Review Article

Prevalence of Tortuous Temporomandibular Joint Disorders: A Systematic Review and Meta-analysis

Please cite this article as follows: Yesoda Aniyan K, Krithika C L, Anuradha G. Prevalence of tortuous temporomandibular joint disorders: a systematic review and meta-analysis. Avicenna J Dent Res. 2025;17(1):14-20. doi:10.34172/ajdr.1985

Background

The temporomandibular joint (TMJ) is a synovial joint present on both sides of the craniomandibular complex. The connecting anatomical configurations are key in jaw movement, enabling everyday tasks of chewing, swallowing, and speaking. The manner of its function ensures non-damage of the anatomy from the stresses generated from each of the aforesaid functions (1). Temporomandibular disorder (TMD) is a cumulative terminology representing musculoskeletal and neuromuscular disorders, symptomized by pain and/or dysfunction in the masticatory muscles, TMJ, and associated structures. Additional related comorbidities are inclusive of headaches, fibromyalgia, tinnitus, chronic fatigue syndrome, depression, and sleep disturbances (2).

The diagnosis and management of this disorder become challenging with its myriad associated symptoms. This is compounded by the varied classifications, followed by Research Diagnostic Criteria (RDC/TMD) and diagnostic criteria (DC/TMD), which are currently being used among diagnosticians (3,4). It is highly noticeable that the number of subjects being reported with TMD-related pain has considerably increased over the years. This could be associated with the increased stress in lifestyles and use of electronic devices (laptops/smartphones/tablets) that has altered the posture across gender, age, and geography boundaries (5). The existing literature predominantly reports the prevalence of TMD among adults alone. Researchers indicate that the knowledge of the prevalence of the disorder would aid as a first step answer to the aforementioned obstacles. It would enable patient literacy of the important preventive methods against disorder development as well as maintenance against symptom worsening. With these research questions as a crux, the following systematic review and meta-analysis was performed to derive the prevalence of TMD disorders across the world.

Materials and Methods

Protocol

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist (PRISMA) (6).The protocol was elaborated in accordance with PRISMA-P (7). All the methods of data collection/analysis and the inclusion/exclusion criteria were prespecified and documented in the review protocol.

Eligibility Criteria

Inclusion Criteria

• Studies reporting the prevalence of TMD in the general population

• No restrictions pertaining to the age or gender of the participants in the study

• Language of referenced articles with no restrictions

• All diagnoses of TMD, irrespective of the presence and absence of pain

Exclusion Criteria

• Narrative reviews, systematic reviews, meta-analyses, case reports or series patients, animal or biomechanical studies, and post-conference abstracts

• Duplicate studies

• Studies with patients reporting secondary oral and systemic conditions such as prosthesis, orthodontic treatment, and partial or completely edentulous subjects

• Studies with restrictions in subject selection, such as fibromyalgia, systemic joint hypermobility, arthritis, tinnitus, post-traumatic stress disorder, trigeminal neuralgia, burning mouth syndrome, atypical facial pain, migraine, atypical odontalgia, cervical pain, neuropathic pain, and dentoskeletal deformities or fractures and congenital/developmental disorders or syndromes associated with TMD

• Data from reviews, letters, books, conference abstracts, expert opinions, technique articles, posters, guidelines, and pilot studies

Information Sources and Search

A detailed and rigorous systematic review search was conducted primarily in PubMed, followed by Scopus and Web of Science (Figure 1), by two researchers (Y.A. and K.C.L.), with the opinion of the third author (A.G.) used in the event of any disagreement. An additional literature search was performed in Google Scholar, and a manual search was conducted in the institute’s central library in the event of non-accessibility of a complete literature text. The MeSH terminologies searched in this regard included “Temporomandibular joint disorders AND prevalence”, “Temporomandibular joint disorders AND epidemiology”, and “Temporomandibular joint disorders AND population” from January 1, 2019 to July 30, 2024. The Cohen kappa statistic between the reviewers was 0.97, indicating substantial agreement.

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Figure 1.

PRISMA Flowchart Illustrating the Search Strategy. Note. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis Checklist

Figure 1.

PRISMA Flowchart Illustrating the Search Strategy. Note. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis Checklist

Risk of Bias in Individual Studies

Two of the authors (K.C.L. and A.G.) used the Critical Appraisal Skills Programme (CASP) Tools for the quality assessment of the selected studies. The CASP had 11 points per study, according to four quality domains, namely, basic study design, methodology validation, the completeness and quality of results, and finally the helpfulness of the results in the local scenario. In the currently reported study, all articles were ascribed to the CASP checklist. The data were further tabulated, inclusive of the main assessment criterion, in Tables 1 and 2, respectively. Further, the risk assessment within the study was performed using RevMan software.

Results

In the selected studies (N = 8), the total number of subjects amounted to 5992, including 754 males and 2691 females, and 2547 of them were of unspecified gender. The ages of the participants ranged from 10 years to 40 years. In addition, DC/TMD (1 study), RDC/TMD (n = 2), American Academy of Orofacial Pain (n = 1), TMD pain screener (n = 1), Fonseca’s Anamnestic Index (n = 3), Oral Health Impact Profile for RMD (n = 1), and Helkimo Index modified by Maglione (n = 1) were used for diagnosis. The study reports ranged from 7 varied countries, with the sample size varying from 70 to 3,263. A summary of the descriptions of the studies is listed in Tables 1 and 2.

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Figure 2.

Risk of Bias Assessment of Selected Articles

Figure 2.

Risk of Bias Assessment of Selected Articles

For article selection, articles using RDC/TMD, DC/TMD, Fonseca’s Questionnaire, Oral Health Impact Profile for RMD, and American Academy of Orofacial Pain were included in the study as the authors convened that under the expert supervision, the criteria for diagnosis would not impact the study quality in terms of diagnosis. Conversely, they indicated that the exclusion would hamper the accurate approximation of the prevalence of the disorder. All the selected studies reported a higher observation of the disorder in the female gender. However, not all the studies ascertained a numerical value in results, thus hampering numerical calculation in this meta-analysis. The mean age of presentation ranged from 10 years to 31.5 years. Considering that the studies also reported the group prevalence, it was impossible to assess the sub-group diagnosis of which type of TMD was prevalent. The heterogeneity among the studies in the meta-analyses was high (I² = 99%), owing to differences in the characteristics of the sample, and thus a random effect was taken into consideration. Based on the tabulated data, the prevalence of TMD in this meta-analysis at a 95% confidence interval was 25.8%. The effect estimate was 0.28.

The forest plot (Figure 3) was calculated to determine the risk ratio and weightages of the study. The study by Wu et al had the maximum weightage at 26.4%. It was concluded that the number of subjects suffering from TMD was statistically significant.

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Figure 3.

Forest Plot Displaying the Weightage and Risk Ratio of Selected Studies

Figure 3.

Forest Plot Displaying the Weightage and Risk Ratio of Selected Studies

Discussion

This systematic review was conducted to estimate the prevalence of TMD across the globe, populations, and age groups. The prevalence rates reported in the selected studies were acquired from educational institutions and healthcare centers of private and public domains in different geographic locations. These contribute to a more probable accurate assessment, unlike pain clinics or TMD specialization clinics, which would overreport the prevalence in a population, thus ascertaining the case group in a general population would be challenging.

Of the 8 studies, 5 evaluated the depression and anxiety scores (Table 2) using validated scales. Unanimously, a significant positive association was found irrespective of age and geographical location. It was noted that there was a significant rise in the stress scores of children and adolescents (10,11,13,15), which is in line with the reporting by Dickson et al, evaluating anxiety disorder in children (17).The mechanism is such that the inflammatory factors produced in pain cross the blood-brain barrier and alter the neurotransmitter metabolism and neuroendocrine function, thereby causing depression (18).

Among the selected studies, 4 assessed the health status of the patient through validated patient-filled questionnaires using the Quality of Life (QoL) Questionnaire (8,9,12,14). QoL is a multidimensional feature classifying the positivity with which a young individual rates his/her life circumstances and state. It crosses the boundaries of psychological symptoms to a comprehensive sense of well-being and life satisfaction inclusive of physical, psychological, and social functioning. In this study, a positive correlation was noted wherein a dip in scores of QoL was associated with TMD, which conforms to the findings of Pigozzi et al (19). One of the studies(16) evaluated the association of lower socio-economic status with the prevalence of TMD and reported a proportional alteration, which matches the results of a meta-analysis performed by Minervini et al (20).

In this meta-analysis, the obtained prevalence was 25.8%. However, this rate was 23% in a previous meta-analysis by Valesan et al (21). The previous study reported this value around 5 years earlier. The researchers were in consensus that there was a gradual rise in the prevalence of the disorder. This can be attributed to lifestyle changes, along with anxiety and depression levels in the community.

The greatest limitation of this study was the unanimous absence of imaging studies for the confirmation of TMD (22). Additionally, adequate sample size representation and calculation require multicentric observations, which were reported in only two studies performed by Jomhawi et al and de Melo Júnior et al, respectively (15,16).

Conclusion

Based on the findings, the prevalence of TMD represents a gradual rise. Considering the chronic nature of the disorder and the high cost of treatment, sustainable treatment alternatives and prevention strategies are the need of the time (23). Oral literacy programs for prevention and the need for management at the first sign of the disorder can be introduced at the school level as the manifestation of this disorder starts in the age group. Sustainable medications from natural resources with lower costs and adverse effects are the other challenges that need to be overcome.

Competing Interests

Nil.

Ethical Approval

Not applicable.

Funding

This study was not funded by any private or public organization.

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