Clinical Review

Temporomandibular disorders

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1154 (Published 12 March 2015) Cite this as: BMJ 2015;350:h1154
  1. Justin Durham, NIHR clinician scientist, senior lecturer1,
  2. Toby R O Newton-John, senior lecturer, clinical psychology2,
  3. Joanna M Zakrzewska, professor3
  1. 1Centre for Oral Health Research & Institute of Health and Society, Newcastle University, Newcastle, UK
  2. 2Graduate School of Health, University of Technology, Sydney, NSW, Australia
  3. 3Facial Pain Unit, Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
  1. Correspondence to: J Durham, Level 5—School of Dental Sciences, Newcastle University, Newcastle NE2 4BW, UK justin.durham{at}ncl.ac.uk

The bottom line

  • TMDs represent a range of conditions with multifactorial complex pathophysiology, which are common up to the age of 40 years

  • TMDs can present as a continuous or episodic pain of varying intensity around and in the ears radiating up to the temple or down the mandible to the neck

  • Persistent (chronic) TMDs can be associated with other chronic pain conditions

  • Early management with education and counselling is highly effective

  • More complex patients or those with persistent TMDs require a biopsychosocial approach delivered by a multidisciplinary pain team

After odontogenic pain, temporomandibular disorders (TMDs) are one of the most common causes of pain in the mouth and face and also have the potential to produce persisting (chronic) pain.1 2 Chronic or persistent (myogenous) TMDs can be associated with other chronic pain conditions,3 including migraine, fibromyalgia, and widespread pain.4 5 6 7 8 They are also known to be comorbid with bruxism, depression, irritable bowel syndrome, and chronic fatigue.6 9 10 With or without these comorbidities, TMDs are recognised to have a considerable impact on quality of life.11 12 13 14 15 16 17

Sources and selection criteria

We conducted a systematic search of Medline (1966 to 5 August 2014), PROSPERO, and Cochrane libraries for systematic reviews relating to interventions for TMDs. For systematic reviews in Medline we used the search strategy suggested by BMJ Clinical Evidence search strategy. We searched PROSPERO and Cochrane libraries using their own search engines with the terms “temporomandibular”, “temporomandibular disorder”, “temporomandibular joint”, and “pain dysfunction syndrome”. The supplementary table summarises the most recent and relevant systematic reviews. It excludes older systematic reviews that duplicate more recent ones unless they are within a five year period and offer contradictory evidence. All Cochrane reviews identified are contained within the summary table.

Early diagnosis and explanation followed by …

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