TMD New Guidelines! Evidence Based Care – PDP213

A Clinician’s guide to TMD Management

Walkthrough of the latest TMD Guidelines with the authors!

What’s the right approach when a patient presents with both acute and chronic painful jaw symptoms?

How can the latest RCS guidelines simplify your diagnosis and treatment process?

In this episode, Professor Justin Durham and Mrs. Emma Beecroft join Jaz to unpack the latest Royal College of Surgeons TMD guidelines designed specifically to help GDPs navigate these tricky cases. Together, they explore practical strategies for managing TMD, breaking down the step-by-step flowchart that makes handling these cases less intimidating.

From understanding the key principles to applying them in everyday practice, this episode will help you feel more confident in delivering better patient care for TMD.

Protrusive Dental Pearl: Important takeaway: Download the New TMD Guidelines 

The folder includes:

• A patient version of the guidelines
• A dentist version of the guidelines
• The full guidelines document
• Video of delivering an equilibrated soft bite guard using heat technique

Key Takeaways:

• The guidelines for TMD are designed to simplify diagnosis and treatment.
• Self-management is crucial for TMD patients and can lead to better outcomes.
• Understanding the difference between muscle and joint pain is essential in TMD management.
• Early intervention in TMD can lead to significant improvements for patients.
• The importance of patient-centered care in managing TMD effectively.
• TMD is a common issue that requires a collaborative approach among dental professionals.
• The role of pain management in TMD is about improving quality of life, not just curing the condition.
• Continuous education and training are vital for dental professionals dealing with TMD. Understanding the pathogenesis of TMD is crucial for effective treatment.
• Stabilization splints can provide relief but should be used judiciously.
• Effective communication can significantly impact patient pain experiences.
• Tailoring treatment to individual patient needs is vital.

Need to Read it? Check out the Full Episode Transcript below!

Highlights for this episode:

• 00:48 Protrusive Dental Pearl
• 05:20 Introducing the Guests: Prof. Justin Durham and Mrs. Emma Beecroft
• 13:05 Stigma and Complexity of TMD in Dentistry
• 17:01 Challenges of Navigating TMD Treatment Perspectives
• 22:07 Diagnosing TMD: Tools and Techniques
• 27:09 Simplified Approach to TMD Examination
• 30:54 Muscle Palpation Pressure 
• 32:20 Acute Limited Opening: Muscle vs. Joint Origin
• 40:20 Diazepam for Acute Myogenous TMD
• 54:58 Debating Soft vs. Stabilization Splints
• 57:17 Patient-Centered TMD Management
• 01:09:28 Conclusion and Resources

This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. 

This episode meets GDC Outcomes B and C.

AGD Subject Code: 200 OROFACIAL PAIN (Diagnosis and treatment)

Dentists will be able to –

1. Explore the varied approaches to TMD care and how to align them with evidence-based practices.
2. Emphasize the importance of self-management strategies and their role in improving patient outcomes.
3. Advocate for a patient-centered approach, focusing on listening, communication, and individualized care plans.

If you loved this episode, be sure to check out this episode: TMD Full Exam with ‘The TMJ Doc’ Dr Priya Mistry – PDP064

Click below for full episode transcript:

Teaser: A standard extroral exam involves, the examination of temporalis and masseter, which are the only two muscles that international recommendations would suggest.

Teaser:
So you don’t need to bother with that lateral pterygoid because you’ve got to be, have a bit of a strange finger to reach it, firstly up and around the back of the tuberosity and not evoke kind of vomit on your shoes.

And a medial pterygoid similarly, it’s not a very nice place to have palpated. And actually the vast majority of the diagnoses have been made with pressing on masseter and pressing on temporalis.

When you ask them to open to where they feel comfortable, anything less than 35 millimeters is restriction. For the acute restricted opening, anything 10 millimetres or less. So if they can’t get a finger between their teeth, that’s the ones we’re kind of more worried about from an acute restricted opening. Sometimes overrunning by 10 minutes to allow someone to feel heard, to be really clearly explained to them why they’re getting their problem can be what they need to get over the hurdle.

Not everyone needs to be in RCP and not everyone needs canine guidance group function. If they’ve already got group function, it’s fine. What they need is smooth and easy movement across the occlusal.

Jaz’s Introduction:
Finally, some decent guidelines for TMD. Have you checked out the new TMD guidelines? This is exactly what today’s episode is about with Professor Justin Durham and Mrs. Emma Beecroft. They’ve joined me on the show today to discuss the 2024 RCS guidelines for the management of painful temporomandibular disorders, which let’s face it, as GDPs, it can be very confusing for us and very scary for us.

In the episode, I likened it to like trauma. When someone comes in and they’ve evulsed a tooth, we’re like, ah, okay, very time sensitive and it’s something that I haven’t done in a long time. What do I do? I pick up the guidelines. I pick up the trauma guidelines which will be a step by step to guide me on what to do. What’s best for my patients.

We also have some wonderful periodontal guidelines, and now we’ve got a lovely flow chart to follow for TMD. The main mission of today is to get you, and this is the Protrusive Dental Pearl, by the way, this is the most important pearl I can give you, which is to download all the free resources I’m putting below.

Okay. So whether you’re on Spotify and you read the description, YouTube, Protrusive Guidance, wherever you’re watching or listening to this, okay. Please make sure you take some time out today to download the guidelines. In fact, I’ve made it very easy. You don’t have to download individual PDF files. I made a zipped folder with the three main PDFs to talk about today, which is the patient version, the dentist version, and the full guidelines, for a really- want to put yourself to sleep.

You read those ones, but the summary document is actually really fantastic. And the patient one is honestly worth its weight in gold because the main thing is we don’t want to reinvent the wheel. Why are we giving our own practice branded guidelines for TMD? There’s no need to give your patient the document that your practice wrote about all the exercises they should do. Why don’t we show them which exercises to do. So what the guidelines for the patient has is a QR code that takes them to the videos where Emma herself, one of the guests of the podcast today is there showing the patient how to do the exercise.

And these are the latest guidelines. So I would say replace your current and existing documentation on TMD with this one, which is the latest and best advice with the videos. So patient’s not guessing anymore and how to actually do those exercises. In that zip folder, I’ve also added a video of how I deliver a soft bite guard, because that is the most accessible, the cheapest guard, which may help patients in acute pain.

And seeing as so many of us are already prescribing soft bite guards, which I don’t do so much of, but I know that this is the most economical and sometimes the speediest way to get someone care. And when I do these, there’s a specific protocol I follow of heating the splint to get even contact. Think about it.

When you give a soft bite guard, they are not balanced. So I’m going to show you a quick and easy way to get the balance. So that video is in there and any other goodies I can think of at a time of me assembling it. So you can download that at protrusive.co.uk/tmd, that’s protrusive.co.uk/tmd those goodies are there for you for free.

Now, before we join the main episode I just really need to emphasize the following; which is the supported self care part in there is the most important thing right? Let me explain why. There are so many different schools of thought for how to manage TMD. This is why patients get confused. This is why we as a profession are a little bit confused. There are colleagues who actively recommend orthodontics as the first line to manage TMD. There are colleagues that swear by neuromuscular methods and TENS or BOTOX as first line.

Well, I would say that the first line should always be supported self care. The foundational advice that you give for any type of joint injury, taking the load off. Applying heat, applying ice, self massage, there’s so much to it and it’s been all compiled in that document that I mentioned. So whilst I was lucky enough to have these two guests on today, I didn’t want to spend too much time on that because that is available to you and you should be giving that to your patient as first line.

Now a lot of what we discuss will upset some clinicians