What criteria should I use to refer a patient with TMJ disorder to a specialist?

Referral to a specialist for temporomandibular joint disorder (TMD) is considered based on specific clinical criteria ¹.

• Initial Referral to Oral and Maxillofacial Surgery:

People may be referred to oral and maxillofacial surgery for specialist investigations and management, depending on clinical judgement, if they have:

• A history of trauma or fracture to the temporomandibular joint (TMJ) complex ¹.
• Markedly limited mouth opening (closed lock) suggesting disc displacement without reduction ¹.
• Pain or reduced jaw function in people with known rheumatic joint disease ¹.
• Recurrent dislocation of TMJ and/or associated syndromes ¹.

• Broader Specialist Referral:

Referral to oral and maxillofacial surgery, ear, nose, and throat (ENT) surgery, neurology, or a multidisciplinary pain clinic for specialist investigations and management may be arranged, depending on clinical judgement, if a person has:

• Worsening symptoms ¹.
• Persistent symptoms despite 6-8 weeks of primary care treatment ¹.
• Persistent inability to manage a normal diet ¹.
• Severe pain and dysfunction from internal derangement that does not respond to conservative measures ¹.
• An uncertain diagnosis ¹.
• Other chronic pain-related comorbidities ¹.

Specialist investigations and management may also be considered for people with significant functional impairment of the TMJ, and/or an intra-articular disorder such as anterior disc displacement or degenerative joint disease ¹.