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Jaw Exercises in the Treatment of Temporomandibular Disorders—An International Modified Delphi Study

  • Erik Lindfors1,2,3,*,
  • Taro Arima4
  • Lene Baad-Hansen3,5
  • Merete Bakke6
  • Antoon De Laat7,8
  • Nikolaos Nikitas Giannakopoulos9
  • Alan Glaros10
  • Antonio Sergio Guimarães11
  • Anders Johansson12,13
  • Yrsa Le Bell14
  • Frank Lobbezoo15,16
  • Ambra Michelotti17
  • Frauke Müller18
  • Richard Ohrbach19
  • Anders Wänman20
  • Tomas Magnusson21
  • Malin Ernberg2,3

1Publ Dent Hlth Serv, Dept Stomatognath Physiol, Box 1813, SE-75148 Uppsala, Sweden

2Karolinska Inst, Dept Dent Med, Huddinge, Sweden

3SCON, Huddinge, Sweden

4Hokkaido Univ, Sect Int Affairs, Fac & Grad Sch Dent Med, Sapporo, Hokkaido, Japan

5Aarhus Univ, Dept Dent & Oral Hlth, Aarhus, Denmark

6Univ Copenhagen, Fac Hlth & Med Sci, Dept Odontol, Copenhagen, Denmark

7Katholieke Univ Leuven, Dept Oral Hlth Sci, Leuven, Belgium

8Katholieke Univ Leuven, Univ Hosp, Dept Dent, Leuven, Belgium

9Univ Wurzburg, Dept Prothodont, Wurzburg, Germany

10Univ Missouri, Sch Dent, Kansas City, MO USA

11Fac Sao Leopoldo Mand, Sao Paulo, Brazil

12Univ Bergen, Prosthodont Fac Med & Dent, Bergen, Norway

13Haukeland Hosp, Natl Unit Orofacial Pain, Bergen, Norway

14Univ Turku, Inst Dent, Turku, Finland

15Univ Amsterdam, Acad Ctr Dent Amsterdam ACTA, Dept Oral Hlth Sci, Amsterdam, Netherlands

16Vrije Univ Amsterdam, Amsterdam, Netherlands

17Univ Naples Federico II, Dept Neurosci Reprod Sci & Oral Sci, Div Orthodont, Naples, Italy

18Univ Geneva, Univ Clin Dent Med, Geneva, Switzerland

19Univ Buffalo, Sch Dent Med, Dept Oral Diagnost Sci, Buffalo, NY USA

20Umea Univ, Fac Med, Dept Odontol Clin Oral Physiol, Umea, Sweden

21Jonkoping Univ, Sch Hlth & Welf, Dept Nat Sci & Biomed, Jonkoping, Sweden

DOI: 10.11607/ofph.2359 Vol.33,Issue 4,December 2019 pp.389-398

Submitted: 24 August 2018 Accepted: 06 January 2019

Published: 30 December 2019

*Corresponding Author(s): Erik Lindfors E-mail:


Aims: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises. Methods: A questionnaire with 31 statements regarding jaw exercises was constructed. Fourteen international experts with some geographic dispersion were asked to participate in this Delphi study, and all accepted. The experts were asked to respond to the statements according to a 5-item verbal Likert scale that ranged from “strongly agree” to “strongly disagree.” The experts could also leave free-text comments, which was encouraged. After the first round, the experts received a compilation of the other experts’ earlier responses. Some statements were then rephrased and divided to clarify the essence of the statement. Subsequently, the experts were then asked to answer the questionnaire (32 statements) again for the second round. Consensus was set to 80% agreement or disagreement. Results: There is consensus among TMD experts that jaw exercises are effective and can be recommended to patients with myalgia in the jaw muscles, restricted mouth opening capacity due to hyperactivity in the jaw closing muscles, and disc displacement without reduction. The patients should always be instructed in an individualized jaw exercise program and also receive both verbal advice and written information about the treatment modality. Conclusion: This Delphi study showed that there is an international consensus among TMD experts that jaw exercises are an effective treatment and can be recommended to patients with TMD pain and disturbed jaw function.


Delphi technique;dentistry;jaw exercises;orofacial pain;physical treatment

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Erik Lindfors,Taro Arima,Lene Baad-Hansen,Merete Bakke,Antoon De Laat,Nikolaos Nikitas Giannakopoulos,Alan Glaros,Antonio Sergio Guimarães,Anders Johansson,Yrsa Le Bell,Frank Lobbezoo,Ambra Michelotti,Frauke Müller,Richard Ohrbach,Anders Wänman,Tomas Magnusson,Malin Ernberg. Jaw Exercises in the Treatment of Temporomandibular Disorders—An International Modified Delphi Study. Journal of Oral & Facial Pain and Headache. 2019. 33(4);389-398.


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