Search

Considering the complex biopsychosocial nature of temporomandibular disorders (TMD), irreversible interventions of any kind should be used with extreme caution. Frequently they are reserved for those patients who have not achieved adequate control with reversible measures and in whom a significant improvement is anticipated. Irreversible restorative interventions range from the simple adjustment of a single restoration or tooth up to an occlusal equilibration, and may use a subtractive, additive or combined approach. This article, the last in a series of six, reviews the available evidence in the use of irreversible restorative interventions in the management of TMD, demonstrates some of the commonly used techniques and provides some guidance for the general dental practitioner (GDP) considering this approach. CPD/Clinical Relevance: The GDP needs to be aware of when to, and more importantly when not to, consider making irreversible changes to a patient's dentition with the aim of managing their TMD.

The temporomandibular joint (TMJ) is a complex arrangement with high functional requirements. Surgery is therefore only considered when conservative management has not been successful. Surgery may not always benefit and carries the risk of the condition worsening. There is a range of techniques available to the surgeon. The most commonly used is arthrocentesis and this is also the least invasive. The end-stage option for patients is total joint replacement. Whichever surgery the patient has received, it is likely that they will be in need of careful management by the primary care team for their continuing care. This article, the fifth in a series of six, outlines the scope of TMJ surgery. CPD/Clinical Relevance: A range of techniques is available for TMJ surgery, and many post-surgery patients will require routine dental management in the primary care setting.

Appliances have been used in the management of temporomandibular disorders (TMD) for many years, and over this time designs have waxed and waned in popularity. The majority of appliance designs have few studies to support their use and what evidence is available, is often of low quality. This article, the fourth in a series of six, reviews the mechanisms of action, evidential support for, and provides advice on when to use commonly used appliance designs. CPD/Clinical Relevance: There are a plethora of splint designs in use, but it is essential that the evidence supporting each is understood so that the most appropriate design is used for each individual situation.

Temporomandibular disorders (TMD) comprise a variety of diagnoses with multifactorial aetiologies. The treatment of these conditions is often multimodal, reflecting the complex nature of their pathogenesis. Pharmacology has long been used for the control of inflammation and pain in various acute and chronic conditions. Although not the mainstay of treatment in TMD, pharmacology frequently plays a supportive role, and numerous drugs are available that act on several potential targets. This article, the third in a series of six, summarizes the pathogenesis of pain relevant to TMD, before reviewing the current medications available, their efficacy and their potential indications. CPD/Clinical Relevance: Understanding the potential medications available can help clinicians select an appropriate drug to complement other treatment for TMD.

For optimal success, a multidisciplinary team approach that uses a combination of non-surgical treatment modalities is recommended in the care of TMD patients. In this article, the second in a series of six focusing on the diagnosis and management of temporomandibular disorders (TMD), the importance of self-management, psychological interventions and physical therapies is discussed. Intra-oral appliances will be covered in a dedicated article later in this series. CPD/Clinical Relevance: Clinicians should have both an understanding and appreciation for the non-surgical management options available to patients diagnosed with TMD.

Temporomandibular disorders (TMD) are the most common causes of chronic pain in the orofacial region. The aetiology of TMD is complex owing to its multifactorial biopsychosocial nature. TMD shares many commonalities, and can be associated with, other chronic pain conditions. The physical and psychological impact of chronic pain on the individual can be far-reaching and should not be underestimated. This article, the first of a six-part series, aims to provide the reader with a background to TMDs as well as an overview of the clinical examination and diagnostic process for patients presenting with TMD-related pain. CPD/Clinical Relevance: Clinicians should be aware of the signs and symptoms of TMD with which their patients might present and understand the complex nature of chronic pain conditions.