# A Scoping Review of Temporomandibular Joint Dysfunction and Orofacial Pain Education in Undergraduate Dentistry Programs

Isabela Rodacoski, Ivan Araujo Pires, William Augusto Gomes de Oliveira Bellani

► To cite this version:

Isabela Rodacoski, Ivan Araujo Pires, William Augusto Gomes de Oliveira Bellani. A Scoping Review of Temporomandibular Joint Dysfunction and Orofacial Pain Education in Undergraduate Dentistry Programs. Journal of Advances in Medicine and Medical Research, 2025, 37 (3), pp.150-161. 10.9734/jammr/2025/v37i35754. hal-04968784

HAL Id: hal-04968784

https://hal.science/hal-04968784v1

Submitted on 26 Feb 2025

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_1.png" /></figure>

Distributed under a Creative Commons Attribution 4.0 International License
<figure><img src="image_2.png" /></figure>

# A Scoping Review of Temporomandibular Joint Dysfunction and Orofacial Pain Education in Undergraduate Dentistry Programs

Isabela Rodacoski a++*, Ivan Araujo Pires b# and William Augusto Gomes de Oliveira Bellani c†

## Authors' contributions

This work was carried out in collaboration among all authors. All authors read and approved the final manuscript.

## Article Information

DOI: https://doi.org/10.9734/jammr/2025/v37i35754

**Open Peer Review History:**

This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers, peer review comments, different versions of the manuscript, comments of the editors, etc are available here: https://pr.sdiarticle5.com/review-history/131557

Received: 19/12/2024

Accepted: 21/02/2025

Published: 25/02/2025

## Review Article

## ABSTRACT

Temporomandibular Joint Dysfunction (TMD) and Orofacial Pain (OFP) are prevalent yet inconsistently addressed in undergraduate dentistry programs, leading to gaps in clinical competency. This scoping review examines the current state of TMD and OFP education,

<footnote>a Health Sciences Education, Faculdades Pequeno Príncipe, Brazil.</footnote>

<footnote>b Scientific Initiation Scholarship Holder, Faculdades Pequeno Príncipe, Brazil.</footnote>

<footnote>c Faculdades Pequeno Príncipe, Brazil.</footnote>

<footnote>++ Master's Student;</footnote>

<footnote># Medical Student;</footnote>

<footnote>† Professor;</footnote>

<footnote>*Corresponding author: E-mail: isabela.rodacoski@aluno.fpp.edu.br;</footnote>
identifying deficiencies and proposing curriculum improvements. A systematic search across six databases identified 87 studies, with nine meeting inclusion criteria. The analysis followed the Joanna Briggs Institute (JBI) methodology and the Population, Concept, and Context (PCC) framework. Findings indicate significant variability in teaching approaches, with many programs offering limited or outdated training focused on occlusal models rather than biopsychosocial frameworks. Students demonstrated inadequate knowledge (average accuracy of 54%), and a shortage of specialized faculty further restricts education. While countries like Sweden and Germany incorporate interdisciplinary models, others, including Brazil, exhibit inconsistent integration of TMD and OFP content. To enhance education, curricula should adopt standardized guidelines, integrate interdisciplinary approaches involving psychology and physiotherapy, expand clinical training opportunities, increase faculty specialization, and promote continuing education programs for graduates. Addressing these deficiencies through structured curriculum reforms will improve student preparedness and patient care in TMD and OFP management.

Keywords: Orofacial pain; temporomandibular joint dysfunction syndrome; dental schools; curriculum; teaching.

# 1. INTRODUCTION

Temporomandibular Disorders (TMD) and Orofacial Pain (OFP) have long been recognized as complex musculoskeletal and neuromuscular conditions that significantly impact oral health and general well-being. The temporomandibular joint (TMJ) plays a critical role in oral function, and its dysfunction can lead to debilitating pain, limited mandibular movement, and other associated symptoms (McNeill, 1997; Barros et al., 2009; Conti et al., 2012; Choi et al., 2013; Leeuw & Klasser, 2018; AAOP, 2023).

Historically, TMD and OFP were often misunderstood, with early literature attributing their causes primarily to occlusal discrepancies and dental malocclusions. However, advances in pain science and dentistry have shifted the paradigm toward a multifactorial understanding, incorporating biomechanical, psychological, and social determinants. Despite these advancements, TMD education in undergraduate dentistry programs remains inconsistent across different institutions and countries (Ommerborn et al., 2009; Aggarwal et al., 2011; Simm & Guimarães, 2013; Alonso et al., 2014; Machado, Lima, Conti, 2014; Al-Khotani et al., 2015; Magri et al., 2018; Araújo et al., 2019; Heir, 2019; Rahmeier et al., 2021). One example of the variability in TMD-related education is using digital learning methods to teach temporomandibular joint (TMJ) interpretation. When conventional and digital interactive learning methods for TMJ magnetic resonance imaging (MRI) interpretation were compared, it was found that while both methods improved students' performance, traditional approaches still yielded better results. This underscores the

need for structured and evidence-based approaches in TMD education, ensuring that students develop essential diagnostic competencies (Arús et al., 2017).

The prevalence of TMD-related symptoms is strikingly high, affecting up to 70% of the population, with 5–12% requiring treatment due to persistent or disabling conditions (Sharma et al., 2011; NIH, 2014; Lomas et al., 2018; Conti, 2021). Given this widespread occurrence, there is an urgent need to ensure that dental professionals receive comprehensive training in the assessment, diagnosis, and management of TMD and OFP.

Despite this necessity, studies indicate that educational approaches remain outdated in many dental schools. Curricula often emphasize traditional mechanistic models, neglecting interdisciplinary pain management strategies and psychosocial aspects of pain perception. As a result, many graduating dental students feel inadequately prepared to manage TMD patients in clinical practice (Ommerborn et al., 2009; Aggarwal et al., 2011; Simm & Guimarães, 2013; Alonso et al., 2014; Machado, Lima, Conti, 2014; Al-Khotani et al., 2015; Magri et al., 2018; Araújo et al., 2019; Heir, 2019; Rahmeier et al., 2021).

Management of TMD primarily involves symptom control, with conservative approaches yielding favorable outcomes during the early intervention window. However, patients with chronic orofacial pain, particularly those with comorbid conditions, present a greater challenge to healthcare professionals (Heir, 2019).

Pain is an unpleasant sensory and emotional experience associated with, or resembling, that is
linked to actual or potential tissue damage (Dworkin & LeResche, 1992). However, pain is inherently subjective. The experience of pain is influenced not only by the magnitude of the actual or potential injury but also by the individual's emotional state and the context in which the noxious stimulus is received (McCulloch Gallagher & Sandbrink, 2019; Karos et al., 2020; Greene & Manfredini, 2021; Fredricson et al., 2023).

The lack of uniformity in TMD education results in OFP, prevalent in both primary healthcare and other levels of care, becoming not only a clinical challenge for general dentists but also an economic burden for the country and a psychological obstacle for patients (Wolf et al., 2006; Wolf et al., 2008; Aggarwal et al., 2011). For instance, in Brazil, TMD and OFP were recognized as specialties by the Federal Council of Dentistry (CFO) in 2002 and currently account for 1.1% of dental specialists, including 820 women and 737 men (CFO, 2024). Additionally, the new National Curriculum Guidelines (DCNs) for Dentistry recommend that starting in 2023, programs should structure their curricula based on health conditions or life cycles (Brazil, 2021). This approach considers outcomes, unresolved challenges, emerging demands from the health reality, and changes stemming from scientific advancements and professional practice. Previously focused on uniprofessional treatment, the emphasis now shifts toward quality of life, comprehensive interprofessional care, and timely intervention.

In light of this, this review aims to analyze scientific articles addressing TMD and OFP education and its integration into practice and curricula across all levels of undergraduate Dentistry programs (Miguel et al, 2024).

## 2. METHODOLOGY

This study employed a scoping review methodology following the guidelines of the Joanna Briggs Institute (JBI) (Aromataris et al., 2024). Scoping reviews are particularly useful for synthesizing evidence in emerging areas where definitions and frameworks are still evolving. This type of review emphasizes the range and scope of existing studies (Coelho et al., 2021; Guedes & Valente, 2023).

### 2.1 Research Question Identification

This review aimed to map the literature on the teaching of Temporomandibular Joint Disorders

(TMD) and Orofacial Pain (OFP) in undergraduate Dentistry programs within higher education institutions. From this perspective, the study contributes to understanding the evolution of education in Dentistry and the dynamics of studies within the health education field concerning TMD and OFP. The analysis was guided by two primary research questions:

1. What is the scope of the published literature focusing on TMD and OFP education in undergraduate Dentistry programs?

2. How is TMD and OFP education integrated into undergraduate Dentistry curricula?

The study design was structured using the mnemonic strategy PCC (Population, Concept, and Context) to guide data collection and assist in identifying key topics. This approach, as outlined in the methodology proposed by Aromataris (2024), directed both the search process and the refinement of inclusion and exclusion criteria employed in this review. In the context of dental education, the study examines three critical factors related to the teaching of Temporomandibular Disorders (TMD). The Population (P) consists of professionals, educators, and students in the field of Dentistry, who are directly involved in the dissemination and acquisition of knowledge on TMD. The Concept (C) pertains to the structure and approach of TMD within dental curricula, including the organization of content, depth of coverage, and pedagogical strategies adopted to facilitate learning. Finally, the Context (C) encompasses the teaching methodologies and the level of integration of TMD within higher education institutions, analyzing how the subject is incorporated into academic programs and the instructional techniques employed to enhance comprehension and clinical application. Understanding these factors is essential for evaluating the effectiveness of current educational approaches and identifying areas for improvement in TMD instruction within dental training.

### 2.2 Search Strategy

The search was conducted across the following databases: ScienceDirect, Virtual Health Library (BVS), PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane Library, and Scientific Electronic Library Online (SciELO).
The search terms used, based on the Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) platforms, were: "dentistry AND education AND temporomandibular joint dysfunction syndrome" combined using Boolean operators. Inclusion criteria were studies focusing on TMD and OFP education in

undergraduate dentistry programs, published in English, Portuguese, or Spanish.

The search was carried out in July 2024, incorporating gray literature and articles published in Portuguese, English, and Spanish, aiming for maximum comprehensiveness.

<figure><img src="image_3.png" /><figcaption>Fig. 1. The flowchart of the selection process, structure according to the PRISM statement standard</figcaption></figure>
A total of 87 studies were identified across the databases, distributed as follows: 25 from ScienceDirect, 24 from BVS, 23 from PubMed, 6 from LILACS, 3 from Cochrane Library, 2 from SciELO, and 4 from other sources. From these, 9 met the final inclusion criteria after removing duplicates and irrelevant articles. Data were analyzed qualitatively to map common themes and educational trends.

## 2.3 Selection of Articles and Theses

The selection of articles and theses was guided by inclusion and exclusion criteria designed to focus the discussion on the topic. These criteria are outlined in Table 1.

The search identified 87 studies, of which 20 duplicates were removed using the Rayyan platform (Qatar Computing Research Institute). Among the remaining 67 articles, 54 were excluded after title screening, and four more were excluded after abstract evaluation, leaving nine articles for further review. None of these nine articles were excluded due to data extraction issues or lack of relevance to the research scope. Ultimately, five articles were included in the review, based on consensus among blind and independent reviewers.

In September 2024, the study was registered and approved as an Open-Ended Registration on the Open Science Framework (OSF) platform, with the access code DOI: 10.17605/OSF.IO/5HM4U.

## 3. RESULTS

The analysis identified key aspects of teaching Temporomandibular Disorders (TMD) and Orofacial Pain (OFP) in undergraduate Dentistry programs. The evidence revealed significant gaps in academic curricula and educational practices adopted by higher education institutions. Out of the 87 initially identified articles, nine were selected for detailed analysis after duplicate removal and the application of

inclusion and exclusion criteria. These articles provided a comprehensive overview of the current educational approaches to TMD and OFP in universities within a global context.

The key findings indicate considerable variation in pedagogical practices among higher education institutions. A lack of uniformity in the teaching of Temporomandibular Disorders (TMD) was widely identified, with significant differences in the number of hours dedicated to the subject and the depth with which the content is addressed. While some universities provide more robust training, others include TMD and Orofacial Pain (OFP) education superficially, often integrating these topics into broader courses, such as Pathology and Preventive Dentistry.

It was observed that Dentistry students demonstrate limited knowledge of TMD and bruxism, with an average accuracy of only 54% on questions related to the topic (Rahmeier et al., 2021). This finding reflects the insufficiency of academic training and suggests that the current content does not adequately prepare students to address these conditions in clinical practice.

Another significant issue identified was the predominance of outdated approaches in curricula, with excessive emphasis on occlusal and biological factors, rather than adopting a more contemporary biopsychosocial perspective. These methodologies were found to be inadequate, perpetuating outdated concepts and failing to align with current guidelines for the management of OFP, which requires a more holistic understanding of the factors involved (Araújo et al., 2019).

Furthermore, the absence of specialized faculty in TMD and OFP was identified as an obstacle to adequate education. The shortage of specialists in academic staff limits universities' ability to provide in-depth training in this area, resulting in fragmented and often insufficient learning experiences.

<table><caption>Table 1. Inclusion and exclusion criteria for the review</caption><thead><tr><td>Criteria</td><td>Description</td></tr></thead><tbody><tr><td>Inclusion</td><td>Articles and gray literature focusing on the teaching of Temporomandibular Disorders (TMD) and Orofacial Pain (OFP) in undergraduate Dentistry programs; Studies published in English, Portuguese, and Spanish.</td></tr><tr><td>Exclusion</td><td>Studies where data extraction was not possible.</td></tr></tbody></table>

Source: Rodacoski; Pires; Bellani, 2025
<table><caption>Table 2. Descriptive summary of the analyzed studies</caption><thead><tr><td>Authors and Year</td><td>Country</td><td>Institution</td><td>Methodology</td><td>Participants</td><td>Description</td></tr></thead><tbody><tr><td>Aggarwal et al., 2011</td><td>United Kingdom</td><td>University of Manchester</td><td>Quantitative study</td><td>General and specialist dentists</td><td>The study investigated knowledge about chronic OFP. Specialists outperformed general dentists in identifying OFP-related conditions. Significant gaps in understanding the prevalence and specific symptoms highlighted the need for greater curricular inclusion.</td></tr><tr><td>Al-Khotani et al., 2015</td><td>Sweden and Saudi Arabia</td><td>Karolinska Institutet</td><td>Quantitative study</td><td>Dentists and physicians</td><td>The authors compared knowledge about OFP in children and adolescents between Swedish and Saudi professionals. Swedish professionals showed higher agreement with specialists, while Saudi professionals exhibited larger knowledge gaps, emphasizing the need for curriculum modernization.</td></tr><tr><td>Alonso et al., 2014</td><td>United States of America</td><td>Case Western Reserve University</td><td>Qualitative study</td><td>Third- and fourth-year Dentistry students</td><td>The study evaluated students' perceptions of their competence in OFP. Fourth-year students felt more comfortable diagnosing and treating intraoral pain compared to third-year students. However, significant gaps in managing psychogenic pain were identified, highlighting areas for curriculum improvement.</td></tr><tr><td>Araújo et al., 2019</td><td>Brazil</td><td>Veiga de Almeida University (UVA)</td><td>Mixed-method study</td><td>Dentists</td><td>A questionnaire on TMD and its relationship with occlusal factors was applied to 2,500 dentists in Piauí, Brazil. Of these, 434 were eligible. Results showed most gained knowledge about occlusion and TMD during their undergraduate studies. Additionally, 41% (181) were treated with TMD, while 63% (277) were referred patients.</td></tr><tr><td>Machado; Lima; Conti, Brazil 2014</td><td></td><td>University of São Paulo</td><td>Bibliographic review</td><td>Not applicable</td><td>Conducted a bibliographic review on the Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES) portal and PubMed, analyzing theses and dissertations on TMD and OFP. A total of 731 studies were recorded: 421 master's theses and 195 doctoral dissertations. Additionally, 576 articles involving Brazilian researchers were published between 2000 and 2013, indicating growing interest in the area.</td></tr><tr><td>Magri et al., 2018</td><td>Brazil</td><td>University of São Paulo</td><td>Quantitative study</td><td>Not applicable</td><td>A retrospective, longitudinal, and descriptive study collected data from the Clinical Informatics System of the Ribeirão Preto Faculty of Dentistry, covering TMD and OFP care from 2006 to 2016. Results showed an increase in the number of treated patients, discharges, and</td></tr></tbody></table>
<table><thead><tr><td>Authors and Year</td><td>Country</td><td>Institution</td><td>Methodology</td><td>Participants</td><td>Description</td></tr></thead><tbody><tr><td>Ommerborn et al., 2009</td><td>Germany</td><td>Heinrich Heine University Düsseldorf</td><td>Quantitative study</td><td>General and specialist dentists</td><td>A questionnaire was used with dentists to identify the most common therapies for craniomandibular disorders. The study found occlusal splints to be the most frequently used therapy, followed by physical therapy. Significant differences in treatment practices were observed between general dentists and specialists.</td></tr><tr><td>Rahmeier et al., 2021</td><td>Brazil</td><td>Federal University of Santa Maria (UFSM)</td><td>Quantitative study</td><td>Dentistry students</td><td>A questionnaire with 15 questions (open-ended and multiple-choice) on TMD and bruxism was applied to 20 students from the 7th and 10th semesters at UFSM. The results showed an average of 54% correct answers, revealing limited student knowledge of TMD and bruxism.</td></tr><tr><td>Simm; Guimarães, 2013</td><td>Brazil</td><td>Maringá University Center</td><td>Quantitative study</td><td>Dentistry program coordinators and directors</td><td>Questionnaires were applied to coordinators and directors of Dentistry programs in Brazilian schools, collecting data on the number of hours dedicated to teaching pain mechanisms. A total of 53 Dentistry schools participated. Results showed an average of 4,530 hours allocated to the course, with significant variations in the proportion of hours dedicated to teaching OFP and TMD.</td></tr></tbody></table>

Source: Rodacoski; Pires; Bellani, 2025.
Thus, the findings of this review highlight the need for curricular reform that incorporates TMD and OFP education more comprehensively, following the latest scientific evidence and pedagogical guidelines that emphasize an interdisciplinary and biopsychosocial approach. The implementation of National Curriculum Guidelines (NCGs) that structure the inclusion of these topics is essential to prepare future dentists to address the clinical challenges posed by these complex conditions.

The key findings indicate considerable variation in pedagogical practices among higher education institutions. A lack of uniformity in the teaching of Temporomandibular Disorders (TMD) was widely identified, with significant differences in the number of hours dedicated to the subject and the depth with which the content is addressed. While some universities provide more robust training, others include TMD and Orofacial Pain (OFP) education superficially, often integrating these topics into broader courses, such as Pathology and Preventive Dentistry.

It was observed that Dentistry students demonstrate limited knowledge of TMD and bruxism, with an average accuracy of only 54% on questions related to the topic (Rahmeier et al., 2021). This finding reflects the insufficiency of academic training and suggests that the current content does not adequately prepare students to address these conditions in clinical practice.

Another significant issue identified was the predominance of outdated approaches in curricula, with excessive emphasis on occlusal and biological factors, rather than adopting a more contemporary biopsychosocial perspective. These methodologies were found to be inadequate, perpetuating outdated concepts and failing to align with current guidelines for the management of OFP, which requires a more holistic understanding of the factors involved (Araújo et al., 2019).

Furthermore, the absence of specialized faculty in TMD and OFP was identified as an obstacle to adequate education. The shortage of specialists in academic staff limits universities' ability to provide in-depth training in this area, resulting in fragmented and often insufficient learning experiences.

Thus, the findings of this review highlight the need for curricular reform that incorporates TMD and OFP education more comprehensively,

following the latest scientific evidence and pedagogical guidelines that emphasize an interdisciplinary and biopsychosocial approach. The implementation of National Curriculum Guidelines (NCGs) that structure the inclusion of these topics is essential to prepare future dentists to address the clinical challenges posed by these complex conditions.

## 4. DISCUSSION

A major finding of this review is the urgent need for curriculum reform in TMD and OFP education. Many dental students graduate without sufficient training in diagnosing and managing these conditions, leading to suboptimal patient care.

The analysis of TMD and OFP education in Dentistry programs reveals significant gaps, highlighting the need for a more comprehensive curriculum aligned with contemporary needs in dental practice (Ommerborn et al., 2009; Aggarwal et al., 2011; Simm & Guimarães, 2013; Alonso et al., 2014; Machado, Lima, Conti, 2014; Al-Khotani et al., 2015; Magri et al., 2018; Araújo et al., 2019; Heir, 2019; Rahmeier et al., 2021).

Current curricula often rely on outdated occlusal and biomechanical models, neglecting the essential biopsychosocial framework required for comprehensive pain management. This limited perspective fails to equip students with the necessary diagnostic and clinical skills to treat complex TMD and OFP cases effectively. Moreover, the lack of specialized faculty further restricts the depth and quality of instruction, leaving many programs with fragmented or superficial coverage of these topics. (Araújo et al., 2019).

Studies from North America and the UK highlight a continued reliance on outdated occlusal theories, with limited incorporation of biopsychosocial approaches to pain management. US dental students often struggle with diagnosing neuropathic and psychogenic pain due to inadequate curriculum exposure (Alonso et al. 2014).

Sweden has been a leader in recognizing TMD as a specialized field, integrating advanced coursework and clinical training into undergraduate programs (Al-Khotani et al., 2016). Germany also incorporates craniomandibular disorder education; however, there remains a gap between undergraduate
knowledge and the actual management practices
of general practitioners (Ommerborn et al.,
2009).

Brazil officially recognized TMD and OFP as a specialty in 2002, but integration into undergraduate curricula remains inconsistent (CFO, 2024). Studies show that while certain universities have adopted comprehensive TMD training, many still treat it as a secondary topic, covered within general pathology or prosthodontics courses (Magri et al., 2018; Araújo et al., 2019).

Studies involving students and practicing dentists, such as the one conducted at UFSM, indicate that a significant portion of students consider their knowledge base insufficient to address TMD disorders and OFP conditions (Rahmeier et al., 2021). Additionally, research conducted in the state of Piauí, Brazil, with dentists, revealed gaps in training, particularly regarding the relationship between TMD and occlusal factors (Araújo et al., 2019). These findings demonstrate that, while many students and dentists have been exposed to these topics during their education, the majority describe their learning as fragmented and insufficient (Rahmeier et al., 2021; Araújo et al., 2019).

A consistent theme across the reviewed articles is the excessive emphasis on biological and somatic approaches in TMD and OFP education, particularly regarding occlusal factors, to the detriment of a holistic understanding that includes psychosocial dimensions (Simm & Guimarães, 2013; Machado et al., 2014; Magri et al., 2018; Araújo et al., 2019; Rahmeier et al., 2021). This bias is also reflected in clinical practice, where outdated treatments, such as occlusal adjustments, are still widely used despite current evidence favoring more effective and less invasive approaches (Magri et al., 2018; Araújo et al., 2019).

Another significant challenge is the shortage of TMD and OFP specialists in the faculty of Dentistry programs. Oftentimes, OFP is addressed superficially within basic science courses, without proper integration into the multidisciplinary approaches essential for comprehensive dental education (Simm & Guimarães, 2013). The lack of specialized faculty limits the ability of universities to provide in-depth training, leaving students unprepared to handle the clinical challenges posed by these conditions.

Recent years have seen important advances, such as the establishment of the Brazilian Society of TMD and OFP, which has worked to systematize and disseminate knowledge in the field, promote more specialization courses, and encourage academic research on the topic. Moreover, there has been a noticeable increase in academic output and the availability of specialization courses, reflecting a growing interest in and need for specialized training (Magri et al., 2018; Machado et al., 2014).

The experience accumulated at the University of São Paulo (USP) over a decade in treating patients with TMD and OFP demonstrates the importance of educational practices focused on pain management, self-care, and multidisciplinary approaches. While this integrative model has proven effective in managing these conditions, it remains limited to a few centers of excellence and is not yet a reality for most Brazilian universities (Magri et al., 2018).

A global comparison of TMD and OFP education and recognition reveals significant structural differences among the analyzed countries. In Sweden, the formalization of TMD and OFP as a specialty since 1993 and its inclusion in undergraduate curricula ensure robust training for both general practitioners and specialists (Al-Khotani et al., 2016). In Germany, while craniomandibular disorders are included in undergraduate curricula and occlusal splint therapy is widely used, there is still a need to improve undergraduate and postgraduate curricula and offer continuing education to bridge the gap between scientific discoveries and clinical practice (Ommerborn et al., 2014). In the United States and the United Kingdom, despite efforts to integrate OFP into curricula, gaps persist, particularly in areas such as neuropathic and psychogenic pain, as well as in standardization and interdisciplinarity (Alonso et al., 2014; Aggarwal et al., 2011). In Saudi Arabia, the absence of specialty recognition and the limited inclusion of OFP in undergraduate education result in deficient training, with an exclusive focus on surgical modalities and neglect of essential conservative approaches. Across all contexts, challenges in managing complex conditions like chronic OFP underscore the need to modernize curricula, enhance interdisciplinarity, and promote continuing education.

Thus, there is a pressing need for curricular reform that incorporates the latest guidelines for
TMD and OFP education. Dentistry programs must adopt an interdisciplinary and biopsychosocial approach, equipping students with a comprehensive and effective understanding of the various dimensions of managing these disorders. Furthermore, curricula must be updated according to the latest scientific evidence, fostering the development of competencies that enable more comprehensive and patient-centered treatment.

The implementation of National Curriculum Guidelines (NCGs) that integrate these advancements and promote high-quality training in TMD and OFP is crucial for adequately preparing future dentists. Through a restructured education, it will be possible to address current deficiencies and improve the quality of dental care.

Integrating an interdisciplinary approach involving dentistry, psychology, physiotherapy, and neurology could significantly improve educational outcomes. Countries such as Sweden and Germany have successfully implemented interdisciplinary models in their dental curricula.

Beyond undergraduate training, continuing education programs play a crucial role in keeping practitioners updated on the latest developments in TMD management. Workshops, certification courses, and clinical residencies should be encouraged to address knowledge gaps.

## 5. CONCLUSIONS

This review highlights critical deficiencies in the education of Temporomandibular Disorders (TMD) and Orofacial Pain (OFP) in undergraduate dentistry programs, emphasizing the lack of standardized curricula, inadequate clinical exposure, and reliance on outdated teaching models.

These gaps hinder students' ability to acquire comprehensive knowledge and practical skills in diagnosing and managing these conditions.

To address these shortcomings, the review calls for the implementation of standardized curriculum guidelines that incorporate a multidisciplinary and biopsychosocial framework. This would involve integrating expertise from related fields such as psychology, physiotherapy, and neurology to provide a more holistic approach to TMD and OFP education.

Furthermore, the shift in dentistry towards patient-centered, evidence-based care necessitates updates to diagnostic criteria, pain management strategies, and non-invasive treatment methods within dental training.

The study also stresses the need for enhanced clinical training opportunities, faculty development programs, and continuing education initiatives to ensure that both students and practicing dentists remain up to date with the latest scientific advancements. Future research should focus on evaluating the impact of curriculum reforms and identifying best practices for interdisciplinary TMD and OFP education.

In conclusion, urgent curriculum reform is essential to equip future dentists with the necessary competencies for effective TMD and OFP management. Implementing structured, evidence-based educational strategies will improve student preparedness, enhance patient outcomes, and advance pain management practices in dental care.

## DISCLAIMER (ARTIFICIAL INTELLIGENCE)

Author(s) hereby declare that NO generative AI technologies such as Large Language Models (ChatGPT, COPILOT, etc) and text-to-image generators have been used during writing or editing of this manuscript.

## CONSENT AND ETHICAL APPROVAL

It is not applicable.

## COMPETING INTERESTS

Authors have declared that no competing interests exist.

## REFERENCES

* Aggarwal, V. R., et al. (2011). Dentists' and specialists' knowledge of chronic orofacial pain: Results from a continuing professional development survey. *Primary Dental Care, 18*(1), 41-44.

* Al-Khotani, A., et al. (2015). Professional knowledge among Swedish and Saudi healthcare practitioners regarding orofacial pain in children and adolescents. *Journal of Oral Rehabilitation, 43*(1), 1-9.

* Alonso, A. A., et al. (2014). Dental students' perceived level of competence in orofacial
pain. *Journal of Dental Education*, 78(10), 1379-1387.

Araújo, I. R. S., et al. (2019). Knowledge of dentists about the relationship between temporomandibular dysfunction and occlusal factors. *Revista de Odontologia da UNESP*, 48, 1-8.

Aromataris, E., et al. (2024). *JBI Manual for Evidence Synthesis*. JBI. Available at: https://synthesismanual.jbi.global. Accessed on: August 7, 2024.

Arús, N. A., et al. (2017). Teaching dental students to understand the temporomandibular joint using MRI: Comparison of conventional and digital learning methods. *Journal of Dental Education*, 81(6), 752-758.

Barros, V. de M., et al. (2009). The impact of orofacial pain on the quality of life of patients with temporomandibular disorder. *Journal of Orofacial Pain*, 23(1), 28-37.

Brazil, National Education Council. Chamber of Higher Education. (2021). *Resolution No. 3, of June 21, 2021. Establishes the national curricular guidelines for the undergraduate dentistry course*. Official Gazette of the Union: Section 1, Brasília, DF, p. 77.

Choi, K., Park, J.-H., & Cheong, H.-K. (2013). Prevalence of musculoskeletal symptoms related to activities of daily living and contributing factors in Korean adults. *Journal of Preventive Medicine & Public Health*, 46(1), 39-49.

Coelho, T. P., et al. (2021). Comparison and analysis of systematic reviews and scoping reviews in patient care in Pharmacy. *Research, Society and Development, 10*(12), e08101219915.

Conti, P. C. R. (2021). *TMD: Temporomandibular disorders and orofacial pain: Clinical application of scientific evidence*. Dental Press.

Dworkin, S. F., & LeResche, L. (1992). Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations, and specifications, critique. *Journal of Craniomandibular Disorders: Facial & Oral Pain*, 6(4), 301-355.

Federal Council of Dentistry Brazil (CFO). (2024). General quantity of specialist dentists. Available at: https://website.cfo.org.br/estatisticas/quanti-dade-geral-de-cirurgioes-dentistas-especialistas/. Accessed on: December 5, 2024.

Fredricson, A. S., et al. (2023). Sick leave and disability pension among TMD patients with musculoskeletal diseases, mental and behavioral disorders—a SWEREG-TMD population-based cohort study. *BMC Public Health*, 23(1), Article 852.

Greene, C. S., & Manfredini, D. (2021). Transitioning to chronic TMD pain: A combination of patient vulnerabilities and iatrogenesis. *Journal of Oral Rehabilitation*.

Guedes, A. C. C. M., & Valente, T. C. O. (2023). Collaborative educational practices in health mediated by information and communication technologies: A literature review. *Revista Eletrônica de Comunicação, Informação & Inovação em Saúde*, 17(4), 962-975.

Heir, G. M. (2019). Chronic orofacial pain, cognitive-emotional-motivational considerations: A narrative review. *Journal of Oral Rehabilitation*, 46(11), 1065-1070.

Karos, K., et al. (2020). The social threats of COVID-19 for people with chronic pain. *Pain*, 161(10), 2293-2294.

Lomas, J., et al. (2018). Temporomandibular dysfunction. *Australian Journal of General Practice*, 47(4), 212-215.

Machado, A., Lima, F., & Conti, P. (2014). Current panorama of temporomandibular disorders' field in Brazil. *Journal of Applied Oral Science*, 22(3), 146-151.

Magri, L. V., et al. (2018). Profile of a temporomandibular dysfunction and orofacial pain service of a Brazilian public university: What has changed in 10 years? Retrospective study. *Brazilian Journal of Pain*, 1(3), 173-178.

McCulloch Gallagher, R., & Sandbrink, F. (2019). The socioeconomic burden of pain from war. *American Journal of Public Health*, 109(1), 41-45. https://doi.org/10.2105/AJPH.2018.304725

McNeill, C. (1997). Management of temporomandibular disorders: Concepts and controversies. *The Journal of Prosthetic Dentistry*, 77(5), 510-522.

Miguel, E. R. A., et al. (2024). Educação interprofissional na formação em saúde: Desafios e oportunidades na pós-graduação. *Cadernos Cajuína*, 9(5), e249534.

Moher, D. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. *Annals of Internal Medicine*, 151(4), 264.

Ommerborn, M. A., et al. (2009). A survey on German dentists regarding the
management of craniomandibular
disorders. *Clinical Oral Investigations*,
*14*(2), 137–144.

Rahmeier, G., et al. (2021). Assessment of dentistry students' knowledge at UFSM about TMD and bruxism. *Revista da ABENO, 21*(1), 1253-1253.

Reny de Leeuw, R., & Klaser, G. D. (2013). *Orofacial pain: Guidelines for assessment, diagnosis, and management*. Quintessence Publishing.

Sharma, S., et al. (2011). Etiological factors of temporomandibular joint disorders. *National Journal of Maxillofacial Surgery, 2*(2), 116-119.

Simm, W. R., & Guimarães, A. S. (2013). The teaching of temporomandibular disorders and orofacial pain at the undergraduate level in Brazilian dental schools. *Journal of Applied Oral Science, 21*(6), 518-524.

Wolf, E., et al. (2006). Patients’ experiences of consultations for nonspecific chronic orofacial pain: A phenomenological study. *Journal of Orofacial Pain, 20*(3), 226–233.

Wolf, E., et al. (2008). Nonspecific chronic orofacial pain: Studying patient experiences and perspectives with a qualitative approach. *Journal of Orofacial Pain, 22*(4), 349–358.

**Disclaimer/Publisher's Note:** The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of the publisher and/or the editor(s). This publisher and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

© Copyright (2025); Author(s). The licensee is the journal publisher. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Peer-review history:

The peer review history for this paper can be accessed here:

https://pr.sdiarticle5.com/review-history/131557