Is nonsurgical management effective in temporomandibular joint disorders? – A systematic review and meta‑analysis

Background: Various nonsurgical interventions have been used for the management of patients with temporomandibular joint (TMJ) disorders, but their clinical effectiveness remains unclear. Hence, the purpose of this systematic review and meta‑analyses was to assess the evidence of the effectiveness of nonsurgical interventions in the management of TMJ disorders. Materials and Methods: A literature search on five databases such as PubMed, PubMed Central Cochrane, TRIP, NGCH databases and hand searching was conducted for a period from October 1995 to 2015. Randomized control trials (RCTs) on the nonsurgical management of TMJ disorders were included and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta‑Analyses guidelines. The quality of the articles was assessed by JADAD scoring. Finally, out of 23 RCTs, 11 articles having any of the primary outcomes (pain pressure threshold [PPT], pain, maximal pain‑free mouth opening, and level of dysfunction) were selected. The extracted data were analyzed using NCSS software. Results: The results showed the evidence of pain reduction (P = 0.00), maximal pain‑free mouth opening (P = 0.0138), and decrease in level of dysfunction (P = 0.0007) but no improvement in PPT to a significant level (P = 0.6600). Conclusion: Our results suggest that the simplest, cost‑effective nonsurgical treatments have a positive therapeutic effect on the initial management of TMJ disorders. However, a consistent methodology recording both the objective and subjective outcomes would be a better choice for added reliability.