American Dental Association

View all recommendations from this society

Released June 27. 2016

Avoid routinely using irreversible surgical procedures such as braces, occlusal equilibration and restorations as the first treatment of choice in the management of temporomandibular joint disorders.

There is a lack of evidence that temporomandibular joint disorders (TMD) (defined as musculo-skeletal disorders, not the lesion of traumatic occlusion) are always progressive, and evidence exists that in many instances, patients with TMD have spontaneous remissions without treatment. Therefore, management is generally conservative and includes reversible strategies such as patient education, medications, physical therapy and/or the use of occlusal appliances that do not alter the shape or position of the teeth or the alignment of the jaws.


Support for the ADA’s development of Choosing Wisely recommendations was provided by a grant from the Robert Wood Johnson Foundation.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their dentist.

How The List Was Created

The American Dental Association (ADA) is a professional organization that supports the practice of evidence-based dentistry and routinely develops clinical guidelines for various clinical topics, including the use of dental sealants to prevent tooth decay and fluoride toothpaste for young children.

To create this list, the ADA’s Council on Access, Prevention and Interprofessional Relations established a Steering Committee consisting of ADA members representing evidence based experts in general dentistry and various disciplines within dentistry, including research, cariology, oral surgery, periodontology, public health, geriatrics and pediatric dentistry. Steering Committee liaisons included representatives from the ADA Council on Dental Practice, Council on Dental Benefit Programs, Council on Communications and Council on Scientific Affairs and representatives from dental specialty organizations.

The Steering Committee reviewed critical issues in dentistry to identify potential recommendation topics and developed, through an evidence-based process, a list of recommendation statements with supporting scientific evidence. Via an intense consensus process, the Steering Committee prepared a list of recommendation statements which were sent to the Council on Access, Prevention and Interprofessional Relations for review. The Council voted to recommend the final five recommendation statements on this list to the ADA Board of Trustees for its approval. The five recommendation statements were approved for distribution by member vote by the ADA Board.

ADA’s disclosure and conflict of interest policy can be found at www.ADA.org.

Sources

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Al-Ani MZ, Davies SJ, Gray RJM, Sloan P, Glenny A-M. Stabilisation splint therapy for temporomandibular pain dysfunction syndrome. Cochrane Database Syst Rev. 2004;(1):CD002778.

Treatment for Temporomandibular Joint Dysfunction: guidelines. Ottowa (ON): Canadian Agency for Drugs and Technologies in Health (CA); 2010 May 17. 6 p.

De Boever JA, Nilner M, Orthlieb JD, Steenks MH; Educational Committee of the European Academy of Craniomandibular Disorders. Recommendations by the EACD for examination, diagnosis, and management of patients with temporomandibular disorders and orofacial pain by the general dental practitioner. J Orofac Pain. 2008 Summer;22(3):268-78.

de Souza RF, Lovato da Silva CH, Nasser M, Fedorowicz Z, Al-Muharraqi MA. Interventions for the management of temporomandibular joint osteoarthritis. Cochrane Database Syst Rev. 2012 Apr 18;4:CD007261.

Guidelines: diagnosis & management of temporomandibular disorders & related musculoskeletal disorders. Toronto (ON): Royal College of Dental Surgeons of Ontario (CA); 11 p.

Ernst E, White AR. Acupuncture as a treatment for temporomandibular joint dysfunction: a systematic review of randomized trials. Arch Otolaryngol Head Neck Surg. 1999 Mar;125(3):269-72.

Forssell H, Kalso EJ. Application of principles of evidence-based medicine to occlusal treatment for temporomandibular disorders: are there lessons to be learned? J Orofac Pain. 2004 Winter;18(1):9-22; discussion 23-32.

de Souza RF, Lovato da Silva CH, Nasser M, Fedorowicz Z, Al-Muharraqi MA. Interventions for the management of temporomandibular joint osteoarthritis. Cochrane Database Syst Rev. 2012 Apr 18;4:CD007261.

Koh H, Robinson PG. Occlusal adjustment for treating and preventing temporomandibular joint disorders. Cochrane Database Syst Rev. 2003;(1):CD003812.

Luther F, Layton S, McDonald F. Orthodontics for treating temporomandibular joint (TMJ) disorders. Cochrane Database Syst Rev. 2010 Jul 7;(7):CD006541.

de Leeuw R, Klasser GD. Orofacial pain: guidelines for assessment, diagnosis, and management. 5th Ed. Hanover Park: Quintessence Books; 2013. 312 p.