Standard of Care for Temporomandibular Disorder (TMD) Practice
Hello everyone! I’m excited to kick off this blog series on behalf of the International Association for Orofacial Pain (IAOFP). My name is Daniele Manfredini from the University of Siena, Italy. Today, we’ll explore the standard of care in temporomandibular disorder (TMD) practice.
Recently, we published a paper on behalf of the International Association for Dental Research in CRANIO®, the official journal of the American Academy of Orofacial Pain. This article outlines 10 key recommendations for best practices in TMD care. You can access the full text here: https://www.tandfonline.com/doi/full/10.1080/08869634.2024.2405298?src=exp-la
Key Recommendations
1. General Framework
- Decisions should always be patient-centered, focusing on why the patient came to the clinic.
- TMDs are part of the broader category of orofacial musculoskeletal disorders.
- The etiology of TMD is multifactorial and biopsychosocial in nature.
2. Diagnosis
- Diagnosis should rely primarily on patient history using a standardized approach conducted by trained examiners.
- Clinical assessment confirms the diagnostic hypothesis through specific maneuvers.
- MRI is the preferred imaging for soft tissue assessment, including disc position, ligaments, and joint inflammation.
- CT scans may be used for detailed bone assessment, especially when surgical intervention is considered.
- Many other diagnostic devices and technologies currently lack validation and are not recommended for routine use.
3. Treatment
- Treatment should reduce pain and functional limitations while educating patients on home care and long-term self-management.
- First-line approaches include self-management, conservative therapies, and cognitive behavioral strategies.
- Oral appliances may serve as temporary aids but should not aim to reposition the jaw or disc permanently.
- Intermediate interventions like arthrocentesis can be useful when conservative care is insufficient.
- Surgery is rare and reserved for specific cases such as ankylosis, tumors, or severe arthritis.
- Irreversible dental procedures to adjust occlusion or disc position are not recommended.
4. Complex Cases
Patients with long-lasting pain, comorbidities, or unusual clinical features may require a multi-disciplinary approach. Referral to specialists such as neurologists, rheumatologists, surgeons, internal medicine experts, or psychiatrists is often necessary.
This overview is just a starting point. For the full recommendations, you can read the complete paper in CRANIO®. Enhance your knowledge and stay up-to-date with best practices in TMD care.
