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REMEDY : BNSSG referral pathways

Temporomandibular Joint Disorders

Checked: 02-11-2018 by vicky.ryan Next Review: 17-10-2019


TMJ dysfunction/pain is a common symptom. If there are no red flags then this can usually be managed by dentists in primary care using conservative measures. There are some useful guidelines on assessment and treatment in Clinical Knowledge Summaries:

Temporomandibular disorders

The British Association of Oral and Maxillofacial Surgeons and Royal College of Surgeons also produced a Commissioning Guide for TMD in 2014.

This guide suggests that patients presenting to their GP should usually be referred to their dentist in the first instance for analgesic advice and bite splints where required. Those patients with a pre-existing history of e.g. Inflammatory joint disease however, should be referred direct to an appropriate secondary care specialist for investigation/ management.


Conservative Management

The Bristol Dental Hospital also has an Information Pack and Referral guidelines.

See page 12 which recommends the following:

Patients must have had their condition initially managed by their dentist and  the following initial conservative measures must have been tried:


Patients should see a general dental practitioner for initial assessment and advice on treatment (see above).

The Commissioning Guide advises that consideration should be given to referring a patient to the local Oral & Maxillofacial services (via dentist or via eRS) if they meet any of the following criteria:

o   Refractory TMJ dysfunction- defined as dysfunction that has failed to respond to conservative or primary care measures after 6 months

o   Limitation or progressive difficulty in mouth opening

o   Persistent inability to manage a normal diet

o   Pain or reduced jaw function in patients with known rheumatic joint disease

o   Recurrent dislocation of TMJ and or associated syndromes (e.g. Ehlers-Danlos)


Red Flags

See the Red Flag symptoms and signs section of CKS.