Health Evidence Bulletins - Wales
Team Leader: Mr Tony Glenn

Date of completion: 5/2/1998

The contents of this bulletin are likely to be valid for approximately one year, by which time significantly new research evidence may become available

5. Temporomandibular Joint Disorders and Complex Facial Pain

(Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation)

The Statements The Evidence
5a. Guidelines are available for the management of unilateral fractures of the condyl i. i. Faculty of Dental Surgery. National Clinical Guidelines 1997. London: Royal College of Surgeons, 1997
(Recommendations classified according to type of evidence
5b. Temporomandibular joint disorders and facial pain may require multiple diagnostic aids followed by management which may include: counselling, physiotherapy, pharmacotherapy, occlusal treatments, surgery, pain clinics, behaviour therapyi.
(Health gain notation - 2 "likely to be beneficial")
i. Oral Health. Protocol for Investment in Health Gain. Welsh Health Planning Forum. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
5c. There is no evidence that the presence or extent of radiographic signs of pathology are of prognostic value in temporomandibular joint disordersi.
(Health gain notation - 6 "likely to be ineffective")
i. Eliasson S, Isacsson G. Radiographic signs of temporomandibular disorders to predict outcome of treatment. Journal of Craniomandibular Disorders: Facial and Oral Pain 1992; 6 (4): 281-287
(Type III evidence - well designed non-randomised trial)
5d. A key outcome measure of the treatment of temporomandibular joint disorders (TMJ) is a stable functional TMJ with maximal intercuspation of the dentition. Success is dependent on the skills of the clinician in assessment as well as surgery, if indicatedi.
(Health gain notation - 1 "beneficial")
i. White RD. Temporomandibular joint considerations in orthognathic surgery. Annals of the Academy of Medicine, Singapore 1995; 24: 76-82
(Type V evidence - expert opinion)


5e. There is no good evidence concerning the effectiveness of interventions for temporomandibular joint disorders i,ii.

(Health gain notation - 4 "unknown")

i. Holmlund AB. Surgery for TMJ internal derangement. Evaluation of treatment outcome and criteria for success. International Journal of Oral and Maxillofacial Surgery 1993; 22: 75-77
(Type V evidence - expert opinion);
ii. Dworkin S F, Le Resches L. Research diagnostic criteria for temporomandibular disorders: Review, Criteria, Examinations and Specifications, Critique. Cranio-disorders. Facial and Oral Pain 1992; 6(64): 301-355
(Type V evidence - expert opinion)
5f. Long term outcome of facial pain treatment is largely unknown. Research shows that conservative treatments including drug therapy and counselling are effective for 70% of patients. Refractory pain is associated with a long complex history of pain, a preoccupation with physical symptoms and poor psychosocial adjustment i.
(Health gain notation - 4 "unknown")
i. Feinman C. The long-term outcome of facial pain treatment. Journal of Psychomatic Research 1993; 37 (4): 381-387
(Type V evidence - expert opinion)
5g. For the majority of patients with facial pain, symptoms can be managed quite effectively with non steroidal anti-inflammatory drugs (NSAIDs) and physical therapy to produce long term freedom from pain i.

(Health gain notation - 3 "trade-off between beneficial and adverse effects")

i. Heft MW. Orofacial pain. Clinics in Geriatric Medicine 1992; 8(3): 557-568
(Type V evidence - expert opinion)

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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk