ROSEMONT, Ill. – The American Association of Oral and Maxillofacial Surgeons (AAOMS) has developed evidence-based guidance for evaluating, diagnosing and treating patients with temporomandibular joint (TMJ) disorders and intra-articular pain and dysfunction (IPD).
The position paper “The Contemporary Management of Temporomandibular Joint Intra-articular Pain and Dysfunction (IPD)” – written by members of the AAOMS Special Committee on Temporomandibular Joint Care – outlines the four key pillars for clinicians to follow in order to optimize patient care:
- Conduct a thorough history, screening and physical examination.
- Obtain appropriate diagnostic imaging.
- Make the correct diagnosis.
- Initiate the least invasive, evidence-based nonsurgical or surgical treatment.
“Significant advances in our understanding of the pathophysiology of TMJ pain and inflammation, along with the application of established principles underlying joint disease, have enabled IPD to be better diagnosed and treated. The well-documented success of nonsurgical treatment as well as minimally invasive surgical options provides the patient and surgeon with sound treatment choices,” said lead author Gary F. Bouloux, DDS, MD, MDSc, chair of the Special Committee and professor and chief of the Division of Oral and Maxillofacial Surgery at Emory University School of Medicine in Atlanta, Ga.
The most frequently used joint in the body, the TMJ is a small hinge and gliding joint located in front of the ear that allows the lower jaw to move and function. TMJ disorders are common, and symptoms can include earaches, headaches or a limited ability to open the mouth. IPD is pain that originates from the joint itself.
According to the position paper, the management of TMJ and IPD has undergone a significant transformation over the last three decades to allow for the development of evidence-based guidance to enable both providers and patients to identify best practices. Because of these advances in patient care, the National Academies in 2019 convened representatives from the Food and Drug Administration, Medical Device Epidemiology Network, patient advocacy groups, oral and maxillofacial surgeons, and orofacial pain experts to identify specific steps to improve care for patients with TMJ pain and dysfunction. The AAOMS guidance is in response to recommendations published by the National Academies in 2022.
The paper explains how numerous potential causes of jaw and facial pain necessitate a thorough history, screening and physical examination and suggests questions to ask patients during the evaluation process.
Regarding diagnostic imaging, the guidance indicates the appropriate initial tool is a panoramic X-ray. Based on the history, clinical examination and differential diagnosis, more advanced imaging such as cone-beam CT, medical-grade CT and MRI should be considered, the authors suggest.
When developing a – diagnosis, the guidance advises clinicians to be comprehensive to ensure that other sources of pain and dysfunction are considered. “The ability to identify and recognize psychosocial factors and comorbid medical conditions is critical to assuring that patient and surgeon expectations for the outcome of any surgical procedure are concordant and realistic,” the authors explain.
The position paper also suggests initiating the least invasive nonsurgical treatments for managing IPD, which may include rest, heat, ice, nonsteroidal anti-inflammatory drugs, muscle relaxants, physical therapy and orthotics. Arthroplasty – surgery to restore the joint – or total joint replacement are surgical options that should be reserved for patients in whom minimally invasive procedures have not been successful, the authors advise.
“It is incumbent on the oral and maxillofacial surgery community – which is uniquely positioned to offer relief to patients suffering from TMJ disease – to treat patients according to the best-available level of evidence and, where possible, continue to add new knowledge to support ongoing improvements in care,” Dr. Bouloux said.
In addition to Dr. Bouloux, AAOMS Special Committee on Temporomandibular Joint Care who authored the paper include Joli C. Chou, DMD, MD, Thomas Jefferson University; William L. Chung, DDS, MD, Indiana University School of Dentistry and Hospital Medicine; Charles A. Crago, DMD, MD, Face and Jaw Surgery Center; Vince E. DiFabio, DDS, MS, University of Maryland School of Dentistry; Louis G. Mercuri, DDS, MS, University of Illinois Chicago; Gregory M. Ness, DDS, The Ohio State University; and Daniel E. Perez, DDS, MS, University of Texas Health Science Center at San Antonio.
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The full paper can be found at AAOMS.org/PositionPapers and in the June issue of the Journal of Oral and Maxillofacial Surgery, AAOM’s official journal.
