Table 1 The origin of conditions which could mimic the presentation of TMD. Signs, symptoms and/or clinical history findings which can present in addition to pain and appropriate onward referral strategies are outlined for dental clinicians
From: Paradigms matter: why persistent pain is different and how dentists can help
Possible origin | History/sign/symptom(s) some or all of which may present | Onward referral |
|---|---|---|
Odontogenic conditions | Pain on biting; pain on eating/drinking; dental or periodontal disease | Dental clinician to complete comprehensive clinical ± radiological examination of all aspects of oral cavity and appropriately manage odontogenic disease |
Otological conditions | Ear pain (without temporomandibular joint pain); ear fullness; hearing change; tinnitus | Referral to GP to investigate ear symptoms or Ear, nose and throat (ENT) specialist |
Primary or secondary headache condition | Headache, not affected by jaw function. Other features may include aura, sensitivity to light and sound | Referral to GP to investigate headache symptoms |
Neoplastic conditions | Detectable swelling or mass;* history of previous malignant tumour with new onset facial pain or headache;* lymphadenopathy;* unplanned weight loss;* neurological signs/symptoms (for example, loss of smell or hearing, visual problems, neurosensory or motor change);* trismus;* voice change;* persistent mouth ulcers;* occlusal changes* | Onward referral to appropriate secondary care medical team |
Infective conditions | Malaise; fatigue; lymphadenopathy;* pyrexia (±) swelling and trismus;* neurological signs/symptoms (for example, loss of smell or hearing, visual problems, neurosensory or motor change);* trismus;* persistent mouth ulcers* | If infection odontogenic in origin, management should be completed by general dental practioner. If odontogenic infection severe or infection not dental in origin, onward referral to appropriate secondary care medical team |
Autoimmune conditions | Fatigue; lymphadenopathy;* neurological signs/symptoms (for example, loss of smell or hearing, visual problems, neurosensory or motor change);* persistent mouth ulcers* | Onward referral to GP or appropriate secondary care medical team |
Systemic conditions | Fatigue; malaise; lymphadenopathy;* unplanned weight loss;* persistent mouth ulcers* | Onward referral to GP or appropriate secondary care medical team |
Trauma | Trismus;* soft tissue trauma; occlusal changes* | Onward referral to appropriate secondary care medical team |
Key: * = Red flags which justify urgent/cancer waiting time referral to appropriate medical team | ||
