Tailored Treatments in Temporomandibular Disorders: Where Are We Now? A Systematic Qualitative Literature Review

Abstract

To conduct a systematic review to evaluate the evidence of possible benefits of tailored treatments for temporomandibular disorders (TMD) based on randomized controlled trials (RCTs). Reports of RCTs investigating treatments tailored to TMD patients' psychosocial characteristics were systematically searched for through March 2013 in the following databases: Cochrane Central Register of Controlled Trials, PubMed, and Web of Science. The methodological quality of the RCTs was assessed using the Cochrane Collaboration's tool for assessing risk of bias. Seven reports met the inclusion criteria. In all studies a subgroup of TMD patients, mainly identified by multidimensional diagnostic systems such as the Research Diagnostic Criteria for TMD Axis II or Multidimensional Pain Inventory, were offered a treatment intervention hypothesized to be suitable for that particular patient group. The quality of the trials was compromised in all cases. Two studies focused on well-functioning TMD patients. In both studies, self-care gave results equal to or better than usual conservative TMD treatment. The treatments were targeted for patients with compromised psychosocial adaptation in five studies, and typically included a cognitive behavioral treatment component. In all trials the results supported the efficacy of tailored treatment, albeit in one trial only in the short-term. The identified studies offer cautious support to the notion that treatment targeted to different psychosocial subgroups of TMD pain patients may be beneficial.