Abstract
Data sourcesMedline (PubMed), the Cochrane Library, Bandolier and references in original articles and systematic reviews (SRs) were searched.Study selectionSystematic reviews in English, Swedish or German that focused on the management of TMD were included. Reviews that covered oro-facial pain or TMD prevention were excluded.Data extraction and synthesisTwo investigators evaluated the methodological quality of each identified systematic review using two measurement tools, AMSTAR (http://www.biomedcentral.com/1471-2288/7/10) and level of research design (LRD) score and the inter-rater reliability assess using Kappa statistics. Disagreements were resolved with discussion.ResultsThirty-eight systematic reviews met inclusion criteria and 30 were analysed (23 qualitative,seven meta-analyses). Ten of these reviews 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.ConclusionsThere is some evidence that occlusal appliances, acupuncture, behavioural therapy, jaw exercises, postural training, and some pharmacological treatments can be effective in alleviating pain in patients with TMD. Evidence is insufficient for the effect of electrophysical modalities and surgery. Occlusal adjustment seems to have no effect according to the available evidence. One limitation of most of the SRs reviewed was that the considerable variation in methodology between the primary studies made definitive conclusions impossible.
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