Self-Management Therapies for Temporomandibular Disorders-Evidence From Systematic Reviews

Chronic pain in the orofacial region affects 10%-15% of the general population. It is most often related to temporomandibular disorders (TMD): pain in the masticatory muscles and the temporomandibular joints. Managing chronic pain conditions requires a biopsychosocial, evidence-based and patient-centred approach. Accordingly, self-management has been advocated for TMD. This umbrella review aimed to evaluate existing evidence in systematic reviews (SRs) on self-management therapy for TMD.

The review was carried out in accordance with the PRISMA and PRIOR guidelines, with a pre-registered protocol (PROSPERO CRD42021276856). PubMed, Scopus, LILACS and the Cochrane Library were searched until December 1st 2023 to identify SRs that evaluated self-management for TMD. Two independent reviewers screened titles and abstracts, performed full-text assessments, extracted all data and performed risk of bias assessment with AMSTAR 2.

A total of 1740 studies were identified. After title and abstract screening, 399 studies underwent full-text assessment and 11 SRs comprising 49 unique primary studies were included. Of these, six SRs reported favorable results for self-management for TMD, whereas five reported insufficient evidence either for or against the use of self-management compared to other interventions. The overlap of primary studies between the SRs was 53%, and the main evidence gaps were related to quality of life and adverse effects outcomes. The methodological shortcomings of the SRs primarily stem from insufficient primary-study design criteria or not providing references for excluded studies.

Existing evidence generally suggests beneficial effects from self-management strategies such as patient education, behavioural therapy and jaw exercises.