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Temporomandibular disorders

Last reviewed: 1 Apr 2025
Last updated: 05 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • cyclic pain
  • continuous pain
  • joint noise
  • abnormal mandibular movement
  • masticatory muscle tenderness
Full details

Other diagnostic factors

  • depression or anxiety
  • headache, backache, earache, or neck pain
Full details

Risk factors

  • female sex
  • pain comorbidities
  • age 20-40 years
  • depression, anxiety, or stress
  • genetics
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • MRI
  • CT or cone-beam CT
Full details

Treatment algorithm

INITIAL

temporomandibular joint pain: at initial presentation

ACUTE

persistent pain after 2 weeks of joint rest and <3 months of duration

ONGOING

chronic pain ≥3 months

refractory pain or disability: osteoarthritis or internal derangement subtype

Contributors

Authors

Andrew Sidebottom, BDS, FDSRCS, MBChB, FRCS, FRCS (OMFS)

Consultant Oral and Maxillofacial Surgeon

Spire Nottingham Hospital

BMI Park Nottingham Hospital

Nottingham

UK

Disclosures

AJS has been and continues to be reimbursed for provision of educational lectures and cadaveric training courses by the following companies: Stryker, Biomet, KLS Martin. These companies make surgical implants used during maxillofacial surgery. AJS has written patient information leaflets for EIDO on various aspects of TMJ surgery. AJS is author of a number of book chapters on management of TMD. None of the above have been influenced by the paid educational provision to the above three companies.

Nabeela Ahmed, BDS, MFDS RCS England, MBChB, FRCS (OMFS)

​Consultant OMFS

Tauranga Hospital

Bay of Plenty District Health Board

New Zealand

Disclosures

NA declares she has no competing interests.

Acknowledgements

Dr Andrew Sidebottom and Dr Nabeela Ahmed would like to gratefully acknowledge Dr Sandra McNeal, a previous contributor to this topic.

Disclosures

SM declares that she has no competing interests.

Peer reviewers

Lawrence R. Lustig, MD

​BMJ Best Practice ENT expert panel member

Professor and Chair

Department of Otolaryngology

Columbia University Vagelos College of Physicians and Surgeons

New York

NY

Disclosures

LRL declares that he has no competing interests.

Shanti Kaimal, BDS, MS

Clinical Associate Professor

Director, Advanced Education Program in Orofacial Pain

Division of TMD and Orofacial Pain

University of Minnesota

Minneapolis

MN

Disclosures

Not disclosed.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

List T, Jensen RH. Temporomandibular disorders: old ideas and new concepts. Cephalalgia. 2017 Jun;37(7):692-704.Full text  Abstract

Durham J, Newton-John TR, Zakrzewska JM. Temporomandibular disorders. BMJ. 2015 Mar 12;350:h1154. Abstract

Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014 Winter;28(1):6-27.Full text  Abstract

Dimitroulis G. Temporomandibular disorders: a clinical update. BMJ. 1998;317:190-4.Full text  Abstract

Kapur N, Kamel IR, Herlich A. Oral and craniofacial pain: diagnosis, pathophysiology and treatment. Int Anesthesiol Clin. 2003;41:115-50. Abstract

Acquired temporomandibular disorders in infants, children, and adolescents. American Academy of Pediatric Dentistry. 2019 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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