Quality Appraisal of Clinical Practice Guidelines for Temporomandibular Joint Disorders using the AGREE II Instrument

Published:November 02, 2021DOI:



      We sought to systematically assess the quality of all clinical practice guidelines (CPGs) describing diagnosis and management of temporomandibular joint disorders (TMDs) using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.

      Materials and Methods

      CPGs detailing all aspects of diagnosis and management, both conservative and non-conservative, for TMDs were reviewed.


      Thirteen guidelines met inclusion criteria. The highest-scoring domain across guidelines was ‘Clarity of presentation’ (68.3%); the lowest scoring domain was ‘Editorial independence’ (31.9%). The highest-scoring guideline described traditional Korean Medicine (KM) approaches to the management of TMDs, earning a mean score of 79.2% across the six quality domains. Only three CPGs met a quality threshold of >60% in at least five domains, qualifying as ‘high’ per the AGREE II criteria: these guidelines were the KM guidelines, RDC/TMD guidelines for diagnostic classification of TMDs, and the Japanese Society for the Temporomandibular Joint guidelines. An average ICC of 0.79 was calculated across all domains, suggesting very strong agreement between independent reviewers.


      We identified a significant lack of quality in multiple areas of CPG development for the diagnosis and therapeutic management of TMDs, suggesting a clear need for new comprehensive and rigorously developed guidelines addressing TMDs.


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