Interventions refuted by evidence or insufficient evidence

Koh & Robinson [40], in their systematic review (identified 660 trials on TMD therapy but only six fulfilled the inclusion criteria), assessed the effectiveness of occlusal adjustment for treating TMD in adults and preventing TMD and found there was no evidence to support this therapy. This has also been confirmed by others.

Jedel & Carlsson's systematic review of seven controlled clinical trials to assess the efficacy of biofeedback, acupuncture and TENS in TMD once again showed poor methodology and no evidence for effectiveness of these therapies [41]. Another systematic review on acupuncture came to the same conclusions [42].

Of the pharmacologic therapies, clonazepam versus placebo in 20 patients decreased pain but the study was very small and the 25% drop-out rate makes these results difficult to interpret [43].

There are no trials of sufficient quality on the use of oral opioids.

Botulinum toxin has been used in a small trial of 15 patients with muscular TMD pain but no evidence for effectiveness was found and one-third of the patients were lost to follow-up [44].

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