Is there a superiority of multimodal as opposed to simple therapy in patients with temporomandibular disorders? A qualitative systematic review of the literature
Bibliographic record
Abstract
BACKGROUND: Pain is the most common motivation for patients with temporomandibular disorders (TMDs) to seek care. Therapeutic options range from patient education to joint surgery. OBJECTIVES: To conduct a systematic review of articles reporting on simple and multimodal management strategies in TMD patients. 'Simple therapy' was defined as care provided by a dentist, without using technical dental interventions, whereas 'multimodal' refers to at least two different modalities. We followed the null hypothesis of no difference between these two approaches. MATERIAL AND METHODS: A systematic search was carried out in the following databases: Ovid Medline (1966-2006), Cochrane Library (Issue 3/2006), and Science Citation Index (1945-2006). Subsequently, the reference lists of the identified articles were searched to find additional pertinent publications. We divided the study reports according to the main presenting symptom: (1) disc displacement without reduction, with pain; (2) TMD pain, without major psychological symptoms; and (3) TMD pain, with major psychological symptoms. RESULTS: Eleven articles representing nine different clinical studies were identified. (1) In the disc displacement group with pain, multimodal therapy was not superior to explanation and advice. (2) A combination of occlusal appliance and biofeedback-assisted relaxation/stress management was not significantly superior to either of these therapies after 6 months. Furthermore, brief information alone or combined with relaxation training or occlusal appliance, respectively, were equally efficacious at the 6-month follow-up. There was no superiority of multimodal therapy including splints as compared with simple care. A slightly better outcome was reported for a combination of education and home physical therapy regimen than for patient education alone. (3) In temporomandibular pain patients with major psychological disturbances, patients benefited more from a combined therapeutic approach compared with simple care. CONCLUSION: Current research suggests that individuals without major psychological symptoms do not require more than simple therapy. In contrast, patients with major psychological involvement need multimodal, interdisciplinary therapeutic strategies. The clinician's acceptance of the importance of psychological factors in TMD pain forms the platform for convincingly educating patients about the need for multimodal management.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.007 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.005 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".