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Clinical Review Fortnightly review

Temporomandibular disorders: a clinical update

BMJ 1998; 317 doi: (Published 18 July 1998) Cite this as: BMJ 1998;317:190
  1. George Dimitroulis, clinical associate
  1. School of Dental Science, Melbourne, Victoria 3000,Australia
  1. Correspondence to: Dr G Dimitroulis,Suite 5, 10th floor, 20 Collins Street, Melbourne, Victoria 3000,Australia
  • Accepted 27 February 1998

Temporomandibular disorders is a collective term used to describe a number of related disorders affecting the temporomandibular joints, masticatory muscles, and associated structures, all of which have common symptoms such as pain and limited mouth opening. General practitioners will sometimes see patients who present with either persistent or recurrent chronic facial pain. Having eliminated the possibility of headache or ear or sinus problems, the next step is to consider the possibility of temporomandibular joint pain and dysfunction, particularly if the pain is accompanied by clicking jaw joints and limited mouth opening. This article reviews the clinical features of temporomandibular disorders and details current treatments for these.

  • The three cardinal features of temporomandibular disorders are orofacial pain, joint noises, and restricted jaw function

  • Although up to 70% of the general population may have at least one sign, only about 5% of those with one or more signs will actually seek treatment

  • The clinical course of temporomandibular disorders does not reflect a progressive disease but rather a complex disorder that is moulded by many interacting factors such as stress, anxiety, and depression, which serve to maintain the disease

  • Non-surgical treatments such as counselling, pharmacotherapy, and occlusal splint therapy continue to be the most effective way of managing over 80% of patients

  • General medical practitioners who deal with temporomandibular disorders should be familiar with the different families of drugs that can be prescribed to relieve symptoms; these include non-steroidal anti-inflammatory drugs, opiates, tranquillisers, and antidepressants


This review is based on my clinical experiences derived from the United Kingdom, the United States, and Australia, where I have developed a special interest in the management of patients with temporomandibular disorders. The published reports I have selected are from those I have collected over many years. For the Medline search, I use the following keywords: temporomandibular …

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