Clinical practice guidelines in primary treatment for temporomandibular disorders: The Japanese Society for the Temporomandibular Joint, 2023 edition

Abstract

Purpose: This guideline aimed to make evidence-based clinical practice guidelines for the primary treatment of temporomandibular disorders (TMDs) for general practitioners who do not specialize in TMD.

Review process: Following the principles of evidence-based medicine, a systematic review and network meta-analysis (NMA) of multiple treatments was conducted, assessing the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Randomized controlled trials published between January 2000 and December 2020 were included. Patients diagnosed with TMD according to the Diagnostic Criteria for Temporomandibular Disorders were considered. Myalgia, arthralgia, and maximal mouth opening were selected as outcomes, and 12 treatments were included in the NMA. The modified Delphi method was used to reach a consensus on recommendations during clinical guideline panel meetings of the Japanese Society for the Temporomandibular Joint.

Results: Self-administered mouth opening exercises, stabilization-type oral appliances, and low-level laser therapy (LLLT) were recognized as effective primary treatments, although the evidence level was graded as “very low” (Grade 2D). During the clinical guideline panel meetings, decisions were developed based on the NMA results, and recommendations for clinical practice guidelines were finalized following consensus.

Conclusions: This guideline recommends mouth opening exercises and the use of stabilization-type oral appliances as primary treatments for TMD. Additionally, it suggests that LLLT be a conditional recommendation, supplemented with additional considerations.