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Article: Volume 42 Number 6 Page 533 - July/August 2015

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  Dent Update 2015; 42: 533-546

Oral medicine:  Pain-Related Temporomandibular Disorder − Current Perspectives and Evidence-Based Management

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Abstract: Pain-related temporomandibular disorder (TMD) is one of the top three most common chronic pain conditions, along with headaches and back pain. TMD has complex pathophysiology and significant associations with a variety of other chronic pain conditions, eg fibromyalgia, irritable bowel syndrome and migraine. Chronic TMD is associated with a negative impact upon quality of life and high levels of healthcare utility. It is important that clinicians are able to diagnose TMD correctly, provide appropriate management in keeping with current evidence-based practice, and identify when to refer patients to specialist care. The presence of risk factors, eg anxiety, depression, pain-related disability and chronic pain conditions elsewhere in the body, may help to identify which TMD patients require referral for multidisciplinary management. TMD should be managed using a holistic approach, incorporating patient education and encouragement towards self-management. TMD care pathways should consider using the three ‘pillars’ of pain management: physical therapies, pharmacotherapy and clinical psychology.

Clinical relevance: TMD is associated with considerable comorbidity and significant negative impact upon quality of life. It therefore follows that dental practitioners should keep up-to-date with the recent scientific evidence and recommendations relating to the diagnosis and management of TMD.

Author notes: Supriya Ghurye, BDS, MJDF RCS(Eng), Oral Medicine CDT, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, Oral Medicine Department, Floor 22 Tower Wing, Great Maze Pond, London, SE1 9RT, Roddy McMillan, BDS, MBChB, MFDS RCS(Eng), FDS(OM) RCPS(Glasg), FHEA, Consultant and Honorary Clinical Teaching Fellow in Oral Medicine and Facial Pain, Eastman Dental Hospital, 256 Gray’s Inn Road, London, WC1X 8LD, UK.

Objective: To advise on the main causes proposed for the development of TMD, how to adopt a biopsychosocial approach to its management and recognize when to refer a patient for specialist input.