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Bruxism and Temporomandibular Disorders: Current Advances and Future Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: 30 November 2025 | Viewed by 8036

Special Issue Editors


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Guest Editor
Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland
Interests: TMDs; TMJ; rehabilitation; craniofacial disorder; masticatory muscles; physiotherapy; electromyography

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Guest Editor
Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima 770-8504, Japan
Interests: biomechanics of temporomandibular joint; temporomandibular disorders; tissue engineering; therapeutic ultrasound; clinical orthodontics
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Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute to our upcoming Special Issue on “Bruxism and Temporomandibular Disorders: Current Advances and Future Challenges”. Bruxism and temporomandibular disorders affect a significant portion of the population. The global prevalence of sleep bruxism is 21%, while awake bruxism affects 23% of individuals. For temporomandibular disorders, the prevalence reaches 34%. These conditions remain a compelling topic for both researchers and clinicians and are characterized by a multifactorial etiology. As such, a multidisciplinary approach is essential to facilitate a quicker diagnosis and appropriate patient treatment. This Special Issue aims to summarize the current state of knowledge regarding bruxism and temporomandibular disorders and outline future directions for diagnosis and therapy.

Dr. Grzegorz Zieliński
Prof. Dr. Eiji Tanaka
Guest Editors

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Keywords

  • TMDs
  • TMJ
  • rehabilitation
  • physiotherapy
  • craniofacial disorder
  • oral health
  • biomechanics
  • masticatory muscles
  • electromyography
  • parafunction
  • nocturnal bruxism
  • tooth contact habit

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Published Papers (10 papers)

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Research

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17 pages, 1886 KiB  
Article
The Rainbow and the Umbrella of Temporomandibular Disorders—Total Antioxidant Capacity and Total Oxidant Status in Patients with Myofascial Pain with Referral
by Joanna Kuć, Anna Zalewska, Krzysztof Dariusz Szarejko, Małgorzata Żendzian-Piotrowska, Walery Tarnawski, Sara Zięba and Mateusz Maciejczyk
J. Clin. Med. 2025, 14(12), 4022; https://doi.org/10.3390/jcm14124022 - 6 Jun 2025
Viewed by 329
Abstract
Background: Temporomandibular disorders (TMDs) represent an umbrella term encompassing various musculoskeletal dysfunctions, including those affecting the masticatory muscles. This study aimed to compare the salivary levels of non-enzymatic antioxidants and redox balance between patients with temporomandibular myofascial pain with referral and matched [...] Read more.
Background: Temporomandibular disorders (TMDs) represent an umbrella term encompassing various musculoskeletal dysfunctions, including those affecting the masticatory muscles. This study aimed to compare the salivary levels of non-enzymatic antioxidants and redox balance between patients with temporomandibular myofascial pain with referral and matched healthy controls. Methods: The sample consisted of 44 individuals diagnosed with temporomandibular myofascial pain with referral and a matched control group. The procedure included a clinical examination based on the Diagnostic Criteria for Temporomandibular Disorders and saliva collection. Biochemical analysis included the assessment of reduced glutathione (GSH) levels, total antioxidant status (TAC), total oxidant status (TOS), and the oxidative stress index (OSI). Results: Patients with temporomandibular myofascial pain with referral exhibited higher levels of total oxidant status and glutathione. The mean value of total antioxidant capacity was lower, although the median was higher compared to the control group. No statistically significant differences were observed in the oxidative stress index between the two groups. Conclusions: Patients with temporomandibular myofascial pain with referral exhibit oxidative imbalance, reflected by increased salivary levels of non-enzymatic antioxidants, elevated total oxidant status, and significant differences in antioxidant capacity compared to healthy controls. Individually tailored physical activity, proper nutrition, and targeted supplementation may be necessary to maintain oxidative-antioxidant balance in this patient population. Full article
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15 pages, 2049 KiB  
Article
Gender Differences in Mouth Opening on Temporomandibular Disorder Patients—Implications for Diagnosis
by David Faustino Ângelo, Henrique José Cardoso, Ricardo São João, Carlos Brás-Geraldes, David Sanz, Francesco Maffia and Francisco Salvado
J. Clin. Med. 2025, 14(11), 3865; https://doi.org/10.3390/jcm14113865 - 30 May 2025
Viewed by 399
Abstract
Background/Objectives: Temporomandibular disorder (TMDs) patients often present limited mouth opening (LMO). A key diagnostic cutoff is a mouth opening threshold >40 mm. However, this universal cutoff may not accurately reflect gender anatomical variations. This study investigates gender-specific differences in maximum mouth opening (MMO) [...] Read more.
Background/Objectives: Temporomandibular disorder (TMDs) patients often present limited mouth opening (LMO). A key diagnostic cutoff is a mouth opening threshold >40 mm. However, this universal cutoff may not accurately reflect gender anatomical variations. This study investigates gender-specific differences in maximum mouth opening (MMO) to propose revised diagnostic criteria for LMO. Methods: A five-year prospective study was conducted from 1 August 2019 to 1 May 2024 in a Portuguese TMDs department. The patients’ gender, MMO, and LMO complaints with clinical validation were recorded. Statistical analyses, including Generalized Additive Models (GAMs) and Generalized Linear Models (GLMs), assessed the relationship between MMO and LMO, with gender-stratified comparisons. Results: In this study 1045 patients were included. The median (accompanied by the interquartile range [25th percentile–75th percentile]) MMO was lower in females (40 mm [34–45]) than in males (44 mm [40–48]). Patients presenting LMO complaints exhibited significantly reduced MMO values compared to those without LMO complaints (p < 0.001). Gender-specific thresholds emerged: for females, LMO was observed when MMO was ≤35 mm, while in males, LMO symptoms appeared when MMO was ≤38 mm. A “gray zone” of diagnostic uncertainty was identified between 36 and 37 mm for females and 38 and 42 mm for males. Conclusions: In this study we observed the gold standard cutoff for diagnosing MMO in female should be <35mm and for male <38mm. These findings suggest that a single LMO threshold does not account for gender-related anatomical differences, potentially leading to underdiagnosis in females and misclassification in males. Revising diagnostic criteria to incorporate gender-specific thresholds could enhance accuracy, improve early diagnosis, and promote personalized treatment strategies for TMDs patients. Further research incorporating additional variables such as age, dental occlusion, craniofacial structure, and body mass index is recommended to refine these diagnostic guidelines. Full article
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14 pages, 675 KiB  
Article
Double-Puncture Arthrocentesis in Arthrogenous TMJ Disorders: Bioviscosupplementation vs. Viscosupplementation a Randomized Controlled Trial
by David Faustino Ângelo, Henrique José Cardoso, David Sanz, Francesco Maffia, Marcella Sarkis, Beatriz Mota and Francisco Salvado
J. Clin. Med. 2025, 14(11), 3750; https://doi.org/10.3390/jcm14113750 - 27 May 2025
Viewed by 462
Abstract
Background/Objectives: Intra-articular injections of hyaluronic acid (HA) or platelet-rich plasma (PRP) have been used in the treatment of temporomandibular joint (TMJ) arthrocentesis to improve lubricative properties and influence regenerative processes. This study aimed to evaluate the potential clinical benefits of complementary bioviscosupplementation with [...] Read more.
Background/Objectives: Intra-articular injections of hyaluronic acid (HA) or platelet-rich plasma (PRP) have been used in the treatment of temporomandibular joint (TMJ) arthrocentesis to improve lubricative properties and influence regenerative processes. This study aimed to evaluate the potential clinical benefits of complementary bioviscosupplementation with hyaluronic acid (HA) and platelet-rich plasma (PRP) in patients undergoing double-portal TMJ arthrocentesis. Methods: A total of forty-six patients (33 females, 13 males; mean age of 45.83 ± 20.62 years) with arthrogenous temporomandibular disorders, identified through clinical and imaging examinations, were randomized into HA+PRP (23 patients) or HA-alone (23 patients) groups. The primary outcome variable was TMJ arthralgia; the secondary outcome was maximum mouth opening (MMO). All the outcome variables were assessed preoperatively (T0) and at several follow-ups (T1—1 month, T2—3 months, T3—6 months, T4—12 months follow-up). Results: The HA+PRP group presents lower TMJ arthralgia levels than the HA group at every follow-up moment (p < 0.05, r ≈ 0.3). At T3 and T4, the HA+PRP group presented a higher MMO average than the HA group (p = 0.03 and p = 0.02; r ≈ 0.3). At T4, the HA group’s success rate was lower than the HA+PRP group (65% vs. 96%), and a higher number of postoperative reinterventions were observed (35% vs. 4%). Conclusions: In this study, complementary intra-articular bioviscosupplementation (HA+PRP) following double-portal TMJ arthrocentesis was associated with better clinical outcomes regarding TMJ arthralgia reduction, MMO improvement, and reduced risk of future TMJ reintervention. Full article
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17 pages, 1263 KiB  
Article
Clinical Manifestations of Temporomandibular Disorders and Their Relationship with Sleep Disturbances and Emotional Disorders in a Spanish Pediatric Population: A Cross-Sectional Study
by Fanny Esther Tapia-Sierra, Jesús Miguel Ticona-Flores, Guillermo Reichard-Monefeldt, Naomi Elvira-Tapia, Nuria Esther Gallardo-López and Montserrat Diéguez-Pérez
J. Clin. Med. 2025, 14(10), 3599; https://doi.org/10.3390/jcm14103599 - 21 May 2025
Viewed by 425
Abstract
The etiology of temporomandibular disorders (TMDs) has been linked to various factors, including functional and psychological factors, which makes it difficult to identify associations between a single etiological factor and the signs and symptoms of TMDs. Objectives: This study aimed to describe [...] Read more.
The etiology of temporomandibular disorders (TMDs) has been linked to various factors, including functional and psychological factors, which makes it difficult to identify associations between a single etiological factor and the signs and symptoms of TMDs. Objectives: This study aimed to describe the presence of TMD symptoms and their relationship with sleep disturbances and emotional disorders in children and adolescents. Methods: This observational study included Spanish children aged between 8 and 13 years. The measurement instruments consisted of the BRUNI survey for sleep disorders and the Educational-Clinical Questionnaire: Anxiety and Depression (CECAD) survey. A clinical examination was subsequently performed following the DC/TMD guidelines for diagnosing TMDs. Frequencies, means, and standard deviations were applied, along with the prevalence ratio as a measure of association and the chi-square test. The significance level was set at 5%. Results: A total of 128 participants participated in the study with a mean age of 10.89 (±2.15) years. The prevalence of TMDs was 54%, while the most common symptoms were muscle pain at 26%, joint pain at 14%, and a combination of both at 14%. Children who presented muscle pain had a mean anxiety score of 44.87 (±11.85), whereas those without symptoms had a mean score of 36 (±10.78, and 0.03 p-value). The BRUNI index revealed that 78.13% of patients with TMDs had difficulty initiating and maintaining sleep, with a prevalence ratio (PR) of 3.57 (p-value 0.041). Conclusions: The present study reveals that temporomandibular disorders are common in children and adolescents, with 54% presenting at least one clinical sign or symptom. Emotional disturbances and sleep problems were also prevalent, affecting 41% and 56% of participants, respectively. Early interdisciplinary screening is essential to manage the co-occurrence of TMDs, emotional distress, and sleep problems in children. Full article
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11 pages, 234 KiB  
Article
Comparative Evaluation of Temporomandibular Disorders and Dental Wear in Video Game Players
by Cezar Ionita, Alexandru Eugen Petre, Alexandra Velicu and Adriana Sarah Nica
J. Clin. Med. 2025, 14(1), 31; https://doi.org/10.3390/jcm14010031 - 25 Dec 2024
Cited by 1 | Viewed by 839
Abstract
Background/Objectives: The increasing prevalence of video gaming has raised concerns about its potential impact on musculoskeletal health, particularly temporomandibular disorders (TMDs). This study aims to compare TMD symptoms, mandibular function, and dental wear between gamers and non-gamers among university students. Methods: [...] Read more.
Background/Objectives: The increasing prevalence of video gaming has raised concerns about its potential impact on musculoskeletal health, particularly temporomandibular disorders (TMDs). This study aims to compare TMD symptoms, mandibular function, and dental wear between gamers and non-gamers among university students. Methods: An observational study included 108 students aged 20 to 23 years, divided into gamers (n = 48) and non-gamers (n = 60). Participants completed questionnaires assessing TMD symptoms, gaming habits, and screen time. Clinical examinations measured mandibular movements, palpation-induced pain, and dental wear using the Smith and Knight Tooth Wear Index. Statistical analyses included independent t-tests, chi-square tests, Pearson’s correlations, and logistic regression. Seven comprehensive tables present the findings with p-values. Results: Gamers reported significantly higher screen time (Mean = 6.5 h/day) compared to non-gamers (Mean = 4.0 h/day; p < 0.001). Maximum unassisted mouth opening was greater in gamers (Mean = 48.31 mm) than in non-gamers (Mean = 46.33 mm; p = 0.04). Gamers exhibited a higher prevalence of pain on palpation of the masseter muscle (45.8% vs. 30.0%; p = 0.05). Dental wear scores were significantly higher in gamers for teeth 2.3 (upper left canine) and 3.3 (lower left canine) (p < 0.05). Positive correlations were found between hours spent gaming and maximum mouth opening (r = 0.25; p = 0.01) and dental wear (r = 0.30; p = 0.002). Logistic regression showed that gaming status significantly predicted the presence of TMD symptoms (Odds Ratio = 2.5; p = 0.03). Conclusions: Gamers exhibit greater mandibular opening, increased dental wear, and a higher prevalence of masticatory muscle pain compared to non-gamers. Prolonged gaming may contribute to altered mandibular function and increased risk of TMD symptoms. Further research is needed to explore underlying mechanisms and develop preventive strategies. Full article
11 pages, 559 KiB  
Article
Electromyographic Diagnostic Ranges Defining Temporomandibular Disorders and Healthy Individuals’ Results in Functional Clenching Index
by Grzegorz Zieliński and Michał Ginszt
J. Clin. Med. 2025, 14(1), 14; https://doi.org/10.3390/jcm14010014 - 24 Dec 2024
Cited by 2 | Viewed by 753
Abstract
Background: Temporomandibular disorders (TMDs) represent a significant public health issue, among which masticatory muscle pain is the most common. Current publications increasingly indicate surface electromyography (sEMG) as an effective diagnostic tool for muscle dysfunctions that may be employed in TMDs recognition. The [...] Read more.
Background: Temporomandibular disorders (TMDs) represent a significant public health issue, among which masticatory muscle pain is the most common. Current publications increasingly indicate surface electromyography (sEMG) as an effective diagnostic tool for muscle dysfunctions that may be employed in TMDs recognition. The objective of this study was to establish reference ranges for TMDs patients with masticatory muscle pain and healthy individuals in the electromyographic Functional Clenching Index (FCI) for the temporalis muscles (TAs) and masseter muscles (MMs). This research aimed to provide an additional diagnostic tool for TMDs patients. Methods: A total of 48 individuals (n = 30 women and n = 18 men) with the muscular painful form of TMDs were recruited alongside a numerically and gender-matched control group—healthy, pain-free controls. The Functional Clenching Indexwas calculated for both groups. Results: Data analysis revealed statistically significant differences with a very large effect size. Healthy individuals had higher FCI scores compared to those with TMDs. The healthy group exhibited higher threshold values compared to the TMDs group. Conclusions: For healthy individuals, the FCI ranges for TAs were between 58 and 145, while for MMs, between 72 and 210. Lower values may indicate muscle activation disorders and occur in patients with the painful, muscular form of TMDs. This is the first study to define reference ranges for electromyographic indices; therefore, caution is recommended, and the replication of this study on a larger and more culturally diverse sample is advised. Full article
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Review

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20 pages, 569 KiB  
Review
Multimodal Approaches in the Management of Temporomandibular Disorders: A Narrative Review
by Izabela Dąbkowska, Lena Sobiech, Agata Czępińska, Adam Bęben, Karolina Turżańska and Piotr Gawda
J. Clin. Med. 2025, 14(12), 4326; https://doi.org/10.3390/jcm14124326 - 17 Jun 2025
Viewed by 378
Abstract
Background/Objectives: Temporomandibular disorders (TMDs) are the most common cause of non-dental pain in the orofacial region. Due to the complex and multifactorial nature of TMD, a multidisciplinary approach is often required. The objective of this narrative review is to evaluate the effectiveness of [...] Read more.
Background/Objectives: Temporomandibular disorders (TMDs) are the most common cause of non-dental pain in the orofacial region. Due to the complex and multifactorial nature of TMD, a multidisciplinary approach is often required. The objective of this narrative review is to evaluate the effectiveness of multimodal therapies in the management of TMD. Methods: A literature search was performed using a combination of keywords: “TMD”, “TMJ”, “disorders”, “manual therapy”, “physical therapy”, “dry needling”, “botulinum toxin”, “Botox”, “splint”, and “psychotherapy”. The search was conducted in the PubMed, Google Scholar, and Scopus databases, focusing on studies involving human subjects. Results: The included studies reported that the use of multimodal approaches—such as physiotherapy, botulinum toxin injections, occlusal splints, and/or psychotherapy—led to symptom improvement or complete resolution in patients with TMD. Conclusions: Temporomandibular disorders are complex conditions with a multifactorial etiology involving both somatic and psychological components. Given the wide range of symptoms and the functional connections of the temporomandibular joint with the nervous, muscular, and skeletal systems—including the cervical spine—effective treatment of TMD requires a multidisciplinary strategy. Full article
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17 pages, 1199 KiB  
Review
The Importance of Genetic Background and Neurotransmission in the Pathogenesis of the Co-Occurrence of Sleep Bruxism and Sleep-Disordered Breathing—Review of a New Perspective
by Joanna Smardz, Andrej Jenca, Jr. and Sylwia Orzeszek
J. Clin. Med. 2024, 13(23), 7091; https://doi.org/10.3390/jcm13237091 - 23 Nov 2024
Viewed by 1587
Abstract
Sleep bruxism (SB) and sleep-disordered breathing (SDB) are two prevalent conditions that significantly impact overall health. Studies suggest that up to 49.7% of individuals with SDB also exhibit symptoms of SB. This review aims to provide a comprehensive analysis of the role of [...] Read more.
Sleep bruxism (SB) and sleep-disordered breathing (SDB) are two prevalent conditions that significantly impact overall health. Studies suggest that up to 49.7% of individuals with SDB also exhibit symptoms of SB. This review aims to provide a comprehensive analysis of the role of genetic background and neurotransmission in the pathogenesis of the co-occurrence of SB and SDB. It seeks to synthesize current knowledge, highlight gaps in the existing literature, and propose a new perspective that integrates genetic and neurobiological factors. This review shows that both SB and SDB may be influenced by a combination of genetic, neurochemical, and environmental factors that contribute to their shared pathophysiology. The key neurotransmitters—dopamine, serotonin, and GABA—may play a significant role in their co-occurrence by regulating motor activity, sleep architecture, and respiratory control. Understanding genetic and neurochemical mechanisms may allow for more precise diagnostic tools and more personalized treatment approaches regarding SB and SDB. Clinically, there is a need for interdisciplinary collaboration between sleep specialists, dentists, neurologists, and geneticists. There is also a need to conduct large-scale genetic studies, coupled with neuroimaging and neurophysiological research, uncovering additional insights into the shared mechanisms of SB and SDB. Full article
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Other

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17 pages, 1211 KiB  
Hypothesis
Quo Vadis Temporomandibular Disorders? By 2050, the Global Prevalence of TMD May Approach 44%
by Grzegorz Zieliński
J. Clin. Med. 2025, 14(13), 4414; https://doi.org/10.3390/jcm14134414 - 20 Jun 2025
Viewed by 464
Abstract
Background/Objectives: Currently, temporomandibular disorders (TMDs) represent a significant public health concern, affecting approximately 34% of the global population. The primary aim of this study was to determine the prevalence of TMDs in the year 2050. A secondary objective was to estimate the prevalence [...] Read more.
Background/Objectives: Currently, temporomandibular disorders (TMDs) represent a significant public health concern, affecting approximately 34% of the global population. The primary aim of this study was to determine the prevalence of TMDs in the year 2050. A secondary objective was to estimate the prevalence for the years 2030, 2075, and 2100. Methods: The methodology of a prognostic study was replicated and adapted to develop prevalence projections for TMDs, utilising the most recent meta-analysis of the global prevalence of temporomandibular disorders and analyses conducted within the R environment. Results: Projections indicate a gradual increase in the global prevalence of TMDs over the coming decades. In 2030, the estimated prevalence is 39% (95% confidence interval: 34–44%). This figure is expected to rise to 41% [36–46%] by 2040 and reach 44% [39–49%] by 2050. The upward trend continues, with projections suggesting a prevalence of 47% [42–52%] in 2075 and 49% [44–54%] by 2100. These data highlight a steadily increasing global burden of TMDs. Conclusions: By the year 2050, the global prevalence of TMDs is projected to reach 44%, which, according to estimates, corresponds to approximately 4,252,160,000 individuals. By 2030, 39% of the population is projected to experience TMDs. By 2075, the global TMD prevalence is expected to rise to 47%, and, by 2100, it could increase further to 49% of the global population. Urbanisation affects TMD prevalence in a region-dependent manner; a significant decrease was observed in Asia, while, in the Americas and Europe, the association was negligible. Globally, the lack of a clear impact of urbanisation on TMD occurrence suggests the influence of environmental and cultural factors. Full article
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12 pages, 1995 KiB  
Systematic Review
The Co-Occurrence of Temporomandibular Disorders in Patients Diagnosed with Tinnitus: A Systematic Review with Meta-Analysis
by Michał Bury, Kacper Nijakowski, Anna Majewska, Jakub Jankowski, Anna Surdacka and Dorota Hojan-Jezierska
J. Clin. Med. 2025, 14(6), 1836; https://doi.org/10.3390/jcm14061836 - 8 Mar 2025
Viewed by 1243
Abstract
Background/Objectives: Persistent and distressing tinnitus and TMDs may significantly impair the quality of patients’ lives. Problems are particularly severe for those who experience both. Although the exact causes of this association are not fully understood, several hypotheses connect TMD conditions with otological symptoms. [...] Read more.
Background/Objectives: Persistent and distressing tinnitus and TMDs may significantly impair the quality of patients’ lives. Problems are particularly severe for those who experience both. Although the exact causes of this association are not fully understood, several hypotheses connect TMD conditions with otological symptoms. Methods: The systematic review presented involved records published between 1 January 2004 and 27 November 2024, in the databases PubMed, Scopus, and Web of Science, according to the PRISMA guidelines. The search queries included “temporomandibular disorder” and “tinnitus”. Inclusion and exclusion criteria were predefined according to PECOS. A risk of bias assessment and meta-analyses were performed. The study’s protocol was registered in PROSPERO (CRD42024533293). Results: Eleven studies included in this review fulfilled all the predefined criteria. In a sample of 114,071 tinnitus patients, 50.99% (95% CI: 33.31–68.54) also had coexisting TMDs. Furthermore, tinnitus patients had more than 2.2 times higher odds of having TMDs compared to the control group (p = 0.002 for random effects). The absence of data regarding randomisation, blinding, and sample size justification was the most frequent risk of bias. Conclusions: Tinnitus frequently co-occurs in patients who suffer from TMDs. It is essential to expand the diagnostic evaluation of patients to confirm its presence and assess its impact on their quality of life. Additionally, dental consultation should be considered to evaluate patients about TMD signs and symptoms when suffering from tinnitus. Full article
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