Should dentists treat temporomandibular disorders?
Temporomandibular disorders (TMDs) are the most common cause of persistent orofacial pain, consisting of more than 30 disorders affecting the masticatory system that result in pain, joint sounds, and/or impaired jaw function.   The functional demands on the masticatory system are diverse and like other musculoskeletal regions of the body, acute disorders are not uncommon. Unfortunately some acute TMDs progress to a more persistent disorder with high levels of pain-related disability and psychological impairment. Furthermore, persistent TMDs can be associated chronic overlapping pain conditions such as fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, chronic headache, and chronic lower back pain. Management requires a person-centred approach and ideally focusses on avoiding the transition from an acute to a persistent disorder.  With persistent TMDs, assessing the biological, psychological and social aspects of the patient’s complaint provides a multidimensional diagnosis so that management can be tailored to the specific individual.  Such management typically requires varying input from dental, medical, psychological, physiotherapy and other health disciplines, and this input can change depending on a patient’s response to management. 

Learning Objectives
• Discuss the group of temporomandibular disorders frequently seen in dental practice and their appropriate assessment.
• Describe the biopsychosocial model of pain and how it relates to TMDs
• Discuss and apply the factors that are known to contribute to acute to chronic TMD transition 
• Discuss the process and challenges of developing a multidisciplinary team to manage persistent TMDs and what scenarios such a team would be used