Temporomandibular disorders

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 10 Feb 2025

Last updated: 05 Mar 2025

Temporomandibular disorders (TMDs) (previously temporomandibular joint syndrome) are a group of disorders associated with pain in the mouth and face that can progress to chronic pain.

TMDs typically present with four characteristic features: temporomandibular joint pain, noise in the joint, masticatory muscle tenderness, and limited mandibular movement.

TMDs can be self-limiting and can considerably affect quality of life.

Diagnostic Criteria for TMD, which comprises the Axis I (physical assessment) and Axis II (psychosocial assessment) domains, provides a standard criteria for the diagnosis of TMDs.

TMDs can primarily be treated by resting the affected joint.

Nonsteroidal anti-inflammatory drugs applied topically may help people with internal derangement (disk displacement) or osteoarthritis subtypes.

Definition

TMDs comprise several painful disorders involving the mandibular joint and muscles of mastication.[1][2] The characteristic features of TMDs include temporomandibular joint pain, noise in the joint, masticatory muscle tenderness, and limited mandibular movement. The presenting symptoms include one or all of the following: temporomandibular joint pain or pain in the muscles of mastication; temporomandibular joint clicking, popping, or crepitus with/without locking; headache in the temporal region; and otalgia and/or tinnitus without a significant ear disorder.[2] The US prospective OPPERA multicenter study, which included patients with TMDs, defined TMD as "a complex condition with a biopsychosocial model of illness" and stated that it is no longer appropriate to regard TMDs as a localized jaw/dental condition.[3] Disorders related to pain (myalgia, headache related to TMD, and arthralgia) and those associated with the temporomandibular joint (disk displacements, degenerative diseases) are the most common types of TMDs.[1] Chronic TMD is defined as pain lasting for ≥3 months.[4] TMDs can have an impact on an individual’s quality of life.

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

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

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

Disclosures

Not disclosed.

Differentials
- Rhinosinusitis
- Pericoronitis
- Chronic headache
More Differentials
Guidelines
- Acquired temporomandibular disorders in infants, children, and adolescents
More Guidelines
Patient information
Temporomandibular disorders
More Patient information
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Temporomandibular disorders

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

temporomandibular joint pain: at initial presentation

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

chronic pain ≥3 months

refractory pain or disability: osteoarthritis or internal derangement subtype

Contributors

Authors

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

Disclosures

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

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Lawrence R. Lustig, MD

Disclosures

Shanti Kaimal, BDS, MS

Disclosures

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

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