Objective: To determine the effectiveness and cost-effectiveness of noninvasive interventions for temporomandibular disorders (TMD).
Methods: We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central register from 1990 to 2014 for effectiveness studies and the Cochrane Health Technology Assessment Database, EconLit, NHS Economic Evaluation Database, and Tufts Medical Center Cost-Effectiveness Analysis Register from 1990 to 2014 for cost-effectiveness studies. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Evidence from eligible studies was synthesized using best-evidence synthesis methodology.
Results: Our search for effectiveness studies yielded 16,995 citations; 31 were relevant and 7 randomized controlled trials (published in 8 articles) had a low risk of bias. We found no relevant cost-effectiveness studies. The evidence suggests that for persistent TMD: (1) cognitive-behavioral therapy and self-care management lead to similar improvements in pain and disability but cognitive-behavioral therapy is more effective for activity interference and depressive symptoms; (2) cognitive-behavioral therapy combined with usual treatment provides short-term benefits in pain and ability to control pain compared with usual treatment alone; (3) intraoral myofascial therapy may reduce pain and improve jaw opening; and (4) structured self-care management may be more effective than usual treatment. The evidence suggests that occlusal devices may not be effective in reducing pain and improving motion for TMD of variable duration. Evidence on the effectiveness of biofeedback is inconclusive.
Discussion: The available evidence suggests that cognitive-behavioral therapy, intraoral myofascial therapy, and self-care management are therapeutic options for persistent TMD.
*UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT)-Canadian Memorial Chiropractic College (CMCC)
†Divisions of Graduate Education and Research
§§Clinical Education, Canadian Memorial Chiropractic College (CMCC)
#Toronto Health Economics and Technology Assessment (THETA) Collaborative
**Leslie Dan Faculty of Pharmacy, University of Toronto
††Institute for Work and Health
‡‡UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto
∥Canada Research Chair in Disability Prevention and Rehabilitation
¶Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa
§Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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This research was undertaken, in part, thanks to funding from the Canada Research Chairs program to P.C.
Supported by the Ontario Ministry of Finance and the Financial Services Commission of Ontario, Toronto, Canada (RFP No.: OSS_00267175). The authors declare no conflict of interest.
Reprints: Kristi Randhawa, MPH, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 6100 Leslie Street, Toronto, ON, Canada M2H 3J1 (e-mail: firstname.lastname@example.org).
Received April 24, 2014
Received in revised form May 13, 2015
Accepted April 7, 2015