Jaw Pain and TMD: 10 Key Points for Good Practice (What Patients Should Know)

The International Association of Dental Research proposes this list of 10 key points for good practice in the field of temporomandibular disorders (TMDs), which represents a summary of the current standard of care for TMD management and patients’ needs.

Patient-centered decision-making is key in TMD care—your goals, daily life impact, and preferences matter.

1. Patient-cantered decision-making alongside patient engagement and perspective is critical to manage TMDs, with management being the process from history through examination into diagnosis and then treatment. Expectations should focus on learning to control and manage the symptoms and decrease their impact on the individual’s everyday life.

2. TMDs are a group of conditions that may cause signs and symptoms, such as orofacial pain and dysfunction of a musculoskeletal origin.

3. The etiology of TMDs is biopsychosocial and multifactorial.

4. Diagnosis of TMDs is based on standardized and validated history taking and clinical assessment performed by a trained examiner and led by the patient perspective.

5. Imaging has been proven to have utility in selected cases but does not replace the need for careful execution of history taking and clinical examination. Magnetic Resonance Imaging is the current standard of care for soft tissues and Cone Beam Computerized Tomography for bone. Imaging should only be performed when it has the potential to impact the diagnosis or treatment. Timing of imaging is important and so is the cost:benefit:risk balance.

6. The evidence base for all interventions or devices should be carefully considered before their implementation over and above normal standard of care. Knowledge on developments in the field should be kept up to date. Currently, technological devices to measure electromyographic activity at chairside, to track jaw motion, or to assess body sway, amongst others, are not supported.

7. TMD treatment should aim to reduce the impact of pain and decrease functional limitation. Outcomes should be evaluated also in relation with the reduction of exacerbations, education in how to manage exacerbations, and improvement in quality of life.

8. TMD treatment should primarily be based on encouraging supported self-management and conservative approaches, such as cognitive-behavioral treatments and physiotherapy. Second-line treatment to support self-management includes provisional, interim, and time-limited use of oral appliances. Only very infrequently, and in very selected cases, are surgical interventions indicated.

9. Irreversible restorative treatment or adjustments to the occlusion or condylar position are not indicated in management of the majority of TMDs. The exception to this may be an acute change in the occlusion, such as in the instance of a high filling or crown with TMD-like symptoms developing immediately following these procedures or a slowly progressing change in dental occlusion due to condylar diseases.

10. The presence of complex clinical presentations with uncertain prognosis, such as in the case of concurrent widespread pain or comorbidities, elements of central sensitization, long-lasting pain, or history of previous failed interventions, should lead to the suspicion of chronification of TMDs or non-TMD pain. Referral to an appropriate specialist is thus recommended; the specialty will be geographic-specific as not all countries have a specialty of orofacial pain.