This is the current release of the guideline.

This guideline updates a previous version: American Academy of Pediatric Dentistry (AAPD). Guideline on acquired temporomandibular disorders in infants, children, and adolescents. Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2006. 3 p. [32 references]

Temporomandibular disorders

To assist the practitioner in the recognition and diagnosis of temporomandibular disorders (TMD) and to identify possible treatment options

Note: It is beyond the scope of this document to recommend the use of specific treatment modalities.

Infants, children, and adolescents undergoing routine dental history and examinations and those with temporomandibular disorders

Evaluation/Screening/Diagnosis

1. Temporomandibular joint (TMJ) history and assessment as a part of comprehensive dental history and examination
2. Palpation of masticatory and associated muscles and the TMJs
3. Documentation of joint sounds
4. Occlusal analysis
5. Assessment of range of mandibular movements
6. Joint imaging

Treatment

1. Reversible therapies, including patient education, physical therapy, behavioral therapy, prescription medications, and occlusal splints
2. Avoidance of irreversible therapies, including occlusal adjustments, mandibular repositioning, and orthodontics
3. Referral to a specialist

The guideline document is an update of the previous document, revised in 2006. The update included an electronic search using the following parameters: Terms: "temporomandibular disorder," "TMJ dysfunction," "TMD AND adolescents," "TMD AND gender differences," "TMD AND occlusion," "TMD AND treatment"; Fields: all fields; Limits: within the last 15 years; humans; English; clinical trials.

69

Not applicable

Not stated

The oral health policies and clinical guidelines of the American Academy of Pediatric Dentistry (AAPD) are developed under the direction of the Board of Trustees, utilizing the resources and expertise of its membership operating through the Council on Clinical Affairs (CCA).

Proposals to develop or modify policies and guidelines may originate from 4 sources:

1. The officers or trustees acting at any meeting of the Board of Trustees
2. A council, committee, or task force in its report to the Board of Trustees
3. Any member of the AAPD acting through the Reference Committee hearing of the General Assembly at the Annual Session
4. Officers, trustees, council and committee chairs, or other participants at the AAPD's Annual Strategic Planning Session

Regardless of the source, proposals are considered carefully, and those deemed sufficiently meritorious by a majority vote of the Board of Trustees are referred to the CCA for development or review/revision.

Once a charge (directive from the Board of Trustees) for development or review/revision of an oral health policy or clinical guideline is sent to the CCA, it is assigned to 1 or more members of the CCA for completion. CCA members are instructed to follow the specified format for a policy or guideline. All oral health policies and clinical guidelines are based on 2 sources of evidence: (1) the scientific literature; and (2) experts in the field. Members may call upon any expert as a consultant to the council to provide expert opinion. The Council on Scientific Affairs provides input as to the scientific validity of a policy or guideline.

The CCA meets on an interim basis (midwinter) to discuss proposed oral health policies and clinical guidelines. Each new or reviewed/revised policy and guideline is reviewed, discussed, and confirmed by the entire council.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Once developed by the Council on Clinical Affairs (CCA), the proposed policy or guideline is submitted for the consideration of the Board of Trustees. While the board may request revision, in which case it is returned to the council for modification, once accepted by majority vote of the board, it is referred for Reference Committee hearing at the upcoming Annual Session. At the Reference Committee hearing, the membership may provide comment or suggestion for alteration of the document before presentation to the General Assembly. The final document then is presented for ratification by a majority vote of the membership present and voting at the General Assembly. If accepted by the General Assembly, either as proposed or as amended by that body, the document then becomes the official American Academy of Pediatric Dentistry (AAPD) oral health policy or clinical guideline for publication in the AAPD's Reference Manual and on the AAPD's Web site.

Every comprehensive dental history and examination should include a temporomandibular joint (TMJ) history and assessment. The history should include questions concerning the presence of head and neck pain and mandibular dysfunction, previous orofacial trauma, and history of present illness with an account of current symptoms. In the presence of a positive history and/or signs and symptoms of temporomandibular disorders (TMD), additional information is suggested and a referral may be considered. A more comprehensive examination should be performed and include palpation of masticatory and associated muscles and the TMJs, documentation of joint sounds, occlusal analysis, and assessment of range of mandibular movements including maximum opening, protrusion, and lateral excursions.

Joint imaging may be recommended by other specialists to investigate joint sounds in the absence of other TMD signs and symptoms. For example, the presence of crepitus may indicate degenerative change that is not yet painful.

Therapeutic modalities to prevent TMD in the pediatric population are yet to be supported by controlled studies. For children and adolescents with signs and symptoms of TMD, reversible therapies should be considered. Because of inadequate data regarding their usefulness, irreversible therapies should be avoided. Referral to a medical specialist may be indicated when otitis media, allergies, abnormal posture, airway congestion, rheumatoid arthritis, or other medical conditions are suspected.

None provided

The type of evidence supporting the recommendations is not specifically stated for each recommendation.

When data did not appear sufficient or were inconclusive, recommendations were based upon expert and/or consensus opinion by experienced researchers and clinicians.

Appropriate recognition and diagnosis of temporomandibular disorders, including identification of possible treatment options

Not stated

An implementation strategy was not provided.

Not applicable: The guideline was not adapted from another source.

American Academy of Pediatric Dentistry

Clinical Affairs Committee - Temporomandibular Joint Problems in Children Subcommittee

Not stated

Council members and consultants derive no financial compensation from the American Academy of Pediatric Dentistry for their participation and are asked to disclose potential conflicts of interest.

This is the current release of the guideline.

This guideline updates a previous version: American Academy of Pediatric Dentistry (AAPD). Guideline on acquired temporomandibular disorders in infants, children, and adolescents. Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2006. 3 p. [32 references]

Electronic copies: Available from the American Academy of Pediatric Dentistry Web site .

Print copies: Available from the American Academy of Pediatric Dentistry, 211 East Chicago Avenue, Suite 700, Chicago, Illinois 60611.

The following is available:

• Overview. American Academy of Pediatric Dentistry 2010-11 definitions, oral health policies, and clinical guidelines. Chicago (IL): American Academy of Pediatric Dentistry; 2010. 2 p. Electronic copies: Available in Portable Document Format (PDF) from the American Academy of Pediatric Dentistry Web site .

None available

This NGC summary was completed by ECRI Institute on August 7, 2007. The information was verified by the guideline developer on August 23, 2007. This NGC summary was updated by ECRI Institute on December 30, 2010. The updated information was verified by the guideline developer on May 9, 2011.

This summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.