Physical therapy for temporomandibular disorders: a scoping review

Abstract

Background: Temporomandibular disorders (TMDs) are heterogeneous and multifactorial musculoskeletal conditions. The current standard of care recommends conservative, patient-centered approaches consistent with the biopsychosocial model. However, the physical therapy literature remains heterogeneous in terms of intervention protocols, assessed outcomes, and follow-up duration.

Objective: To map the available evidence on conservative physical therapy interventions for TMDs, describe the main therapeutic strategies and most frequently investigated outcomes, and identify the main methodological gaps in the literature.

Methods: A Scoping Review was conducted in accordance with the JBI Manual for Evidence Synthesis and the PRISMA-ScR guidelines. Eligibility criteria were reorganized according to the PICO framework. The search was performed in MEDLINE/PubMed and included studies published from 2014 to 2026; the last search was conducted on April 1, 2026. Primary studies involving adults with TMDs diagnosed according to RDC/TMD or DC/TMD criteria and receiving conservative physical therapy interventions were included. Data synthesis was descriptive; no formal risk-of-bias or methodological quality assessment was conducted.

Results: A total of 119 studies, including 7015 participants, were included. Scientific production showed a growing trend, with 93 studies published from 2020 onward (78.2%) and a predominance of randomized controlled trials (n = 92; 77.3%). The diagnostic criteria used were RDC/TMD in 61 studies (51.3%), DC/TMD in 57 studies (47.9%), and mixed criteria in 1 study (0.8%). The most frequently investigated interventions were therapeutic exercise (n = 64; 53.8%), manual therapy (n = 63; 52.9%), and physical modalities (n = 39; 32.8%). Outcomes mainly focused on pain (n = 112; 94.1%), mandibular ROM/maximum mouth opening (n = 86; 72.3%), and function/disability (n = 51; 42.9%). Psychological outcomes (n = 18; 15.1%) and quality of life (n = 16; 13.4%) were less represented. Follow-up longer than 6 months was reported in 4 studies (3.4%). The most frequent limitations included small sample sizes, short follow-up periods, heterogeneity of protocols, and difficulties with blinding or control conditions.

Conclusions: The physical therapy literature on TMDs is broad and growing but remains heterogeneous. Therapeutic exercise, manual therapy, and physical modalities were the most frequently studied interventions, whereas pain and MMO/ROM were the most commonly reported outcomes. Biopsychosocial outcomes, quality of life, psychological aspects, and long-term follow-up were less represented. In the absence of a formal risk-of-bias assessment and due to the heterogeneity of the included studies, definitive conclusions on the comparative effectiveness of interventions cannot be drawn. Physical therapy should be interpreted within conservative, patient-centered, and multidisciplinary care pathways. Future studies should adopt more standardized protocols, multidimensional outcomes, and longer follow-up periods.