A systematic review of the comorbidity between Temporomandibular Disorders and Chronic Fatigue Syndrome

J Oral Rehabil. 2016 Apr;43(4):306-16. doi: 10.1111/joor.12367. Epub 2015 Nov 9.


The most common cause of chronic oro-facial pain is a group of disorders collectively termed temporomandibular disorders (TMDs). Chronic painful TMD is thought to be a 'central sensitivity syndrome' related to hypersensitivity of the nervous system, but the cause is unknown. A similar understanding is proposed for other unexplained conditions, including chronic fatigue syndrome (CFS). Exploring the comorbidity of the two conditions is a valuable first step in identifying potential common aetiological mechanisms or treatment targets.

Method: Systematic literature review. Studies were included if they recruited community or control samples and identified how many reported having both TMD and CFS, or if they recruited a sample of patients with either TMD or CFS and measured the presence of the other condition.

Results: Six papers met inclusion criteria. In studies of patients with CFS (n = 3), 21-32% reported having TMD. In a sample of people with CFS and fibromyalgia, 50% reported having TMD. Studies in people with TMD (n = 3) reported 0-43% having CFS. Studies in samples recruited from oro-facial pain clinics (n = 2) reported a lower comorbidity with CFS (0-10%) than a study that recruited individuals from a TMD self-help organisation (43%).

Conclusion: The review highlights the limited standard of evidence addressing the comorbidity between oro-facial pain and CFS. There is a valuable signal that the potential overlap in these two conditions could be high; however, studies employing more rigorous methodology including standardised clinical assessments rather than self-report of prior diagnosis are needed.

Keywords: central sensitivity syndrome; chronic fatigue syndrome; diagnostic overlap; phenotyping; systematic review; temporo-mandibular disorder.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Comorbidity
  • Facial Pain / complications*
  • Facial Pain / physiopathology
  • Facial Pain / psychology
  • Fatigue Syndrome, Chronic / complications*
  • Fatigue Syndrome, Chronic / physiopathology
  • Fatigue Syndrome, Chronic / psychology
  • Humans
  • Middle Aged
  • Quality of Life
  • Surveys and Questionnaires
  • Temporomandibular Joint Disorders / complications*
  • Temporomandibular Joint Disorders / physiopathology
  • Temporomandibular Joint Disorders / psychology