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Acute temporomandibular disorder

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Brief description of the condition

Acute disorders of the temporomandibular joint, which connects the lower jaw to the skull (e.g. dislocated or locked jaw or problems involving muscles around the joint).

Key signs and symptoms

  • Pain
  • Swelling
  • Joint noises (e.g. pop, clicks and grating associated with movement)
  • Limited opening of mouth
  • Headaches
  • Earache
  • Tinnitus

For dislocated jaw:

  • Unable to move jaw
  • Jaw is displaced in open position

The NICE Clinical Knowledge Summary for TMD includes a list of red flag symptoms for other serious or life-threatening conditions that can have similar symptoms to TMD. 

Initial management

If the jaw is dislocated:

  • Send the patient to emergency care via NHS24/111.

For other temporomandibular joint conditions:47

  • Recommend optimal analgesic/anti-inflammatory drugs (see Analgesia).
  • Advise the patient to use local heat packs or ice packs to relieve the symptoms.
  • Advise the patient to have a soft diet, to avoid chewing gum and to rest their jaw.
  • Consider both the benefits and potential harms of prescribing a short course of diazepam to relax muscles (for adults only).
  • Advise the patient to seek non-urgent dental care.

Subsequent care

Assess physical, psychological and social factors.47,48

Consider:

  • Providing advice on self-management of TMD including self-exercise and self-massage therapy, and strategies for behaviour change to manage parafunctional activities (e.g. nail biting, clenching, grinding).48
  • Providing advice on managing lifestyle and stress (e.g. undertaking gentle regular exercise, maintaining social interactions, relaxation, stress management, and positive sleep habits).47
  • Making a splint for the patient as an adjunct to supported self-care.48
  • Referring the patient for specialist care or to their GP, depending on the findings of the assessment.48

Monitor symptoms in follow-up appointment(s).

The majority of TMD patients can be managed in primary care settings and do not require referral to secondary care dental services. The NHS England Getting It Right First Time (GIRFT) and Royal College of Surgeons of England’s Faculty of Dental Surgery Management of painful Temporomandibular disorder in adults guideline provides advice on when appropriate to refer.