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Dentistry

Cite as: Archiv EuroMedica. 2026. 16; 4. DOI 10.35630/2026/16/Iss.4.31

Received 01 July 2026;
Accepted 27 August 2026;
Published 28 August 2026

DRY NEEDLING IN MYOGENOUS TEMPOROMANDIBULAR DISORDERS: CURRENT EVIDENCE AND CLINICAL PERSPECTIVES FOR DENTAL AND PHYSIOTHERAPEUTIC PRACTICE - A NARRATIVE REVIEW

Weronika Kwaśnica¹ , Zuzanna Jeziorska² ,
Bartosz Szymajda² , Zuzanna Galicka² ,
Justyna Polko² , Izabela Migdał² ,
Jakub Artur Czapkiewicz² , Maja Witek³ ,
Tomasz Horodniczy⁴ , Katarzyna Raczek⁵

¹ Poznan University of Medical Sciences, Poznan, Poland
² Medical University of Silesia, Katowice, Poland
³ Medical University of Warsaw, Poland
⁴ Ortho.pl Dental Office, Wrocław, Poland
⁵ Wroclaw Medical University, Wroclaw, Poland

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  izabela.migdal14@gmail.com

ABSTRACT

Background

Myogenous temporomandibular disorders are characterized by masticatory muscle pain, tenderness, and impaired mandibular function. Dry needling is used as a local intervention for myofascial pain, but its clinical effectiveness, safety, patient selection criteria, and place within conservative management remain uncertain.

Aim

This narrative review critically synthesizes current evidence on the effectiveness and safety of dry needling in myogenous temporomandibular disorders, with particular attention to pain outcomes, mandibular function, patient selection, methodological limitations, and its potential role within interdisciplinary conservative management.

Materials and methods

A SANRA-oriented narrative review was conducted. Literature was identified through searches of PubMed/MEDLINE, Scopus, Web of Science, Embase, and Google Scholar, supported by citation tracking. Systematic reviews, meta-analyses, randomized and controlled clinical trials, clinical guidelines, narrative reviews, scoping reviews, and other clinically relevant studies were considered. Forty publications were included in the final narrative synthesis.

Results

Current evidence suggests that dry needling may provide short-term reductions in pain intensity and pressure sensitivity and may improve selected measures of mandibular function. However, the magnitude, clinical relevance, and durability of these effects remain uncertain because of small samples, heterogeneous diagnostic criteria, variable treatment protocols, different comparator interventions, and short follow-up periods. Standardized criteria for patient selection have not been established.

Conclusions

Dry needling may be considered a potentially useful adjunct within conservative and interdisciplinary management of myogenous temporomandibular disorders. It should not be regarded as a universal or stand-alone treatment. Its optimal position in the treatment pathway and its superiority over botulinum toxin type A or other active interventions have not been established.

Keywords: Temporomandibular Disorders; Dry Needling; Myofascial Pain Syndromes; Masticatory Muscles; Orofacial Pain; Physical Therapy Modalities.

1. INTRODUCTION

Temporomandibular disorders are a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joints, masticatory muscles, and associated craniofacial structures. They represent an important cause of orofacial pain and functional limitation, with clinical manifestations that may include pain during mandibular movement, muscle tenderness, restricted mouth opening, impaired masticatory function, headache, otologic symptoms, and reduced oral health-related quality of life [1-7,34]. Among pain-related temporomandibular disorders, myogenous temporomandibular disorders are particularly relevant for both dental and physiotherapeutic practice because they frequently involve masticatory muscle overload, myofascial pain, trigger point-related tenderness, parafunctional behaviors, and interactions between local musculoskeletal dysfunction and broader pain-modulating mechanisms [1-5,32,33].

The Diagnostic Criteria for Temporomandibular Disorders provide a standardized framework for the diagnosis of common pain-related and intra-articular temporomandibular disorders. Importantly, this framework integrates physical Axis I diagnoses with Axis II assessment of psychosocial and behavioral factors that may contribute to the onset, persistence, and clinical expression of temporomandibular pain [1,2]. This multidimensional perspective is essential in myogenous temporomandibular disorders, where peripheral muscle dysfunction rarely exists in isolation. Instead, pain-related disability may reflect the interaction between masticatory muscle sensitivity, parafunctional activity, sleep-related or awake behaviors, psychological distress, central sensitization, and individual pain coping strategies [1-5,32,33].

Conservative and reversible interventions are generally preferred as first-line strategies in the management of temporomandibular disorders, particularly in chronic pain presentations. Contemporary clinical recommendations emphasize patient education, self-management, exercise, cognitive-behavioral approaches, manual therapy, and other non-surgical strategies, while more invasive or pharmacologically disruptive interventions should be considered cautiously and usually only in selected cases [5-8]. This treatment philosophy is especially important in myogenous temporomandibular disorders, where the therapeutic objective is not only pain reduction, but also restoration of function, improvement of muscle coordination, reduction of overload, and prevention of unnecessary escalation.

Dry needling has gained increasing attention as a locally targeted intervention for myofascial pain and trigger points in the masticatory muscles. In the temporomandibular region, it has been investigated as a stand-alone or adjunctive therapy aimed at reducing pain intensity, improving pressure pain thresholds, increasing mandibular range of motion, and decreasing muscle tenderness [12-24]. Proposed mechanisms include local mechanical effects on myofascial trigger points, modulation of peripheral nociceptive input, changes in muscle perfusion or oxygenation, spinal and supraspinal pain modulation, and potential effects on peripheral and central sensitization [12,13,21]. However, these mechanisms remain incompletely understood, and biological plausibility alone does not establish clinical effectiveness.

Recent evidence syntheses suggest that dry needling may provide short-term benefits in selected temporomandibular and orofacial myofascial pain outcomes. Nevertheless, the certainty of evidence remains limited by small sample sizes, heterogeneous diagnostic criteria, variability in needling protocols, differences in comparator interventions, short follow-up periods, and inconsistent outcome measures [14,15,25]. Several systematic reviews, meta-analyses, and network meta-analyses have addressed dry needling and related conservative or minimally invasive interventions in temporomandibular disorders, but the practical translation of these findings into interdisciplinary dental and physiotherapeutic decision-making remains insufficiently developed [14,15,24,25].

Injection-based therapies, particularly botulinum toxin-A, represent an important comparative context for dry needling in patients with myogenous temporomandibular pain and bruxism-related muscle symptoms [24,29-31,39]. However, detailed issues related to chemodenervation, cost, effects on masticatory muscle function, possible compensatory neuromuscular changes, and potential bone-related outcomes are addressed later in the Results and Discussion sections.

The interdisciplinary nature of myogenous temporomandibular disorders requires cooperation between dental professionals and physiotherapists, with otolaryngological evaluation considered when ear-related symptoms are present. Dentists play a key role in differential diagnosis, exclusion of odontogenic and intra-articular causes of pain, assessment of oral function, and recognition of parafunctional contributors. Physiotherapists contribute to musculoskeletal assessment, manual therapy, therapeutic exercise, pain education, and functional rehabilitation. When symptoms such as otalgia, tinnitus, aural fullness, dizziness, or hearing-related complaints are present, primary otological pathology should be excluded before these symptoms are attributed to temporomandibular disorders [7].

This review addresses a clinically relevant gap by integrating current evidence on dry needling in myogenous temporomandibular disorders with a clinically oriented interpretation of diagnostic boundaries, patient selection, methodological limitations, safety considerations, and interdisciplinary relevance. Rather than repeating an effectiveness-focused synthesis, this narrative review aims to translate heterogeneous evidence into a practical framework for dental and physiotherapeutic decision-making.

2. AIM OF THE REVIEW

The aim of this narrative review is to critically synthesize current evidence on the clinical effectiveness and safety of dry needling in myogenous temporomandibular disorders, with particular attention to pain outcomes, mandibular function, patient selection, methodological limitations, and its potential role within interdisciplinary conservative management.

The review addresses four questions:

1. What evidence supports the effectiveness of dry needling in reducing pain and improving mandibular function in patients with myogenous temporomandibular disorders?
2. Which clinical characteristics, including reproducible masticatory muscle tenderness and familiar pain elicited by palpation, may identify patients in whom dry needling could be considered?
3. What is the potential role of dry needling in relation to education, self-management, exercise, manual therapy, occlusal splints, and injection based treatments, including botulinum toxin type A?
4. Which methodological limitations restrict the interpretation and clinical application of the available evidence?

3. MATERIALS AND METHODS

3.1. Review design

This article was designed as a narrative review conducted in accordance with SANRA-oriented principles [9]. The review was intended to provide a critical synthesis of current evidence rather than a statistical meta-analysis. The methodological approach emphasized transparent literature identification, thematic organization of findings, critical interpretation of evidence quality, and clinical relevance for interdisciplinary dental and physiotherapeutic practice. Guidance on narrative synthesis was considered during development of the interpretive framework [10].

3.2. Literature search strategy

A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Embase, and Google Scholar. Google Scholar was used as a supplementary source for citation tracking and identification of additional clinically relevant publications. The search focused on studies and reviews addressing dry needling, trigger point dry needling, myogenous temporomandibular disorders, myofascial temporomandibular pain, orofacial pain, masticatory muscles, and interdisciplinary management. The search period covered publications from January 2014 to June 2026. Older publications were included when considered methodologically foundational, highly cited, or essential for diagnostic classification, pain mechanisms, or clinical reasoning.

The following search terms and their combinations were used: dry needling OR trigger point dry needling AND temporomandibular disorders OR TMD OR myogenous temporomandibular disorders OR myofascial temporomandibular disorder OR myofascial temporomandibular pain OR orofacial pain AND masseter OR temporalis OR masticatory muscles OR myofascial trigger points OR mandibular function OR mouth opening. Additional search terms included botulinum toxin, botulinum toxin-A, bruxism, manual therapy, physiotherapy, dental practice, otologic symptoms, otalgia, and interdisciplinary care.

3.3. Eligibility criteria

Publications were considered eligible if they met the following criteria: English-language articles; human studies or evidence syntheses involving adults; studies addressing myogenous temporomandibular disorders, myofascial temporomandibular pain, masticatory muscle pain, or closely related orofacial myofascial pain conditions; dry needling evaluated as a primary or adjunctive intervention; outcomes related to pain intensity, pressure pain threshold, mandibular range of motion, muscle tenderness, jaw function, oral health-related quality of life, adverse effects, or clinical applicability; and study types including randomized controlled trials, controlled clinical trials, systematic reviews, meta-analyses, network meta-analyses, clinical guidelines, consensus statements, and clinically relevant narrative or scoping reviews.

3.4. Exclusion criteria

Publications were excluded if they were animal or in vitro studies; focused exclusively on intra-articular temporomandibular joint pathology without a myogenous component; addressed acupuncture without a clear distinction from dry needling unless included only for contextual comparison; were case reports or case series without broader clinical or methodological relevance; were opinion papers, editorials, or non-peer-reviewed sources lacking sufficient scientific or clinical value; lacked accessible abstracts or sufficient methodological detail; or did not allow dry needling to be distinguished from other combined interventions.

3.5. Study selection and data synthesis

The identified publications were screened by title and abstract for relevance to the review aim. Full texts were assessed when the abstract suggested potential eligibility or when the publication was considered clinically or methodologically important. The final selection prioritized studies with direct relevance to dry needling in myogenous temporomandibular disorders, followed by studies addressing related orofacial myofascial pain conditions, interdisciplinary management, diagnostic criteria, and comparator interventions. Forty publications were included in the final narrative synthesis.

The synthesis was organized thematically rather than statistically. Extracted information included article type, study population, diagnostic criteria, intervention characteristics, treated muscles, comparator interventions, outcome measures, main findings, follow-up duration, adverse effects, and stated limitations. Particular attention was paid to heterogeneity in patient selection, dry needling protocols, diagnostic definitions, outcome measures, and follow-up periods.

3.6. Methodological transparency

Because this review was designed as a narrative review, no protocol registration or statistical meta-analysis was performed. Methodological transparency was strengthened by predefined eligibility criteria, a structured search strategy, thematic synthesis, and explicit discussion of evidence limitations. The review should therefore be interpreted as a critical clinical synthesis rather than as a systematic review.

4. RESULTS: Thematic Synthesis of the Literature

4.1. Diagnostic Framework and Clinical Phenotype of Myogenous Temporomandibular Disorders

Myogenous temporomandibular disorders represent a subgroup of pain-related temporomandibular disorders in which symptoms are primarily associated with the masticatory muscles rather than intra-articular temporomandibular joint pathology. The most frequently described clinical features include pain in the masseter or temporalis muscles, tenderness on palpation, pain during mandibular movement or function, reduced pain-free mouth opening, impaired mastication, and referred pain to adjacent craniofacial regions [1-7].

The Diagnostic Criteria for Temporomandibular Disorders provide the main diagnostic framework for distinguishing myogenous pain from intra-articular, odontogenic, neuropathic, and other causes of orofacial pain [1,2]. Across dry needling studies, patient selection varies considerably. Some studies include formally diagnosed myogenous temporomandibular disorders, whereas others include broader categories such as orofacial myofascial pain, masticatory muscle pain, sleep bruxism with temporomandibular disorder symptoms, or myofascial pain syndrome affecting the temporomandibular region [14-25]. This diagnostic variability limits direct comparison between studies.

4.2. Myofascial Trigger Points and Masticatory Muscle Dysfunction

Myofascial trigger points are frequently used as clinical targets in dry needling studies involving the masticatory muscles. Most protocols focus on the masseter and temporalis muscles, although some studies include cervical or additional craniofacial components as part of multimodal treatment [16-24]. Trigger point-related symptoms are commonly associated with local tenderness, reproduction of familiar pain, referred pain patterns, and pain-related limitation of mandibular movement.

The identification of trigger points is not fully standardized across studies. Differences in palpation technique, examiner training, diagnostic criteria, target muscles, and criteria for reproduction of familiar pain affect the comparability of included populations [11,12,35,36,37,38]. Therefore, studies using similar terminology may not always refer to equivalent clinical findings.

4.3. Biological and Neurophysiological Rationale for Dry Needling

The proposed mechanisms of dry needling include local mechanical stimulation of sensitive muscle regions, modulation of peripheral nociceptive input, local twitch responses, changes in muscle perfusion or oxygenation, and activation of segmental or suprasegmental pain-modulating pathways [12,13,21,37,38]. In the masticatory system, these mechanisms have been investigated mainly in relation to the masseter and temporalis muscles [16-24].

Mechanistic findings remain limited. For example, increased masseter muscle oxygenation after trigger point dry needling has been reported, but such physiological outcomes do not by themselves establish clinical effectiveness [21]. Current evidence does not clearly distinguish local tissue effects from neurophysiological modulation, contextual effects, or the influence of co-interventions.

4.4. Clinical Effectiveness of Dry Needling: Pain Outcomes

Pain intensity and pressure pain threshold are the most frequently reported outcomes in studies evaluating dry needling for myogenous temporomandibular disorders and related orofacial myofascial pain conditions. Clinical studies have used visual analogue scales, numerical pain rating scales, pressure algometry, palpation-related tenderness, and pain during mandibular function [14-25].

Several studies have reported reductions in pain intensity after dry needling of the masseter or temporalis muscles in patients with myofascial temporomandibular pain or related clinical presentations [16-24]. Ozden et al. evaluated dry needling in patients with myofascial temporomandibular disorders related to the masseter muscle [16]. Tesch et al. assessed the effect of dry needling on local pressure pain threshold in masticatory myofascial pain in a systematic review and preliminary clinical trial [17]. Dib-Zakkour et al. evaluated dry needling in myogenous temporomandibular joint disorders [18]. Fernandez-Carnero et al. reported short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders [22].

The characteristics of key clinical studies and evidence syntheses are summarized in Table 1.

Systematic reviews and meta-analyses have reported mixed findings. Menendez-Torre et al. found favorable short-term effects for deep dry needling in selected comparisons in myofascial temporomandibular disorders [14]. Kuzdzal et al. evaluated randomized clinical trials on dry needling for orofacial pain and emphasized limitations in the evidence base [15]. Nowak et al. reviewed intramuscular injections and dry needling within the masticatory muscles, highlighting heterogeneity in interventions and outcomes [25].

Where dry needling was delivered as part of multimodal care, the independent contribution of dry needling could not be clearly isolated. This is particularly relevant to trials in which dry needling was combined with cervical manipulation, manual therapy, exercise, or other conservative interventions [19,20].

4.5. Clinical Effectiveness of Dry Needling: Mandibular Function and Range of Motion

Functional outcomes reported in the dry needling literature include maximum mouth opening, pain-free mouth opening, mandibular protrusion, lateral excursions, jaw functional limitation, and oral health-related quality of life [16-24]. These outcomes are relevant because myogenous temporomandibular disorders may interfere with chewing, speech, oral hygiene, dental treatment, and daily mandibular function.

Several studies have reported improvement in mandibular mobility after dry needling, particularly in maximum mouth opening or active pain-free mouth opening [16-24]. In studies targeting the masseter muscle, changes in mouth opening were often reported together with changes in pain intensity or pressure pain threshold [16,17,22]. Dib-Zakkour et al. evaluated dry needling in myogenous temporomandibular joint disorders with pain and functional outcomes [18]. Garcia-de la-Banda-Garcia et al. compared dry needling with manual therapy in myofascial temporomandibular disorders [20].

In multimodal trials, dry needling has been combined with cervical manipulation or other conservative interventions. Dunning et al. evaluated dry needling combined with upper cervical spinal manipulation in patients with temporomandibular disorder [19]. Such trials provide evidence on combined treatment protocols, but they do not allow firm conclusions about the independent functional effect of dry needling. These findings should therefore be interpreted as outcomes of combined treatment packages rather than as proving the independent effectiveness of dry needling.

4.6. Dry Needling Versus Botulinum Toxin-A and Other Injection-Based Therapies

Direct comparative evidence between dry needling and botulinum toxin-A is limited. Kutuk et al. compared abobotulinum toxin-A injection with dry needling in patients with myofascial pain syndrome affecting the temporomandibular joint and reported improvement after both interventions, with greater short-term improvement in pain at rest and mandibular protrusion in the dry needling group [24]. The study had a small sample and limited follow-up.

Botulinum toxin-A has been evaluated in recent evidence syntheses on temporomandibular disorders and myogenous temporomandibular pain [29,30]. Saini et al. performed a systematic review and meta-analysis of botulinum toxin for temporomandibular disorders [29]. De la Torre Canales et al. published an umbrella review of systematic reviews on botulinum toxin-A for myogenous temporomandibular disorders [30]. Reported outcomes include pain intensity, mandibular movement, bruxism-related symptoms, occlusal force, adverse effects, and patient-reported function [29,30].

The comparative characteristics of dry needling and botulinum toxin-A as reported in the literature are summarized in Table 2.

Evidence concerning botulinum toxin-A also includes safety-related and functional topics beyond pain intensity. Moussa et al. reviewed adverse effects of botulinum toxin-A injections on mandibular bone [31]. De Souza Nobre et al. reported temporalis muscle changes after botulinum toxin-A injections in patients treated for masseter hypertrophy [39], and a related randomized trial explored the impact of botulinum toxin on masseter hypertrophy [40]. These findings are not direct evidence in myogenous temporomandibular disorder populations, but they are relevant to later risk-benefit discussion because they concern masticatory muscle and mandibular tissue effects after botulinum toxin-A injections.

4.7. Safety, Tolerability, and Adverse Effects

Safety outcomes in dry needling studies are reported inconsistently. The most commonly described adverse effects are transient local soreness, pain during or after treatment, minor bleeding, bruising, temporary symptom aggravation, and vasovagal-type reactions such as dizziness or light-headedness [26-28]. Boyce et al. analyzed adverse events associated with therapeutic dry needling [26], Brady et al. reported adverse events following trigger point dry needling in physiotherapy practice [27], and Trybulski et al. described adverse reactions to dry needling therapy in Polish physiotherapy practice [28].

In the orofacial region, safety considerations are influenced by anatomy and target muscle selection. The masseter and temporalis muscles are the most frequently treated muscles in clinical studies, whereas deeper structures such as the medial and lateral pterygoid muscles are less commonly included in trials and reviews [16-25]. Studies differ in the extent to which they report needle depth, practitioner training, sterile technique, adverse-event monitoring, contraindications, and follow-up.

In comparative literature involving botulinum toxin-A, adverse-effect reporting includes injection-related discomfort, masticatory muscle weakness, chewing difficulty, facial asymmetry, and potential effects related to repeated chemodenervation [29-31,39,40]. Evidence regarding possible effects on mandibular bone parameters has also been discussed [31]. The consistency and clinical significance of these findings are addressed in the Discussion.

Overall, the available safety literature suggests that minor adverse effects after dry needling are more commonly reported than major adverse events, but reporting standards are inconsistent and long-term safety data in orofacial applications remain limited [26-28].

4.8. Methodological Limitations of the Evidence Base

The main methodological limitations of the available evidence include heterogeneous diagnostic criteria, small sample sizes, short follow-up periods, variability in dry needling protocols, inconsistent comparator interventions, difficulty with blinding, and inconsistent outcome measures [14,15,25]. These limitations affect both the interpretation of pain outcomes and the assessment of mandibular function.

Diagnostic heterogeneity is particularly important because included populations vary across myogenous temporomandibular disorders, broader orofacial myofascial pain, masticatory muscle pain, sleep bruxism with TMD symptoms, bruxism-related myalgia, myofascial pain syndrome affecting the temporomandibular joint, and mixed temporomandibular disorder presentations [14-25,32,33]. Protocol heterogeneity also limits comparison between studies, as interventions differ in target muscles, needling depth, number of sessions, stimulation technique, use of local twitch responses, and co-interventions [14-25].

Because many trials use multimodal protocols or active comparators, the independent effectiveness of dry needling remains difficult to establish [19,20,25]. Short follow-up periods also limit conclusions regarding durability, recurrence, and long-term functional improvement. These evidence limitations are considered in the Discussion when interpreting the clinical position of dry needling in interdisciplinary management.

Figure 1 presents the main methodological domains that should be considered when interpreting studies on dry needling in myogenous temporomandibular disorders, including diagnostic heterogeneity, trigger point identification, protocol variability, comparator selection, follow-up duration, outcome measures, adverse-event reporting, and the difficulty of isolating the independent effectiveness of dry needling.

5. DISCUSSION

5.1. Interpretation of Evidence Strength

The available evidence suggests that dry needling may provide clinically relevant short-term benefits in selected patients with myogenous temporomandibular disorders, particularly with regard to pain reduction, pressure pain threshold, and pain-free mandibular function. However, this conclusion remains limited by small samples, short follow-up periods, heterogeneous diagnostic criteria, variability in needling protocols, and inconsistent comparator interventions [14,15]. Dry needling should therefore be interpreted as a potentially useful adjunctive intervention rather than as an established stand-alone treatment for all patients with temporomandibular disorders.

This distinction is clinically important. Temporomandibular disorders are not a single disease entity, and the therapeutic relevance of dry needling depends on appropriate phenotyping. A patient with reproducible masseter or temporalis tenderness, familiar pain during palpation, pain-related limitation of mouth opening, and signs of myofascial involvement may represent a more rational candidate than a patient whose symptoms are primarily odontogenic, intra-articular, neuropathic, inflammatory, otologic, or centrally mediated without a clear peripheral muscular component.

5.2. Clinical Relevance for Dental Practice

For dental professionals, the clinical relevance of dry needling lies primarily in differential diagnosis, muscle-related orofacial pain, and interdisciplinary care planning. Dentists are often the first clinicians consulted by patients with pain in the temporomandibular or orofacial region. Therefore, they play a central role in excluding odontogenic pain, periodontal disease, occlusal trauma, post-treatment pain, intra-articular temporomandibular joint pathology, neuropathic pain, and other non-muscular causes before a myogenous diagnosis is established.

Dry needling should not be understood as a substitute for diagnosis. Rather, it may be considered only after a clinically meaningful muscular component has been identified. In patients with pain reproduced by palpation of the masseter or temporalis muscles, jaw fatigue, parafunctional overload, limited pain-free mouth opening, or muscle tenderness associated with chewing or clenching, referral to a physiotherapist trained in orofacial assessment and dry needling may be appropriate.

Dry needling may also have practical relevance for dental treatment planning. Patients with myogenous temporomandibular disorders may have difficulty tolerating prolonged mouth opening, restorative procedures, prosthodontic treatment, endodontic treatment, or surgery. If dry needling contributes to pain reduction or improved pain-free mandibular movement, it may indirectly support dental care by improving procedural tolerance. This remains a clinical hypothesis rather than a proven indication.

5.3. Clinical Relevance for Physiotherapeutic Practice

For physiotherapists, dry needling may be considered one component of musculoskeletal management in selected patients with myogenous temporomandibular disorders. Its potential role is most coherent when integrated with manual therapy, therapeutic exercise, patient education, load management, breathing and relaxation strategies, cervical assessment, and functional retraining of mandibular movement.

Dry needling may be used to decrease pain sensitivity and improve tolerance for movement, but its clinical value may depend on whether the reduced pain window is used to introduce active strategies that modify function and behavior. If a patient continues to clench during the day, sleep poorly, experience high stress, avoid movement, or overload the masticatory muscles, symptom recurrence is likely.

5.4. Interdisciplinary and Otolaryngological Considerations

Myogenous temporomandibular disorders often present with symptoms that overlap with dental, musculoskeletal, neurological, and otolaryngological conditions. This overlap is especially relevant when patients report otalgia, tinnitus, aural fullness, dizziness, or hearing-related complaints. Although such symptoms may coexist with temporomandibular disorders, they should not automatically be attributed to the stomatognathic system without appropriate differential diagnosis [7].

Otolaryngological evaluation may be necessary when ear-related symptoms are prominent, atypical, progressive, unilateral, associated with hearing loss, vestibular complaints, infection signs, or when the clinical presentation does not clearly match a myogenous temporomandibular disorder phenotype. This does not shift the focus of dry needling therapy toward otolaryngology, but it strengthens diagnostic safety.

5.5. Patient Selection and Practical Clinical Positioning

Appropriate patient selection is central to the clinical value of dry needling. The available evidence does not support its use as a universal intervention for all temporomandibular disorders. Its most rational application appears to be in patients with a clearly identifiable myogenous component, reproducible masticatory muscle tenderness, familiar pain evoked by palpation, myofascial trigger point-related symptoms, and pain-related limitation of mandibular function.

A practical clinical model may position dry needling after initial conservative measures such as education, self-management, behavioral modification, jaw relaxation strategies, therapeutic exercise, and manual therapy, but before escalation to more pharmacologically disruptive or chemodenervating interventions in selected cases. The treatment sequence should be individualized according to symptom duration, pain severity, functional limitation, patient preference, risk profile, access to trained clinicians, and response to previous conservative care.

5.6. Future Research Directions

Future research should use standardized diagnostic criteria, preferably based on validated temporomandibular disorder classification systems, to distinguish myogenous pain from intra-articular, odontogenic, neuropathic, otologic, and mixed presentations. Dry needling protocols should be described in sufficient detail to allow reproducibility, including target muscles, depth, number of needles, number of sessions, treatment frequency, needle manipulation, local twitch response strategy, unilateral or bilateral application, co-interventions, practitioner training, and adverse-event monitoring.

Outcome measures should be clinically meaningful and patient-centered. Pain intensity alone is insufficient. Future studies should include pressure pain threshold, pain-free mouth opening, jaw functional limitation, chewing ability, oral health-related quality of life, global perceived effect, analgesic use, recurrence rate, treatment satisfaction, and ability to tolerate dental care when relevant. Minimal clinically important differences and responder analyses should be reported whenever possible.

Future trials should compare dry needling not only with placebo or sham interventions, but also with clinically relevant active comparators such as manual therapy, therapeutic exercise, education and self-management, occlusal splints, pharmacological treatment, botulinum toxin-A, and multimodal interdisciplinary care. Safety, cost-effectiveness, and long-term durability should also be investigated.

5.7. Limitations

This review has several limitations related to its design and scope. First, it was conducted as a narrative review rather than a systematic review or meta-analysis. Although a structured and SANRA-oriented approach was used, the search and synthesis were not intended to provide the same level of reproducibility, protocol-driven study selection, or quantitative pooling as a systematic review.

Second, no formal risk-of-bias assessment or certainty-of-evidence grading was performed. Therefore, the conclusions should be interpreted as a critical clinical synthesis rather than as a formal evidence-ranking process.

Third, the review was intentionally restricted to myogenous temporomandibular disorders and closely related orofacial myofascial pain conditions. As a result, findings from broader chronic orofacial pain, headache, neuropathic pain, systemic musculoskeletal conditions, and non-muscular temporomandibular disorders were not considered in detail.

Fourth, only English-language publications were considered, which may have introduced language bias. In addition, relevant unpublished studies, conference abstracts, or studies not indexed in the searched databases may not have been identified.

Fifth, otolaryngological considerations were addressed only in relation to the differential diagnosis of ear-related symptoms. Other relevant disciplines, including neurology, rheumatology, pain medicine, psychology, and sleep medicine, were beyond the primary scope of this review and were therefore not examined in detail.

Finally, the review reflects the literature available up to the end of the search period. Subsequent studies may alter the current interpretation of the clinical role of dry needling in myogenous temporomandibular disorders.

6. CONCLUSION

Current evidence suggests that dry needling may provide short term reductions in pain intensity and pressure sensitivity and may improve selected measures of mandibular function in patients with myogenous temporomandibular disorders. However, the magnitude, clinical relevance, and durability of these effects remain uncertain because of small samples, heterogeneous diagnostic criteria, variable treatment protocols, different comparator interventions, and short follow up periods.

Dry needling may be considered an adjunctive intervention in patients with a clinically identifiable muscular pain component, including reproducible masticatory muscle tenderness and familiar pain elicited by palpation. These characteristics should not be regarded as established predictors of treatment response, because standardized patient selection criteria have not been determined.

The available evidence does not establish the optimal position of dry needling within the treatment pathway. It may have a role within conservative and interdisciplinary management, but its superiority over botulinum toxin type A or other active treatments has not been demonstrated.

Further studies should use standardized diagnostic criteria, reproducible treatment protocols, clinically meaningful outcomes, appropriate comparators, and longer follow up. Dry needling should therefore be regarded as a potentially useful adjunct rather than a definitive or stand alone treatment for myogenous temporomandibular disorders.

7. DISCLOSURE

Author Contributions

Conceptualization: Weronika Kwaśnica, Zuzanna Jeziorska, Bartosz Szymajda. Methodology: Weronika Kwaśnica, Zuzanna Galicka, Justyna Polko. Literature search and evidence selection: Weronika Kwaśnica, Izabela Migdał. Formal analysis and interpretation: Weronika Kwaśnica, Jakub Artur Czapkiewicz. Writing - original draft: Weronika Kwaśnica, Maja Witek. Writing - review and editing: Weronika Kwaśnica, Tomasz Horodniczy, Katarzyna Raczek. Supervision: Weronika Kwaśnica.

All authors read and approved the final version of the manuscript and agree to be accountable for all aspects of the work.

Conflict of Interest

The authors declare no conflict of interest.

Funding

No external funding was received for this work.

Use of Artificial Intelligence

Artificial intelligence assisted tools were used for language editing, structural organization, and preliminary drafting. All scientific content, references, interpretations, and the final version of the manuscript were reviewed and verified by the authors. The authors take full responsibility for the content of the manuscript.

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