463: How Trustworthy Are Network Meta-Analyses of Treatments for Painful Temporomandibular Disorders?

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary orofacial pain, Pharmacological treatments, Non-pharmacological treatments, Treatment/management

Background and Aims: Painful temporomandibular disorders (PTMDs) are among the most common chronic pain conditions, contributing substantially to disability, reduced quality of life, and healthcare costs. Existing interventions span conservative, pharmacological, and surgical interventions. Despite the interventions’ availability, several uncertainties remain about these interventions' effectiveness. Properly presenting evidence is essential to prevent the misuse of research findings and to ensure that research evidence effectively reaches relevant stakeholders. Therefore, this is the first study to assess whether existing systematic reviews (SRs) with network meta-analyses (NMAs) of treatments for PTMDs provide trustworthy clinical conclusions through structured evidence summaries and how NMA findings were presented.

Methods: We comprehensively searched the following databases: MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, PsycINFO, LILACS, ProQuest, and EBSCOhost, to identify eligible studies: systematic reviews with NMAs investigating treatments for TMDs. The initial search was conducted from inception to February 2025 without restrictions, with plans to update it at the end of the project. We systematically assessed the eligible NMAs to map whether and how they presented their NMA findings and provided structured evidence summaries (i.e., reporting the effect estimates of treatments in absolute measures and certainty assessment across outcomes).

Results: From 688 references retrieved, twenty-three NMAs published in 19 unique Journals between 2017 and 2025 were included. These NMAs investigated various treatment modalities for muscular and joint-related PTMDs. All included NMAs focused on pain reduction, while 13 studies (70%) also investigated maximal mouth opening. Only 3 NMAs (13%) investigated the adverse events of treatments and patients’ quality of life. Although 17 NMAs (74%) assessed the evidence certainty via the GRADE and CINeMA approaches, only 6 (27%) NMAs reported the evidence certainty in their conclusions. Only two NMAs (9%) provided structured evidence summaries that included benefits and harms across all outcomes.

Conclusions: Most NMAs for TMD treatments focused primarily on efficacy, while ignoring harms and other patient-centered outcomes. Additionally, most of these NMAs’ conclusions rely solely on treatment rankings via p-scores or SUCRA, without considering the clinical meaningfulness of these treatments’ effects, leading to overestimation of their findings. Furthermore, most NMAs did not provide structured evidence summaries and user-friendly recommendations, potentially leading to widespread distrust of TMDs’ research findings among clinicians and policymakers.

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Presenting Author: Ahmad G.A. Khater
Submitting Author: Ahmad Khater

Senior Author: Carolina B. Meloto

IASP 2026 Global Year theme of Neuropathic Pain: No

• Ahmad G.A. Khater: BDS, MSc - Faculty of Dental Medicine and Oral Health Sciences, The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
• Rachael O. Osagie: BDS, PhD - Faculty of Dental Medicine and Oral Health Sciences, The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
• Sherif Elsaraj: BSc, DMD, MSc, PhD - Faculty of Medicine, University of Ottawa & Centre de recherche en medecine psychosociale du CISSS de I’Outaouais, Canada
• Zovinar Der Khatchadourian: DDS - Faculty of Dental Medicine and Oral Health Sciences, The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
• Carlos Zaror: DDS, MSc, PhD - Department of Pediatric Dentistry and Orthodontics, Universidad de La Frontera, Temuco, Chile
• Melissa Trivisonno: PhD - Statistics Canada, Ottawa, Ontario, Canada
• Carolina B. Meloto: DDS, MSc, PhD - Faculty of Dental Medicine and Oral Health Sciences, The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada