Aims: To assess the effectiveness of acupuncture for the symptomatic treatment of temporomandibular disorders (TMD) from a review of studies using randomized controlled trials (RCTs). Methods: Electronic databases were systematically searched for articles reporting RCTs investigating acupuncture for TMD. The methodological qualities of eligible studies were assessed using the criteria described in the Cochrane Handbook. Results: Nineteen reports were systematically reviewed. There was moderate evidence that classical acupuncture had a positive influence beyond those of placebo (three trials, 65 participants); had positive effects similar to those of occlusal splint therapy (three trials, 160 participants); and was more effective for TMD symptoms than physical therapy (four trials, 397 participants), indomethacin plus vitamin B1 (two trials, 85 participants), and a wait-list control (three trials, 138 participants). Only two RCTs addressed adverse events and reported no serious adverse events. Conclusion: This systematic review noted moderate evidence that acupuncture is an effective intervention to reduce symptoms associated with TMD. There is a need for acupuncture trials with adequate sample sizes that address the long-term efficacy or effectiveness of acupuncture.J Orofac Pain 2010;24:152–162