Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Referral to a specialist for temporomandibular joint disorder (TMD) is considered based on specific clinical criteria NICE CKS.
- Initial Referral to Oral and Maxillofacial Surgery:
People may be referred to oral and maxillofacial surgery for specialist investigations and management, depending on clinical judgement, if they have:
- A history of trauma or fracture to the temporomandibular joint (TMJ) complex NICE CKS.
- Markedly limited mouth opening (closed lock) suggesting disc displacement without reduction NICE CKS.
- Pain or reduced jaw function in people with known rheumatic joint disease NICE CKS.
- Recurrent dislocation of TMJ and/or associated syndromes NICE CKS.
- Broader Specialist Referral:
Referral to oral and maxillofacial surgery, ear, nose, and throat (ENT) surgery, neurology, or a multidisciplinary pain clinic for specialist investigations and management may be arranged, depending on clinical judgement, if a person has:
- Worsening symptoms NICE CKS.
- Persistent symptoms despite 6-8 weeks of primary care treatment NICE CKS.
- Persistent inability to manage a normal diet NICE CKS.
- Severe pain and dysfunction from internal derangement that does not respond to conservative measures NICE CKS.
- An uncertain diagnosis NICE CKS.
- Other chronic pain-related comorbidities NICE CKS.
Specialist investigations and management may also be considered for people with significant functional impairment of the TMJ, and/or an intra-articular disorder such as anterior disc displacement or degenerative joint disease NICE CKS.