The DOI matches its Crossref record; 40 of the 43 references it cites were found in a registry or an index; 11 of the 21 sources its claims cite were checked for support.
Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline
Open accessAbstract
Clinical question: What is the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD)? Current practice: TMD are the second most common musculoskeletal chronic pain disorder after low back pain, affecting 6-9% of adults globally. TMD are associated with pain affecting the jaw and associated structures and may present with headaches, earache, clicking, popping, or crackling sounds in the temporomandibular joint, and impaired mandibular function. Current clinical practice guidelines are largely consensus-based and provide inconsistent recommendations. Recommendations: For patients living with chronic pain (≥3 months) associated with TMD, and compared with placebo or sham procedures, the guideline panel issued: (1) strong recommendations in favour of cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care (such as home exercises, stretching, reassurance, and education); (2) conditional recommendations in favour of manipulation, supervised jaw exercise with mobilisation, CBT with non-steroidal anti-inflammatory drugs (NSAIDS), manipulation with postural exercise, and acupuncture; (3) conditional recommendations against reversible occlusal splints (alone or in combination with other interventions), arthrocentesis (alone or in combination with other interventions), cartilage supplement with or without hyaluronic acid injection, low level laser therapy (alone or in combination with other interventions), transcutaneous electrical nerve stimulation, gabapentin, botulinum toxin injection, hyaluronic acid injection, relaxation therapy, trigger point injection, acetaminophen (with or without muscle relaxants or NSAIDS), topical capsaicin, biofeedback, corticosteroid injection (with or without NSAIDS), benzodiazepines, and β blockers; and (4) strong recommendations against irreversible oral splints, discectomy, and NSAIDS with opioids. How this guideline was created: An international guideline development panel including patients, clinicians with content expertise, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. The panel approached the formulation of recommendations from the perspective of patients, rather than a population or health system perspective. The evidence: Recommendations are informed by a linked systematic review and network meta-analysis summarising the current body of evidence for benefits and harms of conservative, pharmacologic, and invasive interventions for chronic pain secondary to TMD. Understanding the recommendation: These recommendations apply to patients living with chronic pain (≥3 months duration) associated with TMD as a group of conditions, and do not apply to the management of acute TMD pain. When considering management options, clinicians and patients should first consider strongly recommended interventions, then those conditionally recommended in favour, then conditionally against. In doing so, shared decision making is essential to ensure patients make choices that reflect their values and preference, availability of interventions, and what they may have already tried. Further research is warranted and may alter recommendations in the future.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This BMJ Rapid Recommendation clinical practice guideline provides GRADE-based recommendations for chronic pain (≥3 months) associated with temporomandibular disorders (TMD), informed by a linked systematic review and network meta-analysis of 153 trials (8713 participants) and 59 interventions. It strongly recommends several conservative/active therapies and usual care, conditionally supports some others, and recommends against many pharmacological, splint, and invasive interventions, with strong recommendations against irreversible oral splints, discectomy, and NSAIDs with opioids.
Key findings
- Strong recommendations in favour of: CBT with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care. Average effects on pain for these interventions ranged from −1.31 cm to −2.62 cm on a 10 cm visual analogue scale (MID 1 cm).
- Conditional recommendations in favour of: manipulation, supervised jaw exercise with mobilisation, CBT with NSAIDs, manipulation with postural exercise, and acupuncture.
- Conditional recommendations against: reversible occlusal splints, arthrocentesis, cartilage supplement with or without hyaluronic acid injection, low level laser therapy, transcutaneous electrical nerve stimulation, gabapentin, botulinum toxin injection, hyaluronic acid injection, relaxation therapy, trigger point injection, acetaminophen, topical capsaicin, biofeedback, corticosteroid injection, benzodiazepines, and β blockers.
- Strong recommendations against: irreversible oral splints, discectomy, and NSAIDs with opioids. The linked review included 210 studies (233 publications), of which 153 trials (8713 participants) informed network meta-analyses of 59 interventions.
Methods
- An international guideline development panel—including patients, clinicians with content expertise, and methodologists—produced recommendations using the GRADE approach and BMJ Rapid Recommendations procedures, from a patient rather than population or health-system perspective. Strong recommendations required 80% panel consensus; conditional recommendations required majority consensus.
- Recommendations were informed by a linked systematic review and network meta-analysis of randomised trials comparing 59 interventions or combinations against placebo or sham procedures in patients with chronic pain associated with TMD. Trials typically enrolled small numbers with short follow-up, predominantly women aged 30–39 years with longstanding moderate chronic TMD pain.
- The panel identified seven patient-important outcomes, with pain relief as the critical outcome. Because harms were inadequately reported, the panel surveyed clinical experts about anticipated serious and non-serious adverse events.
Limitations
- The paper states the recommendations apply to adult patients with moderate chronic pain (4–6 cm on a 10 cm pain scale for ≥3 months) secondary to TMD as a group of conditions, and do not apply to acute TMD pain (<3 months). It also states that substantial unexplained heterogeneity means different TMD subtypes may benefit more or less from certain interventions.
- The paper states many trials excluded patients with comorbid mental illness, fibromyalgia, or rheumatoid arthritis, or those who had prior TMD surgery, and did not report representation of veterans, individuals receiving disability benefits, or those engaged in litigation; generalisability to these populations is uncertain. Harms evidence was almost entirely very low certainty, and only 32% (19 of 59) of interventions reported harms data.
- Evident from the text: trials were typically small and short-term, mostly enrolled mixed or unspecified TMD subtypes, and 88% (134/153) were conducted in high- or middle-income countries; funding was not reported for 44% (68/153) of trials.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
16 Own result · 11 Own method · 10 Own interpretation · 5 Partly supported · 5 No basis given · 3 Supported · 3 No full text of the sources · 1 Supported so far · 1 Couldn’t confirm · 1 Sources not found · accuracy not yet measured
Every source the paper cites for this claim was checked and supports it.
In the paper
“These trials reported the effects of 59 interventions, or combinations of interventions, when compared with placebo or sham procedures in patients with chronic pain associated with temporomandibular disorders (TMD).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > The evidence
What the sources say
- Supportedcites [1] source
The Study characteristics passage reports that 148 trials involving patients with chronic TMD pain evaluated 59 interventions for pain. The paper uses placebo or sham procedures as the reference for its treatment comparisons, supporting the citing sentence. (LLM, conf=0.90)
plainn = 8,713- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“one trial administered therapy via a programme on the internet supported by asynchronous therapist feedback.37”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Practical issues and other considerations
What the sources say
- Partly supportedcites [37] sourceExperimental — accuracy not yet measured
Methods > Treatment Modalities describes an internet program based on CBT and self-management principles, with asynchronous chat support from a dentist. It says individualized feedback was provided in follow-up phone calls, not that a therapist gave asynchronous feedback. (LLM, conf=0.86)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Harms associated with available interventions to manage chronic pain associated with TMD (GRADE very low to low certainty evidence).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Absolute benefits and harms
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CBT, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care (such as education, support, home exercises and stretching) provide important, but less relief of chronic pain associated with TMD compared with other available treatments, approximating to 1.5× the MID (GRADE moderate to high certainty evidence).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Absolute benefits and harms
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The minimally important difference for chronic pain associated with temporomandibular disorders is 1 cm on a 10 cm visual analogue scale.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Whether use of other available therapies improved pain among people living with chronic pain associated with TMD (GRADE very low to low certainty evidence).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Absolute benefits and harms
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Respondents advised that, overall, people living with chronic pain associated with TMD were likely to accept the typical risks associated with conservative treatments and most pharmacotherapy and supplements for an improvement in pain approximating to the MID (1 cm on a 10 cm visual analogue scale).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Values and preferences
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The minimally important difference for chronic pain associated with temporomandibular disorders is 1 cm on a 10 cm visual analogue scale.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Average effects of these interventions on pain ranged from -1.31 cm to -2.62 cm on a 10 cm visual analogue scale (on which the minimally important difference (MID) is 1 cm).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Understanding the recommendations
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The minimally important difference for chronic pain associated with temporomandibular disorders is 1 cm on a 10 cm visual analogue scale.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Pain relief: 148 (97%) Physical functioning: 36 (24%) Adverse events: 31 (20%) Role functioning: 10 (7%) Mental functioning: 8 (5%) Sleep quality: 4 (3%) Social functioning: 1 (1%) Patient-important outcomes reported (No (%) of trials)”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most trials (134/153; 88%) that informed the evidence for this guideline were conducted in high-or middle-income countries.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Practical issues and other considerations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most trials we reviewed that explored the effectiveness of CBT delivered treatment in person”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Practical issues and other considerations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 24
- Probably not a substantial claim. 26
- The quote only partly states this claim. 1
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Of the five most recently published guidelines, four do not report the methodology used for their development, and they provide lists of available conservative and invasive treatments for TMD without information on comparative effectiveness or certainty of evidence.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Current practice
What the sources say
- Could not verifycites [20] sourceExperimental — accuracy not yet measured
The Methods (Sensitivity analysis; page unavailable) mention TMD diagnostic guidelines, while the Discussion (Alternative treatment options for TMD; page unavailable) lists treatments. Neither assesses five recently published treatment guidelines or says that four omit development methods, comparative effectiveness, or certainty of evidence. Searches for those specific guideline claims found no passage addressing them. (LLM, conf=0.75)
- Not checked — no full text of the sourcecites [21] source
- Not matchedcites [25] Royal College of Dental Surgeons of Ontario. Diagnosis and management of temporomandibular disorders. 2019. https://az184419.vo.msecnd.net/rcdso/pdf/guidelines/RCDSO_Guidelines_Diagnosis_and_Management_of_TMD.pdf.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The linked systematic review included 210 studies (in 233 publications), of which 153 trials (8713 participants) were included in network meta-analyses.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > The evidence
What the sources say
- Partly supportedcites [1] sourceExperimental — accuracy not yet measured
The Results report 233 publications covering 210 eligible trials, and 153 studies enrolling 8713 patients in the meta-analyses. However, the study-selection figure labels the quantitative synthesis as including both network and conventional meta-analysis; the copy does not establish that all 153 trials were included in network meta-analyses specifically. (LLM, conf=0.85)
plainn = 8,713- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The exception, the 2018 guideline from the Korea Standard CPG Development Agency, conducted systematic reviews of the literature to identify evidence to inform their recommendations, but only considered Korean medicine treatments.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Current practice
What the sources say
- Supportedcites [26] source
The CPG development process section says the guideline used a systematic literature review of Korean medicine treatments to inform its clinical questions. The Selection of data section says studies without traditional Korean medicine interventions were excluded. The Funding section identifies the Korea Standard CPG Development Agency as having requested the guideline; page numbers are not provided in our copy. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“We followed the BMJ Rapid Recommendations procedures for creating trustworthy guidance, 41 including using the GRADE approach to critically appraise the evidence and create recommendations (appendix 2 on bmj.com).42”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > How this recommendation was created
What the sources say
- Not checked — no full text of the sourcecites [41] source
- Supportedcites [42] source
The citation to this paper is attached to the GRADE portion of the sentence, not the separately cited BMJ Rapid Recommendations procedures. The Summary Points describe GRADE as a system for rating the quality of evidence and strength of recommendations, and Box 1 describes its process for moving from evidence to recommendations. (LLM, conf=0.92)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“Our recommendations are based on a linked systematic review and network meta-analysis (see box 1). 1”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Abstract
What the sources say
- Supportedcites [1] source
The Introduction states that this systematic review and network meta-analysis informed a parallel guideline published in The BMJ and MAGICapp (page not specified). This supports the citing guideline’s statement that its recommendations are based on the linked review. (LLM, conf=0.94)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The draft summary of findings were prepared prior to the panel meetings, following GRADE guidance from the accompanying network meta-analysis. 1”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > How this recommendation was created
What the sources say
- Partly supportedcites [1] sourceExperimental — accuracy not yet measured
The Certainty of evidence section says the network meta-analysis followed GRADE guidance for communicating its findings, and the Additional analysis section identifies a summary of findings. Neither section, nor the Guideline panel involvement section, says a draft summary was prepared before panel meetings. (LLM, conf=0.82)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Access to cognitive behavioural therapy (CBT) may be facilitated by therapist-supported remote delivery, which is less costly than and likely similarly effective to in-person CBT 38 39 44”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Box2: Practical issues concerning interventions for chronic pain associated with temporomandibular disorders (TMD)
What the sources say
- Not matchedcites [38] Zandieh S Abdollahzadeh M Inness BE . Remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized trials. CMAJ forthcoming.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [39] source
- Partly supportedcites [44] sourceExperimental — accuracy not yet measured
The Introduction says therapist-guided internet CBT can improve access, and the Cost-effectiveness Analysis reports substantially lower costs than face-to-face CBT. But the Results (Primary Outcome; page not provided) say noninferiority at three months was inconclusive, so the claim of likely similar effectiveness is stronger than this trial establishes. The findings concern adults with OCD. (LLM, conf=0.86)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Serious adverse events are unlikely with exercise 45 and CBT 46”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Box2: Practical issues concerning interventions for chronic pain associated with temporomandibular disorders (TMD)
What the sources say
- Supportedcites [45] source
The Conclusion and Implications for practice report no increased risk of serious adverse events with exercise therapy and describe it as relatively safe. In the citing sentence, this source is attached to exercise; the separate CBT claim carries a different citation. (LLM, conf=0.88)
- Partly supportedcites [46] sourceExperimental — accuracy not yet measured
The Discussion reports that clients did not mention severe adverse events, such as suicidality or hospitalization, in emails to their therapists. That supports an absence of reported events in this internet-delivered CBT sample, but it does not establish that serious adverse events are generally unlikely with CBT. The exercise portion is attached to a different citation and is not judged here. (LLM, conf=0.83)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The 59 interventions summarised in the associated network meta-analysis were classified into four sets of recommendations, according to their strength and direction, relative to placebo or sham procedures.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Understanding the recommendations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies typically enrolled small numbers of patients with short follow-up, and predominantly included women aged 30-39 years with longstanding chronic TMD pain of moderate severity.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > The evidence
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Our experts felt that most invasive procedures, such as arthrocentesis and trigger point injections, were associated with the possibility of moderate harm (such as local infection), and that discectomy and irreversible splints may result in serious harms (such as permanent change in range of motion, facial nerve weakness).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Absolute benefits and harms
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As we found moderate to high certainty evidence for important benefits on pain relief (our critical outcome), and the guideline panel was confident that the interventions were not associated with serious harms”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Understanding the recommendations
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Cognitive behavioural therapy (CBT) augmented with relaxation therapy or biofeedback, therapist-assisted jaw mobilisation, and manual trigger point therapy provide the largest reduction in chronic pain severity associated with TMD, approximating twice the minimally important difference (MID) (GRADE moderate certainty evidence).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Absolute benefits and harms
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
- Rests on an assumption: The minimally important difference for chronic pain associated with temporomandibular disorders is 1 cm on a 10 cm visual analogue scale.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Many trials eligible for our review excluded TMD patients with comorbid mental illness, fibromyalgia, or rheumatoid arthritis, or those who had previously undergone TMD surgery, and did not report the representation of veterans (who seem to be more prone to developing TMD 33 ) or of individuals receiving disability benefits or engaged in litigation.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Who does the recommendations apply to?
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, due to the greater risk of moderate or serious harms, patients would likely require an improvement in pain approximating three times the MID with invasive or irreversible procedures.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Values and preferences
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Rests on an assumption: The minimally important difference for chronic pain associated with temporomandibular disorders is 1 cm on a 10 cm visual analogue scale.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most trials enrolled mixed types of TMD or did not specify which subtypes were included; of those that did provide details, the most commonly enrolled subtype of TMD was myalgia (table 2).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > The evidence
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Trials for most interventions did not report effects on adverse events, and of the 32% (19 of 59) of interventions that did report data on harms, the evidence was almost entirely very low certainty.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Absolute benefits and harms
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Table 2 | Characteristics of 153 eligible randomised clinical trials (8713 patients) included in the network meta-analysis of interventions for chronic pain associated with temporomandibular disorders (TMD).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Additional information
plainn = 8,713- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Aside from usual care, there are seven interventions with strong recommendations in favour; however, they all require active participation by patients.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Education into practice
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Our patient partners agreed that, while several conservative interventions showed important net benefits for pain relief and/or functional improvement, individual patients may prefer some types of interventions over others.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Future research
plaindirectn = 3- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“No panel member had financial conflicts of interest; intellectual and professional conflicts were minimised and managed (see appendix 1 on bmj.com for details).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > How this recommendation was created
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Some treatment effects were rated down due to substantial unexplained heterogeneity, and we cannot rule out the possibility that different subtypes of TMD may benefit more or less from certain interventions.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Who does the recommendations apply to?
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Current clinical practice guidelines are largely consensus-based and provide inconsistent recommendations.”
- Also stated in: § Current practice · plain
“Clinical practice guidelines have emerged to support decision making for TMD, but with inconsistent recommendations (table 1) and important limitations in their development.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Current practice · plain
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It is unlikely that new information will change interpretation for outcomes that are supported by high to moderate certainty of evidence.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Absolute benefits and harms
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“A systematic assessment of all clinical practice guidelines on diagnosis and management of TMD published up to May 2020, found considerable deficits in the development and reporting among each of them and concluded there was a need for rigorously developed guidelines.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Current practice
What the sources say
- Not checked — no full text of the sourcecites [28] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The panel recognised that values and preferences were likely to vary between patients, further highlighting the importance of shared decision.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Values and preferences
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Expense may be a barrier to accessing therapists-delivered care unless patients have private health coverage or reside in a jurisdiction where these services are included in public health care”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Box2: Practical issues concerning interventions for chronic pain associated with temporomandibular disorders (TMD)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patient adherence is required for active interventions (such as CBT, supervised exercise): both feasibility and patient preference should be considered when starting a trial of therapy”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Box2: Practical issues concerning interventions for chronic pain associated with temporomandibular disorders (TMD)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our patient partners agreed that, while several conservative interventions showed important net benefits for pain relief and/or functional improvement, individual patients may prefer some types of interventions over others.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Future research
hedgedn = 3- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Three patients with lived experience of chronic pain associated with TMD were full members of our guideline panel.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Future research
plainn = 3- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“As with all BMJ Rapid Recommendations, the executive team and The BMJ judged that no panel member had any financial conflict of interest.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Conflict
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We required 80% consensus among panel members for strong recommendations, and a majority consensus for conditional recommendations.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > How this recommendation was created
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“These panel members participated in the teleconferences and email discussions and met all authorship criteria.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Future research
plainn = 3- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“When formulating the recommendations, the guideline panel focused on patients' perspectives rather than that of society.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Costs and resources
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Funding
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Each recommended intervention requires clinician administration and depends on access and patient participation, and may entail costs that are borne by patients.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Practical issues and other considerations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Personal, professional, and academic interests were minimised as much as possible, while maintaining necessary expertise on the panel to make fully informed decisions.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Conflict
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“These panel members identified important outcomes and informed the discussion on values and preferences.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Future research
plaindirectn = 3- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Each recommended intervention requires clinician administration and depends on access and patient participation, and may entail costs that are borne by patients.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Practical issues and other considerations
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The consensus process was overseen by two experienced guideline methodologists (JWB, TA).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > How this recommendation was created
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, both availability and costs of interventions for chronic pain associated with TMD may influence decision making.”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Costs and resources
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
The paper relies on this without support.
The minimally important difference for chronic pain associated with temporomandibular disorders is 1 cm on a 10 cm visual analogue scale.
“on which the minimally important difference (MID) is 1 cm”
The paper relies on this without support.
Long term opioids, NSAIDs, and invasive or irreversible procedures are associated with a small risk of serious, potentially catastrophic, harms.
“Long term opioids, NSAIDs, and invasive or irreversible procedures are associated with a small risk of serious, potentially catastrophic, harms”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Additional information
“* Total number of enrolled patients using arm-level data (the 153 trials included 59 treatment arms).”
§ Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline > Additional information
“Table 2 | Characteristics of 153 eligible randomised clinical trials (8713 patients) included in the network meta-analysis of interventions for chronic pain associated with temporomandibular disorders (TMD).”
Citations
Cites
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schünemann, H. J. (2008) · BMJ · doi:10.1136/bmj.39489.470347.ad · Cited by 23,305 · cited 1×
“…ofpracticalissuesandotherelementsoftheevidencetothedecision framework 42 43 and identify clusters of interventions for each direction…”
BackgroundSelf-citationCentral sensitization: a generator of pain hypersensitivity by central neural plasticity
Latremoliere, A., & Woolf, C. J. (2009) · The Journal of Pain · doi:10.1016/j.jpain.2009.06.012 · Cited by 3,913
The IASP classification of chronic pain for ICD-11: chronic primary pain
Nicholas, M., Vlaeyen, J. W. S., Rief, W., Barke, A., Aziz, Q., Benoliel, R., Cohen, M., Evers, S., Giamberardino, M. A., Goebel, A., et al. (2019) · Pain · doi:10.1097/j.pain.0000000000001390 · Cited by 1,424
Andrews, J. C., Schünemann, H. J., Oxman, A. D., Pottie, K. C., Meerpohl, J. J., Alonso‐Coello, P., Rind, D. M., Montori, V. M., Brito, J. P., Norris, S. L., et al. (2013) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2013.02.003 · Cited by 1,366
Self-citationPainful Temporomandibular Disorder
Slade, G. D., Ohrbach, R. K., Greenspan, J. D., Fillingim, R. B., Bair, E., Sanders, A. E., Dubner, R. A., Diatchenko, L. B., Meloto, C. B., Smith, S. B., et al. (2016) · Journal of Dental Research · doi:10.1177/0022034516653743 · Cited by 678
Aaron, L. A., Burke, M. M., & Buchwald, D. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.2.221 · Cited by 607
Orofacial Pain Prospective Evaluation and Risk Assessment Study – The OPPERA Study
Maixner, W. D., Diatchenko, L. B., Dubner, R. A., Fillingim, R. B., Greenspan, J. D., Knott, C. E., Ohrbach, R. K., Weir, B. S., & Slade, G. D. (2011) · Journal of Pain · doi:10.1016/j.jpain.2011.08.002 · Cited by 421
Cooper, B. C., & Kleinberg, I. (2007) · CRANIO® · doi:10.1179/crn.2007.018 · Cited by 221
Ohrbach, R., & Dworkin, S. F. (1998) · Pain · doi:10.1016/s0304-3959(97)00194-2 · Cited by 203
Systematic review of population-based epidemiological studies of oro-facial pain
Macfarlane, T. V., Glenny, A., & Worthington, H. V. (2001) · Journal of Dentistry · doi:10.1016/s0300-5712(01)00041-0 · Cited by 200
Rammelsberg, P., LeResche, L., Dworkin, S. F., & Mancl, L. (2003) · PubMed · Cited by 172
Niemeijer, A., Lund, H., Stafne, S. N., Ipsen, T., Goldschmidt, C. L., Jørgensen, C. T., & Juhl, C. B. (2020) · British Journal of Sports Medicine · doi:10.1136/bjsports-2018-100461 · Cited by 157
Nordgren, L. B., Hedman, E., Etienne, J., Bodin, J., Kadowaki, Å., Eriksson, S., Lindkvist, E., Andersson, G., & Carlbring, P. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.05.007 · Cited by 145 · cited 1×
“38 RemoteCBTisalsomorecost-effective, 39 and the World Health Organization Global Oral Health Action Plan has proposed that member states should strengthen access and capacity for using digital technologies to ensure that digital health approaches do not increase inequalities.”
BackgroundIntroduction to BMJ Rapid Recommendations
Siemieniuk, R. A., Agoritsas, T., Macdonald, H., Guyatt, G. H., Brandt, L., & Vandvik, P. O. (2016) · BMJ · doi:10.1136/bmj.i5191 · Cited by 129
Self-citationFillingim, R. B., Slade, G. D., Greenspan, J. D., Dubner, R., Maixner, W., Bair, E., & Ohrbach, R. (2018) · Pain · doi:10.1097/j.pain.0000000000001348 · Cited by 126
MR Imaging of the Temporomandibular Joint
Aiken, A. H., Bouloux, G. F., & Hudgins, P. A. (2012) · Magnetic Resonance Imaging Clinics of North America · doi:10.1016/j.mric.2012.05.002 · Cited by 91
Diagnostic Imaging for Temporomandibular Disorders and Orofacial Pain
Hunter, A. K., & Kalathingal, S. (2013) · Dental Clinics of North America · doi:10.1016/j.cden.2013.04.008 · Cited by 84
Diagnosis and treatment of temporomandibular disorders: an ethical analysis of current practices
Reid, K. I., & Greene, C. S. (2013) · Journal of Oral Rehabilitation · doi:10.1111/joor.12067 · Cited by 79
Temporomandibular Disorder: a practical guide for dental practitioners in diagnosis and management
Beaumont, S., Garg, K., Gokhale, A., & Heaphy, N. (2020) · Australian Dental Journal · doi:10.1111/adj.12785 · Cited by 79
Lundström, L., Flygare, O., Andersson, E., Enander, J., Bottai, M., Ivanov, V. Z., Boberg, J., Pascal, D., Mataix-Cols, D., & Rück, C. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.1967 · Cited by 78
Minervini, G., Franco, R., Marrapodi, M. M., Fiorillo, L., Cervino, G., & Cicciù, M. (2023) · Journal of Oral Rehabilitation · doi:10.1111/joor.13535 · Cited by 73
Oral splints for temporomandibular disorder or bruxism: a systematic review
Riley, P., Glenny, A.-M., Worthington, H. V., Jacobsen, E., Robertson, C., Durham, J., Davies, S., Petersen, H., & Boyers, D. (2020) · British Dental Journal · doi:10.1038/s41415-020-1250-2 · Cited by 67
Self-citationFelin, G. C., Tagliari, C. V. D. C., Agostini, B. A., & Collares, K. (2022) · Journal of Prosthetic Dentistry · doi:10.1016/j.prosdent.2022.08.002 · Cited by 61
Yao, L., Sadeghirad, B., Li, M., Li, J., Wang, Q., Crandon, H. N., Martin, G., Morgan, R., Florez, I. D., Hunskaar, B. S., et al. (2023) · BMJ · doi:10.1136/bmj-2023-076226 · Cited by 57
Self-citation(1998) · PubMed · Cited by 52
Characteristics of 511 patients with temporomandibular disorders referred for physical therapy
Kraus, S. L. (2014) · Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology · doi:10.1016/j.oooo.2014.06.005 · Cited by 42
(1995) · PubMed · Cited by 37
Temporomandibular Disorders: Variation in Clinical Practice
Von Korff, M. R., Howard, J. A., Truelove, E. L., Sommers, E., Wagner, E. H., & Dworkin, S. (1988) · Medical Care · doi:10.1097/00005650-198803000-00007 · Cited by 35
Lam, J., Svensson, P., & Alstergren, P. (2020) · Journal of Medical Internet Research · doi:10.2196/22326 · Cited by 33
Zeng, L., Helsingen, L. M., Bretthauer, M., Agoritsas, T., Vandvik, P. O., Mustafa, R. A., Busse, J. W., Siemieniuk, R. A. C., Lytvyn, L., Li, S., et al. (2023) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2023.07.003 · Cited by 33
Self-citationComplications of Temporomandibular Joint Surgery
Bouloux, G. F. (2017) · Springer eBooks · doi:10.1007/978-3-319-51241-9 · Cited by 30
Forssell, H., Kauko, T., Kotiranta, U., & Suvinen, T. I. (2016) · European Journal of Pain · doi:10.1002/ejp.916 · Cited by 29
Gonzalez, Y. M., Chwirut, J., List, T., et al. (2014) · MedEdPORTAL · doi:10.15766/mep_2374-8265.9946 · Cited by 27
Gullickson, K. M., Hadjistavropoulos, H. D., Dear, B. F., & Titov, N. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100278 · Cited by 26 · cited 8×
“• Serious adverse events are unlikely with exercise 45 and CBT 46 • Long term opioids, NSAIDs, and invasive or irreversible procedures are associated with a small risk of serious, potentially catastrophic, harms”
BackgroundInfluentialAggarwal, V. R., Joughin, A., Zakrzewska, J. M., Appelbe, P., & Tickle, M. (2011) · Health Education Journal · doi:10.1177/0017896911419350 · Cited by 23
Self-citationEditorial: The WHO Global Oral Health Action Plan 2023-2030
Eaton, K. A., Yusuf, H., & Vassallo, P. (2023) · Community Dental Health · doi:10.1922/cdh_jun23editorial02 · Cited by 22
Kim, K.-W., Ha, I.-H., Lee, Y. J., Kim, M.-R., Shin, B.-C., Song, M.-Y., & Cho, J.-H. (2018) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2018.10.007 · Cited by 18
Zeng, L., Li, S., Yang, M., Yan, L., Helsingen, L. M., Bretthauer, M., Agoritsas, T., Vandvik, P. O., Mustafa, R. A., Busse, J. W., et al. (2023) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2023.07.014 · Cited by 14
Self-citationBarrette, L.-X., Connolly, J., Romeo, D., Ng, J., Moreira, A. G., & Rajasekaran, K. (2022) · Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology · doi:10.1016/j.oooo.2021.10.021 · Cited by 10
Temporomandibular disorder: A guide for general dental practitioners
Shah, A., & Naqvi, A. (2022) · Primary Dental Journal · doi:10.1177/20501684221112513 · Cited by 8
Research works printed but not linked: 2
- National Academies of Sciences E . Medicine. Temporomandibular Disorders: Priorities for Research and Care. The National Academies Press, 2020.
- Zandieh S Abdollahzadeh M Inness BE . Remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized trials. CMAJ forthcoming.
Cited by
Sorted by citations
Pathology of pain and its implications for therapeutic interventions
Cao, B., Xu, Q., Shi, Y., Zhao, R., Li, H., Zheng, J., Liu, F., Wan, Y., & Wei, B. (2024) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-024-01845-w · Cited by 236
Yao, L., Sadeghirad, B., Li, M., Li, J., Wang, Q., Crandon, H. N., Martin, G., Morgan, R., Florez, I. D., Hunskaar, B. S., et al. (2023) · BMJ · doi:10.1136/bmj-2023-076226 · Cited by 57
Self-citationTemporomandibular disorders and mental health: shared etiologies and treatment approaches
Wan, J., Lin, J., Zha, T., Ciruela, F., Jiang, S., Wu, Z., Fang, X., Chen, Q., & Chen, X. (2025) · The Journal of Headache and Pain · doi:10.1186/s10194-025-01985-6 · Cited by 77
Intra-Articular Hyaluronic Acid for Knee Osteoarthritis: A Systematic Umbrella Review
Glinkowski, W., & Tomaszewski, W. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14041272 · Cited by 55
“Numerous RCTs have demonstrated significant pain reduction [30,32,127,146,147], as measured by the WOMAC pain scale and VAS, especially in early-to-moderate OA lasting up to six months, indicating efficacy in symptom relief and reduction.”
Canales, G. D. L. T., Câmara‐Souza, M. B., Ernberg, M. M., Al‐Moraissi, E. A., Grigoriadis, A., Poluha, R. L., Christidis, M., Jasim, H., Lövgren, A., & Christidis, N. (2024) · Drugs · doi:10.1007/s40265-024-02048-x · Cited by 39
“Thus, in line with a recently published clinical practical guideline, we recommend that healthcare providers reassess the use of BoNT-A as a treatment for M-TMDs and limit its application only to specific cases with persistent M-TMD where standard treatments are not sufficient to relieve pain [73].”
Background
Metadata
- Authors
- Busse, J. W., Casassus, R., Carrasco-Labra, A., Durham, J., Mock, D., Zakrzewska, J. M., Palmer, C., Samer, C. F., Coen, M., Guevremont, B., Hoppe, T., Guyatt, G. H., Crandon, H. N., Yao, L., Sadeghirad, B., Vandvik, P. O., Siemieniuk, R. A. C., Lytvyn, L., Hunskaar, B. S., & Agoritsas, T.
- Affiliations
- McMaster University (CA)
- Universidad del Desarrollo (CL)
- Center for Integrative Global Oral Health, University of Pennsylvania, School of Dental Medicine, Philadelphia PA, USA
- Newcastle University (GB)
- Mount Sinai Hospital (CA)
- Eastman Dental Hospital (GB)
- Veterans Affairs Canada (CA)
- University of Geneva (CH)
- Chronic Pain Centre of Excellence for Canadian Veterans (CA)
- Innlandet Hospital Trust (NO)
- University Hospital of Geneva (CH)
- Corresponding author
- Busse, Jason W
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2023-12-15
- Volume
- 383
- Pages
- e076227
- ISSN
- 1756-1833 (ISSN-L)
- OpenAlex
- W4389781194
- Semantic Scholar
- 84ac132ca86968cb78777dc4f72c6a14744c96bb
- Cited by
- 152
- References
- 43
- Citations by year
- 2026: 50 · 2025: 66 · 2024: 34 · 2023: 2
- FWCI
- 38.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Dentistry › Oral Surgery › Temporomandibular Joint Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Myofascial pain diagnosis and treatment
- Keywords
- temporomandibular disorders, chronic pain, cognitive behavioral therapy, biofeedback, postural exercises, acupuncture, manipulation, occlusal splint, hyaluronic acid injection, botulinum toxin, nonsteroidal anti-inflammatory drugs, transcutaneous electrical nerve stimulation, low-level laser therapy, comparative effectiveness, conservative treatment, pharmacotherapy, invasive treatment
- MeSH terms
- Network Meta-Analysis, Network Meta-Analysis as Topic, Systematic Reviews as Topic, Adult, Anti-Inflammatory Agents, Non-Steroidal, Humans, Hyaluronic Acid, Temporomandibular Joint Disorders, Meta-Analysis as Topic, Ecosystem, Chronic Pain, Acute Pain
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-12, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-12 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
