Guideline:
Guideline on acquired temporomandibular disorders in infants children and adolescents
Bibliographic Source(s)
- 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]
Guideline Status
This is the current release of the guideline.
Guideline Category
Evaluation
Screening
Treatment
Intended Users
Dentists
Physicians
Guideline Objective(s)
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.
Target Population
Infants children and adolescents undergoing routine dental history and examinations and those with temporomandibular disorders
Interventions and Practices Considered
Evaluation/Screening
- Temporomandibular joint (TMJ) history and assessment as a part of comprehensive dental history and examination
- Palpation of masticatory and associated muscles and the TMJs
- Documentation of joint sounds
- Occlusal analysis
- Assessment of range of mandibular movements
- Joint imaging
Treatment
- Reversible therapies including patient education physical therapy behavioral therapy medications and occlusal splints
- Avoidance of irreversible therapies including occlusal adjustments mandibular repositioning and orthodontics
- Referral to a specialist
Major Outcomes Considered
- Accurate diagnosis of temporomandibular disorders (TMD)
- TMD symptoms
Methods Used to Collect/Select Evidence
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
This revision is based upon a review of current dental and medical literature related to temporomandibular disorders in children and adolescents. A MEDLINE search was conducted using the terms "temporomandibular disorder" "adolescent" and "children".
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus (Committee)
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not stated
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
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:
- The officers or trustees acting at any meeting of the Board of Trustees
- A council committee or task force in its report to the Board of Trustees
- Any member of the AAPD acting through the Reference Committee hearing of the General Assembly at the Annual Session
- 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.
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation
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.
Major Recommendations
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) the examination should include palpation of masticatory and associated muscles and the TMJ's documentation of joint sounds occlusal analysis and assessment of range of mandibular movements including maximum opening protrusion and lateral excursions.
Joint imaging is indicated on a selected basis for 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 (Koh & Robinson 2003).
Referral to a medical specialist may be indicated when otitis media allergies abnormal posture airway congestion rheumatoid arthritis or other medical conditions are suspected.
Clinical Algorithm(s)
None provided
References Supporting the Recommendations
- Koh H Robinson PG. Occlusal adjustment for treating and preventing temporomandibular joint disorders. In: The Cochrane Database of Systematic Reviews [database online]. Issue 1. Hoboken (NJ): John Wiley & Sons Ltd.; 2003 [Art. No.: CD003812].
Type of Evidence supporting the Recommendations
The type of evidence supporting the recommendations is not specifically stated for each recommendation. In general all oral health policies and clinical guidelines are based on 2 sources of evidence: (1) the scientific literature; and (2) experts in the field.
Potential Benefits
Appropriate recognition and diagnosis of temporomandibular disorders including identification of possible treatment options
Potential Harms
Not stated
Description of Implementation Strategy
An implementation strategy was not provided.
IOM Care Need
Getting Better
Staying Healthy
IOM Domain
Effectiveness
Bibliographic Source(s)
- 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]
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
American Academy of Pediatric Dentistry
Guideline Committee
Council on Clinical Affairs
Composition of Group that Authored the Guideline
Not stated
Financial Disclosures/Conflicts of Interest
Council members are asked to identify potential conflicts of interest; none was disclosed.
Guideline Status
This is the current release of the guideline.
Guideline Availability
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 1700 Chicago Illinois 60611
Availability of Companion Documents
The following is available:
- Overview. American Academy of Pediatric Dentistry 2007-08 definitions oral health policies and clinical guidelines. Available in Portable Document Format (PDF) from the American Academy of Pediatric Dentistry Web site.
Patient Resources
None available
NGC STATUS
This NGC summary was completed by ECRI Institute on August 7 2007. The information was verified by the guideline developer on August 23 2007.
COPYRIGHT STATEMENT
This summary is based on the original guideline which is subject to the guideline developer's copyright restrictions.
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