TMJ

1
Facial Pain Letter
Bloods FBC, UEs TFTs /- folate, Fe, Zinc,
B12 Ferritin
Consider TCAs for pain and symptom relief with
GMP Consult at any point where symptoms are
poorly managed
MRI for unexplained neuropathy
Assessment Clinic History /- Radiographs,
Bloods, Special Tests
Diagnosis, Reassurance and Information
(bloods swab)
TMJ
BMS AFP AO
NI
TN (bloods) ?MRI
Analgesia self care advice
Consider Surgery then
Consider local surgery/drugs Decide at 1st visit
Consider neuropathic pain drugs with GMP consult
If limited opening/muscular pain
R/V 3/12 Consider soft splint Esp with
parafunction/TSL R/V 3/12
Consider Physiotherapy
R/V 6/52
R/V 2/52 consider drug maintenance alteration
R/V 6/52 if no better consider drug
increase/alteration
If occlusal concerns esp severe TSL
R/V 2/52 until stable/pain free
R/V 6/12
Restorative R/V
3/12 R/V
R/V every 3/12
R/V 6/52 until stable If symptoms not controlled
consider Liaison Psychiatry R/V
Discharge when pt effectively self managing or
better
1 year 6/12 R/V if resolved
If severe functional problems/loss of joint
tissue
Poorly controlled pain/drug allergy/large drug
doses consider Neurosurgery R/V
3/12 R/V
Surgical R/V
See psychiatry referral guidelines Consider
psychiatry review
Prolonged history/complex case
consider Psychiatry/psychology

Anxiety/stress a factor/clenching Consider
physiotherapy