This review examines the possible association between orofacial pain and dementia by synthesizing current findings from clinical, observational, and mechanistic studies. Although chronic pain has been increasingly recognized as a factor linked to cognitive decline, the specific role of orofacial pain, including conditions such as temporomandibular disorders, trigeminal neuralgia, burning mouth syndrome, and primary headaches, remains underexplored. Given the distinct neuroanatomy of the trigeminal system and its close connection to emotional and cognitive processing, orofacial pain may involve unique mechanisms relevant to neurodegeneration. Studies suggesting possible links between orofacial pain conditions and cognitive impairment were identified, highlighting mechanisms such as neuroinflammation, locus coeruleus dysfunction, and central sensitization. Modifiable cofactors, including poor oral health and sleep disturbances, which may influence both pain and dementia risk and are particularly relevant in dental and orofacial clinical practice, were also examined. Pain assessment and management strategies for individuals with dementia were reviewed as well, with emphasis on the need for validated tools and interdisciplinary care models that incorporate dental and orofacial pain specialists. Given the heterogeneous and limited nature of existing studies, this review does not make causal claims but instead conceptually maps the current landscape, identifies critical gaps in the literature, and outlines implications for research and practice. Dentists and orofacial pain providers may be uniquely positioned to recognize pain-related risk factors in cognitively vulnerable patients and implement preventive or therapeutic strategies. Future longitudinal studies and mechanistic investigations are needed to clarify the direction and clinical significance of the orofacial pain-dementia relationship.

Idiopathic intracranial hypertension (IIH) features elevated intracranial pressure (ICP) without a secondary cause. Trigeminal neuralgia (TN), usually attributed to neurovascular conflict (NVC), has been reported only rarely in association with IIH. We reviewed the literature and present three institutional cases to better characterize this association while explicitly acknowledging the limits of case-based causal inference. We systematically searched PubMed, Ovid Medline, Ovid Embase, Scopus, and Web of Science from inception through August 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The core search combined terms for idiopathic intracranial hypertension or pseudotumor cerebri with trigeminal neuralgia, trigeminal neuropathy, and facial pain. Because causal attribution from case reports is limited, we applied a qualitative framework based on temporality, objective evidence of raised ICP, exclusion of more convincing alternative causes, especially definite NVC, and response to ICP-lowering therapy. Methodological quality was appraised using the Joanna Briggs Institute case report checklist. Quantitative summaries were restricted to published TN phenotypes; trigeminal neuropathy without pain and persistent idiopathic facial pain were summarized separately. Out of 1302 records, 12 case reports met the criteria. Nine described TN, two involved trigeminal neuropathy without pain, and one involved a persistent idiopathic facial pain phenotype. Across the nine TN cases, all patients were female (mean age 38.7 ± 12.5 years). Reported opening pressure ranged from 220 to 480 mmH2O (mean 393.0 ± 89.2 mmH2O), although diagnostic certainty varied, and not all cases fulfilled the full Friedman criteria for definite IIH. Maxillary (V2) and mandibular (V3) involvement predominated, and multidivisional pain was common. Imaging features of raised ICP and improvement after ICP-lowering therapy were recurrent themes, but standardized high-resolution trigeminal magnetic resonance imaging (MRI) sequences were inconsistently reported, limiting exclusion of coexisting classical TN. We additionally describe three institutional cases: two with documented elevated opening pressure (290 and 320 mmH2O) and one probable ICP-related case with suggestive imaging but unavailable opening pressure. In the institutional cohort, dedicated Constructive Interference in Steady State (CISS) or Fast Imaging Employing Steady-state Acquisition (FIESTA) assessment was not uniformly available; in one case, venous contact was of uncertain significance, and in another, microvascular decompression was performed without operative confirmation of arterial compression or pain relief. TN associated with IIH is a rarely reported association. Given the limited case-based evidence, the available data should be regarded as hypothesis-generating rather than definitively causal. When objective intracranial hypertension is present, careful evaluation of both ICP-related markers and alternative TN mechanisms, including NVC, is essential. ICP-lowering therapy has been reported to improve pain in some cases and may address a potential contributing mechanism.

Temporomandibular disorder (TMD) is a common source of nondental orofacial pain. Exercise therapy is a recommended conservative treatment, yet inconsistent reporting of protocols limits reproducibility and clinical application. The primary objective of this scoping review was to determine the reporting of exercise therapy interventions in randomised controlled trials for TMD using the Template for Intervention Description and Replication (TIDieR) checklist. This scoping review assessed the completeness of exercise intervention reporting in randomised controlled trials (RCTs) for TMD using the TIDieR checklist. A comprehensive search across five databases and grey literature identified eligible RCTs. Data were extracted and analyzed using descriptive statistics and a Mann-Whitney U test. Seventy-five RCTs published between 1993 and 2024 were included. The mean TIDieR score was 7.98/12, with only 6.7% of studies reporting all checklist items. Frequently reported elements included intervention name, rationale and procedures. Tailoring, modifications, fidelity and adherence were underreported. No significant improvement in reporting quality was observed post-TIDieR publication. Reporting gaps persist in TMD exercise research, limiting reproducibility and clinical translation. Greater adherence to standardised reporting tools like TIDieR is needed to enhance transparency and evidence-based practice.

Predoctoral dental education in temporomandibular disorders (TMD) remains inconsistent and highly variable despite CODA's mandate. This study examined how different TMD educational models (based on orofacial pain [OFP] postgraduate program affiliation, presence of OFP faculty offering TMD patient exposure, or absence of OFP faculty and clinical exposure) influence student confidence and perceived challenges. An anonymous survey was distributed to third- and fourth-year students at U.S. CODA-accredited dental schools through the Hispanic Student Dental Association and American Student Dental Association. Students rated confidence in TMD-related skills (1-5 scale, 5="most confident") and identified educational challenges. Data were analyzed using ANOVA, chi-square tests, and correlation analyses across four educational models. Among 136 respondents, overall confidence was low-to-moderate (2.4 ± 0.8), with only 26.3% reaching a sufficient threshold (≥3). Confidence was highest for screening and lowest for advanced procedures. Educational model type showed no significant effect on overall confidence (p = .099), whereas prior TMD patient exposure was associated with higher confidence (2.7 ± 0.7 vs. 2.1 ± 0.7, p < .001; r = .384, p < .001). Common challenges included limited patient availability (61.8%), insufficient faculty expertise (42.3%), and poor interdisciplinary integration (46.3%). Students without OFP faculty and clinical exposure reported significantly greater clinical challenges (p < .001). Lack of clinical exposure to TMD patients is strongly associated with low student confidence. Faculty calibration and integration of TMD screening and management into routine care are critical to improving competence and confidence in dental training.

The Effect of Preoperative Child and Parental Anxiety on Emergence Agitation and Postoperative Pain in Children Undergoing Adenoidectomy and Tonsillectomy: A Prospective Observational Study.

ABSTRACT Recent work has reconceptualized Bandura’s moral disengagement paradigm as continuums of moral influence, whereby media cues can influence moral judgments by both weakening (disengaging) moral sensitivities and strengthening (engaging) moral sensitivities. This study applies both continuums of moral influence theorizing and exemplification theory to experimentally investigate how media depictions of victims’ bodily suffering may influence a range of perceptions and emotional reactions. As part of this investigation, this study examines whether such depictions may influence perceptions of victims as humanized or dehumanized, an issue that has been debated in theoretical and critical literature. A 2 X 2 between-subjects experiment (N = 356) that features professionally edited photographic stimuli tests and compares the effects of two visual cues of victim suffering: blood and face pain. Results show that more graphic and intense visual cues of victim suffering differentially increase perceptions of a victim’s suffering, perceptions of image graphicness, audience emotional intensity, and perceptions of a victim’s human complexity. Implications for future research on the moral implications of mass media cues of suffering are discussed.

A case of a patient with left maxillary molar pain unresponsive to standard dental treatment is presented. Advanced imaging revealed an aggressive lesion in the maxillary sinus with associated bone destruction, soft tissue extension, and diffusion restriction suggestive of malignancy. The lesion was subsequently confirmed as maxillary sinus carcinoma. This case highlights the diagnostic challenges associated with nonspecific temporomandibular disorder-like symptoms and emphasizes the importance of recognizing red flags as prompts for cross-sectional imaging and specialist referral, which are essential for ensuring an accurate diagnosis and improving clinical outcomes in patients with atypical or refractory orofacial pain.

To examine the association between oral behaviors and orofacial pain among painful TMD patients. 343 adults with painful TMD completed the Oral Behaviors Checklist (OBC) and Numeric Rating Scale (NRS) for pain intensity; Characteristic Pain Intensity (CPI) was calculated. Patients were grouped as moderate-to-high CPI (≥ 30) or low CPI (< 30), and group differences were compared. Regression analyses were performed, adjusting for age, sex, education, and TMD diagnosis. Group comparisons between moderate-to-high CPI (n = 191) and low CPI (n = 152) groups showed no association between the total OBC score and CPI (p = 0.217). Correlation analysis showed the total OBC score correlated with age (ρ=-0.376), sex (ρ = 0.152), and education (ρ = 0.240). CPI correlated with age (ρ = 0.139) and education (ρ=-0.125). After adjusting for age, sex, education, and TMD diagnosis, the total OBC score was positively associated with CPI (per 10 points: mean ratio [MR] = 1.103; 95% CI 1.025-1.187). A significant interaction between age and total OBC score was also observed (MR = 0.919; 95% CI 0.855-0.987), indicating that the association between oral behaviors and CPI weakened with increasing age. Age correlated positively with CPI and negatively with the total OBC score. Although no significant crude association was observed, the total OBC score became positively associated with CPI after adjustment for age and other covariates. These findings suggest that age-related modification may influence the observed association between oral behaviors and orofacial pain in painful TMD patients.

Gastroesophageal reflux disease (GERD) and temporomandibular disorders (TMDs) are multifactorial conditions characterized by complex interactions among biological, psychological, and behavioral factors. GERD is increasingly recognized as a systemic disorder with multiple extra esophageal manifestations, while TMD represents a major source of chronic orofacial pain worldwide. This study aims to examine the association between GERD and TMD risk in a large-scale, population-based cohort. This nationwide cohort study used data from the Korean National Health Insurance Service. We included 195,533 adults aged ≥ 19 years who completed health screenings between 2010 and 2011. GERD was identified using diagnostic codes and two or more prescriptions of acid-suppressive medications for ≥ 2 weeks. Participants with prior TMD, bruxism, dental trauma, malignancy, or reflux-inducing medications were excluded. A 1:3 propensity score matching was performed to reduce confounding. The primary outcome was the incidence of TMD. Multivariable Cox regression models were used to estimate adjusted hazard ratios with a 95% confidence interval. After matching, 40,755 individuals with GERD and 115,242 controls were included. The incidence of TMD was higher in the GERD group than in the control group (6.65 vs. 4.31 per 1,000 person-years). GERD was associated with an increased risk of TMD, with an adjusted hazard ratio of 1.23 and a 95% confidence interval of 1.15-1.31. Kaplan-Meier analysis showed significantly lower TMD-free survival in the GERD group. GERD was significantly associated with increased TMD risk. Screening for TMD symptoms among individuals with GERD may support early detection and improved care.

Facial pain or pressure is often non-rhinogenic but is frequently misdiagnosed as sinusitis, leading to inappropriate treatment with antibiotics and surgery. The objective of this study was to develop and validate a brief self-administered questionnaire, the Sinus Headache Screener (SHS), to help differentiate chronic rhinosinusitis (CRS) from non-rhinogenic facial pain or pressure (NRFP). Patients presenting to the rhinology clinic with a chief complaint of facial pain or pressure completed an 89-item questionnaire bank developed previously through qualitative methods. A diagnosis of CRS or NRFP was given based on imaging criteria. Psychometric analysis and logistic regression were utilized to select items and create a scoring system that could reliably differentiate the two conditions. Predictive performance was evaluated through the area under the receiver operating characteristic curve (AUC) with bootstrapping. Of 251 patients enrolled, 114 had CRS and 137 had NRFP. Mean (SD) age was 50 (16), and 69.3% were women. Eight items with scoring weights were included in the SHS. Scores ranged from -4 to 9, with higher positive values predictive of NRFP. With a score cutoff of > 0, the SHS had a sensitivity/specificity of 0.87/0.64, and positive/negative predictive values of 0.74/0.80 for NRFP. The optimism-corrected AUC was 0.798 (95% CI: 0.766, 0.877). In patients presenting with sinus headache, the SHS accurately differentiated NRFP from CRS. The use of the SHS as a point-of-care clinical tool can improve diagnostic accuracy and facilitate cost-effective management.

Temporomandibular disorders are common causes of chronic orofacial pain, and their diagnosis is largely based on subjective symptoms, such as pain and its laterality. Ultrasonographic evaluation of the masticatory muscles has traditionally focused on morphological parameters, such as muscle thickness, which provide valuable information; however, these measures alone may not fully reflect the functional and structural condition of muscle tissue. Quantitative assessment of echo intensity may provide an objective and reproducible metric for characterizing structural changes and monitoring clinical status. The aim of this pilot study was to quantitatively assess masseter muscle echo intensity using ultrasonography in young adults with temporomandibular disorders, with particular emphasis on objective measurability and inter-side differences. 10 young adults (5 patients with temporomandibular disorders and 5 healthy controls) were included in this pilot study. Diagnosis was established according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Bilateral ultrasonographic examination of the masseter muscle was performed, and echo intensity was determined in a standardized manner using ImageJ software. Total echo intensity was significantly higher in the temporomandibular disorder group compared to the control group (65.64 ± 9.87 vs. 50.39 ± 5.68; p = 0.022). No statistically significant inter-side difference was detected. Our findings suggest that masseter muscle echo intensity may be sensitive to structural alterations in temporomandibular disorders. The lack of inter-side difference indicates that muscle adaptation may not be limited to the clinically dominant side. Quantitative ultrasonographic assessment of masseter muscle echo intensity may represent a promising non-invasive method for the objective characterization of temporomandibular disorders. As a quantitative parameter, echo intensity may complement symptom-based diagnostics and provide a tool for monitoring disease progression and treatment response. Orv Hetil. 2026; 167(25): 991-996.

Spontaneously hypertensive rats exhibit reduced facial pain sensitivity with altered electrophysiology and transcriptomics in the trigeminal ganglia.

Variability exists in how US dental schools integrate predoctoral temporomandibular disorder (TMD) training, yet multilevel determinants influencing implementation are underexplored. This study applied the Consolidated Framework for Implementation Research (CFIR) to examine differences in predoctoral TMD training and challenges in implementing CODA standards from leadership perspectives. A CFIR-guided REDCap survey was distributed to deans/associate deans of academic affairs across all 75 dental schools (September, 2025 to October, 2025), assessing TMD screening, management, student exposure, and implementation challenges. Schools were classified into TMD-educational models based on orofacial pain (OFP) postgraduate affiliation (Model 1), presence of OFP specialists managing TMD patients (Model 2), OFP specialists providing didactic instruction only (Model 3), and absence thereof (Model 4). Outcomes were compared across models using chi-square tests; thematic analysis summarized implementation challenges via CFIR constructs. Of 38 responses, 84.2% provided both didactic and clinical TMD instruction and routine screening. Overall, 97.4% managed TMD patients, with modalities varying by models (p<0.001). Model 4 schools were significantly less likely to provide TMD management (p = 0.033). Confidence in meeting CODA standards was moderate-to-high for didactic (84.0±18.2 on 0-100 scale, 100 = "high confidence") and clinical (77.3±21.0) components. Perceived challenges differed across models (p = 0.006), including lack of specialists (Model 4), limited general faculty trained in TMD (Models 2 and 3) and patient availability, curricular constraints (Models 1, 2, and 4), and institutional barriers. Variability in TMD education reflects multilevel implementation determinants. Embedding TMD competencies in a primary-care framework, strengthening OFP faculty recruitment, and enhancing curricular integration could improve consistency and implementation fidelity nationwide.

Most studies confirm the effectiveness of virtual reality (VR) in alleviating pain and fear during pediatric venipuncture, with limited evidence regarding physiological stress markers and dynamic assessment. This study aims to investigate the effects of VR technology on pain, fear, and physiological responses in children, as well as family satisfaction during intravenous cannulation. This single-blind randomized controlled trial was conducted in the Pediatrics Department of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China. A total of 188 children requiring intravenous cannulation procedures and their families were allocated into: the control group (n = 96), which received the conventional verbal comfort; and the experimental group (n = 92), which wore VR headsets. The primary outcomes were dynamic fear/pain scores assessed by nurses and self-reported by patients, which were surveyed using the Children's Emotional Manifestation Scale (CEMS) and the Children's Fear Scale (CFS)/the Face, Legs, Activity, Crying, and Consolability scale (FLACC) and the Wong-Baker FACES Pain Rating Scale (Wong-Baker), respectively. The secondary outcomes were dynamic heart rate (HR) and peripheral oxygen saturation (SpO2) measurement, and family satisfaction levels. The pre-specified time points were pre-intervention, immediately post-intervention, at tourniquet application, at venipuncture, and one minute after venipuncture. Results were reported following the Consolidated Standards of Reporting Trials 2025 guidelines. VR significantly reduced children's fear at two pre-venipuncture time points (nurse-assessed CEMS and child-reported CFS; partial η2 = 0.072 and 0.053, both p < 0.05). There were no significant group effects in nurse-assessed FLACC and child-reported Wong-Baker pain scores across three venipuncture time points. However, a significant time-by-group interaction was observed for nurse-assessed FLACC scores (partial η2 = 0.028, p = 0.006). Notably, nurse-assessed FLACC scores were lower than child-reported Wong-Baker scores in both control and experimental groups (Mean Diff.=-1.04 to -2.10, all p < 0.001). The dynamic changes in HR and SpO2 across five time points were lower within the experimental group (partial η2 = 0.106 and 0.045, both p < 0.01). Partial correlation analysis revealed that family satisfaction responded to children's pain, fear, and physiological stress in a "process-sensitive" pattern in the control group but an "outcome-oriented" pattern in the experimental group. In this trial, VR distraction effectively reduced procedural fear (but not pain) during venipuncture. However, the nurse assessment appears to suggest that the effects of VR distraction and conventional intervention on pain experience may vary over time. These findings underscore the importance of multidimensional pain/fear assessment in pediatrics. Our study confirms that VR distraction can significantly reduce fear in children undergoing intravenous cannulation, though pain scores were not significantly lowered. Multidimensional assessment (including subjective fear measures) is therefore important. VR may improve the patient and family experience of painful procedures. We recommend further trials with larger samples to confirm these findings and refine VR interventions. Chinese Clinical Trial Registry, ChiCTR2500113849 (Registration Date: Dec. 3, 2025; Retrospectively registered).

Pain is a complex and unpleasant phenomenon, particularly in children, wherein frequent use of needle procedures during the process of hospitalisation significantly increases somatic and emotional distress in children. This randomised clinical trial was conducted among children aged 4-12 years admitted to a paediatric ward in Karnataka, India. Participants were randomly allocated to one of three arms: a Buzzy device intervention arm, a computer tablet distraction arm, or a control arm receiving routine care. Pain during venipuncture was assessed using the Faces Pain Scale-Revised (FPS-R), scored on a 0-10 scale. A total of 96 children were randomised, with 32 allocated to each of the Buzzy device, computer tablet distraction, and control arms. Both distraction interventions significantly reduced the FPR-R pain score compared with the control arm. The mean FPS-R score was 0.31 ± 0.74 in the Buzzy device arm and 3.25 ± 1.95 in the computer tablet arm. The between-group differences in pain scores were statistically significant (p < 0.001), with the Buzzy device demonstrating greater effectiveness than the computer tablet distraction. The Buzzy device and distraction techniques significantly minimised FPS-R pain scores in children, with the Buzzy device being the most effective. These findings support the incorporation of such interventions into paediatric clinical practice to enhance patient comfort.Trial Registration: Clinical Trials Registry of India (CTRI/2023/04/051864 registered on 21/04/2023).

ABSTRACTChronic neuropathic pain represents a significant global health burden and is hypothesized to be maintained by an altered astrocyte‐neuron interplay. Evidence of astrocyte contributions to neuropathic pain are derived from both post‐mortem immunohistochemical analyses and in vivo pharmacological studies. These data cannot provide insights into dynamic changes in astrocytes within an individual as pain develops. Here, we present the first use of [18F]‐SMBT‐1, a radioisotope that binds monoamine oxidase‐B (MAO‐B) in reactive astrocytes, in a longitudinal (35 days) study of the development of orofacial neuropathic pain. We used the chronic constriction injury of the infraorbital nerve (ION‐CCI) to produce orofacial neuropathic pain in adult male Sprague–Dawley rats, which we compared to both sham‐injury and anesthesia controls. Between 14 and 28 days following ION‐CCI, increases in SMBT‐1 binding occurred in: the trigeminal nerve, ganglion and the spinal trigeminal nucleus; as well as the nucleus accumbens and dorsal striatum. Increased MAO‐B expression in these regions was confirmed using immunohistochemical analysis. MAO‐B expression was also confirmed in the ION, the trigeminal ganglion, and trigeminal root entry zone. These data provide evidence of regional and temporally specific increases in astrocyte reactivity, which may be critical for establishing chronic orofacial neuropathic pain. Longitudinal mapping of changes in astrocyte reactivity during the development of chronic orofacial neuropathic pain will provide an opportunity to test the potential of astrocyte specific compounds delivered at specific time points following nerve injury, to determine the key brain regions that could be targeted to prevent and/or reverse the development of chronic neuropathic pain.

Orofacial pain is complex and can arise from over 160 conditions. It can significantly impact patients both psychosocially and functionally, reflecting the importance of the trigeminal nerve neurobiology. The high misdiagnosis rates are often blamed on siloed training, resulting in delayed diagnosis and patient harm. Dental pain (the most common form of orofacial pain) can vary in its presentation depending on the stage of dental abscess formation, resulting in misdiagnosis of headaches and trigeminal neuralgia. Trigeminal neuralgia is the rarest form of orofacial pain. Other conditions including temporomandibular joint disorders and post-traumatic neuropathic pain related to dental interventions are far more common but often overlooked. This review aims to break down this siloed approach and highlight the more common conditions that present with paroxysmal, elicited or spontaneous allodynia/neuralgia within the trigeminal system, conditions that should be considered before diagnosing a patient with trigeminal neuralgia.

Current Landscape of Clinical Interventions for Trigeminal Neuralgia: A Scoping Review.

Chronic sinonasal mucoceles are benign expansile lesions caused by obstruction of sinus drainage, resulting in mucus accumulation and potential complications including nasal obstruction, facial pain, and visual disturbances. While their clinical aspects are well-characterized, detailed histopathologic descriptions remain limited. We conducted a retrospective clinicopathologic analysis of six patients treated for chronic sinonasal mucoceles between 2014 and 2024. Clinical data, imaging studies (computer tomography (CT) and magnetic resonance imaging (MRI)), endoscopic findings, and histopathologic features were reviewed. The cohort included four male patients and two female patients (age range: 31-85 years, mean: 61 years). Five patients presented with rhinologic symptoms; one was asymptomatic, with the lesion discovered incidentally. Anatomically, four muoceles (67%) involved the frontal-ethmoidal sinuses; the remaining two affected the sphenoid and maxillary sinuses, respectively. CT imaging revealed sinus opacification in five patients, with one showing marked mucosal and bony thickening. Histologically, all specimens exhibited collapsed fibrous walls with hyalinized stroma, sparse cellularity, and absent or denuded epithelium-finding consistent with late-stage changes from chronic pressure and reparative remodeling. Immunohistochemistry confirmed myofibroblastic differentiation of stroma cells. All patients underwent successful endoscopic management without recurrence. Chronic sinonasal mucoceles may present as pseudotumors with distinctive collapsed, hyalinized fibro-membranous walls, distinguishing them from early-stage lesions. Recognition of these characteristic histopathologic features, in conjunction with clinical and radiologic findings, is essential for accurate diagnosis and to avoid overtreatment. Endoscopic surgical management remains an effective treatment with excellent outcomes.

Temporomandibular joint (TMJ) arthrocentesis has emerged as a minimally invasive intervention to improve jaw function and alleviate orofacial pain. To investigate the effects of arthrocentesis on pain and mandibular movement in patients with specific subtypes of temporomandibular disorders (TMD), including anterior disc displacement without reduction (ADDwoR) and osteoarthritis. We conducted a literature search in the Cochrane Library, EMBASE, MEDLINE and Web of Science to identify relevant studies published before 2025-11-27. Randomized controlled trials, non-randomized controlled trials and observational studies were included which compared the outcomes of different arthrocentesis and with other interventions in TMD patients. The mean difference (MD) was used to assess continuous outcomes. This systematic review and meta-analysis included 31 studies involving 1718 participants. Ultrasound-guided arthrocentesis showed significant improvement in maximal mouth opening (MMO) (MD = 2.30 mm, P = 0.04). Single-puncture and double-puncture arthrocentesis showed equivalent efficacy. Compared to platelet-rich plasma (PRP) injection, arthrocentesis showed benefit on MMO improvement at 1 week (MD = 2.61 mm, P = 0.05). At 6 months, PRP demonstrated significant superiority for pain management (MD = 1.53, P = 0.02). Meta-analysis of 3 RCTs demonstrated persistent superiority of arthrocentesis over splint therapy in improving MMO and relieving pain. Ultrasound-guided puncture significantly improves mouth opening while single- and double-needle approaches showed equivalent efficacy. The results suggest that a multimodal strategy combining arthrocentesis for immediate functional improvement with biological injectables like PRP for sustained pain relief is optimal for refractory TMD.