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Temporomandibular Disorder

The purpose of the TMD clinic is to diagnose and treat patients with Temporomandibular Disorders. The patients typically present with one or more of the following signs or symptoms:

  • Peri-auricular pain
  • Limitation or deviation of mandibular movement
  • Noises associated with the temporomandibular joint[s]

In order to avoid inappropriate referrals, the following criteria apply for acceptance onto the assessment clinic:

Patients with peri-auricular pain

  • Should have been assessed by a clinician in an ENT department in order to eliminate disorders of the auditory apparatus
  • Who give a history of trauma or fracture should have been seen in a unit of Oral Maxillofacial Surgery
  • Who have a rapid reduction in mouth opening must have been seen in a unit of Oral Maxillofacial Surgery.

Patients who have a limitation or deviation of mandibular movement:

  • A rapid reduction in mouth opening and peri-auricular pain must have been seen in a unit of Oral Maxillofacial surgery
  • A recent history of trauma and limitation of mouth opening must have been seen in a unit of Oral Maxillofacial surgery
  • Subsequent to dental therapy when an inferior dental alveolar block injection was used should reviewed by their dentist for two weeks in the first instance
  • Associated with facial swelling or erupting teeth must have been seen in a unit of Oral Maxillofacial Surgery.

Noises associated with the temporomandibular joint[s]:

  • Patients with clicking temporomandibular joint which are painless and never lock rarely require any intervention; in the rare event that the patient is perturbed by these symptoms, referral maybe justified
  • Patients who have peri-auricular noises associated with hearing or balances disturbances must be seen in first instance by a clinician in an ENT department to eliminate disorders of the auditory apparatus
  • Patients whose sole complaint is tinnitus are NOT accepted onto the TMD clinic.

In addition to the above:

  • Patients undergoing treatment or supervision for behavioural, psychological or psychiatric disorders may be referred only if supported by the consulting physician's approval
  • Patients with arthritides affecting the temporomandibular joints will only be seen with the agreement of their rheumatologist
  • Patients with suspected or diagnosed neuromuscular / neurological conditions [dyskinesia, or altered perception of senses] should be referred in the first instance to the appropriate clinician
  • Patients who have been discharged after a course of treatment in the TMD clinic may need review. In these cases the patients' GDP / GMP will be invited to re-refer the patient.

Discharge of patients from TMD Clinic:

  • Some patients will self discharge by non attendance to the clinic
  • The majority of patients will be discharged at end of treatment
  • Some patients will be discharged at the end of a 'finished consultant episode'. These patients may need to be re-referred back to the clinic after a period of review in primary care
  • Some patients' treatment will prove to be unsuccessful, in which case a patient's best interest will be served by discharge from the clinic together with suggestion for appropriate further referral.
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