hand, SR are usually published, and there is a lack of a compilation of all that information, which is why umbrella reviews are being carried out currently [24].…”

Evaluation of the Anti-inflammatory Effect of Intra-articular Injection of Chondroitin Sulfate and Sodium Hyaluronate in Mechanically Induced Temporomandibular Joint Injury in Rabbits

“…Management of degenerative arthritis is largely symptomatic. Studies have shown that non-surgical treatment can successfully be used to treat patients with osteoarthritis [3], [4], [5].…”