TMD management in General Practice

If you work in general dental practice can you spare a few minutes to complete this survey about treating patients with TMD?

TMD is a common, painful condition that is very common in the population1. While the prognosis is usually good, a significant minority of patients continue to experience long-term pain which can be debilitating. Severe TMD affects the ability to engage in everyday activities including eating, talking and kissing2 that are important for maintaining social relationships. There continues to be uncertainty over how to best treat TMD3 and this can lead to delays in diagnosis and management.

For patients, these delays can be a real problem. A lack of certainty about the cause of their pain, alongside delays in treatment itself can lead to increased fear, distress and frustration, all of which can serve as strong maintaining factors for pain. For those with severe pain a sense of not being taken seriously or that their pain has not been fully understood often also add to their distress.

Patients with jaw pain often don’t know who they should speak to about it2 and many don’t understand that dentists have expertise to manage problems such as TMD which do not directly involve the teeth. Dentists may wish to seek specialist opinions due to concern over giving a wrong diagnosis4. Both of these factors can lead to increased uncertainty and longer delays for patients before receiving definitive diagnosis and treatment. This is a problem because earlier, appropriate treatment is likely to be an important factor influencing the longer term course and outcomes of TMD5.

There is a need for increased clarity about how the early and ongoing symptoms of TMD should be managed. We are interested to find out how dentists currently manage TMD in primary care as well as their thoughts about currently available patient pathways and gaps. Our hope is that we can use this information to support a funding bid for a clinical trial looking at treatment options for first onset TMD. For those interested, there will be an opportunity to express an interest in participating in a clinical trial in the future as a recruiting site.

1.            Greene CS. Managing the care of patients with temporomandibular disorders. The Journal of the American Dental Association. 2010;141(9):1086-1088.

2.            Durham J, Steele JG, Wassell RW, Exley C. Living with uncertainty: temporomandibular disorders. Journal of dental research. 2010;89(8):827-830.

3.            Durham J, Exley C, Wassell R, Steele JG. ’Management is a black art’–professional ideologies with respect to temporomandibular disorders. British dental journal. 2007;202(11):E29.

4.            Aggarwal VR, Joughin A, Zakrzewska JM, Appelbe P, Tickle M. Dentists’ preferences for diagnosis, management and referral of chronic oro-facial pain: Results from a national survey. Health Education Journal. 2012;71(6):662-669. 5.            Gatchel RJ, Stowell AW, Wildenstein L, Riggs R, Ellis III E. Efficacy of an early intervention for patients with acute temporomandibular disorder–related pain: a one-year outcome study. The Journal of the American Dental Association. 2006;137(3):339-347.