Can poor nutrition and diet influence temporomandibular disorder? A systematic review.
Clinical Snapshot
PICO Framework
| P — Population | Adults (and adolescents/prenatal cohorts) with painful temporomandibular disorders (TMD), including myogenous TMD and myofascial pain subtypes |
| I — Intervention | Dietary patterns, nutritional status, specific nutrients (e.g., vitamin D), or dietary components (e.g., monosodium glutamate) |
| C — Comparator | Controls without TMD, or alternative treatments (e.g., diclofenac), or differing dietary quality scores |
| O — Outcomes | TMD-related pain intensity, symptom presence or severity, nutritional intake differences between TMD and non-TMD populations |
Bottom Line
This systematic review synthesises seven low-risk-of-bias studies examining the relationship between diet, nutrition, and painful temporomandibular disorders (TMD). Despite screening 7,760 records, the evidence base is remarkably sparse and heterogeneous. Prospective cohort data do not support prenatal or adolescent diet quality as independent predictors of TMD. Cross-sectional studies suggest possible associations between specific dietary patterns and TMD symptoms, and women with myogenous TMD appear to have lower intake of several nutrients compared with controls. Experimentally, monosodium glutamate increased pain in myofascial TMD, while the sole RCT found no significant pain difference between vitamin D supplementation and diclofenac. No meta-analysis was possible, no GRADE assessment was performed, and the authors appropriately conclude that evidence is insufficient for causal or therapeutic conclusions. For Australian clinicians, this review does not support specific dietary interventions or nutritional supplementation as evidence-based TMD treatments. Holistic chronic pain assessment including nutritional screening remains reasonable clinical practice, but dietary modification for TMD should not be prioritised over established multimodal approaches. High-quality RCTs with standardised DC/TMD diagnostic criteria and validated dietary assessment tools are urgently needed.
Key Findings
P Value: Not reported in aggregate; individual study-level significance not extractable from abstract
Effect Size: No pooled effect size calculable; narrative findings indicate: monosodium glutamate ingestion increased pain intensity in myofascial TMD; women with myogenous TMD showed lower intake of several nutrients compared with controls; prospective cohorts did not demonstrate independent dietary prediction of TMD
Primary Outcome: Association between dietary patterns/nutritional status and painful temporomandibular disorders
Nnt Or Sensitivity: Not calculable from available data; the single RCT comparing vitamin D supplementation versus diclofenac found no statistically significant difference in pain outcomes between groups
Confidence Interval: Not reported (no meta-analysis performed)
Clinical Application
Dietary assessment and nutritional counselling are low-cost, low-risk adjuncts to standard TMD management. However, current evidence does not support specific dietary prescriptions or nutritional supplementation as evidence-based TMD treatments. Clinicians may reasonably screen for nutritional deficiencies as part of holistic chronic pain assessment without this review providing directive guidance. In Australia, TMD management falls within the scope of orofacial pain specialists, general dental practitioners, and multidisciplinary pain clinics. The RACGP and Australian Dental Association do not currently have specific dietary guidelines for TMD. Vitamin D supplementation is widely available over-the-counter and on the PBS for specific indications (e.g., osteoporosis, deficiency states), but this review does not support PBS-listed vitamin D supplementation specifically for TMD pain. Diclofenac (comparator in the included RCT) is TGA-approved and available in Australia for musculoskeletal pain. The finding of no significant difference between vitamin D and diclofenac should be interpreted cautiously given the single-trial basis. Monosodium glutamate is a common dietary additive in Australian diets; the experimental finding of increased TMD pain warrants further investigation but is insufficient to support clinical dietary restriction advice at this stage. Adults presenting with painful TMD, particularly myogenous or myofascial subtypes; findings may have limited applicability to arthrogenous TMD subtypes. Female patients appear overrepresented in the included studies.
Abstract
BACKGROUND: The relationship between diet, nutrition, and painful temporomandibular disorders (TMD) is not well established, despite increasing interest in lifestyle factors in chronic pain. This systematic review aimed to synthesize available evidence on how dietary patterns and nutritional status may be associated with painful TMD. METHODS: An electronic search was conducted in the databases MEDLINE, CINAHL, EMBASE, the Cochrane Central Registry of Controlled Trials (CENTRAL) and Web of Science for clinical and observational trials from the beginning of each database to November 2025. Risk of bias was performed using the Study Quality Assessment Tools from the National Heart, Lung, and Blood Institute (NHLBI). RESULTS: Out of 7,760 records and after the risk of bias assessment, only seven studies judged as having a low risk of bias were included. Overall, the included studies indicate that the association between dietary factors and TMD remains unclear. Prospective cohort studies did not demonstrate that prenatal or adolescent diet quality independently predicted TMD. Cross-sectional studies suggested that specific dietary patterns may be related to TMD-related symptoms. Women with myogenous TMD showed lower intake of several nutrients compared with controls. Experimental evidence indicated that monosodium glutamate ingestion increased pain intensity in myofascial TMD, while the only randomized trial found no significant pain differences between vitamin D supplementation and diclofenac. CONCLUSIONS: Current evidence suggests that some dietary components and nutritional factors may be associated with TMD-related symptoms or pain responses; however, the findings are limited, heterogeneous, and insufficient to support firm causal or therapeutic conclusions.
References
- 1.de Lima, F. F., Razavian, A., Hosokawa, M., Foscaldo, T. F., Koldzo, M., Poluha, R. L., Christidis, M., Christidis, N., & De la Torre Canales, G. (2026). Can poor nutrition and diet influence temporomandibular disorder? A systematic review. BMC Oral Health. https://doi.org/10.1111/papr.12604
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