Temporomandibular disorders

Last reviewed: 27 Aug 2023
Last updated: 20 Jun 2023



History and exam

Key diagnostic factors

  • cyclic pain
  • continuous pain
  • joint noise
  • abnormal mandibular movement
  • masticatory muscle tenderness
More key diagnostic factors

Other diagnostic factors

  • depression or anxiety
  • headache, backache, earache, or neck pain
Other diagnostic factors

Risk factors

  • female sex
  • pain comorbidities
  • age 20-40 years
  • depression, anxiety, or stress
  • genetics
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • MRI
  • CT or cone-beam CT
More investigations to consider

Treatment algorithm


temporomandibular joint pain: at initial presentation


persistent pain after 2 weeks of joint rest


refractory pain or disability: osteoarthritis or internal derangement subtype



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

Consultant Oral and Maxillofacial Surgeon

Spire Nottingham Hospital




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 has a medicolegal practice which includes provision of expert testimony for the court related to TMD. 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 Maxillofacial Deformity and Trauma Surgeon

Queens Medical Centre




NA declares she has no competing interests.


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


SM declares that she has no competing interests.

Peer reviewers

Shanti Kaimal, BDS, MS

Clinical Associate Professor

Director, Advanced Education Program in Orofacial Pain

Division of TMD and Orofacial Pain

University of Minnesota




  • Differentials

    • Sinusitis
    • Pericoronitis
    • Chronic headache
    More Differentials
  • Guidelines

    • Acquired temporomandibular disorders in infants, children, and adolescents
    More Guidelines
  • Patient leaflets

    Temporomandibular joint syndrome (clicking jaw)

    More Patient leaflets
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