Guidance for GDPs’ on temporomandibular joint dysfunction management in practice
King's College Hospital, England
: Dent Health Curr Res
Objectives: Temporomandibular joint (TMJ) dysfunction encompasses pain and deterioration of the muscles mastication (MoM) and jaw joint. TMJD is a difficult condition to diagnose and manage and often general dental practitioners will refer to specialist services early on prolonging the delay in patients’ receiving appropriate care. In this article, guidance is provided for dentists to be made aware of TMJD signs, how to examine the TMJ, address particular causes of TMJD and primary management/ when to make an appropriate referral to seek specialist advice.
Methods: Data was collected from the maxillofacial department of King's College NHS Foundation Trust of percentage clinic time spent on patients presenting with TMJD. It was found that over 60% of the patients seen in this period attended for primary management including jaw exercises and bite guards. This can be done in general practice prior to a referral, freeing specialist clinics for urgent cases. This prompted a guidance form to be created.
Conclusion: When collating a history for TMJ pain it is important to account for diet, stress, grinding habits, previous TMJD and occlusion. Examination should be categorized according to TMJ and MoM each palpated at rest and clenched. First stage management often involves advice, jaw exercises and bite guards used as a diagnostic tool as well as to relieve clenching. Regular reviews are required and escalation as necessary. If unsuccessful with previous methods, it may be necessary to take imaging and refer to physiotherapists. If all methods of management fail, a specialist in TMJD can be contacted.
Gupta Ashana studied at University of Birmingham from 2012-2017 for Undergraduate training to obtain BDS. Vocational training was completed in Buxton, Derbyshire where treatment was given to a high population needs. Moving on, she returned to London, where she grew up to undertake a year in Oral and Maxillofacial surgery at the Kings’ College NHS Foundation Trust. Here, time is spent on call, in theatre, completing minor oral surgery and running clinics and consultations.