To do or not to do extraction in temporomandibular joint pain: a systematic review background and rationale

The effect of dental extraction on temporomandibular joint (TMJ) pain remains controversial in oral surgery practice and has important implications for treatment planning in patients with temporomandibular disorders (TMDs). This systematic review evaluated whether third molar or other dental extractions are associated with changes in TMJ pain or TMD symptoms compared with non-extraction or pre-extraction controls. A protocol-registered review was conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science, ScienceDirect, Google Scholar, ClinicalTrials.gov, and Clinical Trials Registry-India were searched up to August 2025. Human studies enrolling patients with clinically diagnosed TMD and comparing extraction with non-extraction approaches were included. Primary outcomes were TMJ pain, function, and patient-reported quality of life. Risk of bias was assessed using RoB 2.0 and ROBINS-I/NOS, and random-effects meta-analysis with GRADE certainty assessment was performed when appropriate. Eight studies met inclusion criteria, of which six were included in quantitative synthesis. Dental extraction was associated with a significant reduction in TMJ pain or symptoms (pooled risk ratio/odds ratio=0.49; 95% confidence interval 0.31-0.66; P<0.00001; I²=34%) with low-to-moderate certainty of evidence. Dental extraction may reduce TMJ pain in selected patients; however, individualized clinical judgment and further high-quality randomized controlled trials are required.