Neurology · Medical Literature
Prevalence of dizziness in patients with temporomandibular disorders: a systematic review and meta-analysis.
Abstract
Temporomandibular disorders (TMDs) are characterised by pain and dysfunction in the temporomandibular joints and surrounding muscles. Dizziness is a frequent symptom reported by TMD patients, but the prevalence of dizziness in this population remains unclear. A systematic review and meta-analysis was conducted to identify relevant studies assessing the prevalence of dizziness in TMD patients. Seven electronic databases were searched using a combination of Boolean operators and Medical Subject Headings (MeSH) keywords to maximise sensitivity and specificity. The meta-analysis revealed a significant association between TMDs and dizziness in descriptive studies (pooled odds ratio (OR): 0.42, 95% confidence interval (CI): 0.20-0.88) but found a non-significant association in analytical studies (pooled OR: 0.55, 95% CI: 0.19-1.59). Heterogeneity was low in analytical studies (0%), while descriptive studies showed higher heterogeneity (96%). The studies included in the review generally reported a significant prevalence of vertigo and other aural symptoms in TMD patients. Some investigations highlighted the value of sociodemographic characteristics and the statistical association between TMD and vestibular symptoms. Furthermore, dizziness was quantitatively attributed to TMDs in some studies, while others reported a correlation between TMDs and otolaryngological symptoms. The current review demonstrated that TMDs are associated with increased dizziness and vestibular symptoms, particularly in descriptive research. A causal relationship could not be established due to the heterogeneity and observational nature of the studies included. These findings emphasise the need for careful interpretation and recommend prospective studies to clarify the relationship. When diagnosing and treating TMD patients, clinicians should consider these symptoms together. CRD420251026371.
Clinical relevance
What is the prevalence of dizziness and vestibular symptoms in patients with temporomandibular disorders (TMDs), and is there a statistically significant association between TMD diagnosis and dizziness? __SNAPSHOT__ {"studyDesign":"Systematic review and meta-analysis of observational studies (descriptive and analytical), PROSPERO-registered (CRD420251026371)","setting":"Multi-database search across seven electronic databases; individual included studies: setting not reported in abstract","sampleSize":"not reported (number of included studies and total participant count not specified in abstract)","population":"Patients with a clinical diagnosis of temporomandibular disorders (TMDs), characterized by pain and dysfunction in the temporomandibular joints and surrounding masticatory muscles; specific inclusion criteria for individual studies not detailed in abstract","intervention":"Presence of TMD diagnosis (exposure)","comparator":"Non-TMD controls in analytical studies; not applicable for descriptive (single-arm prevalence) studies","primaryOutcome":"Prevalence of dizziness (including vertigo and other aural/vestibular symptoms) in TMD patients; pooled odds ratio for the TMD–dizziness association","followUp":"not reported (cross-sectional or observational study designs implied; no longitudinal follow-up described)","fundingSource":"not reported"}
Key findings
The meta-analysis stratified results by study design type. In descriptive studies, a statistically significant association between TMD and dizziness was identified (pooled OR: 0.42, 95% CI: 0.20–0.88). Critically, an OR below 1.0 in this context requires careful interpretive caution: as reported in the abstract, the direction and framing of this OR are not fully clarified (e.g., whether it reflects the odds of dizziness in TMD vs. non-TMD, or some other comparison), and absolute prevalence figures are not provided. In analytical (comparative) studies, the association was non-significant (pooled OR: 0.55, 95% CI: 0.19–1.59), with the confidence interval crossing 1.0. Heterogeneity was substantial in descriptive studies (I² = 96%) and negligible in analytical studies (I² = 0%). NNT/NNH cannot be calculated from the data reported. No specific adverse event data were applicable given the observational design. Individual included studies broadly reported a significant prevalence of vertigo and other aural symptoms in TMD populations, and some studies quantitatively attributed dizziness to TMD or reported correlations with otolaryngological symptoms; specific prevalence figures were not extracted in the abstract.
Practice implications
This systematic review and meta-analysis suggests an association between TMDs and dizziness/vestibular symptoms, particularly in descriptive research. However, several interpretive limitations are critical for clinicians: (1) The OR of 0.42 in descriptive studies, being less than 1.0, is counterintuitive for a 'significant association' claim and may reflect the pooling methodology, referent group framing, or a prevalence ratio artifact—this warrants careful review of the full text before clinical application. (2) The analytical study pool showed no statistically significant association (OR 0.55, 95% CI 0.19–1.59), which directly contradicts inferring a causal or even robust associative relationship. (3) Extreme heterogeneity in descriptive studies (I² = 96%) renders the pooled estimate unreliable and biologically uninformative without subgroup explanation. (4) A causal relationship between TMD and dizziness was explicitly not established by the authors. (5) The findings apply broadly to TMD patient populations as defined across the included studies, but specific subgroups (e.g., by TMD subtype, age, sex, vestibular diagnosis type) were not delineated in the abstract. Patients with isolated dizziness not evaluated for TMD are not represented. Clinicians in neurology, otolaryngology, and orofacial pain should consider TMD as part of the differential in patients presenting with unexplained dizziness or vestibular symptoms, but this review does not provide sufficient evidence to mandate screening or alter treatment algorithms. Only the abstract was available for this summary; full-text review is strongly recommended before translating findings to practice. __LIMITATIONS__ Extreme statistical heterogeneity in descriptive studies (I² = 96%) undermines the reliability and interpretability of the pooled prevalence estimate.,The pooled OR direction (< 1.0) in descriptive studies is not intuitively consistent with the stated conclusion of 'significant association' and requires full-text clarification of referent group and pooling methodology.,Analytical studies showed a non-significant result (OR 0.55, 95% CI 0.19–1.59), directly undercutting a generalizable association claim.,All included studies are observational in design; no temporality can be established, precluding causal inference.,Total number of included studies and aggregate participant count are not reported in the abstract, preventing assessment of statistical power or publication bias.,TMD diagnostic criteria likely varied across included studies, introducing misclassification and clinical heterogeneity.,Dizziness and vestibular symptom definitions almost certainly varied across included studies, further limiting comparability.,Absolute prevalence rates of dizziness in TMD patients are not reported, limiting clinical utility.,Sociodemographic characteristics highlighted in some studies are not systematically controlled for across the meta-analysis.,Funding source is not reported; potential for selective reporting or publication bias cannot be assessed.,Generalizability is uncertain given the unknown geographic and clinical diversity of included study populations.,Only the abstract was available for this review; full evaluation of risk-of-bias assessment tools, GRADE certainty ratings, and subgroup analyses was not possible. __BOTTOM_LINE_CATEGORY__ low_certainty __BOTTOM_LINE__ This systematic review and meta-analysis found a statistically significant TMD–dizziness association in descriptive studies (pooled OR 0.42, 95% CI 0.20–0.88) but a non-significant result in analytical comparative studies (pooled OR 0.55, 95% CI 0.19–1.59), with extreme heterogeneity in the descriptive pool (I² = 96%) and no causal relationship established. Clinicians evaluating patients with unexplained dizziness or vestibular symptoms may reasonably consider TMD in the differential, but this evidence base is insufficient to change screening or management protocols. Prospective studies using standardized TMD and vestibular diagnostic criteria are needed before practice recommendations can be made.