The research we rely on
Evidence Library
Every treatment we offer, and the conditions we see, with the published research behind them, graded at its true strength. Each study has a plain-English summary, and a clinician view with the full citation. Where the research does not favour a treatment we use, it is here too.
- Studies
- 87
- Topics
- 15
- Last reviewed
- 28 October 2026
How to read this library
Two questions for every study
How sure is the research?
- Supported by guidelines
Recommended in current clinical guidelines, built on a body of trials.
- Moderate-certainty evidence
Several good-quality studies point the same way; new research could still change the picture.
- Low-certainty or mixed evidence
Some positive results, but studies are small, varied or disagree with each other.
- Early, limited evidence
Very few studies, small pilots or a biological rationale; benefit is not established.
What kind of study is it?
- Clinical guideline
Expert panels weigh all the research and make recommendations.
- Systematic review & meta-analysis
Every relevant trial on a question, found, appraised and pooled.
- Randomised controlled trial
People are allocated to treatments by chance, so the groups can be compared fairly.
- Pilot trial
A small early trial that tests whether a bigger study is worth running.
- Narrative review
An expert summary of the research, without a formal search or pooling.
Higher rungs usually give more reliable answers, but a well-run trial can matter more than a weak review. Summaries here are written only from each study's published abstract and checked a second time against it.
At a glance
The evidence map
Core care
- Jaw exerciseModerate-certainty evidence8 studies
- Manual therapySupported by guidelines7 studies
- Education & self-managementLow-certainty or mixed evidence7 studies
- Stress, habits & pain psychologySupported by guidelines8 studies
- The jaw–neck connectionLow-certainty or mixed evidence6 studies
- MassageLow-certainty or mixed evidence7 studies
Conditions
Foundations
Guidelines & diagnosis
Clinical guidelines and diagnostic criteria that shape how TMD is assessed and managed.
The bottom line
International and UK guidelines support education, self-management, exercises, selected hands-on treatments and cognitive behavioural therapy, a type of talking therapy, for persistent pain linked to temporomandibular disorders (TMD), which affect the jaw joint and surrounding muscles. The international guideline recommends against several treatments, including certain mouth splints, low-level laser therapy and electrical nerve stimulation, with different strengths of recommendation. Standard diagnostic criteria can help identify common painful types of TMD, but are less accurate for some joint disorders. A separate guideline on overgrowth of part of the jaw joint recommends timely diagnosis and mainly surgical treatment, although the supporting research is limited.
At the clinic: Every new patient starts with a full assessment of the jaw, neck and nervous system together, and treatment plans are built on published research, with referral on to dentists, ENT or neurology when another specialist is needed. Technology is used only where the evidence supports it, always inside an assessed plan, and you are told plainly what each option can and cannot do.
Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline
Busse JW et al. · BMJ (Clinical research ed.)
For pain linked to temporomandibular disorders, which affect the jaw joint and surrounding muscles, lasting at least three months, an international guideline strongly recommends cognitive behavioural therapy, a type of talking therapy, selected hands-on treatments, supervised jaw and posture exercises, and usual care such as home exercises, reassurance and education. It makes conditional recommendations against reversible mouth splints, low-level laser therapy and electrical nerve stimulation through the skin, meaning these recommendations are less firm than its strong recommendations.
Management of painful Temporomandibular disorder in adults
Beecroft E et al. · NHS England GIRFT / Royal College of Surgeons of England, Faculty of Dental Surgery
This UK guideline for adults with painful temporomandibular disorders, which affect the jaw joint and surrounding muscles, combines research with expert agreement. It supports education, self-management, exercise, selected hands-on therapies and cognitive behavioural approaches, a form of talking therapy, particularly for pain lasting at least three months. It also explains referral pathways and the roles of primary and specialist care.
Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†
Schiffman E et al. · Journal of oral & facial pain and headache
International experts developed standard criteria for diagnosing temporomandibular disorders, which affect the jaw joint and surrounding muscles. Testing found that the criteria could accurately identify common painful types and one disorder within the jaw joint. Clinicians using the criteria for painful types showed high agreement. Criteria for other common joint disorders were not accurate enough for diagnosis, although they could help with initial screening. The framework also includes questionnaires, with newer ones selected to be shorter and publicly available.
Clinical Practice Guideline: Condylar Hyperplasia of the Mandible—Diagnosis and Treatment
Riechmann M et al. · Deutsches Arzteblatt international
This guideline covers condylar hyperplasia, abnormal growth of the part of the lower jaw that forms the jaw joint. Experts recommend timely diagnosis through a medical history, examination and imaging. Treatment is mainly surgical. Most treatment studies involved small numbers of people and offered low-level evidence.
Core care
Jaw exercise
Supervised and home exercise for the jaw muscles and joint.
The bottom line
Research suggests that jaw exercises may help reduce pain and improve mouth opening in people with jaw joint or muscle problems. A large review found moderate-to-high-certainty evidence of pain benefit from supervised jaw exercises and stretching compared with placebo or sham treatment. Other reviews found low-quality or limited evidence, and exercises have not clearly outperformed mouth splints for pain. Findings vary for a jaw that is locked because of a displaced joint disc: one trial found greater improvement in mouth opening with exercises than with a splint, while another found no clear added benefit from physiotherapy alongside advice.
At the clinic: Any jaw exercise programme follows a full assessment of the jaw, neck and nervous system together, with clear goals agreed and reviewed at each visit. You are told plainly what exercise can and cannot do.
Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials
Yao L et al. · BMJ (Clinical research ed.)
A large review compared many treatments for long-term jaw pain. Therapist-assisted jaw movement and supervised jaw exercise with stretching were among the treatments that probably helped pain more than placebo, based on moderate-to-high certainty evidence.
Exercise therapy improves pain and mouth opening in temporomandibular disorders: A systematic review with meta-analysis
Idáñez-Robles AM et al. · Clinical rehabilitation
This review pooled 16 randomised trials, meaning studies where people were allocated to groups by chance. It found that exercise therapy reduced jaw pain and improved mouth opening, including when exercise was added to a splint.
Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis
Armijo-Olivo S et al. · Physical therapy
This review of 48 trials of hands-on treatment and exercise for jaw problems rated the evidence as low quality. It found no clear evidence that exercise was better than other non-surgical treatments. Problems with study quality and differences between studies leave considerable uncertainty about the benefits.
Effectiveness of exercise therapy versus occlusal splint therapy for the treatment of painful temporomandibular disorders: a systematic review and meta-analysis
Zhang L et al. · Annals of palliative medicine
This review compared jaw exercises with mouth splints for painful jaw problems across six trials. Neither treatment was clearly better for pain or jaw movement. The authors noted the evidence was limited.
Randomized controlled trial on physical therapy for TMJ closed lock
Craane B et al. · Journal of dental research
This trial involved 49 people with a jaw joint disc that had moved out of place and did not return during opening, causing a closed lock. Adding physiotherapy sessions to advice about jaw habits did not show a clear additional benefit for pain or jaw function over one year. Both groups improved over time.
Randomized clinical trial of treatment for TMJ disc displacement
Haketa T et al. · Journal of dental research
In this trial, 52 people with a jaw joint disc that had moved out of place and did not return during opening were allocated by chance to a mouth splint or jaw-movement exercises they performed themselves. Both groups improved over 8 weeks. Mouth opening improved more with exercise, suggesting a possible advantage for this aspect of jaw function.
Comparison of NSAID therapy alone versus combined NSAID and home exercise therapy in patients with temporomandibular joint osteoarthritis and arthralgia
Erdogan O et al. · Cranio : the journal of craniomandibular practice
In people with jaw joint arthritis and joint pain, adding home exercises to anti-inflammatory tablets improved mouth opening and quality of life more than tablets alone. Pain eased similarly in both groups.
Effectiveness of Ultrasound Therapy, TheraBite Device, Masticatory Muscle Exercises, and Stabilization Splint for the Treatment of Masticatory Myofascial Pain: A Randomized Controlled Trial
Salloum K et al. · Clinical and experimental dental research
This trial allocated 80 adults by chance to jaw muscle exercises, ultrasound treatment, a mouth splint or a jaw-stretching device for persistent jaw muscle pain with limited opening. At four weeks, pain was lower with ultrasound and splints than with exercises. The researchers reported similar effectiveness across the four treatments at five months, although this does not establish that they work equally well.
Core care
Manual therapy
Hands-on joint mobilisation and soft-tissue techniques for the jaw and neck.
The bottom line
Research here mainly concerns jaw pain. An international guideline strongly recommends assisted joint movements and hands-on treatment of tender muscle points for jaw pain lasting at least three months. A large analysis of trials found that these approaches probably improve pain compared with dummy treatments. Other reviews report short-term improvements but highlight weaknesses in the research. In one trial of people with a locked jaw, physiotherapy showed no clear extra benefit over advice. For neck and upper back muscle pain, a review found no clear difference between hands-on treatment and dry needling. Results depend on the condition, treatment and outcome studied.
At the clinic: Every new patient has a full assessment of the jaw, neck and nervous system together, and any hands-on treatment forms part of a plan built on published research. You are told plainly what it can and cannot do, and clear goals are agreed and reviewed at each visit.
Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline
Busse JW et al. · BMJ (Clinical research ed.)
An international guideline on jaw pain lasting at least three months strongly recommends therapist-assisted joint movements and hands-on treatment of tender muscle points compared with dummy treatments. It gives a weaker, conditional recommendation for manipulation, another hands-on joint technique. It also conditionally recommends against several treatments, including low-level laser therapy and removable bite splints.
Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials
Yao L et al. · BMJ (Clinical research ed.)
This analysis included 153 trials involving 8713 people with long-standing jaw pain. Participants were allocated to treatments by chance. Therapist-assisted jaw movements and hands-on treatment of tender muscle points probably improved pain compared with dummy treatments.
Effectiveness of physiotherapy for temporomandibular disorders: a systematic review of pain and functional outcomes
Skorupa-Strojna A et al. · Scandinavian journal of pain
This review of 51 recent trials found that physiotherapy, including manual therapy, was generally linked with less pain and better jaw movement in the short term. The studies were varied and often small, which limits how firmly conclusions can be drawn.
Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis
Armijo-Olivo S et al. · Physical therapy
This review of 48 trials found that manual therapy for the jaw or neck, alone or with exercise, showed promising effects. However, no high-quality evidence was found, so there is considerable uncertainty about how well it works.
Randomized controlled trial on physical therapy for TMJ closed lock
Craane B et al. · Journal of dental research
People with a 'locked' jaw were allocated by chance to physiotherapy (joint mobilisation, exercises and massage) or advice alone. Both groups improved over a year, and physiotherapy added no clear extra benefit.
Effectiveness of an 8-week neck exercise training on pain, jaw function, and oral health-related quality of life in women with chronic temporomandibular disorders: a randomized controlled trial
de Oliveira-Souza AIS et al. · Journal of oral & facial pain and headache
In this trial, 54 women with jaw disorders involving muscle pain were allocated by chance to eight weeks of neck exercises, manual therapy or a dummy treatment. Neck exercises improved the effect of oral health on daily life more than manual therapy at the end of treatment and three months later. Results comparing manual therapy with the dummy treatment were not reported.
Core care
Education & self-management
Understanding the condition, jaw-friendly habits and self-care between visits.
The bottom line
Education, support with changing habits and jaw exercises may help people with jaw pain, but the evidence is mixed. Some reviews found benefits, while others found insufficient evidence to judge whether self-management helps more than other treatments. Counselling may reduce muscle-related jaw pain, and one review found similar improvements in tenderness and mouth opening with counselling and mouth splints. Some studies found no clear extra benefit from adding other treatments. The effects on quality of life and unwanted effects remain insufficiently studied.
At the clinic: Treatment plans at the clinic are built on published research, and you are told plainly what each option, including self-care, can and cannot do. Clear goals are agreed and reviewed at each visit.
Self-Management Therapies for Temporomandibular Disorders-Evidence From Systematic Reviews
Bijelic T et al. · Journal of oral rehabilitation
This review of earlier reviews looked at self-management for jaw pain. It found the research generally suggests benefit from education, habit change and jaw exercises. However, nearly half the reviews said the evidence was not yet strong enough to be sure.
Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials
Al-Moraissi EA et al. · International journal of oral and maxillofacial surgery
This review combined 48 studies in which people were allocated to treatments by chance. It compared different mouth splints and counselling. For muscle-related jaw pain, moderate-quality evidence suggested that counselling alone, or counselling combined with a hard splint, may reduce pain after treatment compared with a control group. What the control group received was not reported.
Counselling and self-management therapies for temporomandibular disorders: a systematic review
de Freitas RF et al. · Journal of oral rehabilitation
This review of seven randomised studies (where people are allocated to treatments by chance) found counselling and self-care helped jaw muscle tenderness and mouth opening. Results were similar to those seen with mouth splints.
Self-management in temporomandibular disorders: a systematic review of behavioural components
Story WP et al. · Journal of oral rehabilitation
This review looked at the techniques used to support behaviour change in self-management programmes for jaw problems. Across the programmes, a small proportion of the available techniques were used. The authors said more studies are needed to establish whether these programmes work better than no treatment or a placebo, meaning a dummy treatment.
Headache Attributed to Masticatory Myofascial Pain: Clinical Features and Management Outcomes
Costa YM et al. · Journal of oral & facial pain and headache
People with jaw muscle pain and headaches received either advice on changing habits, or the same advice plus a mouth splint. Headaches became less intense and less frequent in both groups, with no clear difference between them.
Randomized controlled trial on physical therapy for TMJ closed lock
Craane B et al. · Journal of dental research
In this study of 49 people with a locked jaw, everyone received detailed advice about avoiding certain jaw and mouth habits. Twenty-three people also received physiotherapy. Pain and jaw function improved in both groups over a year, with no clear extra benefit from physiotherapy. Because everyone received advice, the study could not establish how much the advice itself helped.
Additional effects of therapeutic exercise and education on manual therapy for chronic temporomandibular disorders treatment: a randomized clinical trial
Justribó-Manion C et al. · Physiotherapy theory and practice
In a small study of 34 people with long-standing jaw problems, adding education about pain and exercises to hands-on treatment did not clearly improve jaw- and face-related disability more than hands-on treatment alone. The authors reported possible benefits for fear of movement and distressing thoughts about pain, but differences between the groups were uncertain.
Core care
Stress, habits & pain psychology
Cognitive behavioural approaches, relaxation and biofeedback for persistent jaw pain.
The bottom line
An international guideline strongly recommends cognitive behavioural therapy (CBT), a talking-and-skills approach, with or without relaxation or biofeedback for jaw pain lasting three months or more. It conditionally recommends against relaxation or biofeedback used alone. Research findings vary: one review found evidence of pain relief with CBT, while a Cochrane review found low- to very low-certainty evidence and no clear pain benefit at treatment completion. Small studies suggest behaviour-based approaches may help daytime clenching habits, but pain benefits remain uncertain. For night-time grinding, the benefits of CBT are not well supported.
At the clinic: Every new patient starts with a full assessment of the jaw, neck and nervous system together, and treatment plans are built on published research, with patients told plainly what each option can and cannot do. When something needs another specialist, Krina refers on to dentists, ENT or neurology.
Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline
Busse JW et al. · BMJ (Clinical research ed.)
An international guideline for jaw pain lasting three months or more strongly recommends cognitive behavioural therapy (CBT), a talking-and-skills approach, with or without relaxation or biofeedback. Its recommendations against using relaxation or biofeedback alone are conditional rather than firm rules.
Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials
Yao L et al. · BMJ (Clinical research ed.)
This review examined treatments for long-lasting jaw pain. Its combined analysis included 153 trials involving 8,713 people, who were allocated to treatments by chance. Cognitive behavioural therapy (CBT), a talking-and-skills approach, combined with biofeedback or relaxation probably improved pain compared with dummy treatment. CBT alone also showed a pain benefit, with a smaller estimated effect. The evidence for these pain findings was rated high to moderate certainty.
Psychological therapies for temporomandibular disorders (TMDs)
Penlington C et al. · The Cochrane database of systematic reviews
This review examined psychological therapies for painful jaw problems lasting three months or more. Most studies assessed cognitive behavioural therapy (CBT), a talking-and-skills approach. At the end of treatment, there was no clear evidence that CBT reduced pain more than comparison care or other treatments. The studies had important weaknesses, and the evidence was rated low to very low certainty, so further research may change the findings.
Psychological treatments for temporomandibular disorder pain-A systematic review
Christidis N et al. · Journal of oral rehabilitation
This review suggests psychological treatments may reduce jaw pain to a similar extent as standard care. Combining psychological treatment with standard care may offer additional pain relief, but the supporting evidence was rated very low quality.
Comparing botulinum toxin and biofeedback therapies for awake bruxism: a randomized clinical trial
Foscaldo TF et al. · BMC oral health
In this small trial, 40 adults with jaw disorders and daytime clenching were allocated by chance to biofeedback, which uses muscle-activity measurements as feedback, or botulinum toxin injections. Some clenching-related behaviours decreased in the biofeedback group compared with its starting measurements. However, neither treatment improved pain or psychological symptoms, and no clear differences were detected between the treatments.
The relationship between psychological factors and temporomandibular disorders: a systematic review and meta-analysis
Saini RS et al. · Head & face medicine
This review of 21 studies found links between jaw disorders and anxiety, depression and stress. These findings do not establish that psychological factors cause jaw disorders or that treating them will reduce jaw pain.
Core care
The jaw–neck connection
How the neck relates to jaw pain, and treatment directed at the cervical spine.
The bottom line
Research links jaw problems with reduced neck movement, neck muscles that tire sooner and greater difficulty because of neck symptoms. Some evidence suggests that hands-on neck treatment or neck exercises may reduce jaw pain. Combining jaw and neck treatment may offer additional short-term benefit, but that evidence is less certain. Physiotherapy may also slightly reduce associated headache pain, although certainty is low to very low. These findings do not establish that neck problems cause jaw pain or that everyone will benefit from neck treatment.
At the clinic: Every new patient starts with a full assessment of the jaw, neck and nervous system together, not the jaw in isolation. Treatment plans are built on published research, and you are told plainly what each option can and cannot do.
Effect of Manual Therapy and Therapeutic Exercise Applied to the Cervical Region on Pain and Pressure Pain Sensitivity in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis
La Touche R et al. · Pain medicine (Malden, Mass.)
This review pooled trials of hands-on neck treatment in people with jaw problems. There was moderate-certainty evidence that neck treatment reduced pain more than placebo hands-on treatment or minimal treatment. Combining treatment of the jaw and neck may offer greater short-term pain relief and help people open their mouth further without pain, but this evidence was low certainty.
Cervical musculoskeletal disorders in patients with temporomandibular dysfunction: A systematic review and meta-analysis
de Oliveira-Souza AIS et al. · Journal of bodywork and movement therapies
This review compared people with and without jaw problems. Those with jaw problems tended to have weaker neck muscle endurance, stiffer neck movement and more neck-related disability. Their head and neck posture, however, was similar to that of people without jaw problems.
Effectiveness of an 8-week neck exercise training on pain, jaw function, and oral health-related quality of life in women with chronic temporomandibular disorders: a randomized controlled trial
de Oliveira-Souza AIS et al. · Journal of oral & facial pain and headache
In this trial, 54 women with jaw problems were allocated by chance to an 8-week neck exercise programme, hands-on therapy or a placebo treatment. The neck exercise group had better pain and jaw function results than the placebo group at the end of treatment and at one- and three-month follow-up.
Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: A multi-center randomized clinical trial
Dunning J et al. · Cranio : the journal of craniomandibular practice
This trial allocated 120 people with jaw problems by chance to either dry needling, which uses fine needles, combined with hands-on upper-neck manipulation, or a mouth splint, an anti-inflammatory medicine and hands-on jaw joint treatment. The needling-and-neck group had a greater reduction in jaw pain at three months. The reported mouth-opening result describes a reduction rather than an increase in pain-free opening, so it does not clearly support an improvement in this outcome. The trial cannot show how much of the pain benefit came from the neck treatment itself.
Effects of physical therapy for temporomandibular disorders on headache pain intensity: A systematic review
van der Meer HA et al. · Musculoskeletal science & practice
This review examined whether physiotherapy for jaw problems, including hands-on treatment of the jaw and neck, may reduce associated headache pain. It found a small reduction, but certainty was low to very low. Many studies were of poor quality and the treatments varied considerably, so the benefit remains uncertain.
Association Between Subjective Tinnitus and Cervical Spine or Temporomandibular Disorders: A Systematic Review
Bousema EJ et al. · Trends in hearing
This review looked at links between ringing in the ears (tinnitus), neck problems and jaw problems. People with tinnitus reported neck problems more often, and tinnitus and jaw problems were linked in both directions. The evidence was weak.
Conditions
Somatic tinnitus
Tinnitus influenced by the jaw or neck, and physiotherapy-based treatment.
The bottom line
Signals from the jaw or neck can influence some people's tinnitus. This is called somatic or somatosensory tinnitus. Research involving people allocated to treatment groups by chance suggests that jaw-focused physiotherapy may reduce tinnitus severity in people with jaw-related tinnitus. Adding hands-on jaw and neck treatment to exercises and advice may also help. These findings do not establish how well treatment works for tinnitus linked to neck problems alone. A review reports that improvement generally means reduced severity or loudness, with complete disappearance being rare.
At the clinic: If your tinnitus seems linked to your jaw or neck, your first visit includes a full assessment of the jaw, neck and nervous system together. You will be told plainly what treatment can and cannot do, and you will be referred on to ENT or neurology when something needs another specialist.
Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial
Delgado de la Serna P et al. · Pain medicine (Malden, Mass.)
People with jaw-related tinnitus were allocated to two treatment groups by chance. Both groups received exercises, self-massage and advice. The group that also received hands-on jaw and neck treatment had greater improvements in tinnitus severity and jaw pain. Assessments continued for six months after treatment, although separate results for each follow-up were not reported.
Reduction of Somatic Tinnitus Severity is Mediated by Improvement of Temporomandibular Disorders
van der Wal A et al. · Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
People with moderate to severe jaw-related tinnitus were randomly given either jaw-focused physiotherapy, with splints if needed, or basic advice only. Tinnitus severity improved more with treatment, and about a third of that improvement was linked to reduced jaw pain.
Somatosensory Tinnitus: Recent Developments in Diagnosis and Treatment
Michiels S · Journal of the Association for Research in Otolaryngology : JARO
This review describes how jaw- and neck-related tinnitus can be identified and treated. It reports that physiotherapy combining advice, exercises and hands-on techniques often lowers tinnitus severity. Complete disappearance of the tinnitus is rare.
Conditions
Clenching & grinding (bruxism)
What is known about managing awake and sleep bruxism.
The bottom line
Research on treatments for clenching and grinding gives mixed results. Splints worn over the teeth, devices that give feedback about clenching, some medicines and botulinum toxin injections may help with particular symptoms or measures of grinding. However, weaknesses in the research limit confidence in these findings, and side effects have been reported. There is not enough evidence to say whether splints help more than no treatment or other approaches. Daytime clenching and grinding appear common, particularly in adults with jaw disorders, but research on how common they are does not establish which treatment helps.
At the clinic: At the clinic, clenching and grinding are assessed as part of a full assessment of the jaw, neck and nervous system together, and you are told plainly what each option can and cannot do. Krina refers on to dentists or other specialists when something needs another specialist.
Oral splints for patients with temporomandibular disorders or bruxism: a systematic review and economic evaluation
Riley P et al. · Health technology assessment (Winchester, England)
This review of 52 trials examined splints worn over the teeth for jaw disorders or clenching and grinding, including their costs. The evidence was of very low quality. For people with jaw disorders, it did not show a clear reduction in pain compared with no splint or minimal treatment. This pain finding does not establish whether splints help grinding. Results for tooth wear were not reported, and value for money remained uncertain.
AWAKE BRUXISM PREVALENCE ACROSS POPULATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Stanisic N et al. · The journal of evidence-based dental practice
This review estimated how common clenching and grinding while awake are in adults. Around a quarter of adults in the general population reported possible daytime clenching or grinding. Estimates based on clinical assessment were lower, at around one in six. The condition was more common in people with jaw disorders. This review assessed how common it was, rather than whether treatments helped.
Conditions
Persistent facial pain
Management of chronic and persistent idiopathic facial pain.
The bottom line
The research reviewed here discusses persistent facial pain with no clear cause, but offers limited evidence about how well treatments work. Reviews recommend careful diagnosis, avoiding dental treatment for this pain when teeth are healthy, and involving different healthcare professionals. Suggested treatments include certain antidepressant medicines and talking therapy to help manage pain. These are review recommendations rather than firm evidence of benefit, and further research is needed to guide treatment.
At the clinic: Every new patient has a full assessment of the jaw, neck and nervous system together, and Krina refers on to dentists, ENT or neurology when something needs another specialist. Patients are told plainly what each option can and cannot do.
Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes
May A et al. · Cephalalgia : an international journal of headache
This review describes different types of facial pain, including persistent pain, pain occurring in attacks and pain associated with jaw problems. It notes that people often see a dentist first and may undergo unnecessary dental treatment when no dental cause has been identified. Recognising the different pain conditions may help guide management.
Core care
Massage
Massage and myofascial release for jaw muscle pain.
The bottom line
Small trials suggest that massage and myofascial release, hands-on treatments involving muscles and surrounding tissue, may help with pain and jaw movement in some people with jaw problems. Several studies combined hands-on treatment with exercises or advice, so they cannot establish the effects of massage alone. Results are mixed: a physiotherapy programme including massage showed no clear extra benefit over advice for a locked jaw joint. Many studies assessed changes over days or weeks, although some followed people for longer. Research on physiotherapy for teeth clenching or grinding was judged very low quality.
At the clinic: At the clinic, hands-on soft-tissue work is part of selected manual therapy inside an assessed plan. The Signature Jaw Massage is a separate wellness experience, and we make no medical claims for it.
Evaluation of the efficacy of manual soft tissue therapy and therapeutic exercises in patients with pain and limited mobility TMJ: a randomized control trial (RCT)
Gębska M et al. · Head & face medicine
Women with painful, tight jaw muscles and limited opening were randomly split into exercise alone, massage plus exercise, or a muscle-relaxation technique plus exercise for 10 days. All groups improved. Massage was linked with earlier pain relief.
Effect of myofascial release therapy applied to selective muscles on mobility and function in patients with temporomandibular dysfunction and co-occurring chronic low back pain: A randomized controlled trial
Şenel Topaloğlu E et al. · Medicine
People with both jaw problems and low back pain were randomly given myofascial release, an exercise programme, or no treatment for 4 weeks. Both active treatments helped. Myofascial release showed greater improvement in most measures.
The Application of Manual Techniques in Masticatory Muscles Relaxation as Adjunctive Therapy in the Treatment of Temporomandibular Joint Disorders
Urbański P et al. · International journal of environmental research and public health
People with mainly muscle-related jaw problems who needed dental prosthetic treatment received either a muscle-relaxation technique or myofascial release, with 10 sessions in each group. People were assigned to the groups in turn rather than at random. Both groups had reduced electrical activity in the jaw muscles and less pain, but no clear difference between treatments was found. There was no untreated group for comparison.
Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial
Delgado de la Serna P et al. · Pain medicine (Malden, Mass.)
People with tinnitus attributed to jaw problems all received exercises, self-massage and education. They were assigned by chance to receive either this programme alone or additional hands-on treatment to the jaw, neck and jaw muscles. Overall, the additional-treatment group had better results for jaw pain and tinnitus. Assessments continued for six months after treatment. This study did not test massage on its own.
Randomized controlled trial on physical therapy for TMJ closed lock
Craane B et al. · Journal of dental research
People with a locked jaw joint received either physiotherapy, including massage, joint mobilisation and exercises, plus advice, or advice alone. Both groups improved over a year. The physiotherapy added no clear extra benefit.
Reported concepts for the treatment modalities and pain management of temporomandibular disorders
Wieckiewicz M et al. · The journal of headache and pain
This review described treatments for jaw pain, including massage, exercises, advice and dental splints. The authors suggested considering these non-surgical approaches first because they regarded them as having a low risk of side effects. The size of any benefit from massage is not reported.
Technology
Dry needling
Fine-needle treatment of tender trigger points in the jaw, head and neck muscles.
The bottom line
Dry needling may help some people with muscle pain or headaches, but findings vary. For face and jaw pain, the evidence is low to very low certainty: reviews found no clear pain advantage over placebo treatments or hands-on therapy, or from adding needling to usual care. Some research suggests short-term benefits from combining needling with other treatments for headaches coming from the neck, but the contribution of needling itself is unclear. For neck and upper back muscle pain, a review found no clear difference from hands-on treatment. Long-term benefits and the most appropriate amount of treatment remain unclear.
At the clinic: Krina is trained in dry needling to levels 1 and 2. She uses it as one component of an assessed plan, never in isolation. Needling sits alongside exercise, postural work and manual therapy. She explains what she is targeting and why, and asks for your consent each time. If you would rather avoid needles, she will use hands-on alternatives.
Dry needling for orofacial pain: a systematic review and meta-analysis of randomized clinical trials
Kuzdzal A et al. · Pain reports
This review included 24 trials involving 1,318 people with face and jaw pain. Most trials had weaknesses, and confidence in the evidence was low to very low. Adding dry needling to usual care showed no clear pain benefit over usual care alone at follow-ups of up to 6 weeks. The authors found little reliable evidence of benefit overall.
Are acupuncture and dry needling effective in the management of masticatory muscle pain: A network meta-analysis of randomised clinical trials
Al-Moraissi EA et al. · Journal of oral rehabilitation
This review compared dry needling and acupuncture with placebo treatments for jaw muscle pain. It found no clear difference in pain between either treatment and placebo. Dry needling may improve how far people can open their mouths in the short term, but this finding was based on very low-quality evidence.
Effectiveness of deep dry needling versus manual therapy in the treatment of myofascial temporomandibular disorders: a systematic review and network meta-analysis
Menéndez-Torre Á et al. · Chiropractic & manual therapies
This review compared deep dry needling with hands-on (manual) therapy for jaw muscle pain. It found no clear difference in pain relief between the two. The authors urge caution because the studies were low quality and varied widely.
Technology
Low-level laser therapy
Photobiomodulation applied over painful jaw muscles or the joint.
The bottom line
Research reviews suggest low-level laser therapy may reduce jaw pain in the short term. Some also report better mouth opening, but findings vary. Differences in treatment settings and concerns about study quality limit confidence in the results, and longer-term benefits remain uncertain. Further research is needed to establish consistent treatment methods. An international guideline makes a conditional recommendation against laser, alone or alongside other treatments, for jaw pain lasting three months or more. A broader review of light therapy suggests possible benefits for some other conditions, with varying confidence in the evidence.
At the clinic: Krina treats laser as a supporting tool, not a stand-alone answer. Where laser is used, it accompanies education, guided jaw exercise and manual therapy.
Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline
Busse JW et al. · BMJ (Clinical research ed.)
An international guideline looked at treatments for jaw pain lasting three months or more. It made a conditional recommendation against low-level laser, whether used alone or alongside other treatments. It favoured exercise, manual therapy and psychological approaches.
Efficacy of Low-Level Laser Therapy in the Treatment of Temporomandibular Myofascial Pain: A Systematic Review and Meta-Analysis
Munguia FM et al. · Journal of oral & facial pain and headache
This review pooled eight studies comparing laser with a dummy laser for jaw muscle pain. Laser appeared to reduce pain more than the dummy treatment. However, the studies were few, varied and at risk of bias, so the results are not definitive.
Differential effectiveness of photobiomodulation in muscular and articular temporomandibular disorders: a systematic review and critical appraisal
Candido-do-Prado LG et al. · Lasers in medical science
This review combined 18 randomised trials. In a randomised trial, people are allocated to treatments by chance. The review reported that laser was linked with less pain and better jaw movement, in both muscle and joint problems. The authors suggest effects may be more consistent for joint problems.
Effects of photobiomodulation on multiple health outcomes: an umbrella review of randomized clinical trials
Son Y et al. · Systematic reviews
This review of earlier reviews looked at light therapy across 15 health conditions. It found some possible benefits. However, the evidence for most outcomes was of low certainty, and the authors call for better trials and standard treatment methods.
Effectiveness of low-level laser therapy on temporomandibular disorders. A systematic review of randomized clinical trials
Díaz L et al. · Photodiagnosis and photodynamic therapy
This review included 44 trials in which people were allocated to treatments by chance. It reported less jaw pain and improved mouth opening with laser therapy. However, laser settings and treatment methods varied between studies, making it difficult to establish a consistent treatment approach.
Comparative efficacy of low-level laser therapy (LLLT) to TENS and therapeutic ultrasound in management of TMDs: a systematic review & meta-analysis
Ansari S et al. · Cranio : the journal of craniomandibular practice
This review compared laser with electrical nerve stimulation and therapeutic ultrasound for jaw problems. It included 12 trials in which people were allocated to treatments by chance, and combined results from nine. The authors reported greater pain relief and better mouth opening with laser. The size of these differences and confidence in the evidence are not reported.
Is low level laser effective for the treatment of orofacial pain?: A systematic review
Tengrungsun T et al. · Cranio : the journal of craniomandibular practice
This review of 33 studies examined laser therapy for face and jaw pain. Some studies favoured laser, while others found no clear difference from other treatments. The authors concluded that evidence of benefit over dummy laser or other treatments was limited.
Technology
Radiofrequency & diathermy (TMJ Velvet)
Capacitive-resistive radiofrequency (TECAR) warming of deep tissues.
The bottom line
Research on diathermy, a treatment that heats body tissues, for jaw problems is at an early stage. A TMJ Velvet case report described improvement in one child, while a small study of diathermy without a comparison group found improvement mainly in limitations on jaw function. The device used in that small study was not reported. Wider research on related treatments for muscle and joint pain suggests possible pain relief, but results vary considerably. Two trials found no clear advantage over dummy treatment for neck muscle pain or painful muscle knots. Another trial found greater improvement when TECAR was added to physiotherapy, but did not use a dummy treatment. These findings do not establish whether TMJ Velvet provides effective or lasting relief for jaw disorders.
At the clinic: Krina may use TMJ Velvet early in an appointment to warm the jaw area before manual therapy and guided exercise. It is a preparation and comfort tool, never the treatment on its own. She will not present it as repairing a disc or realigning your jaw. Its role is to sit alongside the active work you do together.
Severe Post-Traumatic Trismus Unresponsive to Drug Therapy in a 12-Year-Old Patient Treated with a Capacitive-Resistive Electrical Transfer Therapy: A Case Report
Campanella G et al. · Oral
This report describes one 12-year-old with severe jaw stiffness after an injury that had not improved with medicines. Mouth opening and pain improved after TMJ Velvet sessions. A single case cannot show the treatment works, and the authors call for larger studies.
Temporomandibular Disorder Treatment With Diathermy Stimulation Technique: A Pilot Study
Goker F et al. · International journal of dentistry
A small study gave 10 adults with jaw joint problems five weekly diathermy sessions, with no comparison group. Scores tended to improve, but the clearest statistical evidence of improvement was in reported limitations on jaw function. The size and practical importance of that improvement were not reported. Without a comparison group, the study cannot establish whether diathermy caused the changes.
Effectiveness of TECAR Therapy for Managing Pain in Sports-Related Musculoskeletal Pathologies: A Systematic Review with Meta-analysis
Kudich E et al. · SN Comprehensive Clinical Medicine
This review set out to pool studies on whether TECAR deep-heating therapy helps pain in sports-related muscle and joint problems. Its findings are not openly available to summarise here.
Effects of Transfer Energy Capacitive and Resistive On Musculoskeletal Pain: A Systematic Review and Meta-Analysis:
Vahdatpour B et al. · Galen medical journal
This review combined studies of TECAR for muscle and joint pain and found less pain than in comparison groups at four and eight weeks. Results varied considerably between studies, which limits confidence in how consistently the treatment may help. Findings specifically about jaw pain were not reported.
For dentists, GPs & clinicians
Download a reading list
A branded PDF of the research for one condition, prepared in your name — useful for your own CPD, for patients who ask, or before you refer.
- Clinician summary and full citation for every study, with DOI links
- The evidence level for each topic, from guideline-backed to early
- Studies that don’t favour a treatment, not just the ones that do
- How to refer a patient, with the clinic’s details
Research tells us what tends to help groups of people. Your assessment tells us what is likely to help you. Krina uses both, and will always tell you plainly what an option can and cannot do.