Temporomandibular Disorders (TMDs) Position Statement
The American Association for Dental, Oral, and Craniofacial Research (AADOCR) recognizes Temporomandibular Disorders (TMDs) as a group of musculoskeletal conditions modulated by neural circuits involving the temporomandibular joints (TMJs), the masticatory muscles, and associated tissues1. TMDs are the most common type of non-odontogenic orofacial pain2. The signs and symptoms associated with these disorders are diverse, may be reported as pain, joint sounds, and limited function and are the most prevalent cause of chronic orofacial pain1,3. In addition, TMDs may be associated with systemic conditions and most likely linked to other overlapping or comorbid pain conditions (comorbidities)3-6. Chronic TMDs are associated with higher pain intensity and disability that substantially impacts the quality of life7.
Strong methodological studies have permitted progress in the understanding of the etiology and pathophysiology of TMDs, advancing the field beyond the mechanistic view that focused on dental occlusal factors and maxillomandibular relationships3,8.In its 2020 report on TMD Priorities for Research and Care, the National Academies of Sciences, Engineering, and Medicine (NASEM) issued 11 recommendations spanning research, treatment, training, and education, highlighting both the field’s advancements and its ongoing needs3. Evidence has highlighted that TMDs are multifactorial and complex disorders better understood within a biopsychosocial framework. Therefore, a multidisciplinary management integrating dentistry and medicine, complemented by behavioral approaches, is required to address multiple factors and comorbidities3,9. Management should be patient-centered, conservative, reversible and evidence-based, focusing on decreasing pain and reestablishing function, hence improving quality of life.2,3,9,10 Consistent with AAOP guidelines,2 standard of care recommendations for TMD management has been endorsed by the INfORM network of the IADR for dissemination purposes.10
Based on the above:
AADOCR recommends that the diagnosis of TMDs or related orofacial pain conditions should be based primarily on information obtained from the patient's history, clinical examination, and, when indicated, be complemented by TMJ imaging or other procedures.2,10 Understanding that Magnetic Resonance Imaging and Cone Beam Computerized Tomography are considered the reference standards of care for soft and hard tissue evaluation respectively,11,12 the implementation of these modalities are not only to confirm clinical diagnosis but they must impact the treatment outcome.2,10 Current chairside electronic diagnostic devices lack the clinical validity (sensitivity and specificity) required to separate individuals with or without TMDs (cases vs. controls) or to distinguish among TMDs subgroups (painful or intra-articular diagnoses).13,14 Standard orthopedic, rheumatologic, or neurologic tests may be used when clinically indicated, and validated psychometric tools can help assess psychosocial factors.1,2, 10,15 Validated instruments are recommended for adults,16 as well as adapted instruments for children and adolescents.17
As most patients without severe psychosocial impairment tend to improve without any active treatment,18,19 AADOCR recommends that treatment of patients with TMD should be primarily based on the use of self-management, conservative, reversible, and evidence-based therapeutic modalities. TMD management should aim to reduce pain levels, decrease dysfunction and limit their impact. 2,10 Studies of the natural history of many TMDs suggest that these conditions tend to improve or resolve over time. Specifically about 70 percent of soft and hard tissue intra-articular TMJ conditions are stable over time.20,21 While no specific therapies have been proven to be uniformly effective, many of the conservative approaches have proven to be equally effective when provided as a management plan tailored to diagnosis and patient needs, which includes patient education and self-management in which patients are taught about their disorder and how to manage their symptoms, stabilization appliances, pharmacological and physical therapy.2,3,10,22. In general, treatment regimens should include counseling and cognitive-behavioral strategies aiming to make the patients aware and modify their oral behaviors.23,24 TMJ surgery is reserved to a minority of cases,25 most of which can be managed with minimally invasive techniques such as arthrocentesis.26,27 These modalities do not produce irreversible changes as invasive treatments; therefore they present a better risk-benefit-cost ratio and reduce patient harm. These treatment concepts are also supported by recent data from the National Dental Practice-Based Research Network prospective cohort.28 Within this framework, irreversible treatment approaches based on, for instance, the correction of dental occlusion and/or condyle position are not recommended. Cautionary remarks and ethical considerations should be prioritized.29
AADOCR also recommends advancing basic and clinical research and strengthening the implementation-focused education on orofacial pain within both predoctoral and postdoctoral dental curricula, in line with similar expert recommendations.3,8,30,31 Orofacial pain has been recognized as the 12th dental specialty by the National Commission on Recognition of Dental Specialties and Certifying Boards (NCRDSCB), in accordance with the American Dental Association’s requirements for specialty recognition.32 To fulfill this recommendation, it is necessary to strengthen the predoctoral curriculum and expand the number of accredited orofacial pain residency programs to enhance the workforce expertise and to improve access to evidence-based care for individuals with TMDs.
AADOCR emphasizes the importance of broad, interdisciplinary collaboration to advance understanding and treatment of TMDs. AADOCR is committed to fostering cross-disciplinary education and research initiatives that address the multifactorial nature of TMDs. Investing in diverse research approaches will accelerate the translation of discoveries into effective, equitable care. By supporting collaboration among researchers, clinicians, educators, and community stakeholders, AADOCR aims to improve the quality of life for individuals affected by TMDs through advances in prevention, diagnosis, management, and education.
(adopted 2026)
