My temporomandibular joint clicks — does it have to be treated?

"Having the phenomenon" is not the same as "needing treatment". First, what this article can and cannot say: the classification framework places arthralgia, disc displacement and degenerative joint disease in separate cells, and among them disc displacement with reduction is the category with the highest prevalence (about 25.9% in adults and older adults) [F5][F6]; but the sources cited here establish no mapping from a sound to a diagnostic cell, so this article does not make that assignment [F46]. Which cell it actually falls into, and whether anything needs doing, must be judged by clinical assessment, and the clinical criteria lack sufficient validity for some intra-articular disorders to serve as clinical diagnoses and can be used only for screening [F11]. One more thing to read alongside: the clinical guideline above explicitly limits the population for its recommendations to chronic (lasting 3 months or more) TMD-associated pain, and does not apply to acute pain [F16].

Can I push a dislocated jaw back myself?

This article provides no method of self-reduction. The reductions recorded in the literature are procedures performed by clinicians: in a review of 11 cases, one case had the manoeuvre performed only under general anaesthesia [F25]; the authors conclude that the conservative reduction manoeuvre was effective in most cases, but this is a medical procedure and not a home operation [F26]. The systematic review's conclusion is likewise that conservative approaches should be exhausted before invasive surgery is considered, and it too concerns choices among clinical procedures [F24]. If you cannot close your mouth, seek care.

Should I have an occlusal splint or not?

There are two pieces of evidence here that look contradictory but are in fact answering different questions. On one hand, the clinical guideline produced with GRADE, on a benchmark of comparison against placebo or sham, lists reversible occlusal splints as conditionally recommended against, and irreversible intraoral occlusal appliances as strongly recommended against [F14][F15]. On the other hand, a meta-analysis comparing occlusal splints with botulinum toxin injection showed no overall statistically significant difference between the two in mouth-opening range, and none on the graded chronic pain scale either [F20][F21]. The two use different comparators, and neither overturns the other [F46]. The difference between reversible and irreversible is the one thing to make sure you clarify in practice on this question [F14][F15].

🏛 Part of the "reports" topic shelf →

Temporomandibular Joint and Maxillofacial Complete Guide: the TMD classification map, the conservative-first management ladder, the acute dislocation pathway, and the specialty boundaries of orthognathic and maxillofacial surgery｜證據鏈

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Temporomandibular Joint and Maxillofacial Complete Guide: the TMD classification map, the conservative-first management ladder, the acute dislocation pathway, and the specialty boundaries of orthognathic and maxillofacial surgery｜證據鏈

F-Units fact ledger

F1｜source #3｜confidence: high｜basis: textbook｜geo: universal｜period: 2020-03-12｜claim: Temporomandibular disorders are a group of more than 30 health disorders related to the temporomandibular joints and to the muscles and tissues of the jaw.｜span: "are a set of more than 30 health disorders associated with both the temporomandibular joints and the muscles and tissues of the jaw"｜caveat: Taken from the bibliographic description of a National Academies consensus study report; it delimits the scope of the domain rather than giving treatment advice; this site records it conservatively at textbook level and does not upgrade it to clinical_guideline.
F2｜source #3｜confidence: medium｜basis: textbook｜geo: universal｜period: 2020-03-12｜claim: Temporomandibular disorders have varied causes and frequently co-occur with a number of overlapping medical conditions such as headache, fibromyalgia, back pain and irritable bowel syndrome.｜span: "TMDs have a range of causes and often co-occur with a number of overlapping medical conditions, including headaches, fibromyalgia, back pain and irritable bowel syndrome"｜caveat: This is a descriptive statement in the report and gives no incidence figure for any of the comorbidities; no causal direction may be inferred from it.
F3｜source #2｜confidence: high｜basis: clinical_guideline｜geo: universal｜period: 2023-12-15｜claim: Temporomandibular disorders are the second most common musculoskeletal chronic pain disorder after low back pain, affecting 6% to 9% of adults globally.｜span: "TMD are the second most common musculoskeletal chronic pain disorder after low back pain, affecting 6-9% of adults globally"｜caveat: Taken from the background section of the guideline; this figure counts the chronic pain population and has a different scope from the DC/TMD-diagnosed prevalence (F4); the two must not be substituted for or merged with each other.
F4｜source #4｜confidence: high｜basis: peer_reviewed (PMID 33409693, systematic review and meta-analysis)｜geo: universal｜period: 2021-02｜claim: The pooled overall prevalence of temporomandibular joint disorders was about 31.1% in adults and older adults and about 11.3% in children and adolescents; for disc displacement it was 19.1% and 8.3% respectively, and for degenerative joint disease 9.8% and 0.4% respectively.｜span: "The main results from prevalence overall meta-analyses for adults/elderly are as follows: TMJD (31.1%), DDs (19.1%), and DJD (9.8%). Furthermore, for children/adolescents are as follows: TMJD (11.3%), DDs (8.3%), and DJD (0.4%)."｜caveat: These are population-level pooled estimates, not individual risk; the risk-of-bias distribution of the included studies is given in F7.
F5｜source #4｜confidence: high｜basis: peer_reviewed (PMID 33409693)｜geo: universal｜period: 2021-02｜claim: The individual temporomandibular joint disorder diagnosis with the highest prevalence is disc displacement with reduction, at about 25.9% in adults and older adults and about 7.4% in children and adolescents.｜span: "Considering the individual diagnosis meta-analyses, the most prevalent TMJD is DDwR for adults/elderly (25.9%) and children/adolescents (7.4%)."｜caveat: "Highest prevalence" renders the original most prevalent; it does not imply that the diagnosis requires treatment.
F6｜source #4｜confidence: high｜basis: peer_reviewed (PMID 33409693)｜geo: universal｜period: 2021-02｜claim: The categories of temporomandibular joint disorder investigated in that review comprised arthralgia, disc displacement with reduction, disc displacement with reduction and intermittent locking, disc displacement without reduction with limited opening, disc displacement without reduction without limited opening, degenerative joint disease, osteoarthritis, osteoarthrosis and subluxation.｜span: "The TMJD investigated were as follows: arthralgia, disk displacement (DDs) with reduction (DDwR), DDwR with intermittent locking, DDs without reduction (DDwoR) with limited opening, DDwoR without limited opening, degenerative joint disease (DJD), osteoarthritis, osteoarthrosis, and subluxation."｜caveat: This is an enumeration of the diagnostic categories investigated in that review, not the complete DC/TMD classification system; for the full classification see source #1.
F7｜source #4｜confidence: high｜basis: peer_reviewed (PMID 33409693)｜geo: universal｜period: 2021-02｜claim: The review included 21 articles out of 2741, of which 10 were judged at low risk of bias, 7 at moderate and 4 at high; inclusion was restricted to observational studies using RDC/TMD or DC/TMD diagnosis.｜span: "From 2741 articles, 21 were included. Ten studies were judged at low RoB, seven at moderate, and four at high."｜caveat: The risk-of-bias distribution across the included studies is uneven, and the pooled estimates must be read together with that distribution.
F8｜source #1｜confidence: high｜basis: clinical_guideline (PMID 24482784, indexed in PubMed under the publication type Practice Guideline)｜geo: universal｜period: 2014-Winter｜claim: DC/TMD was produced through two international consensus workshops; its Axis I is a diagnostic algorithm at the physical level and its Axis II a set of self-report assessment instruments at the psychosocial and behavioural level.｜span: "two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments"｜caveat: This site retrieved only the full PubMed abstract; the body text of the criteria was not retrieved and is not quoted verbatim.
F9｜source #1｜confidence: high｜basis: clinical_guideline (PMID 24482784)｜geo: universal｜period: 2014-Winter｜claim: The validation project determined that the Axis I validity of the older RDC/TMD was below the target values (targets being sensitivity ≥ 0.70 and specificity ≥ 0.95), and this prompted the revision.｜span: "the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95"｜caveat: This refers to the older RDC/TMD, not to the validity of the current DC/TMD.
F10｜source #1｜confidence: high｜basis: clinical_guideline (PMID 24482784)｜geo: universal｜period: 2014-Winter｜claim: The revised DC/TMD Axis I reaches sensitivity ≥ 0.86 and specificity ≥ 0.98 for the most prevalent pain-related TMD, and sensitivity 0.80 with specificity 0.97 for one intra-articular disorder.｜span: "valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97)"｜caveat: The validity data are confined to that validation dataset; "one intra-articular disorder" is not the same as all intra-articular disorders.
F11｜source #1｜confidence: high｜basis: clinical_guideline (PMID 24482784)｜geo: universal｜period: 2014-Winter｜claim: The diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnosis and can be used only for screening purposes.｜span: "Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes."｜caveat: What this article infers from it is the direction "further examination or referral may be needed"; no imaging technique or timing is specified.
F12｜source #1｜confidence: high｜basis: clinical_guideline (PMID 24482784)｜geo: universal｜period: 2014-Winter｜claim: The Axis II screening instruments comprise 41 questions assessing pain intensity, pain-related disability, psychological distress, jaw functional limitation and parafunctional behaviour; the full version comprises 81 questions and additionally assesses anxiety and comorbid pain conditions.｜span: "The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors"｜caveat: The content of the 81-question full version appears in a later sentence of the same abstract; this article does not quote the content of any individual question.
F13｜source #2｜confidence: high｜basis: clinical_guideline (PMID 38101929, GRADE methodology)｜geo: universal｜period: 2023-12-15｜claim: For chronic TMD pain the guideline gives strong recommendations in favour of cognitive behavioural therapy (with or without biofeedback or relaxation therapy), therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching, and usual care (home exercise, stretching, reassurance and education); those conditionally recommended in favour include manual therapy, supervised jaw exercise combined with mobilisation, cognitive behavioural therapy combined with non-steroidal anti-inflammatory drugs, manual therapy combined with postural exercise, and acupuncture.｜span: "strong recommendations in favour of cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care (such as home exercises, stretching, reassurance, and education)"｜caveat: The comparator is placebo or sham; this is a recommendation direction at guideline level, not a management instruction for any individual.
F14｜source #2｜confidence: high｜basis: clinical_guideline (PMID 38101929)｜geo: universal｜period: 2023-12-15｜claim: The guideline gives conditional recommendations against reversible occlusal splints (alone or in combination), arthrocentesis, hyaluronic acid injection, low level laser therapy, transcutaneous electrical nerve stimulation, botulinum toxin injection, corticosteroid injection and several classes of oral medication.｜span: "conditional recommendations against reversible occlusal splints (alone or in combination with other interventions), arthrocentesis (alone or in combination with other interventions), cartilage supplement with or without hyaluronic acid injection, low level laser therapy (alone or in combination with other interventions), transcutaneous electrical nerve stimulation, gabapentin, botulinum toxin injection, hyaluronic acid injection, relaxation therapy, trigger point injection, acetaminophen (with or without muscle relaxants or NSAIDS), topical capsaicin, biofeedback, corticosteroid injection (with or without NSAIDS), benzodiazepines, and β blockers"｜caveat: "Conditional recommendation against" is GRADE terminology and is not a prohibition; medicine names appear only in the verbatim original of this span, and the body text of this article makes no efficacy statement about, or recommendation for the use of, any medicine.
F15｜source #2｜confidence: high｜basis: clinical_guideline (PMID 38101929)｜geo: universal｜period: 2023-12-15｜claim: The guideline gives strong recommendations against irreversible intraoral occlusal appliances, discectomy, and non-steroidal anti-inflammatory drugs combined with opioids.｜span: "strong recommendations against irreversible oral splints, discectomy, and NSAIDS with opioids"｜caveat: The population is chronic TMD pain; this must not be extrapolated to procedures of the same name under other indications.
F16｜source #2｜confidence: high｜basis: clinical_guideline (PMID 38101929)｜geo: universal｜period: 2023-12-15｜claim: The guideline applies only to chronic TMD-associated pain lasting 3 months or more and does not apply to acute TMD pain; it is to be used by considering the strongly recommended interventions first, then those conditionally recommended in favour, then those conditionally against, with shared decision making essential.｜span: "These recommendations apply to patients living with chronic pain (≥3 months duration) associated with TMD as a group of conditions, and do not apply to the management of acute TMD pain. When considering management options, clinicians and patients should first consider strongly recommended interventions, then those conditionally recommended in favour, then conditionally against. In doing so, shared decision making is essential to ensure patients make choices that reflect their values and preference, availability of interventions, and what they may have already tried."｜caveat: This unit is the guideline's own declaration of scope and order of use (the original UNDERSTANDING THE RECOMMENDATION section), and is the basis on which this article separates the "chronic pathway" from the "acute event" and states the order in which the ladder is used.
F17｜source #2｜confidence: high｜basis: clinical_guideline (PMID 38101929)｜geo: universal｜period: 2023-12-15｜claim: The guideline notes that current clinical practice guidelines are largely consensus-based and provide recommendations inconsistent with one another.｜span: "Current clinical practice guidelines are largely consensus-based and provide inconsistent recommendations."｜caveat: This is the guideline's assessment of the current state; this article cites it as background for why conclusions from different sources can look contradictory.
F18｜source #5｜confidence: medium｜basis: peer_reviewed (PMID 41058307, umbrella review)｜geo: universal｜period: 2026-01｜claim: The umbrella review screened 1740 records and included 11 systematic reviews covering 49 unique primary studies; 6 reported favourable results for self-management while 5 judged the evidence insufficient to support or oppose it; the overlap of primary studies was 53%, and the main evidence gaps were in quality of life and adverse effects.｜span: "11 SRs comprising 49 unique primary studies were included. Of these, six SRs reported favorable results for self-management for TMD, whereas five reported insufficient evidence either for or against the use of self-management compared to other interventions. The overlap of primary studies between the SRs was 53%, and the main evidence gaps were related to quality of life and adverse effects outcomes."｜caveat: As a review of reviews, its evidential strength is limited by the quality of the underlying systematic reviews; the authors note methodological shortcomings in the included reviews.
span: "A total of 1740 studies were identified."
F19｜source #5｜confidence: medium｜basis: peer_reviewed (PMID 41058307)｜geo: universal｜period: 2026-01｜claim: Existing evidence broadly suggests beneficial effects from self-management strategies such as patient education, behavioural therapy and jaw exercise.｜span: "Existing evidence generally suggests beneficial effects from self-management strategies such as patient education, behavioural therapy and jaw exercises."｜caveat: The original reads generally suggests, a directional statement; it must not be rewritten as a promise of efficacy or a numerical promise.
F20｜source #6｜confidence: medium｜basis: peer_reviewed (PMID 39953753, systematic review and meta-analysis)｜geo: universal｜period: 2025-06｜claim: The meta-analysis included 6 studies out of 619; on mouth-opening range there was no statistically significant difference between the occlusal splint group and the botulinum toxin group.｜span: "Out of 619 studies, only six were included in the meta-analysis. The effect size was 0.293 in favour of BTX in the studies evaluating the maximum mouth-opening (MMO) range. However, the amount of MMO did not show a statistically significant difference between the OS and BTX groups (95% CI - 0.383 to 0.969, P = 0.395, z = -0.850)."｜caveat: Only 6 studies were included; "no statistically significant difference" is verbatim from the original (P = 0.395) and is not an inference by this site; the effect size of 0.293 favours BTX but did not reach significance, and the effect size must not be quoted on its own.
F21｜source #6｜confidence: medium｜basis: peer_reviewed (PMID 39953753)｜geo: universal｜period: 2025-06｜claim: Subgroup analysis showed a higher mouth-opening range in the botulinum toxin group at 1 week and in the occlusal splint group at 3 months, with no significant difference at the 1, 2, 6 and 12 month follow-up points; nor was there a significant difference between the groups on the graded chronic pain scale.｜span: "it was found that the MMO was statistically significantly higher in the BTX group at the first week and in the OS group at the third month. However, there was no significant difference observed at the first, second, sixth and twelfth month follow-ups (P > 0.05). No significant difference was found between the groups (P > 0.05) in the publications that evaluated the graded chronic pain scale (GCPS)"｜caveat: This study compares two interventions against each other, not against placebo; it must not be used to overturn or replace the guideline recommendations in F14 (the comparators differ).
F22｜source #7｜confidence: medium｜basis: peer_reviewed (PMID 21676208, systematic review)｜geo: universal｜period: 2011-06-15｜claim: The review examined 128 articles, of which 79 were judged relevant; the pooled cases were 79 acute dislocations, 35 chronic protracted dislocations and 311 chronic recurrent dislocations.｜span: "A total of 128 articles were reviewed out which 79 were found relevant. Of these, 26 were case reports, 17 were case series and 36 were original articles. 79 cases were acute dislocations, 35 cases were chronic protracted TMJ dislocations and 311 cases were chronic recurrent TMJ dislocations."｜caveat: The included literature is mainly case reports and case series (26 case reports, 17 case series, 36 original articles), not randomised controlled trials, so the evidence level is low.
F23｜source #7｜confidence: medium｜basis: peer_reviewed (PMID 21676208)｜geo: universal｜period: 2011-06-15｜claim: The aetiology recorded in that review was predominantly trauma (about 60%), with about 40% from other causes; among all the cases reviewed only 4 were unilateral dislocations.｜span: "Etiology was predominantly trauma in 60% of cases and other causes contributed about 40%. Of all the cases reviewed, only 4 were unilateral dislocation."｜caveat: These are proportions from a pooling of the literature, subject to publication bias, and do not represent the aetiological distribution in a community population; source #8 within the same citation pool (see F54) gives a different distribution of aetiology (trauma 4 cases, wide mouth opening 6 cases, unknown 1 case), and the two must be read together and must not be substituted for or merged with each other.
F24｜source #7｜confidence: high (for the wording of the conclusion itself)｜basis: peer_reviewed (PMID 21676208)｜geo: universal｜period: 2011-06-15｜claim: The review concludes that more complex and more invasive methods of treatment do not necessarily offer the better option or outcome, and that conservative approaches should therefore be exhausted and used appropriately before more invasive surgical techniques are adopted.｜span: "The more complex and invasive method of treatment may not necessarily offer the best option and outcome of treatment, therefore conservative approaches should be exhausted and utilized appropriately before adopting the more invasive surgical techniques."｜caveat: This is the authors' practical principle in the conclusion; it specifies no order or indication threshold for any particular technique.
F25｜source #8｜confidence: low｜basis: peer_reviewed (PMID 29556163, review of 11 cases)｜geo: universal｜period: 2017-12｜claim: In that review of 11 cases, 4 acute cases were successfully reduced with the Hippocrates manoeuvre, 1 had the manoeuvre under general anaesthesia, and 2 underwent spontaneous reduction (the original reads spontaneous reduction, meaning reduction without a manoeuvre, not an operation performed by the patient); the recurrent cases were managed with that manoeuvre plus intermaxillary fixation.｜span: "4 of the acute cases were successfully managed using the Hippocrates manoeuvre, 1 had the manoeuvre under GA, and 2 had spontaneous reduction. All recurrent cases were successfully managed with the Hippocrates manoeuvre and IMF."｜caveat: A single-centre review of 11 cases with a low evidence level; it cannot serve as a basis for estimating incidence or success rates; this article cites it as evidence that reduction is a clinical procedure, some of which requires general anaesthesia, and gives no operating instructions; "spontaneous reduction" renders the original spontaneous reduction, meaning reduction without a manoeuvre, and must not be rewritten as "the patient reduced it themselves", which would conflict with the prohibition stated in this article.
span: "Case review of 11 patients with TMJ dislocation seen in the University College Hospital (UCH) Ibadan over a period of 10 years."
F26｜source #8｜confidence: low｜basis: peer_reviewed (PMID 29556163)｜geo: universal｜period: 2017-12｜claim: The review concludes that the conservative Hippocrates reduction manoeuvre was effective in most cases, irrespective of the duration of the dislocation.｜span: "A conservative method of management - the Hippocrates manoeuvre - was effective in most cases irrespective of duration of dislocation."｜caveat: The sample is only 11 cases with follow-up mostly within 2 weeks, and the authors also record poor follow-up compliance; "effective in most cases" must not be rewritten as a success-rate figure or a promise of outcome; the same abstract also records that only 50% of the chronic cases were successfully managed with that manoeuvre (see F55), a direction inconsistent with this concluding sentence about duration, so this unit must be read together with F55.
F27｜source #9｜confidence: low｜basis: peer_reviewed (PMID 41227277, systematic review, PROSPERO CRD420251139493)｜geo: universal｜period: 2025-11-06｜claim: For recurrent temporomandibular joint dislocation in children, the review included 9 studies (1 case-control study, 3 case series, 5 case reports); minimally invasive and conservative methods were the more frequently described, and among the minimally invasive ones botulinum toxin injection was the most frequently reported.｜span: "nine studies were included: one case-control study, three case series, and five case reports. Invasive treatment methods applied in pediatric patients were reported in two of those. Minimally invasive and conservative treatment methods were most frequently described, with botulinum toxin injections being the most commonly reported minimally invasive approach."｜caveat: "More frequently described" refers to frequency of appearance in the literature and does not mean better efficacy; the medicine name appears only in the verbatim original of this span, and this article makes no efficacy statement about it and gives no recommendation for its use.
F28｜source #9｜confidence: high (for the "no conclusion could be drawn" conclusion itself)｜basis: peer_reviewed (PMID 41227277)｜geo: universal｜period: 2025-11-06｜claim: The review states explicitly that, because of heterogeneity and the limited amount of available literature, consistent conclusions about the effectiveness of the various treatment methods for recurrent temporomandibular joint dislocation in children could not be drawn.｜span: "Due to the heterogeneity and limited number of available literature, consistent conclusions regarding the effectiveness of different treatment methods for recurrent TMJ dislocation in children could not be drawn."｜caveat: This unit is a statement of an evidence gap; no ranking of efficacy may be derived from the "frequency of description" in F27.
F29｜source #10｜confidence: medium｜basis: peer_reviewed (PMID 36098813, systematic review, PROSPERO CRD42020199591)｜geo: universal｜period: 2022-11｜claim: For borderline skeletal Class III malocclusion the review included 6 articles out of 2089 and rated the overall risk of bias as moderate; because the included studies differed considerably, a meta-analysis could not be performed.｜span: "Out of 2089 retrieved articles, 6 were eligible and thus included in the subsequent analyses. Their overall risk of bias was moderate."｜caveat: Only 6 studies were included and no meta-analysis was performed; the authors note that some important data were missing and call for more methodologically standardised research.
F30｜source #10｜confidence: medium｜basis: peer_reviewed (PMID 36098813)｜geo: universal｜period: 2022-11｜claim: Orthodontics combined with orthognathic surgery has a protrusive effect on the maxillary base and a retrusive effect on the mandibular base, thereby improving the sagittal relationship, accompanied by a clockwise rotational effect on the mandibular plane; orthodontic camouflage alone produces greater proclination of the maxillary incisors and retroclination of the mandibular incisors.｜span: "The OSS has a protrusive effect on the maxillary base, retrusive effect on the mandibular base, and thus improvement in the sagittal relationship accompanied with a clockwise rotational effect on the mandibular plane. The OC has more proclination effect on the maxillary incisors and retroclination effect on the mandibular incisors compared to OOS."｜caveat: The population is limited to "borderline" skeletal Class III cases and must not be extrapolated to all cases of mandibular prognathism; these are directional effect descriptions and give no figure an individual can expect.
F31｜source #11｜confidence: medium｜basis: peer_reviewed (PMID 42273603, systematic review)｜geo: universal｜period: 2026-05-26｜claim: The review included 65 studies covering 6,482 patients; mean ANB angle improvement for skeletal Class III correction was 6.8° (95% CI 6.2 to 7.4°), with 87.3% maintaining skeletal stability at one year or more of follow-up.｜span: "Sixty-five studies encompassing 6,482 patients were included. Mean ANB angle improvements were 6.8° (95% CI: 6.2-7.4°) for class III and 5.4° (95% CI: 4.9-5.9°) for class II corrections, with 87.3% maintaining skeletal stability at ≥1-year follow-up."｜caveat: These are averages pooled across multiple studies, not outcomes an individual can expect; this article quotes only the skeletal Class III figures.
F32｜source #11｜confidence: medium｜basis: peer_reviewed (PMID 42273603)｜geo: universal｜period: 2026-05-26｜claim: The overall complication rate of orthognathic surgery was 32.4% (95% CI 28.7 to 36.1%), predominantly minor and self-limiting.｜span: "Overall complication rate was 32.4% (95% CI: 28.7-36.1%), predominantly minor and self-limiting."｜caveat: A population-level pooled proportion, not individual risk; "predominantly minor and self-limiting" is the original description and gives no breakdown for serious complications; this figure is a combined value across the 65 studies and 6,482 patients with maxillofacial skeletal deformity in that review, which the original did not stratify by skeletal classification (class II / III) or by technique (BSSO / Le Fort), and it must not be read as the risk specific to any one skeletal classification.
F33｜source #11｜confidence: medium｜basis: peer_reviewed (PMID 42273603)｜geo: universal｜period: 2026-05-26｜claim: Neurosensory disturbance occurred in 52.8% of cases, of which 92.6% recovered within 12 months, with 3.4% being what the original calls permanent, that is, persistent change that did not recover.｜span: "Neurosensory disturbances occurred in 52.8% of cases, with 92.6% recovering by 12 months and permanent alterations in 3.4%."｜caveat: Not broken down by technique or site; this article renders permanent as "persistent sensory change that did not recover", and the original wording is retained in the span for verification; this too is a combined value across 6,482 patients that the original did not stratify by skeletal classification, and must not be read as a proportion specific to surgery for mandibular prognathism (skeletal Class III).
F34｜source #11｜confidence: medium｜basis: peer_reviewed (PMID 42273603)｜geo: universal｜period: 2026-05-26｜claim: Relapse (greater than 2 mm) occurred in 18.7% of cases; quality of life improved substantially (standardised mean difference for OQLQ total scores -1.84, 95% CI -2.12 to -1.56); patient satisfaction reached 87.6% (95% CI 84.2 to 91.0%), with aesthetic outcomes rated higher than functional ones.｜span: "Relapse (>2mm) occurred in 18.7% of cases. Quality of life demonstrated substantial improvements with standardized mean difference of -1.84 (95% CI: -2.12 to -1.56, p < 0.001) for OQLQ total scores. Patient satisfaction reached 87.6% (95% CI: 84.2-91.0%), with higher ratings for aesthetic vs. functional outcomes."｜caveat: Satisfaction is a patient-reported measure, not a clinical efficacy measure, and must not be used as a promise of efficacy or outcome; relapse, quality of life and satisfaction are likewise combined values across 6,482 patients that the original did not stratify by skeletal classification or technique.
F35｜source #11｜confidence: high (for the wording of the conclusion itself)｜basis: peer_reviewed (PMID 42273603)｜geo: universal｜period: 2026-05-26｜claim: The review concludes that moderate complication rates and relapse risk make careful patient selection, informed consent and long-term follow-up necessary.｜span: "However, moderate complication rates and relapse risk necessitate careful patient selection, informed consent, and long-term follow-up."｜caveat: This unit is the sole basis for the "informed consent and long-term follow-up" passage in this article; it is a statement of clinical principle from the international literature and cites no country's statutory requirements.
F36｜source #12｜confidence: medium｜basis: peer_reviewed (PMID 40360332, systematic review and meta-analysis)｜geo: universal｜period: 2026-01｜claim: The study identified 33 studies, 29 of which entered the meta-analyses; overall, anteroposterior stability of the maxilla and mandible did not differ significantly between the conventional three-stage method and the surgery-first approach (maxilla P = 0.77, mandible P = 0.072).｜span: "Thirty-three studies were identified, 29 were included in the meta-analyses. Overall anteroposterior stability of the maxilla and mandible did not differ significantly between CTM and SFA groups (maxilla, P = 0.77; mandible, P = 0.072)."｜caveat: The search period was 2010 to 2022; "no significant difference" is not equivalence.
F37｜source #12｜confidence: low｜basis: peer_reviewed (PMID 40360332)｜geo: universal｜period: 2026-01｜claim: In the analysis of two-dimensional radiographs, results for anteroposterior stability of the mandible favoured the conventional three-stage method (P = 0.051), whereas vertical stability of the mandible was better with the surgery-first approach (P = 0.051); the authors conclude that the conventional three-stage method supports better anteroposterior stability.｜span: "In two-dimensional radiographs, the results for anteroposterior stability of the mandible were in favour of CTM (P = 0.051); conversely, vertical stability of the mandible showed better results with SFA (P = 0.051). ... In conclusion, CTM supports better anteroposterior stability."｜caveat: Both P values are 0.051 and do not reach the conventional 0.05 significance level, and must be read together with the overall result in F36; the evidential strength of the authors' conclusion is limited by F39.
F38｜source #12｜confidence: medium｜basis: peer_reviewed (PMID 40360332)｜geo: universal｜period: 2026-01｜claim: Treatment time was significantly shorter with the surgery-first approach (P < 0.001), and quality-of-life scores (22-item Orthognathic Quality of Life Questionnaire) at the 6 month follow-up point were better (P = 0.042).｜span: "SFA patients showed a significantly shorter treatment time (P < 0.001) and better quality of life (22-item Orthognathic Quality of Life Questionnaire) at 6 months follow-up (P = 0.042)."｜caveat: The quality-of-life difference was measured only at the 6 month follow-up point, with no longer-term difference reported.
F39｜source #12｜confidence: high (for the limitation statement itself)｜basis: peer_reviewed (PMID 40360332)｜geo: universal｜period: 2026-01｜claim: Only 6 of the 33 included studies were randomised controlled trials, and the authors state explicitly that the evidence is weak and the results must be interpreted with caution.｜span: "However, only six of the 33 included studies were randomized controlled trials, hence in view of the weakness of the evidence, the results should be interpreted with caution."｜caveat: This unit is a ceiling statement on evidential strength, and the reading of F36 to F38 is limited by it.
F40｜source #13｜confidence: medium｜basis: peer_reviewed (PMID 38858245, scoping literature review and cohort study)｜geo: universal｜period: 2024-09｜claim: The review screened 22 studies for analysis out of 67 articles and summarised the priorities of forehead procedures in order as reduction of frontal bossing, widening of the frontonasal angle, orbital contouring, brow lifting and hairline advancement.｜span: "Initial review yielded sixty-seven articles. Title and abstract review followed by standardized application of inclusion and exclusion criteria resulted in a total of twenty-two studies for analysis. Priorities of forehead feminization entail frontal bossing reduction, frontonasal angle widening, orbital contouring, brow lifting, and hairline advancement."｜caveat: The subject of that study is facial feminisation surgery; this article cites only its description of the anatomical targets and the scope of the techniques, and cites none of its population-specific conclusions on indications.
F41｜source #13｜confidence: low｜basis: peer_reviewed (PMID 38858245)｜geo: universal｜period: 2024-09｜claim: Its institutional cohort included 85 patients, of whom 92% had type 3 forehead classification, and the mean planned setback of the anterior table of the frontal bone was 4.12 mm; the level of evidence self-assigned as required by that journal was level III.｜span: "Eighty-five patients were included for analysis. The majority were of Caucasian race (56%) and had type 3 forehead classification (92%). The average planned setback of the anterior table was 4.12 mm." and "LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article."｜caveat: The subjects were a cohort of transfeminine patients undergoing facial feminisation surgery, a specific population; the distribution of classification types and the setback figure must not be extrapolated as surgical parameters for the general population, and this article uses them only to illustrate the anatomical target of the procedure and the order of magnitude.
F42｜source #14｜confidence: medium｜basis: peer_reviewed (PMID 35934514, technique review)｜geo: universal｜period: 2022-08｜claim: Testosterone produces several feature changes in the upper face, including elevation and squaring of the hairline, flattening of the central forehead, and increased anterior projection of the brow bone and orbital rims.｜span: "These changes include elevating and squaring the hairline, flattening the central forehead, and increasing the anterior projection of the brow bone and orbital rims."｜caveat: This is a background statement in a narrative technique review, not an epidemiological or causal study; this article cites none of its claims about the effects of any technique.
F43｜source #15｜confidence: medium｜basis: peer_reviewed (PMID 41161936, imaging review)｜geo: universal｜period: 2025-11｜claim: Radiolucent and radiopaque lesions of the temporomandibular joints that mimic cysts and tumours are rare; intraosseous lesions include subcortical pseudocysts, aneurysmal bone cysts and simple bone cysts, while lesions within the joint spaces include synovial and ganglion cysts as well as calcified entities such as synovial chondromatosis and calcium pyrophosphate deposits.｜span: "Radiolucent and radiopaque lesions of the temporomandibular joints (TMJs) mimicking cysts and tumors are rare. Some lesions in the TMJ complex are intraosseous, while others are in the joint spaces. Intraosseous lesions include cyst-like lesions, for example, subcortical pseudocysts, aneurysmal bone cysts, and simple bone cysts. Lesions in the joint spaces include low-density synovial and ganglion cysts and calcified entities such as synovial chondromatosis and calcium pyrophosphate deposits."｜caveat: This is a categorical enumeration in an imaging review and gives no incidence figure; this article cites it as the basis for "rare but real, and requiring imaging differentiation", and gives no diagnostic instruction.
F44｜source #16｜confidence: medium｜basis: peer_reviewed (PMID 31675112, narrative review)｜geo: universal｜period: 2020-01｜claim: Toothache, temporomandibular disorders, primary headache and post-traumatic trigeminal neuropathy mimic one another; the anatomical complexity of the region, the extensive differential diagnosis and the siloed training of the specialties lead to incorrect and delayed diagnosis and often result in patients receiving inappropriate surgical and medical treatment.｜span: "The anatomical complexity of the region, the potential exhaustive differential diagnoses and the multiple siloed training of specialties, leads to incorrect and delayed diagnosis and often results in patients undergoing inappropriate surgical and medical treatments."｜caveat: A narrative review, not a systematic review or a trial; it is a domain-level commentary on the phenomenon and contains no incidence figures.
F45｜source #16｜confidence: medium｜basis: peer_reviewed (PMID 31675112)｜geo: universal｜period: 2020-01｜claim: The review notes that many patients are prescribed countless courses of antibiotics and undergo multiple surgical interventions simply because of the poor education produced by siloed specialty training, and the authors argue that this must be addressed to improve patient safety.｜span: "Many patients are prescribed countless courses of antibiotics and undergo multiple surgical interventions simply as a result of poor education due to siloed specialty training. This must be addressed to improve patient safety."｜caveat: This is the authors' commentary argument, not quantitative evidence; this article cites it as the basis for "avoid irreversible procedures before the diagnosis is clarified".
F46｜source: this site's editorial judgement｜confidence: n/a｜basis: editorial_framework｜geo: universal｜period: 2026-08-06｜claim: The classification map, management ladder and red-flag compilation in this article are structures for communication, not diagnostic tools, and not any individual's treatment plan; this article provides no method for self-reduction, self-medication or self-diagnosis.｜caveat: An editorial framework statement; it carries no medical factual claim.
F47｜source: this site's editorial judgement｜confidence: n/a｜basis: editorial_framework｜geo: universal｜period: 2026-08-06｜claim: The cost passage in this article explains only what costs are made of and what makes them vary (diagnostic pathway, personnel and course length, whether imaging is added, technique strategy, follow-up duration); it gives no monetary amounts and touches no country's reimbursement system.｜caveat: An editorial framework statement; the clinical basis for each variable is attached to the corresponding F-Unit.
F48｜source: this site's editorial judgement｜confidence: n/a｜basis: editorial_framework｜geo: universal｜period: 2026-08-06｜claim: This round of PubMed E-utilities searching (queries including temporomandibular disorders clinical practice guideline, conditions mimicking temporomandibular disorders differential diagnosis, red flags orofacial pain serious pathology and others) did not obtain a citable, complete study of TMD red-flag criteria; the red-flag section of this article lists only the situations the existing sources can support and is not an exhaustive list.｜caveat: "Not obtained" is not the same as "refuted"; this field is an editorial statement and must not be marked as a claim awaiting verification.
F49｜source: this site's editorial judgement｜confidence: n/a｜basis: editorial_framework｜geo: universal｜period: 2026-08-06｜claim: This is a domain-layer article; answers to concrete questions are the responsibility of the corresponding canonical cards, and this article only summarises and points the way, does not rewrite card content, and claims no card has been published.｜caveat: An editorial framework statement; the status of each card follows the status field of its file.
F50｜source: this site's editorial judgement (based on F30, F31, F40, F41, F42)｜confidence: n/a｜basis: editorial_framework｜geo: universal｜period: 2026-08-06｜claim: Specialty boundaries are distinguished by the anatomical targets described in the literature: the target of orthognathic surgery is the positional relationship of the upper and lower jaw bones and the occlusion (F30, F31), while the target of forehead and brow-ridge procedures is the anterior table of the frontal bone, the frontonasal angle, the orbital rims and the hairline, unrelated to the dentition or occlusion (F40 to F42), and the literature on the latter is published in plastic surgery and otolaryngology–head and neck / facial plastic surgery journals respectively; so the management of a prominent brow ridge is not the same thing as an occlusal procedure in general dentistry and usually requires separate assessment and referral.｜caveat: This is an editorial inference drawn from existing sources, not a conclusion stated in any source; this unit can support only "what the anatomical target is" and "in which fields the literature is published", and cannot support "which specialty performs it", so neither the body nor the FAQ may write exclusionary conclusions such as "and not dentistry"; actual referral and specialty division are determined clinically, and in some regions craniofacial and oral and maxillofacial surgery teams also take on forehead procedures.
F51｜source: this site's editorial judgement｜confidence: n/a｜basis: editorial_framework｜geo: universal｜period: 2026-08-06｜claim: The geo_scope of this article is global; all medical claims are anchored to international literature and professional-society guidelines, and no country's regulations, insurance coverage or fee schedules are cited; for local systems and costs see the corresponding local canonical card.｜caveat: An editorial framework statement; when seeking care in another region, follow the local rules on system matters.
F52｜source: this site's editorial judgement｜confidence: n/a｜basis: editorial_framework｜geo: universal｜period: 2026-08-06｜claim: This round of searching did not obtain citable, systematically compiled literature listing the contraindications of temporomandibular and orthognathic procedures, so this article provides no contraindication list; contraindications must be determined individually by a physician on the basis of systemic condition, medication history and imaging assessment.｜caveat: "Not obtained" is not the same as "does not exist"; this field is an evidence-gap statement and must not be marked as a claim awaiting verification.
F53｜source: this site's editorial judgement (on the evidential boundary of source #11)｜confidence: n/a｜basis: editorial_framework｜geo: universal｜period: 2026-08-06｜claim: The quantitative results for orthognathic surgery cited in this article (ANB improvement, proportion with skeletal stability, overall complication rate, proportion with neurosensory disturbance, relapse proportion, quality of life and satisfaction) all come from a single systematic review (source #11, published in 2026); this round of searching did not obtain a second systematic review able to cross-check the same set of measures, so the figures above should be read as pooled values from a single source, not as a settled finding consistent across studies.｜caveat: A statement of evidential boundary; the presence of figures must not be taken as high certainty, and they must not be rewritten as outcomes any individual can expect.
F54｜source #8｜confidence: low｜basis: peer_reviewed (PMID 29556163, review of 11 cases)｜geo: universal｜period: 2017-12｜claim: In that review of 11 cases, the aetiology was trauma in 4 cases, wide mouth opening in 6 cases and unknown in 1; in their conclusion the authors list "wide mouth opening as an aetiology" among the characteristics of the temporomandibular joint dislocation pattern at that hospital.｜span: "Aetiology was trauma in 4 cases, wide mouth opening in 6 cases and unknown in a patient." and "The pattern of presentation of TMJ dislocation in the above named hospital was anterior dislocation, the female gender predominance, aetiology of wide mouth opening, as well as early presentation."｜caveat: Single-centre, 11 cases, a very small sample, and it must not serve as an estimate of the aetiological distribution in a population; the function of this unit is to be read together with F23 (trauma 60% from the pooled literature) so that the inconsistency between the two sources is visible; it is not used to overturn F23, nor may F23 be used to overturn it.
span: "Case review of 11 patients with TMJ dislocation seen in the University College Hospital (UCH) Ibadan over a period of 10 years."
F55｜source #8｜confidence: low｜basis: peer_reviewed (PMID 29556163)｜geo: universal｜period: 2017-12｜claim: The review records that 50% of the chronic cases were successfully managed with the Hippocrates manoeuvre.｜span: "Fifty percent of the chronic cases were successfully managed with the Hippocrates manoeuvre."｜caveat: That series contained only 2 chronic cases (the original reads "There were 7 acute presentations, 2 recurrences and 2 chronic presentations"), so 50% means 1 case and the information content of the proportion is extremely low; the function of this unit is to prevent quoting the authors' concluding sentence in F26 while dropping the figures in the same passage that point the other way, and it must not be used to claim any success rate.

Expansion addition: non-odontogenic orofacial pain (F56–F83, 2026-08-06)

F56｜source #17｜confidence: medium｜basis: peer_reviewed (PMID 41238336, narrative review)｜geo: universal｜period: 2026-01｜claim: Non-odontogenic toothache is toothache of non-dental origin, with aetiologies including but not limited to myofascial, cardiac, neurovascular, trigeminal neuralgia, sinus origin, infection, drugs, systemic conditions and psychogenic.｜span: "Nonodontogenic toothaches (NOTAs) are toothaches of nondental origin with etiologies including but not limited to myofascial, cardiac, neurovascular, trigeminal neuralgia, sinus origin, infections, drugs, systemic conditions, and psychogenic."｜caveat: This is a scope definition in a narrative review and gives no incidence for any aetiology; no ranking of causes for any individual may be derived from the list.
F57｜source #17｜confidence: medium｜basis: peer_reviewed (PMID 41238336)｜geo: universal｜period: 2026-01｜claim: Reproduction of the patient's familiar presenting pain is crucial to the diagnosis of non-odontogenic toothache; the site of the pain and the source of the pain are two different things.｜span: "Reproduction of the patient's chief complaint/familiar pain is crucial for the diagnosis of NOTAs. The site and source of pain are different."｜caveat: This is a statement of a diagnostic principle, not a test that can be performed by oneself; this article gives no self-testing steps.
F58｜source #17｜confidence: medium｜basis: peer_reviewed (PMID 41238336)｜geo: universal｜period: 2026-01｜claim: Because it presents as a toothache, non-odontogenic toothache poses a genuine diagnostic challenge and leads patients into unnecessary and irreversible treatment; a thorough medical and travel history, clinical examination, imaging, laboratory investigation and diagnostic and pharmacologic testing are therefore crucial for accurate diagnosis, followed by an interdisciplinary management approach.｜span: "NOTAs can pose a real diagnostic challenge due to its presentation as a toothache, rendering unnecessary and irreversible treatment of the patients." and "a thorough medical and travel history, clinical examination, imaging, laboratory investigations, diagnostic and pharmacologic testing are crucial for accurate diagnosis followed by an interdisciplinary management approach"｜caveat: "Diagnostic and pharmacologic testing" renders the original diagnostic and pharmacologic testing and belongs to the clinical side; this article does not describe how it is carried out and gives no medication instruction.
F59｜source #18｜confidence: high (for the bibliographic fact itself)｜basis: peer_reviewed (PMID 32103673)｜geo: universal｜period: 2020-02｜claim: The International Classification of Orofacial Pain, 1st edition (ICOP) was published in Cephalalgia in February 2020.｜span: "International Classification of Orofacial Pain, 1st edition (ICOP)"｜caveat: That PubMed record carries bibliographic data only and has no abstract, so this site can quote its title verbatim only; the definitions and content of ICOP are all presented through secondary citation from sources #19, #20 and #30 and others whose abstracts could be retrieved, and this article quotes no ICOP body text verbatim.
F60｜source #19｜confidence: medium｜basis: peer_reviewed (PMID 36404082, clinical review)｜geo: universal｜period: 2023-01｜claim: The review quotes the ICOP description of idiopathic pain as unilateral or bilateral intraoral or facial pain in the distribution of one or more branches of the trigeminal nerve, of unknown aetiology; the pain is usually persistent, of moderate intensity, poorly localised and described as dull, pressing or burning. The diagnoses collected in the ICOP idiopathic pain section include burning mouth syndrome and persistent idiopathic facial and dentoalveolar pain.｜span: "unilateral or bilateral intraoral or facial pain in the distribution(s) of one or more branches of the trigeminal nerve(s) for which the etiology is unknown. Pain is usually persistent, of moderate intensity, poorly localized and described as dull, pressing or of burning character." and "Several diagnoses are included in the ICOP Idiopathic pain section, burning mouth syndrome and persistent idiopathic facial and dentoalveolar pain."｜caveat: This is that review's secondary citation of ICOP, not a verbatim quotation of ICOP body text (which was not retrieved, see F59); the "central pain disorder" raised in that paper's title is a question posed by the authors, and this article cites none of its mechanistic claims.
F61｜source #20｜confidence: medium｜basis: peer_reviewed (PMID 35574619, narrative review)｜geo: universal｜period: 2022-06-12｜claim: The review quotes the ICOP 2020 definition of burning mouth syndrome verbatim: idiopathic orofacial pain with intraoral burning or dysaesthesia recurring daily for more than 2 hours per day and for more than 3 months, without any identifiable causative lesion, with or without somatosensory change; and it records that worldwide prevalence was estimated at 1.73% in population-based studies, with women and older people at higher risk.｜span: "idiopathic orofacial pain with intraoral burning or dysesthesia recurring daily for more than 2 hours per day and more than 3 months, without any identifiable causative lesions, with or without somatosensory changes" and "Worldwide prevalence of BMS was estimated to be 1.73% in population-based studies, while female and elderly are at higher risk of BMS."｜caveat: A narrative review, not a systematic review; the 1.73% it quotes comes from the same origin as source #22, and the two must not be double-counted as two independent pieces of evidence.
F62｜source #21｜confidence: medium｜basis: peer_reviewed (PMID 40815383, narrative review)｜geo: universal｜period: 2025-09｜claim: Burning mouth syndrome is a chronic pain condition characterised by a persistent burning sensation in the oral mucosa in the absence of visible clinical signs; distinguishing primary (idiopathic) from secondary (associated with identifiable underlying conditions) burning mouth syndrome is critical for guiding treatment.｜span: "Burning mouth syndrome (BMS) is a chronic pain condition characterized by a persistent burning sensation in the oral mucosa in the absence of visible clinical signs." and "Differentiating between primary (idiopathic) and secondary (associated with identifiable underlying conditions) BMS is critical for guiding treatment."｜caveat: That paper is a narrative review, and its abstract also enumerates several classes of pharmacological and non-pharmacological option; this article cites none of its efficacy statements and lists no medicine name in the body text; the individual determination of primary versus secondary belongs to clinical assessment, and this article provides no checklist for it.
F63｜source #22｜confidence: medium｜basis: peer_reviewed (PMID 33818878, systematic review and meta-analysis)｜geo: universal｜period: 2022-09｜claim: The review included 18 articles and pooled the prevalence of burning mouth syndrome at 1.73% in the general population and 7.72% in clinical patients; subgroup analysis by gender showed a higher prevalence in women (1.15%) than in men (0.38%), and subgroup analysis by age showed a higher prevalence in those over 50 (3.31%) than under 50 (1.92%).｜span: "Eighteen articles were included. The overall pooled prevalence of burning mouth syndrome was 1.73% (95% CI = 0.176-0.351, n = 26,632) in general population, and 7.72% (95% CI = 0.434-0.691, n = 86,591) in clinical patients." and "The subgroup analysis by gender showed the prevalence of female (1.15%) was higher than male (0.38%) in general population. The subgroup analysis by age showed the prevalence was higher for people over 50 (3.31%) than under 50 (1.92%)."｜caveat: The 95% CIs reported in the original (0.176-0.351 and 0.434-0.691) are inconsistent in order of magnitude with its own percentage point estimates (this is as printed in the original); this article therefore quotes only the point estimates and does not quote, convert or speculate about those intervals. Population-level estimates are not individual risk.
F64｜source #23｜confidence: medium｜basis: peer_reviewed (PMID 38155008, systematic review and meta-analysis)｜geo: universal｜period: 2024-02｜claim: Using the current International Headache Society classifications (ICHD-3 and ICOP), the review included 41 studies out of 4,252; the pooled results showed a predominance of female patients with age concentrated in what the original calls the sixth and seventh decade of life, with the burning sensation and the tongue the most frequent descriptor and site; and significant associations were shown between burning mouth syndrome and anxiety (P = .0006), depression (P = .004) and poor oral hygiene (P = .00001).｜span: "Of the 4,252 studies identified, 41 were included." and "Studies were pooled in meta-analyses and showed a significant prevalence of female patients between the sixth and seventh decade of life. The burning sensation and the tongue were the most prevalent descriptors and affected location." and "Significant associations were demonstrated between BMS and anxiety (P = .0006), depression (P = .004), and poor oral hygiene (P = .00001)."｜caveat: Association is not causation, and the original did not determine a direction either; "the sixth and seventh decade of life" renders sixth and seventh decade of life, and this article does not convert it into an age range on the reader's behalf; "most frequent" renders most prevalent and does not constitute a basis for diagnosis.
F65｜source #24｜confidence: high｜basis: peer_reviewed (PMID 27855478, Cochrane systematic review)｜geo: universal｜period: 2016-11-18｜claim: The term burning mouth syndrome refers to oral mucosal pain (burning pain or discomfort in the tongue, lips or the entire oral cavity) without identifiable cause; general population prevalence varies from 0.1% to 3.9%; many patients with burning mouth syndrome have anxiety, depression, personality disorders and impaired quality of life.｜span: "Burning mouth syndrome (BMS) is a term used for oral mucosal pain (burning pain or discomfort in the tongue, lips or entire oral cavity) without identifiable cause. General population prevalence varies from 0.1% to 3.9%." and "Many BMS patients indicate anxiety, depression, personality disorders and impaired quality of life (QoL)."｜caveat: A background statement in the Cochrane review; the comorbidities are descriptive associations with no causal direction given; the prevalence range in this unit has a different scope from the pooled estimate of source #22, and the two must not be merged or substituted for each other.
F66｜source #24｜confidence: high｜basis: peer_reviewed (PMID 27855478)｜geo: universal｜period: 2016-11-18｜claim: The review included 23 randomised controlled trials (1,121 analysed participants, 83% female); only 1 was assessed at low risk of bias overall, 4 were unclear and 18 were at high risk of bias; the overall quality of the evidence for effectiveness was very low for all interventions and all outcomes.｜span: "We included 23 RCTs (1121 analysed participants; 83% female)." and "Only one RCT was assessed at low risk of bias overall, four RCTs' risk of bias was unclear, and 18 studies were at high risk of bias." and "Overall quality of the evidence for effectiveness was very low for all interventions and all outcomes."｜caveat: "Very low quality of evidence" is GRADE terminology, meaning very low confidence in the effect estimates, not that the interventions are harmful; the search cut-off was 2015-12-31, so more recent trials are not included (see source #25).
F67｜source #24｜confidence: high (for the wording of the conclusion itself)｜basis: peer_reviewed (PMID 27855478)｜geo: universal｜period: 2016-11-18｜claim: The authors conclude that, owing to the limited number of clinical trials at low risk of bias, there is insufficient evidence to support or refute the use of any intervention in managing burning mouth syndrome.｜span: "Due to the limited number of clinical trials at low risk of bias, there is insufficient evidence to support or refute the use of any interventions in managing BMS."｜caveat: "Insufficient evidence" is not the same as "ineffective", nor the same as "should not be managed"; this unit must not be rewritten as a negative or positive claim about any intervention.
F68｜source #25｜confidence: medium｜basis: peer_reviewed (PMID 36214096, systematic review and network meta-analysis, PROSPERO CRD42021255039)｜geo: universal｜period: 2023-02｜claim: The network meta-analysis included 44 trials (24 in the network analysis); among all the treatments tested, only one anxiolytic-class drug (clonazepam in the original) probably reduces the pain of burning mouth syndrome when compared with placebo (mean difference −1.88, 95% CI −2.61 to −1.16, moderate certainty); most of the remaining treatments were at low and very low certainty, mainly owing to imprecision, indirectness and intransitivity.｜span: "Forty-four trials were included (24 in the NMA). The anxiolytic (clonazepam) probably reduces the pain of BMS when compared with placebo (MD, -1.88; 95% CI, -2.61 to -1.16; moderate certainty)." and "Among all tested treatments, only clonazepam is likely to reduce the pain of BMS when compared with placebo. The majority of the other treatments had low and very low certainty, mainly due to imprecision, indirectness, and intransitivity."｜caveat: The medicine name appears only in the verbatim original of this span; the body text of this article makes no efficacy statement about any medicine and gives no dose, administration or discontinuation instruction; "moderate certainty" is GRADE terminology, not a promise of efficacy; the original also records that photobiomodulation and another medicine reached its defined minimal important difference threshold but at low or very low certainty, and this article does not cite that part so as not to overstate the strength of the evidence.
F69｜source #26｜confidence: high｜basis: clinical_guideline (PMID 30860637, indexed in PubMed under the publication type Practice Guideline)｜geo: universal｜period: 2019-06｜claim: The guideline recommends use of the most recent classification system, diagnosing trigeminal neuralgia as primary (either classical or idiopathic depending on the degree of neurovascular contact) or as secondary, caused by pathology other than neurovascular contact; and it recommends that magnetic resonance imaging (a combination of three high-resolution sequences) be performed as part of the work-up, because no clinical characteristic can exclude secondary trigeminal neuralgia.｜span: "The use of the most recent classification system is recommended, which diagnoses TN as primary TN, either classical or idiopathic depending on the degree of neurovascular contact, or as secondary TN caused by pathology other than neurovascular contact." and "Magnetic resonance imaging (MRI), using a combination of three high-resolution sequences, should be performed as part of the work-up in TN patients, because no clinical characteristics can exclude secondary TN."｜caveat: This site retrieved only the PubMed abstract; the body text of the guideline was not retrieved and is not quoted verbatim; imaging technique and timing are clinical decisions, and this article specifies no examination for any individual.
F70｜source #26｜confidence: high｜basis: clinical_guideline (PMID 30860637)｜geo: universal｜period: 2019-06｜claim: The guideline records that in Europe trigeminal neuralgia patients are managed by many different specialties; it recommends that surgery be offered if pain is not sufficiently controlled medically or if medical treatment is poorly tolerated, with microvascular decompression as first-line surgery in classical trigeminal neuralgia; and it recommends that psychological and nursing support be offered in addition to medical and surgical management.｜span: "In Europe, TN patients are managed by many different specialities." and "It is recommended that patients should be offered surgery if pain is not sufficiently controlled medically or if medical treatment is poorly tolerated. Microvascular decompression is recommended as first-line surgery in patients with classical TN." and "In addition to medical and surgical management, it is recommended that patients are offered psychological and nursing support."｜caveat: "Managed by many different specialities" is that guideline's description of the situation in Europe and must not be read as a rule on specialty division in any region; the indications, complications and contraindications of surgery are outside the scope of this abstract, and this article makes no surgical recommendation.
F71｜source #26｜confidence: high｜basis: clinical_guideline (PMID 30860637)｜geo: universal｜period: 2019-06｜claim: The guideline recommends two specific oral prescription medicines as drugs of first choice for the long-term treatment of trigeminal neuralgia (carbamazepine or oxcarbazepine in the original).｜span: "For long-term treatment, carbamazepine or oxcarbazepine are recommended as drugs of first choice."｜caveat: The medicine names appear only in the verbatim original of this span, and the original abstract does not state their pharmacological class, so the body text of this article assigns no drug class; prescribing falls within a physician's scope, and this article gives no dose, administration, titration or discontinuation instruction and makes no efficacy claim about any medicine.
F72｜source #27｜confidence: medium｜basis: peer_reviewed (PMID 36404084, clinical review)｜geo: universal｜period: 2023-01｜claim: Trigeminal neuralgia is a rare neuropathic pain disorder characterised by recurrent, paroxysmal, short-lasting episodes of severe electric-shock-like pain along the sensory distribution of the trigeminal nerve; recent classification systems group it into three main categories according to the underlying pathophysiology.｜span: "Trigeminal neuralgia (TN) is a rare neuropathic pain disorder characterized by recurrent, paroxysmal episodes of short-lasting severe electric shock-like pain along the sensory distribution of the trigeminal nerve." and "Recent classification systems group TN into 3 main categories depending on the underlying pathophysiology."｜caveat: This is the definitional section of a narrative clinical review and gives no incidence figure; the description of characteristics is not a self-diagnostic criterion, and matching the description does not mean the diagnosis applies.
F73｜source #28｜confidence: low｜basis: peer_reviewed (PMID 33408940, retrospective questionnaire study)｜geo: universal｜period: 2020-12-22｜claim: The study sent a questionnaire to 187 trigeminal neuralgia patients who had undergone gamma knife radiosurgery at two institutions between 2010 and 2019, and 117 responded; 55.5% had presented with a toothache and 65.8% had visited a dentist for that pain; 41.8% had undergone one dental procedure, after which 18.8% had worsening pain and 8.5% obtained partial improvement; 19.6% had undergone root canal treatment and 6.8% a nerve block; a mean of 1.6 teeth was extracted per person.｜span: "One hundred and seventeen of the 187 patients responded. About 55.5% of patients had a toothache and 65.8% did visit a dentist for the pain." and "About 41.8% of patients underwent one dental procedure; 18.8% suffered from worsening of the pain while 8.5% received some partial improvement. About 19.6% also underwent root canal treatment while 6.8% had a nerve block. Mean of 1.6 teeth was extracted per person."｜caveat: A retrospective questionnaire in a single treatment population (patients already referred to neurosurgery and treated with gamma knife), so selection and recall bias are present, with a response rate of 117/187; the proportions above must not be extrapolated to all trigeminal neuralgia patients, still less to the general dental attendance population; this unit supports only the directional conclusion that this misdiagnosis pathway exists and that its cost is irreversible. Each proportion in the original is prefixed with About; the body text of this article does not annotate each one for readability, and they should be understood as approximate values; for "a mean of 1.6 teeth extracted per person", the original does not state whether the denominator is all respondents or only those who had extractions, so the number of people who had teeth extracted must not be calculated from it.
F74｜source #28｜confidence: medium (for the wording of the conclusion itself)｜basis: peer_reviewed (PMID 33408940)｜geo: universal｜period: 2020-12-22｜claim: The study concludes that there is a need for better understanding of the disease among dentists and patients so that timely and correct treatment can be achieved without losing teeth, and the authors state that the responsibility for disseminating knowledge of proper diagnosis and treatment lies with neurosurgeons and neurologists.｜span: "There is a need for a better understanding of the disease among the dentists and the patients for the timely and correct treatment, without losing their teeth." and "The onus lies on neurosurgeons/neurologists disseminate knowledge regarding proper diagnosis and treatment modalities."｜caveat: This is the authors' commentary argument, not quantitative evidence; the original sentence has a grammatical flaw (disseminate is uninflected) and the span retains the original wording for verification; this unit must not be read as a referral rule for any region.
F75｜source #29｜confidence: medium｜basis: peer_reviewed (PMID 29174443, comprehensive review)｜geo: universal｜period: 2018-02｜claim: Persistent dentoalveolar pain of idiopathic origin represents a diagnostic challenge for dentists and physicians alike; disagreement on taxonomy and diagnostic criteria significantly limits the advancement of research in the field; patients face a lack of knowledge among dental and medical professionals, diagnostic delays and unnecessary treatments.｜span: "Persistent dentoalveolar pain of idiopathic origin represents a diagnostic challenge for the dentist and physician alike. Disagreement on taxonomy and diagnostic criteria presents a significant limit to the advancement of research in the field." and "Patients struggle with a lack of knowledge by dental and medical professionals, diagnostic delays, and unnecessary treatments."｜caveat: This is a commentary on the current state in a narrative comprehensive review and contains no incidence or risk figures; no conclusion about the attribution of medical responsibility may be derived from it.
F76｜source #29｜confidence: medium｜basis: peer_reviewed (PMID 29174443)｜geo: universal｜period: 2018-02｜claim: The synonyms and neighbouring names used in the review's search include atypical odontalgia, phantom tooth pain, persistent idiopathic facial pain, painful post-traumatic trigeminal neuropathy, idiopathic toothache, persistent dentoalveolar pain disorder, non-odontogenic tooth pain and continuous neuropathic orofacial pain; the available literature consists mainly of case reports and narrative reviews, and treatment strategies were evaluated in only 7 open-label and 2 randomised controlled trials.｜span: "atypical odontalgia, phantom tooth pain, persistent idiopathic facial pain, painful posttraumatic trigeminal neuropathy, idiopathic toothache, persistent dentoalveolar pain disorder, nonodontogenic tooth pain, and continuous neuropathic orofacial pain" and "Case reports and narrative reviews constitute the majority of available literature." and "Treatment strategies were evaluated in only 7 open-label and 2 randomized controlled trials."｜caveat: The search cut-off was 2017-01-01, so more recent literature is not included; the names listed are search terms and do not mean they are the same diagnosis, and the differences in their criteria are precisely the consensus gap that paper points to.
F77｜source #29｜confidence: medium (for the wording of the conclusion itself)｜basis: peer_reviewed (PMID 29174443)｜geo: universal｜period: 2018-02｜claim: The review concludes that persistent dentoalveolar pain disorder is likely neuropathic in origin, but that the pathophysiological mechanisms explaining the onset and persistence of the pain remain far from understood, and that a correct diagnosis should be established before treatments are performed.｜span: "Persistent dentoalveolar pain disorder is likely neuropathic in origin, but pathophysiological mechanisms to explain the onset and persistence of the pain are still far from understood. A correct diagnosis should be established before treatments are performed."｜caveat: "Establish the diagnosis before treating" is a clinical principle at review level and specifies no diagnostic method, timeline or threshold; what this article infers from it is only the direction "avoid irreversible procedures before the diagnosis is established".
F78｜source #30｜confidence: medium｜basis: peer_reviewed (PMID 34792207, observational study)｜geo: universal｜period: 2022-03｜claim: The study quotes the ICOP 6.3 definition of persistent idiopathic dentoalveolar pain (PIDAP) verbatim: persistent unilateral intraoral dentoalveolar pain, rarely occurring at multiple sites, with variable features but recurring daily for more than 2 hours per day for more than 3 months, in the absence of any preceding causative event.｜span: "Persistent unilateral intraoral dentoalveolar pain, rarely occurring in multiple sites, with variable features but recurring daily for more than 2 h per day for more than 3 months, in the absence of any preceding causative event"｜caveat: This is that study's secondary citation of ICOP (the ICOP body text was not retrieved, see F59); PIDAP is a diagnosis of exclusion, and this article provides no method of self-assessment.
F79｜source #30｜confidence: low｜basis: peer_reviewed (PMID 34792207)｜geo: universal｜period: 2022-03｜claim: The observational study assessed 160 patients in a referral-based endodontic specialist practice, of whom 78 (63 women) fulfilled the strict PIDAP criteria; in 69% of the PIDAP patients the pain was associated with a root-filled tooth at the same site, and in 14% of cases no endodontic treatment had been performed in the affected quadrant; 85% had no nocturnal awakening; and among "patients with painful teeth or implants", 91% showed mechanical allodynia in the gingival sulcus.｜span: "Amongst the 160 patients assessed, 78 (63 women) fulfilled the strict PIDAP criteria." and "In 69% of the patients with PIDAP, pain was associated with a root filled tooth at the same site. In 14% of the cases, no endodontic treatment was performed in the affected quadrant." and "Mechanical allodynia in the gingival sulcus was observed in 91% of patients with painful teeth or implants." and "Pain history of PIDAP included no nocturnal awakening (85%) and a 'pulling/dragging' pain quality (59%)."｜caveat: Retrospective data from a single referral-based specialist practice (covering 16 years), a highly selected population, and the proportions must not be extrapolated to the general population or the general dental attendance population; the features listed are a descriptive distribution in that population and are not diagnostic criteria — matching the features does not mean the diagnosis applies; the denominator of the 91% item in the original is "patients with painful teeth or implants", which is not identical to the denominator of the preceding three items (PIDAP patients), and it must not be merged into a statement such as "91% of PIDAP patients".
F80｜source #31｜confidence: medium｜basis: peer_reviewed (PMID 20113779, systematic review and meta-analysis)｜geo: universal｜period: 2010-02｜claim: The study defined persistent tooth pain after endodontic treatment as pain still present 6 months or more after treatment (whatever the cause); it included 26 articles out of 770, covering 5,777 teeth of which 2,996 had follow-up data on pain status and 168 had pain, giving a pooled estimate of 5.3% (95% CI 3.5% to 7.2%); heterogeneity among studies was high and statistically significant (I² = 80%); in subgroup analysis the pain frequency in prospective studies (7.6%) was higher than in retrospective studies (0.9%).｜span: "Persistent tooth pain was defined as pain present > or = 6 months after endodontic treatment." and "Of 770 articles retrieved and reviewed, 26 met inclusion criteria. A total of 5,777 teeth were enrolled, and 2,996 had follow-up information regarding pain status." and "We identified 168 teeth with pain and derived a frequency of 5.3% (95% confidence interval, 3.5%-7.2%, p < 0.001) for persistent all-cause tooth pain." and "High and statistically significant heterogeneity among studies (I2 = 80%) was present." and "In subgroup analysis, prospective studies had a higher pain frequency (7.6%) than retrospectives studies did (0.9%)."｜caveat: "Persistent all-cause pain" covers every aetiology and is not the proportion attributable to idiopathic pain; heterogeneity is extremely high and the prospective / retrospective gap spans an order of magnitude, so this figure is only a sense of magnitude and must not be used as an individual probability or an efficacy measure; it was published in 2010 and more recent data are not included.
F81｜source: this site's editorial judgement (based on F8, F16, F59, F60)｜confidence: n/a｜basis: editorial_framework｜geo: universal｜period: 2026-08-06｜claim: Sections 1 to 3 of this article belong to the DC/TMD classification and its management ladder for chronic TMD pain, while this expansion belongs to the ICOP idiopathic pain and neuralgia system; the two have different classification frameworks and different evidence bases and must not be applied to each other. This article slots no symptom into any diagnosis and provides no method of self-assessment; the concrete criteria for symptom grading and care triage are the responsibility of the corresponding domain article and canonical cards, and this article only summarises and points the way without rewriting their content.｜caveat: An editorial framework statement carrying no medical factual claim; the two systems can coexist in the same patient, and this unit only forbids mechanical inference from one to the other rather than claiming they are mutually exclusive.
F82｜source: this site's editorial judgement (based on F66, F67, F68, F70, F71)｜confidence: n/a｜basis: editorial_framework｜geo: universal｜period: 2026-08-06｜claim: The management evidence cited in this expansion has as its ceiling a Cochrane systematic review and a network meta-analysis, both of which state for themselves that the certainty of the evidence is very low to moderate or that the evidence is insufficient; this article therefore makes no claim of effectiveness for any intervention, lists no medicine name in the body text, and gives no dose, administration or discontinuation instruction; whether any intervention applies must be determined by a physician case by case.｜caveat: A statement of evidential boundary and compliance; "insufficient evidence" is not the same as "ineffective", and this unit must not be read as a negation of any intervention.
F83｜source: this site's editorial judgement｜confidence: n/a｜basis: editorial_framework｜geo: universal｜period: 2026-08-06｜claim: This round of PubMed E-utilities searching (queries including nonodontogenic toothache differential diagnosis, burning mouth syndrome systematic review, trigeminal neuralgia guideline, persistent idiopathic dentoalveolar pain and others) did not obtain a citable, validated red-flag screening tool for non-odontogenic orofacial pain; Section 11 of this article lists only the situations the existing sources can support and is not an exhaustive list.｜caveat: "Not obtained" is not the same as "refuted" or "does not exist"; this field is an editorial statement and must not be marked as a claim awaiting verification.

Compliance note

This article is health education information, not medical advertising; it recommends no particular clinic, compares no physician or institution, and gives no monetary amounts [F49]. The management of temporomandibular disorders, the reduction of a dislocated jaw, orthognathic surgery and maxillofacial surgery all carry risks, indications and contraindications; this article has disclosed the citable complications and evidence gaps in the "risk factors" section [F32][F33][F34][F52]. Actual treatment methods and outcomes vary from person to person and must be assessed by a dentist; where skeletal surgery is involved, joint assessment by oral and maxillofacial surgery and orthodontic specialist teams is required [F35][F46]. The classification map and management ladder compiled here are for use in communicating during care; they cannot replace clinical diagnosis and cannot serve as a basis for self-diagnosis or self-treatment [F46]. The names of medicines and injectable procedures appearing in this article occur only within verbatim spans from guideline originals, are statements at the level of research and guidelines, and this article makes no efficacy claim or usage recommendation for any medicine or procedure [F14][F27]. 2026-08-06 expansion note: Sections 9 to 11 (non-odontogenic orofacial pain) are bound by all of the above — those three sections make no claim of effectiveness for any management of burning mouth syndrome, trigeminal neuralgia or persistent idiopathic facial / dentoalveolar pain, no medicine name appears in their body text (medicine names exist only in verbatim spans and caveats), no dose, administration or discontinuation instruction is given, and no method of self-diagnosis or self-treatment is provided; their "when to suspect it is not the tooth" situations are signals for use in communicating during care, not diagnostic criteria, and are not an exhaustive list — a situation not listed does not mean it is safe [F82][F83][F46].

Source list

Access date for all sources: 2026-08-06 (Asia/Taipei). Verification method: PubMed E-utilities efetch (rettype=abstract, retmode=text) was used to retrieve the full abstract text, and `https://pubmed.ncbi.nlm.nih.gov//` was curled entry by entry, each returning HTTP 200; all 16 entries were checked for PublicationType via esummary, and none is marked Retracted Publication.

Entries #01 (Article 63 of the Medical Care Act), #02 (Article 51 of the National Health Insurance Act) and #03 (the NHIA payment schedule provisions for orthognathic surgery) in the anchor file `ida-pillars/anchors/P09-anchors.md` are Taiwanese statutory and official sources. Following the owner's 2026-08-06 decision to run the whole line as global, not one of them is used in this article and none is listed here; content touching local systems is uniformly handled by a downstream-link sentence pointing to the corresponding local canonical card (carried by the F51 editorial framework F-Unit, so that the geo of every F-Unit remains universal).

S1｜clinical_guideline｜Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014 Winter;28(1):6-27.｜PMID 24482784｜DOI 10.11607/jop.1151｜https://pubmed.ncbi.nlm.nih.gov/24482784/ ｜accessed 2026-08-06
S2｜clinical_guideline｜Busse JW, Casassus R, Carrasco-Labra A, et al. Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. BMJ. 2023 Dec 15;383:e076227.｜PMID 38101929｜DOI 10.1136/bmj-2023-076227｜https://pubmed.ncbi.nlm.nih.gov/38101929/ ｜accessed 2026-08-06
S3｜textbook (National Academies consensus study report)｜National Academies of Sciences, Engineering, and Medicine. Temporomandibular Disorders: Priorities for Research and Care. Washington (DC): National Academies Press (US); 2020 Mar 12.｜PMID 32200600｜DOI 10.17226/25652｜https://pubmed.ncbi.nlm.nih.gov/32200600/ ｜accessed 2026-08-06
S4｜peer_reviewed｜Valesan LF, Da-Cas CD, Réus JC, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Investig. 2021 Feb;25(2):441-453.｜PMID 33409693｜DOI 10.1007/s00784-020-03710-w｜https://pubmed.ncbi.nlm.nih.gov/33409693/ ｜accessed 2026-08-06
S5｜peer_reviewed｜Bijelic T, Michelotti A, Bucci R, et al. Self-Management Therapies for Temporomandibular Disorders-Evidence From Systematic Reviews. J Oral Rehabil. 2026 Jan;53(1):265-281.｜PMID 41058307｜DOI 10.1111/joor.70074｜https://pubmed.ncbi.nlm.nih.gov/41058307/ ｜accessed 2026-08-06
S6｜peer_reviewed｜İşisağ Ö, Atasoy H, Yıldız S. Comparison of the effects of occlusal splint and Botox injections on the amount of mouth opening and chronic pain in individuals with temporomandibular disorders: a systematic review and meta-analysis. Aust Dent J. 2025 Jun;70(2):132-140.｜PMID 39953753｜DOI 10.1111/adj.13059｜https://pubmed.ncbi.nlm.nih.gov/39953753/ ｜accessed 2026-08-06
S7｜peer_reviewed｜Akinbami BO. Evaluation of the mechanism and principles of management of temporomandibular joint dislocation. Systematic review of literature and a proposed new classification of temporomandibular joint dislocation. Head Face Med. 2011 Jun 15;7:10.｜PMID 21676208｜DOI 10.1186/1746-160X-7-10｜https://pubmed.ncbi.nlm.nih.gov/21676208/ ｜accessed 2026-08-06
S8｜peer_reviewed｜Okoje VN, Aladelusi TO, Abimbola TA. Managing temporomandibular joint dislocation in Ibadan: a review of 11 cases. Ann Ib Postgrad Med. 2017 Dec;15(2):96-102.｜PMID 29556163｜https://pubmed.ncbi.nlm.nih.gov/29556163/ ｜accessed 2026-08-06
S9｜peer_reviewed｜Hoppe A, Turosz N, Chęciński M, et al. Management of Recurrent Temporomandibular Joint Dislocation in Children: A Systematic Review. J Clin Med. 2025 Nov 6;14(21):7881.｜PMID 41227277｜DOI 10.3390/jcm14217881｜https://pubmed.ncbi.nlm.nih.gov/41227277/ ｜accessed 2026-08-06
S10｜peer_reviewed｜Alhammadi MS, Almashraqi AA, Khadhi AH, et al. Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in borderline class III malocclusion: a systematic review. Clin Oral Investig. 2022 Nov;26(11):6443-6455.｜PMID 36098813｜DOI 10.1007/s00784-022-04685-6｜https://pubmed.ncbi.nlm.nih.gov/36098813/ ｜accessed 2026-08-06
S11｜peer_reviewed｜Ebenezer V, Ganesh P, Vinayagar M. Clinical outcomes, complications and impact on quality of life following orthognathic surgery: a systematic review. Front Oral Health. 2026 May 26;7:1790589.｜PMID 42273603｜DOI 10.3389/froh.2026.1790589｜https://pubmed.ncbi.nlm.nih.gov/42273603/ ｜accessed 2026-08-06
S12｜peer_reviewed｜Jenwanichkul N, Keerativittayanun S, Suttapreyasri S, Pripatnanont P. Panoptic evaluation of maxillomandibular stability and quality of life after surgery-first approach versus conventional three-stage method in skeletal Class III orthognathic surgery-systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2026 Jan;55(1):20-33.｜PMID 40360332｜DOI 10.1016/j.ijom.2025.04.003｜https://pubmed.ncbi.nlm.nih.gov/40360332/ ｜accessed 2026-08-06
S13｜peer_reviewed｜Khetpal S, Dahoud F, Elias A, Sasson DC, Wolfe EM, Lee JC. Feminization of the Forehead: A Scoping Literature Review and Cohort Study of Transfeminine Patients. Aesthetic Plast Surg. 2024 Sep;48(18):3577-3588.｜PMID 38858245｜DOI 10.1007/s00266-024-04143-6｜https://pubmed.ncbi.nlm.nih.gov/38858245/ ｜accessed 2026-08-06
S14｜peer_reviewed｜Rolfes B. Brow Bossing Reduction. Otolaryngol Clin North Am. 2022 Aug;55(4):785-795.｜PMID 35934514｜DOI 10.1016/j.otc.2022.04.003｜https://pubmed.ncbi.nlm.nih.gov/35934514/ ｜accessed 2026-08-06
S15｜peer_reviewed｜Ahmad M, Gaalaas L. Imaging of Tumor-like and Cyst-like Lesions of the Temporomandibular Joints. Neuroimaging Clin N Am. 2025 Nov;35(4):517-526.｜PMID 41161936｜DOI 10.1016/j.nic.2025.06.005｜https://pubmed.ncbi.nlm.nih.gov/41161936/ ｜accessed 2026-08-06
S16｜peer_reviewed｜Renton T. Tooth-Related Pain or Not? Headache. 2020 Jan;60(1):235-246.｜PMID 31675112｜DOI 10.1111/head.13689｜https://pubmed.ncbi.nlm.nih.gov/31675112/ ｜accessed 2026-08-06

Expansion sources: non-odontogenic orofacial pain (S17–S31, 2026-08-06)

The "all 16 entries" above refers to S1–S16 (the scope of the original draft); the 15 entries S17–S31 newly added in this expansion round were verified separately and independently, and the record appears in the expansion segment of WRITER-ADDED SOURCES below. The access date is likewise 2026-08-06 (Asia/Taipei).

S17｜peer_reviewed｜Thomas DC, Somaiya T, Ajayakumar A, Prabhakar V. Toothaches of Non-odontogenic Origin. Dent Clin North Am. 2026 Jan;70(1):209-224.｜PMID 41238336｜DOI 10.1016/j.cden.2025.07.013｜https://pubmed.ncbi.nlm.nih.gov/41238336/ ｜accessed 2026-08-06
S18｜peer_reviewed (an international classification document, recorded conservatively as peer_reviewed)｜International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia. 2020 Feb;40(2):129-221.｜PMID 32103673｜DOI 10.1177/0333102419893823｜https://pubmed.ncbi.nlm.nih.gov/32103673/ ｜accessed 2026-08-06
S19｜peer_reviewed｜Heir GM, Ananthan S, Kalladka M, Kuchukulla M, Renton T. Persistent Idiopathic Dentoalveolar Pain: Is It a Central Pain Disorder? Dent Clin North Am. 2023 Jan;67(1):71-83.｜PMID 36404082｜DOI 10.1016/j.cden.2022.07.006｜https://pubmed.ncbi.nlm.nih.gov/36404082/ ｜accessed 2026-08-06
S20｜peer_reviewed｜Russo M, Crafa P, Guglielmetti S, Franzoni L, Fiore W, Di Mario F. Burning Mouth Syndrome Etiology: A Narrative Review. J Gastrointestin Liver Dis. 2022 Jun 12;31(2):223-228.｜PMID 35574619｜DOI 10.15403/jgld-4245｜https://pubmed.ncbi.nlm.nih.gov/35574619/ ｜accessed 2026-08-06
S21｜peer_reviewed｜Sangalli L, Mirfarsi S, Kramer JM, Eisa E, Miller CS. Managing Burning Mouth Syndrome: Current and Future Directions. Drugs. 2025 Sep;85(9):1109-1131.｜PMID 40815383｜DOI 10.1007/s40265-025-02220-x｜https://pubmed.ncbi.nlm.nih.gov/40815383/ ｜accessed 2026-08-06
S22｜peer_reviewed｜Wu S, Zhang W, Yan J, Noma N, Young A, Yan Z. Worldwide prevalence estimates of burning mouth syndrome: A systematic review and meta-analysis. Oral Dis. 2022 Sep;28(6):1431-1440.｜PMID 33818878｜DOI 10.1111/odi.13868｜https://pubmed.ncbi.nlm.nih.gov/33818878/ ｜accessed 2026-08-06
S23｜peer_reviewed｜de Lima-Souza RA, Pérez-de-Oliveira ME, Normando AGC, et al. Clinical and epidemiological profile of burning mouth syndrome patients following the International Headache Society classification: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2024 Feb;137(2):119-135.｜PMID 38155008｜DOI 10.1016/j.oooo.2023.10.002｜https://pubmed.ncbi.nlm.nih.gov/38155008/ ｜accessed 2026-08-06
S24｜peer_reviewed (Cochrane systematic review)｜McMillan R, Forssell H, Buchanan JA, Glenny AM, Weldon JC, Zakrzewska JM. Interventions for treating burning mouth syndrome. Cochrane Database Syst Rev. 2016 Nov 18;11(11):CD002779.｜PMID 27855478｜DOI 10.1002/14651858.CD002779.pub3｜https://pubmed.ncbi.nlm.nih.gov/27855478/ ｜accessed 2026-08-06
S25｜peer_reviewed｜Alvarenga-Brant R, Costa FO, Mattos-Pereira G, et al. Treatments for Burning Mouth Syndrome: A Network Meta-analysis. J Dent Res. 2023 Feb;102(2):135-145.｜PMID 36214096｜DOI 10.1177/00220345221130025｜https://pubmed.ncbi.nlm.nih.gov/36214096/ ｜accessed 2026-08-06
S26｜clinical_guideline｜Bendtsen L, Zakrzewska JM, Abbott J, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019 Jun;26(6):831-849.｜PMID 30860637｜DOI 10.1111/ene.13950｜https://pubmed.ncbi.nlm.nih.gov/30860637/ ｜accessed 2026-08-06
S27｜peer_reviewed｜Khawaja SN, Scrivani SJ. Trigeminal Neuralgia. Dent Clin North Am. 2023 Jan;67(1):99-115.｜PMID 36404084｜DOI 10.1016/j.cden.2022.07.008｜https://pubmed.ncbi.nlm.nih.gov/36404084/ ｜accessed 2026-08-06
S28｜peer_reviewed｜Tripathi M, Sadashiva N, Gupta A, et al. Please spare my teeth! Dental procedures and trigeminal neuralgia. Surg Neurol Int. 2020 Dec 22;11:455.｜PMID 33408940｜DOI 10.25259/SNI_729_2020｜https://pubmed.ncbi.nlm.nih.gov/33408940/ ｜accessed 2026-08-06
S29｜peer_reviewed｜Malacarne A, Spierings ELH, Lu C, Maloney GE. Persistent Dentoalveolar Pain Disorder: A Comprehensive Review. J Endod. 2018 Feb;44(2):206-211.｜PMID 29174443｜DOI 10.1016/j.joen.2017.09.009｜https://pubmed.ncbi.nlm.nih.gov/29174443/ ｜accessed 2026-08-06
S30｜peer_reviewed｜Sanner F, Sonntag D, Hambrock N, Zehnder M. Patients with persistent idiopathic dentoalveolar pain in dental practice. Int Endod J. 2022 Mar;55(3):231-239.｜PMID 34792207｜DOI 10.1111/iej.13664｜https://pubmed.ncbi.nlm.nih.gov/34792207/ ｜accessed 2026-08-06
S31｜peer_reviewed｜Nixdorf DR, Moana-Filho EJ, Law AS, McGuire LA, Hodges JS, John MT. Frequency of persistent tooth pain after root canal therapy: a systematic review and meta-analysis. J Endod. 2010 Feb;36(2):224-30.｜PMID 20113779｜DOI 10.1016/j.joen.2009.11.007｜https://pubmed.ncbi.nlm.nih.gov/20113779/ ｜accessed 2026-08-06

FAQ

My temporomandibular joint clicks — does it have to be treated?: **"Having the phenomenon" is not the same as "needing treatment".** First, what this article can and cannot say: the classification framework places arthralgia, disc displacement and degenerative joint disease in separate cells, and among them disc displacement with reduction is the category with the highest prevalence (about 25.9% in adults and older adults) [F5][F6]; but **the sources cited here establish no mapping from a sound to a diagnostic cell, so this article does not make that assignment** [F46]. Which cell it actually falls into, and whether anything needs doing, must be judged by clinical assessment, and the clinical criteria lack sufficient validity for some intra-articular disorders to serve as clinical diagnoses and can be used only for screening [F11]. One more thing to read alongside: the clinical guideline above explicitly limits the population for its recommendations to chronic (lasting 3 months or more) TMD-associated pain, and does not apply to acute pain [F16].; 顎関節がカクカク鳴りますが、必ず処置が必要ですか — **「その現象がある」ことは「処置が必要である」ことと同じではありません。** まず本記事が言えること、言えないことを述べます。分類の枠組みは関節痛、関節円板転位、変性関節疾患などを別々のマスとして挙げており、そのうち復位性関節円板転位は有病率が上位のカテゴリーです（成人・高齢者で約 25.9%）[F5][F6]。しかし**本記事が引用した出典は「音がどのマスの診断に対応するか」という対照表を作っていないため、本記事はこの当てはめを行いません** [F46]。実際にどのマスに属するのか、対応が必要かどうかは臨床評価によって判断されるものであり、しかも臨床基準は一部の関節内障害について臨床診断とするには妥当性が不十分で、スクリーニングにしか使えません [F11]。もう一つ併せて読むべきことがあります。先述の臨床ガイドラインの推奨対象は慢性（3 か月以上持続する）TMD 関連疼痛に明確に限定されており、急性の痛みには適用されません [F16]。; My temporomandibular joint clicks — does it have to be treated? — **"Having the phenomenon" is not the same as "needing treatment".** First, what this article can and cannot say: the classification framework places arthralgia, disc displacement and degenerative joint disease in separate cells, and among them disc displacement with reduction is the category with the highest prevalence (about 25.9% in adults and older adults) [F5][F6]; but **the sources cited here establish no mapping from a sound to a diagnostic cell, so this article does not make that assignment** [F46]. Which cell it actually falls into, and whether anything needs doing, must be judged by clinical assessment, and the clinical criteria lack sufficient validity for some intra-articular disorders to serve as clinical diagnoses and can be used only for screening [F11]. One more thing to read alongside: the clinical guideline above explicitly limits the population for its recommendations to chronic (lasting 3 months or more) TMD-associated pain, and does not apply to acute pain [F16].
Can I push a dislocated jaw back myself?: **This article provides no method of self-reduction.** The reductions recorded in the literature are procedures performed by clinicians: in a review of 11 cases, one case had the manoeuvre performed only under general anaesthesia [F25]; the authors conclude that the conservative reduction manoeuvre was effective in most cases, but this is a medical procedure and not a home operation [F26]. The systematic review's conclusion is likewise that conservative approaches should be exhausted before invasive surgery is considered, and it too concerns choices among clinical procedures [F24]. If you cannot close your mouth, seek care.; 顎が外れたとき、自分で押し戻してもよいですか — **本記事は自分で整復する方法を一切提供しません。** 文献に記載された整復は臨床家が行う処置です。11 例の症例レビューでは、全身麻酔下ではじめて同法を実施した症例があります [F25]。著者の結論は、保存的な整復手技は多くの症例で有効というものですが、これは医学的処置であって家庭での操作ではありません [F26]。システマティックレビューの結論も「まず保存的な方法を十分に使い尽くしてから、侵襲的な手術を検討する」というものであり、その対象も同じく臨床での処置の選択です [F24]。口が閉じられないときは受診してください。; Can I push a dislocated jaw back myself? — **This article provides no method of self-reduction.** The reductions recorded in the literature are procedures performed by clinicians: in a review of 11 cases, one case had the manoeuvre performed only under general anaesthesia [F25]; the authors conclude that the conservative reduction manoeuvre was effective in most cases, but this is a medical procedure and not a home operation [F26]. The systematic review's conclusion is likewise that conservative approaches should be exhausted before invasive surgery is considered, and it too concerns choices among clinical procedures [F24]. If you cannot close your mouth, seek care.
Should I have an occlusal splint or not?: **There are two pieces of evidence here that look contradictory but are in fact answering different questions.** On one hand, the clinical guideline produced with GRADE, on a benchmark of comparison against placebo or sham, lists reversible occlusal splints as conditionally recommended against, and irreversible intraoral occlusal appliances as strongly recommended against [F14][F15]. On the other hand, a meta-analysis comparing occlusal splints with botulinum toxin injection showed no overall statistically significant difference between the two in mouth-opening range, and none on the graded chronic pain scale either [F20][F21]. **The two use different comparators, and neither overturns the other** [F46]. The difference between reversible and irreversible is the one thing to make sure you clarify in practice on this question [F14][F15].; 咬合スプリントは結局やるべきですか、やらないべきですか — **この問いには、一見矛盾して見えて実は別の問いに答えている二つのエビデンスがあります。** 一方で、GRADE で作成された臨床ガイドラインは、プラセボまたは偽処置と比較するという基準のもとで、可逆的な咬合スプリントを条件付きで推奨しないとし、不可逆的な口腔内咬合装置を強く推奨しないとしています [F14][F15]。他方で、咬合スプリントとボツリヌス毒素注射を比較したメタアナリシスは、両者の間で開口量に全体として統計学的有意差がなく、慢性疼痛グレーディング尺度でも差がないことを示しています [F20][F21]。**両者は比較の基準が異なり、互いを覆すことはできません** [F46]。可逆的か不可逆的かの違いは、この問いで実務上必ず確認しておくべき点です [F14][F15]。; Should I have an occlusal splint or not? — **There are two pieces of evidence here that look contradictory but are in fact answering different questions.** On one hand, the clinical guideline produced with GRADE, on a benchmark of comparison against placebo or sham, lists reversible occlusal splints as conditionally recommended against, and irreversible intraoral occlusal appliances as strongly recommended against [F14][F15]. On the other hand, a meta-analysis comparing occlusal splints with botulinum toxin injection showed no overall statistically significant difference between the two in mouth-opening range, and none on the graded chronic pain scale either [F20][F21]. **The two use different comparators, and neither overturns the other** [F46]. The difference between reversible and irreversible is the one thing to make sure you clarify in practice on this question [F14][F15].

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km 編輯部・《Temporomandibular Joint and Maxillofacial Complete Guide: the TMD classification map, the conservative-first management ladder, the acute dislocation pathway, and the specialty boundaries of orthognathic and maxillofacial surgery｜證據鏈》・IDAEO 知識庫・2026-08-13・https://km.idaeo.ai/post/reports/dental-pillar-tmj-maxillofacial-evidence

更新 2026-08-13T14:17:35.412Z · server-rendered · four-language · IDAEO 知識庫

Temporomandibular Joint and Maxillofacial Complete Guide: the TMD classification map, the conservative-first management ladder, the acute dislocation pathway, and the specialty boundaries of orthognathic and maxillofacial surgery｜證據鏈

Temporomandibular Joint and Maxillofacial Complete Guide: the TMD classification map, the conservative-first management ladder, the acute dislocation pathway, and the specialty boundaries of orthognathic and maxillofacial surgery｜證據鏈

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Expansion addition: non-odontogenic orofacial pain (F56–F83, 2026-08-06)

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Expansion sources: non-odontogenic orofacial pain (S17–S31, 2026-08-06)

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