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

Abstract 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.