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Background The nature of certain musculoskeletal impairments associated with temporomandibular disorders (TMD) is unclear. Understanding impairments within TMD subgroups is important to guide management. Objectives Characterise local musculoskeletal impairments in adults with persistent TMD. Methods PubMed, EMBASE, CINAHL, Scopus, Web of Science and Cochrane databases were searched from inception to 12 January 2020. Bibliographies were searched for additional articles, including grey literature. Case‐control and interventional studies reporting temporomandibular range of motion (ROM), muscle function (MF) or proprioception in TMD and control groups were included. Risk of bias was assessed using SIGN checklist for case‐control studies. Results were pooled using random‐effects model. Confidence in cumulative evidence was determined using American Academy of Neurology guidelines. Results Sixty‐six studies were included, most rated moderate risk of bias. Twelve primary outcomes were assessed, with partial scope for meta‐analysis. Significant reductions were found for active maximal mouth opening (P < .00001, MD=−4.65 mm), protrusion (P < .0001, MD=−0.76 mm) and maximum bite force (P < .00001) in TMD versus controls. Subgroup analysis scope was limited. Reduced AMMO was found in myogenic TMD subgroups versus controls (P = .001, MD= −3.28 mm). Few studies measured proprioception, with high methodological variability. Confidence in cumulative evidence ranged from high to very low. Conclusion ROM and bite force impairments accompany TMD. Insufficient data were available to investigate impairments within TMD subgroups. Implications Several musculoskeletal impairments have been identified, which may guide clinical management of TMD. Lack of subgroup data, and data for proprioception and MF, highlights future direction for research. PROSPERO CRD42020150734.

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Background: Bite is an important function of the human stomatognathic system. Despite this, it is commonly impaired in temporomandibular disorder (TMD) populations. The aim of this review is to evaluate the effectiveness of conservative interventions on self-reported and physical measures of bite function in individuals with TMD. Methods: This review was performed in compliance with PRISMA guidelines. An electronic search was performed on databases including PubMed, CINAHL, Embase, and Cochrane Central. Inclusion criteria were journal articles evaluating the effect of any non-pharmacological conservative interventions on bite function in participants diagnosed with TMD. Risk of bias for individual studies was assessed using the Cochrane risk-of-bias v2 tool, and the NIH NHLBI pre-post tool. Data was synthesised based on outcome measures of bite function, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.Results: Eleven studies were eligible for this review. Interventions included splinting, photobiomodulation, needling, exercise, manual therapy, and patient education, which were evaluated using mastication-related pain, self-reported chewing difficulty, and bite force/endurance outcome measures. Findings suggested manual therapy, needling, oral splinting, exercise, and PBM interventions may improve bite function in TMD, although confidence in cumulative evidence ranged from moderate to very low.There was no evidence that patient education improved bite function. Conclusion:Conservative interventions may be helpful to address bite-related impairments associated with TMD, although further research is needed to improve the quality of evidence and direct clinical guidelines.

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