ABSTRACT

BACKGROUND AND OBJECTIVES:

Temporomandibular disorder (TMD) is the term used to describe a set of painful and functional conditions that can affect the temporomandibular joint (TMJ), the masticatory muscles and/or their associated structures. For myofascial TMD, conservative therapies, including drugs, physical therapy, occlusal splint and pain self-management show the best benefits to the patient. The objective of this study was to carry out, through a bibliometric analysis, a review of the existing knowledge regarding the treatments used in myofascial TMD.

CONTENTS:

The search was conducted in the Web of Science (WOS) and SCOPUS databases in July and updated in December 2023, through the MeSh descriptors “Temporomandibular Joint Dysfunction Syndrome” and “Therapeutics”. Moreover, bibliometric mapping was performed using the VOSviewer software. For the analysis, data on the terms of the title and abstract, type of document, number of citations, name of journals, most cited article and year of publication were included. Besides these, the country of the corresponding author, type of treatment, type of study and the results were included in the analysis. Of the 760 articles identified, 63 were selected to compose this review. Of these, most were original articles, clinical trials and were published in 2012. The most frequent treatments were: occlusal splint, laser, manual therapy, botulinum toxin and dry needling. Of the 15 countries analyzed, Brazil was the country with the highest number of publications.

CONCLUSION:

There was an increase in articles published on the topic, with Brazil being the country with the highest number of publications. Finally, the most used treatments were occlusal splint and laser.

Keywords:
Facial pain; Myofascial pain; Temporomandibular joint dysfunction syndrome; Therapeutics

RESUMO

JUSTIFICATIVA E OBJETIVOS:

Disfunção temporomandibular (DTM) é um termo utilizado para descrever um conjunto de condições dolorosas e funcionais que podem afetar a articulação temporomandibular (ATM), os músculos mastigatórios e/ou suas estruturas associadas. Para DTM miofascial, terapias conservadoras, incluindo fármacos (analgésicos e/ou anti-inflamatórios), fisioterapia, placa oclusal e autogestão da dor apresentam os melhores benefícios para o paciente. O objetivo deste estudo foi abordar, através de uma análise bibliométrica, o conhecimento existente sobre os tratamentos utilizados na DTM de origem miofascial.

CONTEÚDO:

A busca foi realizada na base de dados Web of Science (WOS) e SCOPUS, em julho e atualização em dezembro de 2023, por meio dos descritores do MeSh “Temporomandibular Joint Dysfunction Syndrome” e “Therapeutics”. Além disso, um mapeamento bibliométrico foi realizado no software VOSviewer. Para análise, foram incluídos dados sobre os termos do título e do resumo, tipo de documento, número de citações, nome dos periódicos, artigo mais citado e ano de publicação e, além destes, o país do autor correspondente, tipo de tratamento, tipo de estudo e resultados. Dos 760 artigos identificados, 63 foram selecionados para compor esta revisão. Destes, a maioria era artigos originais, ensaios clínicos e foram publicados em 2012. Os tratamentos mais frequentes foram: placa oclusal, laser, terapia manual, toxina botulínica e agulhamento a seco. Dos 15 países analisados, o Brasil foi o país com maior número de publicações.

CONCLUSÃO:

Houve um aumento de artigos sobre a temática publicados, sendo o Brasil o país com mais publicações e os tratamentos mais utilizados foram placa oclusal e laser.

Descritores:
Dor facial; Síndrome da disfunção da articulação temporomandibular; Síndrome da dor miofascial

HIGHLIGHTS

Brazil is the country with the highest number of publications on temporomandibular dysfunction of myofascial origin in recent years.

The most used treatments for temporomandibular dysfunction of myofascial origin were the occlusal splint and laser.

In the articles included the words that appeared most often were myofascial pain, psychotherapy and temporomandibular disorders.

INTRODUCTION

Temporomandibular disorder (TMD) is a term used to describe a set of painful and functional conditions that can affect the temporomandibular joint (TMJ), the masticatory muscles and/or their associated structures¹1 What is orofacial pain? American Academy of Orofacial Pain. 2015 [cited 2015 April, 16]. Available from: http://www.aaop.org.
http://www.aaop.org... ,²2 Chantaracherd P, John MT, Hodges JS, Schiffman EL. Temporomandibular joint disorders’ impact on pain, function, and disability. J Dent Res. 2015;94(3 Suppl):79S-86S.. The etiology of this dysfunction is multifactorial, involving genetic, individual, and environmental factors. It has been observed that increased stress has favored the appearance of muscle tension which, in turn, affects the functioning of the stomatognathic system and the TMJ³3 Bilici IŞ, Emes Y, Aybar B, Yalçın S. Evaluation of the effects of occlusal splint, trigger point injection and arthrocentesis in the treatment of internal derangement patients with myofascial pain disorders. J Craniomaxillofac Surg. 2018;46(6):916-22.,⁴4 Pihut ME, Margielewicz J, Kijak E, Wiśniewska G. Evaluation of articular disc loading in the temporomandibular joints after prosthetic and pharmacological treatment in model studies. Adv Clin Exp Med. 2017;26(3):455-60..

According to the Diagnostic Criteria for TMDs, they can be categorized as myalgia, arthralgia, or headache attributed to TMD⁵5 Ohrbach R. Editor. Diagnostic Criteria for Temporomandibular Disorders: Assessment Instruments. Version15May2016. [Critérios de Diagnóstico para Desordens Temporomandibulares: Protocolo Clínico e Instrumentos de Avaliação: Brazilian Portuguese Version 25May2016] Pereira Jr FJ, Gonçalves DAG, Trans. www.rdc-tmdinternational.org. Accessed on julho 2022.
www.rdc-tmdinternational.org... . Myalgia can be divided into subgroups: local myalgia, myofascial pain with spreading, and referred myofascial pain⁵5 Ohrbach R. Editor. Diagnostic Criteria for Temporomandibular Disorders: Assessment Instruments. Version15May2016. [Critérios de Diagnóstico para Desordens Temporomandibulares: Protocolo Clínico e Instrumentos de Avaliação: Brazilian Portuguese Version 25May2016] Pereira Jr FJ, Gonçalves DAG, Trans. www.rdc-tmdinternational.org. Accessed on julho 2022.
www.rdc-tmdinternational.org... ,⁶6 Deregibus A, Ferrillo M, Grazia Piancino M, Chiara Domini M, de Sire A, Castroflorio T. Are occlusal splints effective in reducing myofascial pain in patients with muscle-related temporomandibular disorders? A randomized-controlled trial. Turk J Phys Med Rehabil. 2021;67(1):32-40.. Myofascial pain affects 46% of the global population, and the morbidity rate among dental patients with TMDs ranges from 27% to 76%⁷7 Fleckenstein J, Zaps D, Rüger LJ, Lehmeyer L, Freiberg F, Lang PM, Irnich D. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord. 2010;11:32.. Besides the high prevalence, individuals who suffer from TMD are at a greater risk of experiencing depressive symptoms, difficulty in activities of daily living (ADL) and have a lower quality of life⁶6 Deregibus A, Ferrillo M, Grazia Piancino M, Chiara Domini M, de Sire A, Castroflorio T. Are occlusal splints effective in reducing myofascial pain in patients with muscle-related temporomandibular disorders? A randomized-controlled trial. Turk J Phys Med Rehabil. 2021;67(1):32-40.,⁸8 Gerber LH, Sikdar S, Armstrong K, Diao G, Heimur J, Kopecky J, Turo D, Otto P, Gebreab T, Shah J. A systematic comparison between subjects with no pain and pain associated with active myofascial trigger points. PM R. 2013;5(11):931-8.,⁹9 Pastore GP, Goulart DR, Pastore PR, Prati AJ, de Moraes M. Self-medication among myofascial pain patients: a preliminary study. Open Dent J. 2018;12:347-53..

Among existing TMDs, myofascial TMD is the most common¹⁰10 de Melo LA, Bezerra de Medeiros AK, Campos MFTP, Bastos Machado de Resende CM, Barbosa GAS, de Almeida EO. Manual therapy in the treatment of myofascial pain related to temporomandibular disorders: a systematic review. J Oral Facial Pain Headache. 2020;34(2):141-8.. This pain is described as dull and persistent, being the most common symptom of this type of TMD¹⁰10 de Melo LA, Bezerra de Medeiros AK, Campos MFTP, Bastos Machado de Resende CM, Barbosa GAS, de Almeida EO. Manual therapy in the treatment of myofascial pain related to temporomandibular disorders: a systematic review. J Oral Facial Pain Headache. 2020;34(2):141-8.,¹¹11 Christidis N, Ndanshau EL, Sandberg A, Tsilingaridis G. Prevalence and treatment strategies regarding temporomandibular disorders in children and adolescents-A systematic review. J Oral Rehabil. 2019;46(3):291-301.. Besides the episodes of musculoskeletal pain, this type of dysfunction is represented by tenderness to palpation of the TMJ and masticatory muscles, as well as joint range of motion (ROM) restrictions³3 Bilici IŞ, Emes Y, Aybar B, Yalçın S. Evaluation of the effects of occlusal splint, trigger point injection and arthrocentesis in the treatment of internal derangement patients with myofascial pain disorders. J Craniomaxillofac Surg. 2018;46(6):916-22.,¹²12 Sobral APT, Godoy CLH, Fernandes KPS, Bussadori SK, Ferrari RAM, Horliana ACRT, Monken S F, Motta LJ. Photomodulation in the treatment of chronic pain in patients with temporomandibular disorder: protocol for cost-effectiveness analysis. BMJ Open. 2018;8(5):e018326.,¹³13 Stechman-Neto J, Porporatti AL, Porto de Toledo I, Costa YM, Conti PC, De Luca Canto G, Mezzomo LA. Effect of temporomandibular disorder therapy on otologic signs and symptoms: a systematic review. J Oral Rehabil. 2016;43(6):468-79.. An essential aspect for the diagnosis and management of myofascial TMD is the consideration of morbidities often associated with it. In particular, psychosocial stressors associated with several comorbidities are critically related to this manifestation of pain⁶6 Deregibus A, Ferrillo M, Grazia Piancino M, Chiara Domini M, de Sire A, Castroflorio T. Are occlusal splints effective in reducing myofascial pain in patients with muscle-related temporomandibular disorders? A randomized-controlled trial. Turk J Phys Med Rehabil. 2021;67(1):32-40.,¹⁰10 de Melo LA, Bezerra de Medeiros AK, Campos MFTP, Bastos Machado de Resende CM, Barbosa GAS, de Almeida EO. Manual therapy in the treatment of myofascial pain related to temporomandibular disorders: a systematic review. J Oral Facial Pain Headache. 2020;34(2):141-8.,¹¹11 Christidis N, Ndanshau EL, Sandberg A, Tsilingaridis G. Prevalence and treatment strategies regarding temporomandibular disorders in children and adolescents-A systematic review. J Oral Rehabil. 2019;46(3):291-301..

In the 1990s, dental factors were typically associated with TMDs, with the treatment of these problems often leading to such dysfunction⁷7 Fleckenstein J, Zaps D, Rüger LJ, Lehmeyer L, Freiberg F, Lang PM, Irnich D. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord. 2010;11:32.. However, according to more recent evidence, conservative therapies, including pharmaceutical (analgesics and/or anti-inflammatory drugs), physical therapy, occlusal splint and pain self-management show the best benefits for the patient⁶6 Deregibus A, Ferrillo M, Grazia Piancino M, Chiara Domini M, de Sire A, Castroflorio T. Are occlusal splints effective in reducing myofascial pain in patients with muscle-related temporomandibular disorders? A randomized-controlled trial. Turk J Phys Med Rehabil. 2021;67(1):32-40.,¹⁴14 Bai B, Bai X, Wang C. Mapping research trends of temporomandibular disorders from 2010 to 2019: A bibliometric analysis. J Oral Rehabil. 2021;48(5):517-30.,¹⁵15 Kuzmanovic Pficer J, Dodic S, Lazic V, Trajkovic G, Milic N, Milicic B. Occlusal stabilization splint for patients with temporomandibular disorders: Meta-analysis of short and long term effects. PLoS One. 2017;12(2):e0171296.,¹⁶16 Al-Moraissi EA, Farea R, Qasem KA, Al-Wadeai MS, Al-Sabahi ME, Al-Iryani GM. Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2020;49(8):1042-56.,¹⁷17 Machado D, Martimbianco ALC, Bussadori SK, Pacheco RL, Riera R, Santos EM. Botulinum toxin type a for painful temporomandibular disorders: systematic review and meta-analysis. J Pain. 2020;21(3-4):281-93.,¹⁸18 Keskin Tunç S, Ünalan Değirmenci B, Alpaslan Yaylı N, Aslan Ş, Akdeniz MŞ. Evaluation the effects of low-level laser therapy on disc displacement with reduction. Turk J Phys Med Rehabil. 2020;66(1):24-30.,¹⁹19 Aksu Ö, Pekin Doğan Y, Sayıner Çağlar N, Şener BM. Comparison of the efficacy of dry needling and trigger point injections with exercise in temporomandibular myofascial pain treatment. Turk J Phys Med Rehabil. 2019;65(3):228-35..

In this sense, the objective of the present study was to describe, through a bibliometric analysis, which treatments are most commonly used for the management of TMD of myofascial origin in order to guide any professional interested in this topic by mapping current treatment trends..

CONTENTS

The search was conducted in the Web of Science (WOS) and SCOPUS database in July and update in December 2023. The following MeSH descriptors and their synonyms were used: Temporomandibular Joint Dysfunction Syndrome, Therapeutics. Thus, the following search key was formed: in WOS ((ALL= (Temporomandibular Joint Dysfunction Syndrome OR TMJ Syndrome OR Temporomandibular Joint Syndrome)) AND ALL= (Therapeutics OR Therapeutic OR Therapy OR Therapies OR Treatment OR Treatments)) AND ALL= (Facial Pain OR Face Pain OR Orofacial Pain OR Craniofacial Pain OR Myofascial Pain); and in SCOPUS: (TITLE-ABS-KEY (temporomandibular AND joint AND dysfunction AND syndrome OR TMJ AND syndrome OR temporomandibular AND joint AND syndrome) AND TITLE-ABS-KEY (therapeutics OR therapeutic OR therapy OR therapies OR treatment OR treatments) AND TITLE-ABS-KEY (facial AND pain OR face AND pain OR orofacial AND pain OR craniofacial AND pain OR myofascial AND pain).

An initial scan was carried out to select the articles that met the inclusion criteria: articles that address therapies that are or were used in the treatment of temporomandibular myofascial dysfunction and articles which studied dysfunction was not associated with another disease or that had a joint origin. Thus, articles that were not available in full, or that did not have an abstract, on patients that had TMD because of another disease or that were qualitative studies were excluded. There were no restrictions on the language and period of publication.

The search results were exported in Excel and RIS format and were analyzed in terms of the type of document, number of citations, name of journals, most cited article and year of publication. In addition to these, the country of the corresponding author, type of treatment, type of study and the results were also analyzed.

For the bibliometric analysis, the VOSviewer software was used. This software performs an analysis through data exported from the database and displays them in a cluster format. In the network map produced by VOSviewer, the results are displayed in nodes and links of different colors. Nodes represent an element type (countries, co-authors), the larger the node the higher the frequency of occurrence of the element. The links, which interconnect the nodes, represent the collaborative relationships between the elements. The more frequent these collaborations are, the denser and closer the links will be. In addition, the colors of the nodes and links identify which clusters the element belongs to¹⁴14 Bai B, Bai X, Wang C. Mapping research trends of temporomandibular disorders from 2010 to 2019: A bibliometric analysis. J Oral Rehabil. 2021;48(5):517-30.,²⁰20 Zhang J, Xie J, Hou W, Tu X, Xu J, Song F, Wang Z, Lu Z. Mapping the knowledge structure of research on patient adherence: knowledge domain visualization-based co-word analysis and social network analysis. PLoS One. 2012;7(4):e34497.. In this study, a bibliometric mapping was performed for an in-depth analysis based on the title and abstract terms, as well as on the co-authors.

A total of 760 articles were identified, from which 63 articles were selected to compose the sample for meeting the inclusion criteria of this study. The period of publication was from 1993 to 2023, with 2012 being the year with the highest number of records (6) and the years 1993, 1994, 1996, 2000, 2004, 2007 and 2014 with only 1 record each. The years 1999, 2002, 2009, 2010, 2011 and 2013 with 2 articles, while 2006, 2008, 2018, 2021 and 2023 with 3 articles, and 2017 and 2019 with 4 articles, 2015, 2020 and 2022 with 5 articles.

According to the type of document, original articles and reviews were found, with original articles being the most frequently found, totaling 22 articles (57.89%) and 16 reviews (42.11%). Regarding the type of study, most were clinical trials (50%), followed by systematic reviews (31.58%) and literature reviews (15.79%), as well as case reports (2.63%) (Table 1).

According to the type of treatment, there was a wide variety of techniques used for the management of TMD, with the most common being: Occlusal splint (19), Laser (16), Manual Therapy (9), Botulinum Toxin (9) and Counseling (9). The number of treatments listed exceeds the number of articles included, as some articles cite or use more than one type of treatment in their intervention or narration (Table 2).

In total, 13 countries were analyzed, with the number of studies published highlighted by color intensity, according to the map produced in Microsoft Excel (Figure 1). The country with the highest number of published articles is Brazil (15), followed by the United States (11), Turkey (6), Spain, Iran and Finland (4), Canada and Italy (3), China (2), as well as South Korea, Austria, Switzerland, India, Poland, Japan, the United Kingdom, Egypt, Israel, Sweden and Australia (1). Based on the analysis of citations by country, Figure 2 shows the correlation of authors from different countries that contribute to each other. For instance, Brazil collaborates with many countries, such as Spain, USA, Canada and Turkey. The minimum number of documents for a country was defined as 2. Thus, 10 countries met the established criteria, forming 5 clusters.

In the top 3 journals, Journal Oral Rehabilitation had the greatest number of articles (4), followed by the Journal of Oral & Facial Pain and Headache (4) and the Journal of Orofacial Pain with 3 articles.

The network view shows the correlation between co-authors and keywords. With regard to co-authors, the minimum number of occurrences was of 1 document per author. Of the 270 authors, 12 authors met the established criteria. The co-authorship network map provides the visualization of relevant connections between authors, which can subsidize possible collaboration opportunities.

A cluster is formed by each different color, for which each cluster indicates that the author is working collaboratively and in the same area, involving the same research topic. Different colors with links indicate that they collaborate with people with different themes (Figure 3).

The same analysis was carried out for the keywords. The minimum occurrence was 3 for a term, with 353 terms being found, of which 56 met the established criteria. This type of analysis is important to verify the most important topics used by researchers and scientific areas internationally (Figure 4).

DISCUSSION

During the last decade, scholars from all over the world have published studies about TMD¹⁴14 Bai B, Bai X, Wang C. Mapping research trends of temporomandibular disorders from 2010 to 2019: A bibliometric analysis. J Oral Rehabil. 2021;48(5):517-30.. Although 2012 had the highest number of publications on the treatment of TMD, from 2015 onward an increase in the number of studies was observed, with 3-5 publications per year on this topic. Brazil leads in terms of the number of publications, ahead of the USA. According to the study¹⁴14 Bai B, Bai X, Wang C. Mapping research trends of temporomandibular disorders from 2010 to 2019: A bibliometric analysis. J Oral Rehabil. 2021;48(5):517-30. the USA had the highest number of citations, with a broad international scientific center for research related to TMD. This may have occurred due to the objective of the present research being only on treatments for myofascial TMD, different from the objective of authors¹⁴14 Bai B, Bai X, Wang C. Mapping research trends of temporomandibular disorders from 2010 to 2019: A bibliometric analysis. J Oral Rehabil. 2021;48(5):517-30., who searched for the general literature on TMDs. In addition, they report that despite the USA being the most productive country, that is, the country with the most published articles, it is in Europe that the institutions collaborate the most on research on TMD.

The oldest publication was by the authors²¹21 Turk DC, Zaki HS, Rudy TE. Effects of intraoral appliance and biofeedback/stress management alone and in combination in treating pain and depression in patients with temporomandibular disorders. J Prosthet Dent. 1993;70(2):158-64., who evaluated the effects of intraoral appliance and biofeedback in the treatment of pain and sensitivity in the muscles of mastication and in the TMJ region, in depression and in the management of stress in patients with TMD. However, the study on TMDs began in 1920, when an author²²22 Wright WH. Deafness as influenced by malposition of the Jaws. J Nat Dental Assoc. 1920;7(12):979-92. stated that the loss of molar teeth would be responsible for deafness and that TMJ was related to ear and face symptoms. Thereafter, those studies began their research into the symptomatology, diagnosis, etiology, and treatment of TMDs.

It is important to mention that, in 1992, a study²³23 Dworkin SF, Turner JA, Wilson L, Massoth D, Whitney C, Huggins KH, Burgess J, Sommers E, Truelove E. Brief group cognitive-behavioral intervention for temporomandibular disorders. Pain. 1994;59(2):175-87. developed the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). With a multiaxial approach, the RDC/TMD is indicated a physical diagnosis for the most common forms of TMD and assessment of the psychosocial status of patients with this disorder²⁴24 de Lucena LB, Kosminsky M, da Costa LJ, de Góes PS. Validation of the Portuguese version of the RDC/TMD Axis II questionnaire. Braz Oral Res. 2006;20(4):312-7.. After many years of being used in scientific research, the RDC/TMD was updated. In 2014, the Diagnostic Criteria for Research in Temporomandibular Disorders (DC/TMD) was launched, which can be used in research, with a high rate of reliability and also in clinical practices for TMD assessment²⁵25 Schiffman E, Ohrbach R. Executive summary of the Diagnostic Criteria for Temporomandibular Disorders for clinical and research applications. J Am Dent Assoc. 2016;147(6):438-45..

CO-OCCURRENCE OF AUTHORS AND KEYWORDS

The correlation between the authors of the studies was demonstrated in figure 2, in which 12 authors met the established criteria. This means that these authors collaborate with each other in research on TMD. Divided into 3 clusters, they are analyzed as follows:

In Cluster 1, colored red, the authors verified the effect of treatments on pain and anxiety in patients with TMD. Through a randomized clinical trial (RCT) published in 2020, in which participants were divided into 4 groups: 1-occlusal splint (OS), 2- manual therapy (MT), 3- counseling (C) and 4- combination of an occlusal splint and counseling (OSC), the authors concluded that the therapies used decreased pain and the level of anxiety, though no therapy proved to be superior to another.²⁶26 Melo RA, de Resende CMBM, Rêgo CRF, Bispo ASL, Barbosa GAS, de Almeida EO. Conservative therapies to treat pain and anxiety associated with temporomandibular disorders: a randomized clinical trial. Int Dent J. 2020;70(4):245-53.

In Cluster 2, the blue group, the systematic review¹⁰10 de Melo LA, Bezerra de Medeiros AK, Campos MFTP, Bastos Machado de Resende CM, Barbosa GAS, de Almeida EO. Manual therapy in the treatment of myofascial pain related to temporomandibular disorders: a systematic review. J Oral Facial Pain Headache. 2020;34(2):141-8. investigated the effectiveness of manual therapy in the treatment of TMD-related myofascial pain. Five articles were included, of which one compared it with botulinum toxin²⁷27 Guarda-Nardini L, Stecco A, Stecco C, Masiero S, Manfredini D. Myofascial pain of the jaw muscles: comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique. Cranio. 2012;30(2):95-102., the other with manual therapy and previously instructed manual therapy performed at home²⁸28 Yao L, Sadeghirad B, Li M, Li J, Wang Q, Crandon HN, Martin G, Morgan R, Florez ID, Hunskaar BS, Wells J, Moradi S, Zhu Y, Ahmed MM, Gao Y, Cao L, Yang K, Tian J, Li J, Zhong L, Couban RJ, Guyatt GH, Agoritsas T, Busse JW. Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials. BMJ. 2023;383:e076226. Erratum in: BMJ. 2024;384:q253.. The others compared manual therapy with counseling²⁹29 Michelotti A, Parisini F, Farella M, Cimino R, Martina R. Fisioterapia muscolare in pazienti con disordini temporomandibolari. Studio clinico controllato [Muscular physiotherapy in patients with temporomandibular disorders. Controlled clinical trial]. Minerva Stomatol. 2000;49(11-12):541-8.,³⁰30 Kalamir A, Pollard H, Vitiello A, Bonello R. Intra-oral myofascial therapy for chronic myogenous temporomandibular disorders: a randomized, controlled pilot study. J Man Manip Ther. 2010;18(3):139-46.,³¹31 Kalamir A, Graham PL, Vitiello AL, Bonello R, Pollard H. Intra-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomised, clinical trial. Chiropr Man Therap. 2013;21:17.. The authors found that manual therapy was effective for the outcome analyzed, though not superior to botulinum toxin or counseling¹⁰10 de Melo LA, Bezerra de Medeiros AK, Campos MFTP, Bastos Machado de Resende CM, Barbosa GAS, de Almeida EO. Manual therapy in the treatment of myofascial pain related to temporomandibular disorders: a systematic review. J Oral Facial Pain Headache. 2020;34(2):141-8.. More studies are needed on the subject, since there are few studies that have evaluated the effectiveness of manual therapy for myofascial TMD pain. In addition, the studies have presented inconclusive data and little homogeneity.

Cluster 3, the green group, also a systematic review, carried out in 2013, analyzed the effectiveness of counseling or self-management therapies and other therapies (occlusal splints, physiotherapy, postural training, muscle relaxation exercises, cognitive behavioral therapy, prescription of drugs) in pain relief and functional abilities of patients with TMD. Despite the large number of records found (581 articles), only 7 met the inclusion criteria for analysis. The study concluded that counseling was effective in improving muscle sensitivity to palpation and mouth opening in patients with and without TMD-related pain. This data indicates that therapies with counseling and self-management can be used and are an alternative form of conservative and low-cost treatment³²32 de Freitas R F, Ferreira MÂ, Barbosa GA, Calderon PS. Counselling and self-management therapies for temporomandibular disorders: a systematic review. J Oral Rehabil. 2013;40(11):864-74..

The co-occurrence of keywords was also analyzed by the VOS-viewer software. The most frequent keywords were: myofascial pain (23) and double blind (14) in cluster 1, management (19) and temporomandibular joint disorders (12) in cluster 2, therapy (12) in cluster 3 and temporomandibular disorders (19) and efficacy (15) in cluster 4, as well as orofacial pain (15) in cluster 5. All these words demonstrate links to each other. Of the terms related to TMD, the most frequent is myofascial pain, which can be explained by the fact that pain in this region is a common symptom for this specific type of TMD.

TYPE OF TREATMENT

The most reported treatment in this bibliometric review was occlusal splint (OS). This treatment is widely used in clinical practice and consists of an intraoral device, removable, made of acrylic and can be used during the day or night⁶6 Deregibus A, Ferrillo M, Grazia Piancino M, Chiara Domini M, de Sire A, Castroflorio T. Are occlusal splints effective in reducing myofascial pain in patients with muscle-related temporomandibular disorders? A randomized-controlled trial. Turk J Phys Med Rehabil. 2021;67(1):32-40.,²⁶26 Melo RA, de Resende CMBM, Rêgo CRF, Bispo ASL, Barbosa GAS, de Almeida EO. Conservative therapies to treat pain and anxiety associated with temporomandibular disorders: a randomized clinical trial. Int Dent J. 2020;70(4):245-53.. The research compared the mandibular splint and the upper Michigan splint, which are two of the most common approaches to occlusal splints and found that there was no significant difference between the two types of splints. Occlusal splints were compared to manual therapy and counseling26, demonstrating the effectiveness in reducing pain as much as other therapies. The same was observed when compared to laser³³33 Öz S, Gökçen-Röhlig B, Saruhanoglu A, Tuncer EB. Management of myofascial pain: low-level laser therapy versus occlusal splints. J Craniofac Surg. 2010;21(6):1722-8., both of which are effective in reducing pain and improving mandibular movements.

On the other hand, in a recent systematic review³⁴34 Batista, JFOL, Vila-Noca, TEL, Moraes, SLD, Pellizzer, E P, Vasconcelos, BCE, Gomes, JML, Lemos, CAA, Heimer, MV. Are exercises with or without occlusal splints more effective in the reduction of pain in patients with temporomandibular disorders of myogenic origin? A systematic review. J. Appl. Oral Sci. 2022;30:e20220298., the analyzed studies showed no difference in the improvement of pain, quality of life and mandibular movements between the groups that performed only exercises or exercises associated with the use of the occlusal splint, corroborating the results of the study³⁵35 Qvintus V, Suominen AL, Huttunen J, Raustia A, Ylöstalo P, Sipilä K. Efficacy of stabilisation splint treatment on facial pain - 1-year follow-up. J Oral Rehabil. 2015;42(6):439-46. in their randomized clinical trial. When compared with TENS³⁶36 Tripathi P, Mathur H, Tripathi S, Saxena VS, Ahmed J. Miseries and remedies of myofascial pain dysfunction syndrome: Comparative study. J Indian Acad Oral Med Radiol. 2019;31:210-6., the occlusal splint showed better results in reducing pain, muscle sensitivity and mouth opening.

The oldest studies in this review already used occlusal splints as a treatment for myogenic TMD²¹21 Turk DC, Zaki HS, Rudy TE. Effects of intraoral appliance and biofeedback/stress management alone and in combination in treating pain and depression in patients with temporomandibular disorders. J Prosthet Dent. 1993;70(2):158-64.,³⁷37 Fricton JR. Etiology and management of masticatory myofascial pain. J Musculoskeletal Pain. 1999;7(1-2):143-60.. The authors²¹21 Turk DC, Zaki HS, Rudy TE. Effects of intraoral appliance and biofeedback/stress management alone and in combination in treating pain and depression in patients with temporomandibular disorders. J Prosthet Dent. 1993;70(2):158-64. performed two clinical trials. In the first trial, participants were divided into 3 groups: splint group (GPO), biofeedback associated to stress management group (GBF/GE) and control group (patients on the waiting list). The authors found that the GPO was more effective than the GBF/GE in pain and depression. However, with 6 months of follow-up, these results declined in the GP, while in the GBF/GE the improvements remained. In the second trial, the authors treated a group of 30 participants using an oral splint, biofeedback, and stress management. They observed that the participants showed improvements in pain and depression, before and after treatment (6 months).

When compared to the groups in the first clinical trial, the combination of therapies was superior. However, the data must be analyzed with caution, since, in the second clinical trial, besides not having a control group, the authors did not evaluate the therapies in isolation, instead only evaluating them before and after the combination therapies. The author³⁷37 Fricton JR. Etiology and management of masticatory myofascial pain. J Musculoskeletal Pain. 1999;7(1-2):143-60., in his narrative review, on the other hand, suggests that occlusal splint is effective when used alone or in combination with other treatments, though the author does not report whether one is better than the other.

Regarding studies that compare different types of splints, authors⁶6 Deregibus A, Ferrillo M, Grazia Piancino M, Chiara Domini M, de Sire A, Castroflorio T. Are occlusal splints effective in reducing myofascial pain in patients with muscle-related temporomandibular disorders? A randomized-controlled trial. Turk J Phys Med Rehabil. 2021;67(1):32-40. report that there was no statistically significant difference between the use of splints in the upper or lower arch to reduce pain over a period of 6 months, unlike the study³⁸38 Alencar F Jr, Becker A. Evaluation of different occlusal splints and counselling in the management of myofascial pain dysfunction. J Oral Rehabil. 2009;36(2):79-85., who, using 3 different types of splints, found that they all offered pain reduction at different times (7 days, 60 days and 90 days).

The authors³⁸38 Alencar F Jr, Becker A. Evaluation of different occlusal splints and counselling in the management of myofascial pain dysfunction. J Oral Rehabil. 2009;36(2):79-85.,³⁹39 Ekberg E, Nilner M. Treatment outcome of appliance therapy in temporomandibular disorder patients with myofascial pain after 6 and 12 months. Acta Odontol Scand. 2004;62(6):343-9. recommended the use of an occlusal splint for patients with myofascial TMD, as their research found that participants who used the splint achieved improvement in symptoms, persisting for 6 and 12 months. The divergences found in the studies are due to the fact that the splints do not have the same manufacturing standard besides, the different follow-up time and the association or not of counseling in the groups that were treated with splints.

According to the systematic review³²32 de Freitas R F, Ferreira MÂ, Barbosa GA, Calderon PS. Counselling and self-management therapies for temporomandibular disorders: a systematic review. J Oral Rehabil. 2013;40(11):864-74., intraoral appliances were effective in improving the sensitivity to palpation of the masticatory muscles and maximal mouth opening. Nonetheless, the other approaches studied (counseling, pain education, physical therapy) also obtained similar results, indicating the likely joint action on psychosocial factors.

The second most common treatment was low-frequency laser (LBF), with 15 studies, of which 1 was a case report, 7 clinical trials, 1 literature review and 6 systematic reviews. Regarding the case report⁴⁰40 Pessoa DR, Costa DR, Prianti BM, Costa DR, Delpasso CA, Arisawa EÂLS, Nicolau RA. Association of facial massage, dry needling, and laser therapy in Temporomandibular Disorder: case report. Codas. 2018;30(6):e20170265., there was a decrease in painful sites, though LBF was associated with other therapies. Thus, it cannot be inferred that it alone caused this improvement. Clinical trials that have found laser efficacy in decreasing pain³³33 Öz S, Gökçen-Röhlig B, Saruhanoglu A, Tuncer EB. Management of myofascial pain: low-level laser therapy versus occlusal splints. J Craniofac Surg. 2010;21(6):1722-8.,⁴¹41 Seifi M, Ebadifar A, Kabiri S, Badiee MR, Abdolazimi Z, Amdjadi P. Comparative effectiveness of low level laser therapy and transcutaneous electric nerve stimulation on temporomandibular joint disorders. J Lasers Med Sci. 2017;8(Suppl 1):S27-S31.,⁴²42 Magri LV, Carvalho VA, Rodrigues FC, Bataglion C, Leite-Panissi CR. Effectiveness of low-level laser therapy on pain intensity, pressure pain threshold, and SF-MPQ indexes of women with myofascial pain. Lasers Med Sci. 2017;32(2):419-28.,⁴³43 Santos Tde S, Piva MR, Ribeiro MH, Antunes AA, Melo AR, Silva ED. Lasertherapy efficacy in temporomandibular disorders: control study. Braz J Otorhinolaryngol. 2010;76(3):294-9.,⁴⁴44 Shirani AM, Gutknecht N, Taghizadeh M, Mir M. Low-level laser therapy and 18yo-fascial pain dysfunction syndrome: a randomized controlled clinical trial. Lasers Med Sci. 2009;24(5):715-20. and increased ability to open the mouth³³33 Öz S, Gökçen-Röhlig B, Saruhanoglu A, Tuncer EB. Management of myofascial pain: low-level laser therapy versus occlusal splints. J Craniofac Surg. 2010;21(6):1722-8.,⁴¹41 Seifi M, Ebadifar A, Kabiri S, Badiee MR, Abdolazimi Z, Amdjadi P. Comparative effectiveness of low level laser therapy and transcutaneous electric nerve stimulation on temporomandibular joint disorders. J Lasers Med Sci. 2017;8(Suppl 1):S27-S31.,⁴²42 Magri LV, Carvalho VA, Rodrigues FC, Bataglion C, Leite-Panissi CR. Effectiveness of low-level laser therapy on pain intensity, pressure pain threshold, and SF-MPQ indexes of women with myofascial pain. Lasers Med Sci. 2017;32(2):419-28.,⁴³43 Santos Tde S, Piva MR, Ribeiro MH, Antunes AA, Melo AR, Silva ED. Lasertherapy efficacy in temporomandibular disorders: control study. Braz J Otorhinolaryngol. 2010;76(3):294-9.,⁴⁴44 Shirani AM, Gutknecht N, Taghizadeh M, Mir M. Low-level laser therapy and 18yo-fascial pain dysfunction syndrome: a randomized controlled clinical trial. Lasers Med Sci. 2009;24(5):715-20. were compared with occlusal splints³³33 Öz S, Gökçen-Röhlig B, Saruhanoglu A, Tuncer EB. Management of myofascial pain: low-level laser therapy versus occlusal splints. J Craniofac Surg. 2010;21(6):1722-8. or laser placebos⁴¹41 Seifi M, Ebadifar A, Kabiri S, Badiee MR, Abdolazimi Z, Amdjadi P. Comparative effectiveness of low level laser therapy and transcutaneous electric nerve stimulation on temporomandibular joint disorders. J Lasers Med Sci. 2017;8(Suppl 1):S27-S31.,⁴²42 Magri LV, Carvalho VA, Rodrigues FC, Bataglion C, Leite-Panissi CR. Effectiveness of low-level laser therapy on pain intensity, pressure pain threshold, and SF-MPQ indexes of women with myofascial pain. Lasers Med Sci. 2017;32(2):419-28.,⁴³43 Santos Tde S, Piva MR, Ribeiro MH, Antunes AA, Melo AR, Silva ED. Lasertherapy efficacy in temporomandibular disorders: control study. Braz J Otorhinolaryngol. 2010;76(3):294-9.,⁴⁴44 Shirani AM, Gutknecht N, Taghizadeh M, Mir M. Low-level laser therapy and 18yo-fascial pain dysfunction syndrome: a randomized controlled clinical trial. Lasers Med Sci. 2009;24(5):715-20..

Of the articles that used laser, only one⁴⁵45 Leal de Godoy CH, Motta LJ, Santos Fernandes K P, Mesquita-Ferrari RA, Deana AM, Bussadori SK. Effect of low-level laser therapy on adolescents with temporomandibular disorder: a blind randomized controlled pilot study. J Oral Maxillofac Surg. 2015;73(4):622-9. differed from the results above. The authors did not find significant statistical differences between the groups that used active laser and placebo in the temporal and masseter muscles after treatment. The divergence may have occurred due to the small study sample, 9 adolescents, 5 from the plaque group and 4 from the placebo group. In addition, the age range of adolescents between 14-23 years old differs from the other studies⁴⁵45 Leal de Godoy CH, Motta LJ, Santos Fernandes K P, Mesquita-Ferrari RA, Deana AM, Bussadori SK. Effect of low-level laser therapy on adolescents with temporomandibular disorder: a blind randomized controlled pilot study. J Oral Maxillofac Surg. 2015;73(4):622-9.. The studies found that LBF therapy can be considered an alternative or complementary approach for the management of myofascial TMDs, due to its analgesic and myorelaxant effects. Besides, it is a non-invasive, non-pharmacological therapy that has no side effects⁴⁶46 Chan NHY, Ip CK, Li DTS, Leung YY. Diagnosis and treatment of myogenous temporomandibular disorders: a clinical update. Diagnostics (Basel). 2022;12(12):2914..

It is worth mentioning that systematic reviews⁴⁷47 Wu X, Zhu J, Zheng B, Liu J, Wu Z. Effectiveness of low-level gallium aluminium arsenide laser therapy for temporomandibular disorder with myofascial pain: a systemic review and meta-analysis. Medicine (Baltimore). 2021;100(52):e28015.,⁴⁸48 Serrera-Figallo MA, Ruiz-de-León-Hernández G, Torres-Lagares D, Castro-Araya A, Torres-Ferrerosa O, Hernández-Pacheco E, Gutierrez-Perez JL. Use of botulinum toxin in orofacial clinical practice. Toxins (Basel). 2020;12(2):112.,⁴⁹49 Maia ML, Bonjardim LR, Quintans Jde S, Ribeiro MA, Maia LG, Conti PC. Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review. J Appl Oral Sci. 2012;20(6):594-602.,⁵⁰50 Petrucci A, Sgolastra F, Gatto R, Mattei A, Monaco A. Effectiveness of low-level laser therapy in temporomandibular disorders: a systematic review and meta-analysis. J Orofac Pain. 2011;25(4):298-307.,⁵¹51 Honnef LR, Pauletto P, Conti Réus J, Massignan C, Souza BDM, Michelotti A, Flores-Mir C, De Luca Canto G. Effects of stabilization splints on the signs and symptoms of temporomandibular disorders of muscular origin: A systematic review. Cranio. 2022:1-12. found that LBF therapy reduced pain related to myofascial TMD. However, the heterogeneity of laser parameters (characteristics of the light beam, frequency and output; number and duration of laser application) requires caution in interpreting the results⁴⁹49 Maia ML, Bonjardim LR, Quintans Jde S, Ribeiro MA, Maia LG, Conti PC. Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review. J Appl Oral Sci. 2012;20(6):594-602.. In a recent systematic review⁵¹51 Honnef LR, Pauletto P, Conti Réus J, Massignan C, Souza BDM, Michelotti A, Flores-Mir C, De Luca Canto G. Effects of stabilization splints on the signs and symptoms of temporomandibular disorders of muscular origin: A systematic review. Cranio. 2022:1-12. with meta-analysis, carried out in 2022, the authors studied the ideal wavelength ranges for laser application. The authors stated that laser therapy with a wavelength of 910-1100nm was the most effective in the treatment TMD of muscular origin³⁷37 Fricton JR. Etiology and management of masticatory myofascial pain. J Musculoskeletal Pain. 1999;7(1-2):143-60..

Manual therapy, when combined or not with other therapies (exercise, relaxation, biofeedback) can be effective in reducing pain and increasing mouth opening²⁶26 Melo RA, de Resende CMBM, Rêgo CRF, Bispo ASL, Barbosa GAS, de Almeida EO. Conservative therapies to treat pain and anxiety associated with temporomandibular disorders: a randomized clinical trial. Int Dent J. 2020;70(4):245-53.,⁵²52 Medlicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Phys Ther. 2006;86(7):955-73.. However, the authors⁵³53 Fernández-de-Las-Peñas C, Von Piekartz H. Clinical reasoning for the examination and physical therapy treatment of temporomandibular disorders (TMD): a narrative literature review. J Clin Med. 2020;9(11):3686., in their literature review, emphasize that patients with myofascial TMD need a multimodal approach and not isolated interventions, given that the etiology of the disease is multifactorial. A current systematic review¹⁰10 de Melo LA, Bezerra de Medeiros AK, Campos MFTP, Bastos Machado de Resende CM, Barbosa GAS, de Almeida EO. Manual therapy in the treatment of myofascial pain related to temporomandibular disorders: a systematic review. J Oral Facial Pain Headache. 2020;34(2):141-8. analyzed the effectiveness of manual therapy in treating pain in myofascial TMD and found that although manual therapy was effective in reducing pain, it is not more effective than counseling or botulinum toxin.

Other treatments were described in the studies included in this review. Authors¹⁷17 Machado D, Martimbianco ALC, Bussadori SK, Pacheco RL, Riera R, Santos EM. Botulinum toxin type a for painful temporomandibular disorders: systematic review and meta-analysis. J Pain. 2020;21(3-4):281-93. found that botulinum toxin (TXB) was more effective than placebo (only within 1 month) and conventional treatment (up to 12 months). The study⁵⁴54 Blanco-Rueda JA, López-Valverde A, Márquez-Vera A, Méndez-Sánchez R, López-García E, López-Valverde N. Preliminary findings of the efficacy of botulinum toxin in temporomandibular disorders: uncontrolled pilot study. Life (Basel). 2023;13(2):345. found that most patients experienced pain improvement when opening their mouth and pain when chewing after 6 months of application. For the authors¹⁷17 Machado D, Martimbianco ALC, Bussadori SK, Pacheco RL, Riera R, Santos EM. Botulinum toxin type a for painful temporomandibular disorders: systematic review and meta-analysis. J Pain. 2020;21(3-4):281-93.,¹⁰10 de Melo LA, Bezerra de Medeiros AK, Campos MFTP, Bastos Machado de Resende CM, Barbosa GAS, de Almeida EO. Manual therapy in the treatment of myofascial pain related to temporomandibular disorders: a systematic review. J Oral Facial Pain Headache. 2020;34(2):141-8.,⁵⁵55 Awan KH, Patil S, Alamir AWH, Maddur N, Arakeri G, Carrozzo M, Brennan PA. Botulinum toxin in the management of myofascial pain associated with temporomandibular dysfunction. J Oral Pathol Med. 2019;48(3):192-200. there is no statistically significant difference between TXB and manual therapy (MT), although MT presents greater pain reduction in patients with myofascial TMD.

Regarding TXB and low-frequency laser (LBF), the study⁴⁸48 Serrera-Figallo MA, Ruiz-de-León-Hernández G, Torres-Lagares D, Castro-Araya A, Torres-Ferrerosa O, Hernández-Pacheco E, Gutierrez-Perez JL. Use of botulinum toxin in orofacial clinical practice. Toxins (Basel). 2020;12(2):112. corroborated the findings by authors¹⁷17 Machado D, Martimbianco ALC, Bussadori SK, Pacheco RL, Riera R, Santos EM. Botulinum toxin type a for painful temporomandibular disorders: systematic review and meta-analysis. J Pain. 2020;21(3-4):281-93., as both stated that, although LBF is faster in improving pain, it is not more effective than TXB. Thus, it is clear that the evidence on botulinum toxin is insufficient to support the use of TXB as an exclusive treatment to reduce myofascial TMD pain¹⁰10 de Melo LA, Bezerra de Medeiros AK, Campos MFTP, Bastos Machado de Resende CM, Barbosa GAS, de Almeida EO. Manual therapy in the treatment of myofascial pain related to temporomandibular disorders: a systematic review. J Oral Facial Pain Headache. 2020;34(2):141-8.,¹⁷17 Machado D, Martimbianco ALC, Bussadori SK, Pacheco RL, Riera R, Santos EM. Botulinum toxin type a for painful temporomandibular disorders: systematic review and meta-analysis. J Pain. 2020;21(3-4):281-93.,⁵⁶56 Kütük SG, Özkan Y, Kütük M, Özdaş T. Comparison of the efficacies of dry needling and botox methods in the treatment of myofascial pain syndrome affecting the temporomandibular joint. J Craniofac Surg. 2019;30(5):1556-9.,⁵⁷57 Schwartz M, Freund B. Treatment of temporomandibular disorders with botulinum toxin. Clin J Pain. 2002;18(6 Suppl):S198-203..

A drug study, where morphine and lidocaine were used, found no difference between the two drugs, although it was better than placebo, producing analgesic effects for up to 48 hours⁵⁸58 Kang SK, Lee YH, Park H, Ro JY, Auh QS. Effects of intramuscular morphine in men and women with temporomandibular disorder with myofascial pain. Oral Dis. 2018;24(8):1591-8.. A meta-analysis has already pointed out that muscle relaxation produced by cyclobenzaprine has a positive effect in the treatment of myofascial TMD. Nevertheless, this effect was only studied for 3 weeks, requiring evidence with long-term effects and also analyzing the side effects of this drug⁵⁹59 Häggman-Henrikson B, Alstergren P, Davidson T, Högestätt ED, Östlund P, Tranaeus S, Vitols S, List T. Pharmacological treatment of oro-facial pain - health technology assessment including a systematic review with network meta-analysis. J Oral Rehabil. 2017;44(10):800-26..

Dry needling may be better than other interventions. However, the evidence is of low quality and has a small effect size⁶⁰60 Vier C, Almeida MB, Neves ML, Santos ARSD, Bracht MA. The effectiveness of dry needling for patients with orofacial pain associated with temporomandibular dysfunction: a systematic review and meta-analysis. Braz J Phys Ther. 2019;23(1):3-11.. Moreover, the number and frequency of sessions, which muscles should be needled, remains unstandardized⁴⁰40 Pessoa DR, Costa DR, Prianti BM, Costa DR, Delpasso CA, Arisawa EÂLS, Nicolau RA. Association of facial massage, dry needling, and laser therapy in Temporomandibular Disorder: case report. Codas. 2018;30(6):e20170265.,⁵²52 Medlicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Phys Ther. 2006;86(7):955-73.,⁵³53 Fernández-de-Las-Peñas C, Von Piekartz H. Clinical reasoning for the examination and physical therapy treatment of temporomandibular disorders (TMD): a narrative literature review. J Clin Med. 2020;9(11):3686.,⁶¹61 Sirikaku K, Watinaga GK, de Souza Moraes S, Guimarães TB, Onishi ET. Effect of dry needling on the masseter muscle in the tinnitus perception of patients with temporomandibular disorder. J Maxillofac Oral Surg. 2023;22(3):571-8.. Counseling and pain education are also used as an alternative to low-cost conservative treatment, being beneficial for the treatment of myofascial TMD to improve the psychological domains of the dysfunction and remove harmful behavior for the control of signs and symptoms. However, alone, they are no longer effective, having similar results to other therapies¹⁰10 de Melo LA, Bezerra de Medeiros AK, Campos MFTP, Bastos Machado de Resende CM, Barbosa GAS, de Almeida EO. Manual therapy in the treatment of myofascial pain related to temporomandibular disorders: a systematic review. J Oral Facial Pain Headache. 2020;34(2):141-8.,²⁶26 Melo RA, de Resende CMBM, Rêgo CRF, Bispo ASL, Barbosa GAS, de Almeida EO. Conservative therapies to treat pain and anxiety associated with temporomandibular disorders: a randomized clinical trial. Int Dent J. 2020;70(4):245-53.,³³33 Öz S, Gökçen-Röhlig B, Saruhanoglu A, Tuncer EB. Management of myofascial pain: low-level laser therapy versus occlusal splints. J Craniofac Surg. 2010;21(6):1722-8.,⁵³53 Fernández-de-Las-Peñas C, Von Piekartz H. Clinical reasoning for the examination and physical therapy treatment of temporomandibular disorders (TMD): a narrative literature review. J Clin Med. 2020;9(11):3686.,⁶²62 Okeson JP, de Kanter RJ. Temporomandibular disorders in the medical practice. J Fam Pract. 1996;43(4):347-56..

Other therapies were found in this analysis, such as exercises, physiotherapy, biofeedback, acupuncture, Kinesiotaping, ozone therapy, relaxation, photobiomodulation, cognitive behavioral therapy, hypnosis and neuroreflexotherapy. Some are effective in reducing pain and other symptoms of myofascial TMD.

LIMITATIONS

This bibliometric analysis was not able to evaluate all works published on therapies in the treatment of myofascial TMD, as only articles from the Web of Science (WOS) and SCOPUS database were included. The lack of similar methodologies made it difficult to compare and analyze the treatments used in the articles.

CONCLUSION

Based on this bibliometric review, the authors reached the conclusion that there has been an increase in published articles on therapies for the treatment of TMDs of myofascial origin, although the number of publications is still low. Brazil was the country with the highest number of published articles related to the topic and the authors’ correlation revolved around Brazilian authors and splint and laser were the most used treatments, followed by manual therapy and botulinum toxin.

ACKNOWLEDGEMENTS

This study was conducted with the support of the Coordination of Higher Education and Graduate Training – Brazil (CAPES) – Financial Code 001.

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