Professor Igor Blum, Editor of the Primary Dental Journal (PDJ), reviews the latest thinking on temporomandibular disorders – the theme of the upcoming issue.
The history of dentistry is often one of mechanical solutions for biological problems. For decades, the management of temporomandibular disorders (TMDs) was dominated by the search for the “perfect bite”, a quest that frequently led patients down a path of irreversible occlusal adjustments and increasingly complex orthodontic or restorative interventions. However, as we stand in 2026, the paradigm has shifted. We have moved from a focus on gnathology to an era of neurobiology.1 This fundamental paradigm shift in how the dental and medical communities understand and treat TMD marks a transition from viewing the temporomandibular apparatus as a purely mechanical system to viewing it as a complex biological and neurological interface.2
TMD comprises a group of musculoskeletal conditions that affect the muscles of mastication, the temporomandibular joint (TMJ) and associated structures.3,4 The symptoms can include localised or referred tenderness/pain in the TMJ or associated structures, clicking or grating sounds in the TMJs, restricted jaw movements, muscle pain, headache, tinnitus, impaired hearing, and earache.5 These symptoms can cause a wide range of biopsychosocial impacts including impacts on health-related quality of life commensurate with other types of persistent pain.6,7 Therefore, TMD is most accurately viewed through a biopsychosocial lens: an intricate interface where peripheral nociception is modified by masticatory function, sleep hygiene, autonomic stress physiology, and central sensitisation.8
TMDs are the second most common cause of orofacial pain after “toothache” (odontogenic pain).6 They affect up to one in 15 of the UK population and predominantly arise in the 20–40-year age range.6,7 Females more commonly present with symptoms of TMD than males.4,6 Many patients present with a simple concern (“my jaw clicks”; “it hurts to chew”; “I wake with headaches”) but behind this sits a spectrum of conditions ranging from self-limiting myalgia to inflammatory arthropathy, internal derangement, or degenerative joint change. The challenge – and the opportunity – for us as clinicians is to respond with care that is proportionate, evidence-informed, and firmly grounded in the patient’s lived experience. In this framework, “jaw pain” is not a diagnosis – it is a symptom. Our primary clinical mandate is to move beyond mechanical reductionism to identify the predominant pain driver, stratify patient risk, and select interventions that prioritise the prevention of iatrogenic harm while maximising functional recovery and patient comfort.
Two fundamental axioms guide contemporary TMD care. First, most clinical presentations are self-limiting and respond predictably to conservative, non-invasive management. Second, in the minority of cases where symptoms persist, the lack of resolution is rarely the result of a missed occlusal detail or an insufficiently complex appliance design. Instead, persistent pain is seldom explained by a solitary structural finding.
The upcoming themed issue of the Primary Dental Journal aims to highlight the presentation and management of some of the more common and important TMD conditions encountered in dental practice; a core theme in the papers is to highlight the vital role that primary dental care clinicians contribute to the assessment, diagnosis and management of patients with TMDs. The cornerstone remains careful assessment. A structured history is not an administrative formality: it is a diagnostic instrument. Onset and temporal pattern, functional limitation, triggers, parafunctional behaviours, prior interventions, and red flags (trauma, systemic inflammatory disease, progressive neurological symptoms, swelling, fever, unexplained weight loss) shape the differential diagnoses. Equally important are the psychosocial drivers that influence pain persistence – sleep disturbance, anxiety, depression, and the impact on daily roles.5 The clinical examination then adds specificity: localisation of tenderness, pattern of movement, joint sounds, range and deviation, and the relationship between pain and function.9
Standardisation matters because it improves communication and research translation. Diagnostic frameworks such as the recently published brief Diagnostic Criteria for Temporomandibular Disorders (bDC for TMD)10 have moved the field forward by improving reliability and reinforcing the distinction between common muscle-related pain and less frequent joint pathology. Yet even the best taxonomy is only valuable when applied with humility: imaging and joint noises can be compelling, but they are not always causal. A click may reflect disc displacement with reduction in an otherwise stable, asymptomatic joint. Crepitus may indicate degenerative change, but the severity of radiographic findings often correlates poorly with pain intensity. The clinician’s reflex must be to contextualise findings rather than to chase them. After all, TMD care is, at its core, an exercise in clinical judgement and therapeutic restraint. It asks us to be precise in diagnosis, generous in explanation, conservative in intervention, and collaborative in approaches.
The emphasis of modern management is conservative care first – because it works for most patients and because it preserves options. Education is not “reassurance” in the dismissive sense; it is an evidence-based intervention that reduces fear, improves adherence, and supports self-efficacy. Simple explanations about joint function, muscle overload, and the natural history of many TMDs can be transformative. From there, treatment becomes a suite of low-risk strategies: activity modification, soft diet during flare-ups, heat/cold, short courses of anti-inflammatory analgesia where appropriate, and targeted exercises. Physiotherapy approaches (range-of-motion, coordination training, postural strategies, and manual techniques) remain highly relevant, particularly when delivered as part of a broader plan rather than as isolated “sessions”.11
Occlusal splints continue to have a role, especially for symptom modulation and protection in selected patients,12 but the narrative must be updated. Splints are not magic devices that “realign” joints; they are tools to reduce overload, support muscle relaxation, and improve symptom control. Clinicians should be explicit about indications, limits, and follow-up – particularly in patients with sleep bruxism, where the aim may be harm reduction rather than eradication of activity. In persistent cases, behavioural and psychological interventions are not optional add-ons; they are often essential. Cognitive behavioural approaches, stress regulation, and techniques that address hypervigilance to pain can change outcomes.13 Even brief, chairside communication strategies (language that reduces threat, validates experience, and sets realistic expectations) can shift the trajectory from chronicity toward recovery.
I trust that the Temporomandibular Disorder-themed issue of the journal will serve as a tabletop reference in general dental practice. It is hoped that it will help clinicians to integrate the principles of TMD into clinical practice to improve patient-related outcomes. In this token, I would like to express my special thanks to the Guest Editor of the TMD-themed issue, Dr Ziad Al-Ani, and to all contributing authors for crafting this superb issue of the Primary Dental Journal.
To receive the Temporomandibular Disorder issue of the PDJ, join the College by Thursday 16 April 2026.
The Primary Dental Journal is the College’s quarterly peer-reviewed journal dedicated to general dental practice. The titles and abstracts of PDJ papers are available to all dental professionals via the searchable PDJ homepage, with full paper access available to College members through the PDJ Library.
The Temporomandibular Disorder issue will be available online in late April and printed copies should arrive with College members in May.
References
- Xue Q, Ming H, Huang Y, et al. Association between temporomandibular disorders and somatization: a narrative review. J Oral Facial Pain Headache. 2026;40(1):42-52.
- Dutra Dias H, Botelho AL, Bortoloti R, et al. Neuroscience contributes to the understanding of the neurobiology of temporomandibular disorders associated with stress and anxiety. Cranio. 2024;42(4):439-444.
- Beecroft E, Palmer J, Penlington C, et al. Management of painful temporomandibular disorder in adults. [Internet]. London: NHS England Getting It Right First Time (GIRFT) and Royal College of Surgeons of England Faculty of Dental Surgery; 2025. Available at: rcseng.ac.uk/dental-faculties/fds/publications-guidelines/clinical-guidelines [Accessed Feb 2026].
- Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6(4):301-355.
- Einstein A, Hassan S, Ghritlahare H. Understanding Temporomandibular Joint Disorders. In: Bhargava D. (Ed.) Temporomandibular Joint Disorders. Singapore: Springer; 2021. pp29-67.
- Maixner W, Diatchenko L, Dubner R, et al. Orofacial pain prospective evaluation and risk assessment study–the OPPERA study. J Pain. 2011;12(11 Suppl):T4-11.e1-2.
- Slade GD, Bair E, Greenspan JD, et al. Signs and symptoms of first-onset TMD and sociodemographic predictors of its development: the OPPERA prospective cohort study. J Pain. 2013;14(12 Suppl):T20-32.e1-3.
- Sharma S, Breckons M, Brönnimann Lambelet B, et al. Challenges in the clinical implementation of a biopsychosocial model for assessment and management of orofacial pain. J Oral Rehabil. 2020;47(1):87-100.
- Shaffer SM, Brismée JM, Sizer PS, et al. Temporomandibular disorders. Part 1: anatomy and examination/diagnosis. J Man Manip Ther. 2014;22(1):2-12.
- Durham J, Ohrbach R, Baad-Hansen L, et al. Constructing the brief diagnostic criteria for temporomandibular disorders (bDC/TMD) for field testing. J Oral Rehabil. 2024;51(5):785-794.
- Skorupa-Strojna A, Kulesa-Mrowiecka M. Effectiveness of physiotherapy for temporomandibular disorders: a systematic review of pain and functional outcomes. Scand J Pain. 2026;26(1):20250073.
- Khijmatgar S, Tartaglia GM, Sardella A, et al. Occlusal splint effects on visual capacities in patients with temporomandibular disorders (TMD): a prospective interventional cohort study. BDJ Open. 2025;11(1):56.
- Turner JA, Mancl L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial. Pain. 2006;121(3):181-194.