More therapy is not necessarily better: patient education and self-management perform similarly to other conservative interventions for temporomandibular disorders.

A COMMENTARY ON: Ferland G, Vincent R, Desmeules F, Cormier AA, Huon M, Pitance L. Patient Education and Self-Management in Adults With Temporomandibular Disorders: Results From a Systematic Review With Meta-Analysis. J Oral Rehabil. 2026;53:1394-1408. https://doi.org/10.1111/joor.70187 .

DESIGN

Systematic review and meta-analysis of randomized controlled trials evaluating patient education and self-management interventions for adults with temporomandibular disorders (TMDs).

CASE SELECTION: MEDLINE, PubMed, Embase, Cochrane CENTRAL, CINAHL, and PsycINFO were searched from inception to March 2025. Eligible randomized controlled trials included adults diagnosed with TMD according to RDC/TMD or DC/TMD criteria and evaluated patient education and/or self-management interventions, either alone or in combination with another conservative therapy. Forty-seven trials involving 3238 participants were included.

DATA ANALYSIS: Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias tool. Random-effects meta-analyses were performed using standardized mean differences (SMDs) for pain, mandibular function, and health-related quality of life (HRQoL). Certainty of evidence was assessed using the GRADE approach.

RESULTS

Other conservative interventions demonstrated greater short-term pain reduction than education/self-management alone (SMD 0.79; 95% CI 0.27 to 1.32) and greater short-term improvement in HRQoL (SMD 0.61; 95% CI 0.20 to 1.01). However, no significant differences were observed for medium-term pain or mandibular function. Adding education/self-management to other conservative interventions did not improve short-term pain outcomes. Similarly, combining education/self-management with oral appliances, manual therapy, exercise, or electrotherapy was not consistently superior to education/self-management alone in reducing medium- and long-term pain or functional limitation. Most included trials exhibited substantial methodological limitations and considerable clinical heterogeneity.

CONCLUSIONS

Education and self-management appear to provide clinical outcomes comparable to those of many other conservative treatments for TMDs, particularly beyond the short term. While some interventions may offer greater short-term pain relief or HRQoL improvement, the evidence does not support consistent additional benefit from combining education/self-management with other conservative therapies.