Fitness to Practise (FtP) investigations by the General Dental Council (GDC) can be stressful for dental professionals, sometimes involving significant delays and costs. Although the GDC has taken steps toward a more proportionate and balanced regulatory approach, the need for further improvements has been acknowledged. The current FtP system remains inflexible, bound by existing legislation, with forms of information gathered at various stages of an FtP investigation, and a limited scope for early resolution. A key consideration is whether a dental professional's fitness to practise is currently impaired. Introducing opportunities for presenting effective evidence of insight, reflection, and targeted action relating to the issues raised to prevent further repetition - evidence of remediation considered at an early stage of an FtP investigation - could reflect a more compassionate and learning-focused approach to help demonstrate the absence of present impairment and ensuring that patient safety is maintained. This aligns with the practices of some of the other UK healthcare regulators and may help to reduce the number of cases that progress unnecessarily, particularly the small number of cases which are closed later in the process with no further action. This article explores the potential for integrating early remediation into dental regulation to enhance fairness and efficiency.
The temporomandibular joint (TMJ) is a uniquely complex, bi-articular joint that enables both rotational and translational mandibular movement. Joint sounds, such as clicking and crepitation, are among the most common clinical findings associated with temporomandibular disorders (TMDs) and frequently cause patient concern. Understanding the underlying anatomy of the TMJ, its fibrocartilaginous surfaces, articular disc morphology, and complex muscular attachments is essential to diagnosing the origin of these joint sounds. This article outlines the anatomy and clinical relevance of the TMJ to help clinicians adopt a conservative, evidence-based approach to the assessment of joint sounds, recognising that most are benign and self-limiting, while ensuring accurate diagnosis of sounds suggestive of internal derangement or degenerative change.
OBJECTIVE:To provide a comprehensive overview of the diagnosis and management of temporomandibular disorders (TMDs) in patients with comorbid sleep-related conditions, specifically obstructive sleep apnoea (OSA) and sleep bruxism, while exploring their clinical interrelationships within an integrated dental care model. METHODS:A narrative review of the existing literature was conducted to synthesise current evidence regarding the physiological and pathological links between sleep disordered breathing, neuromuscular jaw dysfunction, and nocturnal parafunctional habits. RESULTS:This review demonstrates that TMD and sleep disorders are intrinsically linked, with sleep bruxism often acting as a potential protective mechanism for airway patency in OSA patients, while fragmented sleep exacerbates chronic TMD pain. Findings suggest that a "siloed" treatment approach often leads to sub-optimal outcomes. Conversely, an integrated diagnostic framework - utilising screening questionnaires alongside clinical TMD examinations - facilitates more accurate identification of these interrelated conditions. CONCLUSION:Effective management requires a shift from isolated dental interventions to a coordinated, interdisciplinary approach. By combining conservative measures, such as sleep hygiene and physiotherapy, with targeted therapies like mandibular advancement devices, dentists can significantly enhance oral rehabilitation success. Collaboration between dental professionals and medical sleep specialists is essential to ensure patient safety, optimise treatment sequencing, and improve the overall quality of life for patients presenting with this complex triad of disorders.
BACKGROUND:Temporomandibular disorders (TMDs) affect up to 1 in 15 people, significantly impairing daily function and quality of life. Despite clinical guidance recommending a biopsychosocial approach, treatment remains largely biomedical, often relying on occlusal splints or invasive procedures with limited evidence. This study describes a patient-centred, supported, self-management intervention for TMDs co-developed with patients, and its implementation into clinical practice. METHODS:The intervention was co-developed with patients through syntheses of systematic reviews, qualitative research, and adaptation from a chronic widespread pain intervention. It incorporates a biopsychosocial framework including pain science education, jaw posture control, behavioural activation, cognitive restructuring, and habit reversal. The intervention guide is designed for remote delivery by a trained facilitator. It was evaluated in a proof-of-concept trial and service evaluation. RESULTS:The evaluation study (N=104) demonstrates the intervention's feasibility and efficacy for TMD, reducing pain, interference, and healthcare use. Patients favoured the personalised, remote, guided delivery. Key mechanisms included breaking physical/psychosocial vicious cycles using goal-setting, thus enabling patients to regain control and reverse unhelpful patterns. CONCLUSION:The intervention aligns with biopsychosocial models of care, empowering patients with self-management skills to manage their TMDs. Its flexible, remote format enhances accessibility and environmental sustainability. By addressing key gaps in current pathways, this work also underscores the importance of patient co-design in producing acceptable, scalable, and effective health interventions.
The primary dental care team commonly encounters patients presenting with trismus as the result of various benign causes. Common among these causes are the range of temporomandibular disorder diagnoses. In a rare but significant number of cases the cause may be an underlying malignancy in which case urgent referral is mandatory. This article describes the implementation of the Trismus Checklist, a nine-item screening tool designed to improve patient safety by structuring the diagnostic process for trismus. Objective measurement techniques, including recording the intra-incisal distance, while emphasising the need to account for a pre-existing overbite or open bite are outlined. A passive stretch test is recommended to differentiate between myogenic limitations and mechanical obstructions. The routine use of the described Trismus Checklist helps safeguard clinicians against missing significant pathology. It is suggested that objective monitoring and follow-up are essential for all patients presenting with trismus, regardless of the initial suspected diagnosis.
Temporomandibular disorders (TMDs) comprise a heterogeneous group of conditions affecting the temporomandibular joints, masticatory muscles, and associated structures. Occlusal splint therapy remains one of the most prescribed conservative interventions for the management of TMD. However, considerable debate persists regarding its mechanism of action, clinical indications, and comparative effectiveness relative to other conservative management strategies. This article provides an overview of splint therapy in the management of TMD, focusing on stabilisation splints, anterior repositioning splints, and Nociceptive Trigeminal Inhibition Tension Suppression System (NTI-tss) appliances.
This article presents the reflections of a clinician who has been involved in the diagnoses and management of temporomandibular disorders (TMDs) for approximately 40 years. It provides an illustration of how our understanding of TMDs has advanced over the years. The author describes how an adverse reaction to a routine restorative procedure led to a study of the articulatory system. This opinion paper discusses several key points regarding TMD diagnosis and management, distilled through decades of practical experience. TMD is a phrase that encompasses distinct diagnoses; it is not a single condition, and not all TMDs affect the temporomandibular joint (TMJ). The development of sound classification systems for TMD have been an aid to both research into and clinical management of TMD. TMDs are multifactorial and effective management will require a multidisciplinary approach. In the case of a chronic pain TMD patient an understanding of the effects that chronic pain can have on the general wellbeing of the patient is invaluable, and dentists are encouraged to acknowledge and develop such skills. There is an important role for the general dental practitioner in the diagnosis and management of TMD.
Temporomandibular disorder (TMD) is a complex, multifactorial condition influenced by musculoskeletal, psychological, postural, and behavioural factors. Addressing these layers in isolation can result in partial or short-term relief. A growing body of clinicians advocate for an integrative, patient-centred approach that combines physical, psychological, and behavioural therapies to promote long-term healing. This article explores how myofunctional therapy, temporomandibular joint massage, and hypnosis can improve TMD treatment and advocates for their widespread adoption in dentistry.
Temporomandibular disorders (TMDs) present a diverse group of musculoskeletal conditions affecting the temporomandibular joint, with symptoms ranging from pain to limited mandibular function. With growing interest in how orthodontic practices might influence or intersect these disorders, this review evaluates TMD from an orthodontic perspective. The paper outlines the multifactorial aetiology of TMD, incorporating biological, psychological, and biomechanical elements. Clinical evaluation and diagnosis are explored with emphasis on evidence-based assessment tools and imaging modalities. The review also considers the debated relationship between malocclusion, occlusal interferences, and TMD, revealing weak associations but no conclusive causal links. Orthodontic treatments, including extractions, orthognathic surgery, and appliance therapy, are critically examined, along with controversial concepts such as reverse orthodontics. Despite anecdotal claims, most current evidence indicates that well-executed orthodontics neither causes nor cures TMD. Management should prioritise reversible, conservative strategies, including patient education, behavioural modifications, splint therapy, and physical therapy. Surgery remains a last resort for non-responsive cases. The review advocates for a cautious, individualised approach to TMD in orthodontic patients, highlighting the need for more robust longitudinal data to inform future practice.
Early, appropriate diagnosis of temporomandibular disorders (TMD) can influence the course of the condition and help to reduce symptoms. As most patients first present in the primary dental care setting, primary care clinicians should be able to recognise and diagnose TMD. The Brief Diagnostic Criteria for Temporomandibular Disorders (bDC/TMD), published in 2023, was developed to simplify assessment and diagnosis for dental clinicians. This article outlines the clinical assessment, examination and diagnostic steps within the bDC/TMD, and highlights its practical benefits for dental clinicians.
