Temporomandibular Disorders

This tool provides information to facilitate the management of temporomandibular disorders (TMD) in adults.

TMD is defined as a group of conditions that affect the masticatory muscles, the temporomandibular joint and its surrounding structures. TMD includes sprain and strain injuries. TMD can present as pain, abmormal joint sounds, limited jaw movement, and joint muscle tenderness.

Focused examination

1. Patient History 

  • Assess level of concern for major structural or other pathologies. If required, refer to an appropriate healthcare provider.

  • Identify and assess other conditions and co-morbidities. Manage using appropriate care pathways.

  • Address any prognostic factors that may delay recovery.

Major structural or other pathologies may be suspected with certain signs and symptoms (red flags):

  • fracture of the mandible (swelling, malocclusion, limited movement), dislocation of the mandibular condyle (muscle spasm, inability to close the mouth, anxiety), fracture/dislocation of the cervical spine (positive Canadian C-spine rule), cancer (history of cancer, unexpected weight loss, nocturnal pain, age >50), infection (fever, intravenous drug use, recent infection), osteoporotic fractures (history of osteoporosis, use of corticosteroid, older age)  

Examples of other conditions/co-morbidities:

  • physical conditions: back pain, headache

  • Psychological conditions: depression, anxiety

  • co-morbidities: diabetes, heart disease

Promote recovery by addressing prognostic factors that may delay recovery, including:

  • Symptoms of depression or anxiety, passive coping strategies, job dissatisfaction, high self-reported disability levels, disputed compensation claims, somatization

2. Physical Examination

  • Assess level of concern regarding major structural or other pathologies.

  • Assess TMJ and cervical range of motion.

  • Perform orthopedic tests and palpate the area.

3. Management 

  • Offer information on nature, management, and the course of TMD. Reassure the patient about the benign and self-limiting nature of TMD and reinforce the importance of maintaining activities of daily living.

  • Discuss the range of effective interventions with the patient and, together, select a therapeutic intervention.

Patient Handouts

CCGI_TMD_patient handout_ENG.jpg
CCGI_TMD_patient handout_FR.jpg
 

Management of recent-onset temporomandibular disorders (symptoms ≤3 months duration)

Most individuals with TMD recover on their own within a few weeks of the injury. However, it is recommended that the following be performed as a component of standard clinical care: 

  • monitor symptoms

  • reassure about the nature of the pain 

  • encourage maintenance of activities of daily living 

Management of persistent temporomandibular disorders (symptoms >3 months duration)

Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any of the following therapeutic interventions*: 

  • Consider self-care management program including, but not limited to, reassurance about the favourable prognosis of TMD, advice on return to activities, maintenance of activities of daily living, discussion of expected pain and pain mechanism, discussion of prognosis, pain coping skills, and self-care strategies or general health

  • Consider intraoral myofascial therapy

  • Consider cognitive behavioural therapy 

  • Do not offer occlusal device for pain and range of motion

*Interventions are recommended if guidelines used terms such as ‘recommended for consideration’ (e.g., ‘offer’, ‘consider’), ‘strongly recommended’, ‘recommended without any conditions required’, or ‘should be used’. Recommendations from low-quality evidence are not listed.

Care Pathway for the management of TMD

(click here for French version)

4. Reevaluation and Discharge

  • Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered.

  • Monitor for any emerging factors that may delay recovery.

5. Referrals and Collaboration

  • Refer the patient to an appropriate healthcare provider for further evaluation at any time during their care if they develop worsening symptoms and new physical or psychological symptoms.