A systematic review of the effectiveness of conservative therapy in the treatment and management of temporomandibular joint disorders
Bibliographic record
Abstract
Background: Temporomandibular disorders (TMD) encompass neuromusculoskeletal conditions affecting the temporomandibular joint (TMJ) and surrounding orofacial structures, particularly the muscles of mastication. Despite numerous treatment options, there is a dearth of evidence-based conservative interventions. This systematic review aims to evaluate the level of evidence for conservative TMD interventions to inform clinical practice guidelines. Methods: A systematic search was conducted across databases including CINAHL, Cochrane Library, Medline, PubMed, ScienceDirect, Scopus, and Web of Science, supplemented by a hand search. The final search was completed on June 2022 and a supplementary search was performed in March 2023. Inclusion criteria encompassed studies evaluating conservative therapies for TMD in human subjects, while exclusion criteria included non-English studies, unavailable full texts, and studies not focused on conservative treatments. Risk of bias was assessed using the PEDro scale for RCTs, the Newcastle-Ottawa scale (NOS) for NRCTs, and the Liddle scale for case reports and series. Data were synthesized qualitatively. This review was registered in PROSPERO (CRD42023409560). Results: From 4,148 records, 789 duplicates and 3 retracted articles were removed. Title screening excluded 3,141 articles, abstract screening excluded 172 articles, and full-text screening excluded 9 articles, leaving 31 eligible articles. An additional study identified through a hand search brought the total to 32, comprising 19 RCTs, 10 NRCTs, 1 case report, and 2 case series. The interventions evaluated included dry needling, exercise, physical therapy, ischemic compression, manipulation/mobilisation, and manual therapy. Strong evidence supports the effectiveness of dry needling, while moderate evidence was found for exercise, manual therapy, and multimodal interventions, such as cervical spine manipulation combined with other therapies. Limited evidence supports thoracic spine manipulation, myofascial techniques, physical therapy, and proprioceptive neuromuscular facilitation. Conclusion: These findings highlight the potential benefits of conservative therapies in TMD management. Clinicians should prioritize dry needling, exercise, and manual therapy, particularly in combination with other modalities, to optimize patient outcomes. Researchers should focus on conducting high-quality RCTs with standardized protocols and larger sample sizes to strengthen the evidence base, particularly for under-researched interventions such as thoracic spine manipulation and proprioceptive neuromuscular facilitation. Policymakers should consider integrating the strongest evidence-based interventions into clinical guidelines to improve accessibility and standardization of conservative TMD treatments
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.066 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.009 |
| Bibliometrics | 0.013 | 0.012 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 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 source (direct Gemma or distilled Codex), 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".