How to Find a TMJ Provider?
By Ann McCulloch | Reviewed by Dr. Bradley Eli, DMD, MS
In Part 1, I shared my perspective that jaw pain/jaw dysfunction can be treated and managed, but its not appropriate to expect TMJ to be “fixed” if you have had persistent symptoms for some time. The due to the complex nature of the temporomandibular jaw joint region is complex. The jaw, muscles and supporting ligaments are highly adaptable to meeting the wide-ranging needs for continuous use in eating, smiling, talking, swallowing and breathing. You can inadvertently put stree on the jaw without realizing there has been an injury. It’s also common to postpone treatment in hopes jaw pain will improve. However, the risk in waiting is that it could become increasingly distracting, disabling and become more extensive to treat a temporomandibular joint disorder (TMD).
This article raises issues to consider as you search for the right individual or team of clinicians to diagnose and treat TMD. Because jaw pain and/or dysfunction can fluctuate over time with changes in lifestyle or medical condition, look for a dental TMD expert that will teach you strategies to prevent re-injury and help you self-manage symptoms that flare up from time to time.
Here, I am focusing primarily on common musculoskeletal TMJ disorders and common joint disorders such as disc displacements and degenerative changes. In addition to dental TMJ providers, you may also want to pursue treatment offered by physical therapists, chiropractors, osteopaths, and others that have advanced trainings. Referred to as Complimentary Alternative Medicine or CAM, physical medicine, allied healthcare providers, and other descriptors finding a CAM provider man help you during treatment. This is especially true if from a Dental TMJ provider or as a follow-up to maintain the improvement of your symptoms.
- How to Find a TMJ Provider?
- 82% of TMD Patients have Jaw Pain or Stiffness
- NASEM Report on Improving Care for Individuals with TMD
- Why it’s so Hard to Find a TMD Provider?
- Why it’s Difficult for MDs to Refer TMD Providers?
- My Journey to Find the Right TMJ Provider
- How Should you Pursue Treatment for TMJ?
- Challenges for Patients with TMJ Disorders
- Why Jaw Patients often go to a Medical Provider First?
- Different Approaches for TMJ Disorder Treatment
- Dental Organizations focused on TMD
- TMJ Dentists
82% of TMD Patients have Jaw Pain or Stiffness
Ana Miriam Velly, Associate Professor with the Faculty of Dentistry at McGill University, reports on a US study of TMD symptoms, diagnoses, treatments, treatment adherence, and painful TMDs and jaw function outcomes through 6 months. Management of painful temporomandibular disorders: Methods and overview of The National Dental Practice-Based Research Network prospective cohort study published February 1, 2022 says that “Eighty-two percent had pain or stiffness of the jaw on awakening, and 40.3% had low-intensity pain.”
We also learn that the most common diagnoses were myalgia (72.4%) and headache generated from TMDs (51.0%). Myalgia is a muscle disorder in the masticatory system and typically the pain is aggravated by movement of the jaw, chewing or clenching. Myalgia is generally a dull aching pain in the muscles of the jaw and head.
NASEM Report on Improving Care for Individuals with TMD
I recommend a recently published report on the current state of medical and dental care for TMDs. Called a Consensus Study Report, Temporomandibular Disorders: Priorities for Research and Care (2020) is the culmination of a study conducted by the National Academies of Sciences, Engineering and Medicine (NASEM) and sponsored by the National Institute of Dental and Craniofacial Research (NIDCR) and the National Institutes of Health (NIH).
NASEM organized a panel of TMD patients and a group of experts from 18 healthcare disciplines working over a two-year period. The report is available for free at [link] and the Highlights and the Overview of Recommendations are succinct. As a patient and as a person involved in the field of care for TMDs, I commend the committee on its actionable recommendations to “bridge the medical and dental gap”. An important recommendation is to create consistent introductory training for all frontline healthcare providers on how to identify common TMJ disorders and prioritize access to care for patients with complex or chronic conditions. [1]
The NASEM report defines TMDs as “a set of diseases and disorders that are related to alterations in the structure, function, or physiology of the masticatory system and that may be associated with other systemic and comorbid medical conditions.” [2]
Why it’s so Hard to Find a TMD Provider?
It’s challenging to find a TMD care provider for non-surgical treatment options for several reasons, but here are six worth understanding:
1. Most general dentists are not trained in or choose not to treat patients with TMDs.
Dental schools have not been required to offer introductory courses on TMJ anatomy, pain mechanisms and treatment of TMDs. In 2020 the Commission on Dental Accreditation (CODA) instituted guidelines that now require basic training in accredited dental schools. In general, however, a dentist who includes TMD patients in their practice has pursued extensive continuing education in the field or obtained post-graduate training in an orofacial program and is board-certified as an Orofacial Pain Specialist.
2. The Orofacial Pain Specialty is new and not well understood.
In March 2020, the American Dental Association (ADA) recognized the specialty field of orofacial pain. There is a shortage of Orofacial Pain Specialists in the US and more than 10 states in the US lack a single specialist. This group of highly trained dentists are expert in the diagnosis of complex TMD and orofacial pain conditions, however many orofacial pain specialists have not developed relationships with medical associations most likely to refer patients.
Awareness of the orofacial pain specialty is lacking in both dentistry and medicine. There is a difference between an Orofacial Pain Specialist and a dentist who calls him/herself a TMD Specialist, and this adds to confusion.
3. Appealing terms used by marketing consultants.
If you use common keywords when you are searching the internet you might find it hard to know how to differentiate dentist A from dentist B. Marketing consultants recommend the use of buzzwords such as “conservative dentistry”, “non-invasive”, “holistic”, “integrated care” and other terms that mean different things to different people. It is difficult for dentists to explain the differences in their approach on websites and this is a case where you can’t judge the merits of an expert dentist by the appearance or quantity of information on their website, unfortunately.
4. Areas of focus in dentistry are expanding.
Preventative dentistry has been so successful in preventing cavities that many dentists are expanding their services and developing subspecialties. Examples include expertise in cosmetic dentistry, expanding into clear aligner therapy, performing dental implants, periodontitis, or expanding into treatment of sleep disordered breathing. Dentists are becoming experts in oral health more comprehensively and some dentists are incorporating integrated medicine in their practices.
Many of these new areas of focus offer treatments that can positively impact jaw function, oral behaviors, and overall health. Some of these focus areas require training in jaw joint anatomy and understanding common TMJ disorders. The consequence of these trends, however, is that a patient who is self-referring may not know how to differentiate the diagnostic skills of a dentist who offers a hybrid of wellness or facial esthetics services promoted to address jaw dysfunction. Some ENT providers refer TMJ patients to orofacial pain specialists. In addition, some of the treatments offered are new and have not been tested in clinical research, so they are not deemed to be evidence-based therapy.
5. Confusing TMJ terminology used by providers.
Many of the TMJ Specialists in dentistry belong to membership-based associations that use unique terminology to describe their treatment philosophy or their adherence to certain protocols. It is impressive that these dentists are highly educated and trained and devote their time to caring for patients with TMD.
The problem is that the patient is unlikely to appreciate the difference in approach at the time of decision unless the patient obtains second and third opinions, which can become very confusing. This is true for other chronic pain conditions like back pain, knee pain, and neck pain, but it is especially true for treatment of TMD and orofacial pain.
It is likely that your primary care physician can help you sort through treatment options for back, knee and neck pain. However, it is unlikely that he/she would help evaluate jaw pain treatment philosophies.
6. Treatment Options are not well explained.
As with other medical conditions, the type of treatments offered should be appropriate to the severity and the duration of the TMJ condition. Many of the familiar treatment options offered by dentists are biomechanical treatments targeting functional changes to the jaw structure. They often pay less attention paid to both pain management and acute care for minor, recent injury, or slowly progressing pain that is moderately tolerable.
In addition, while there is a growing consensus that coordinated care, integrative care, and transformative care are beneficial for patients with protracted TMD conditions, these models only exist in a few locations. The NASEM report advocates for biopsychosocial care for TMD patients; this term is typically understood only by healthcare professionals in the field.
Why it’s Difficult for MDs to Refer TMD Providers?
The same three factors as above make it difficult for medical professionals (doctors, physical therapists, osteopaths, and chiropractors) to provide referrals to a patient.
Additional explanations why MD’s struggle to refer TMD providers:
- There exists a lack of clarity between medical and dental scope of care for TMDs.
- Most MDs are not trained (but could be) to identify and differentiate between the most common of the 30 categories of TMJ disorders.
- MDs use standardized medical diagnostic codes. There are standardized diagnostic codes for TMDs and other orofacial pain conditions. This diagnostic criteria and coding are, however, not taught in dental school, except at the post-doctoral level in orofacial pain programs. This is a factor that inhibits the ability of the MD to confer with the TMD dentist.
- Doctors are trained to recommend and offer evidence-based medicine; they understand pharmacological treatment, physical therapy, and other modalities. They are not trained to differentiate between types of oral appliances, occlusal therapy or some of the other approaches used by TMJ dentists that are not well supported with clinical research findings.
- In March 2020, the American Dental Association (ADA) recognized the specialty field of orofacial pain. There is a shortage of Orofacial Pain Specialists in the US and more than 10 states in the US lack a single specialist. This group of highly trained dentists are expert in the diagnosis of complex TMD and orofacial pain conditions, however many orofacial pain specialists have not developed relationships with medical associations most likely to refer patients. Awareness of the orofacial pain specialty is lacking in both dentistry and medicine. Because of the shortage of specialists and long waiting lists for examination, many dentists are reluctant to refer patients.
My Journey to Find the Right TMJ Provider
Over the course of my career, I lived in NYC, Maine, Nebraska, Arizona, and California. I found a new dentist each time I relocated. My chronic pain condition has been spinal and hip-related, but at a certain point I was told I had TMJ. I was not told what type of disorder I had or how severe it was, so my mind jumped to the fear of jaw surgery. Being a compliant patient of the dentist who told me this, I didn’t ask any probative questions. I was treated for TMD and sleep apnea for 20 years during a period when I had children, stepchildren, and a demanding career.
I asked my primary care provider for his advice, and he gave me the business card of an oral surgeon, without understanding my primary concern about jaw dysfunction was mild in nature. Over the years I have been tested and scanned with technology, I have had/used orthodontics, splint therapy, surgery, treatments for obstructive sleep apnea, myofunctional therapy and craniosacral therapy.
Did I see the right providers? In the right sequence? The answer is no.
I was not aware of the options; I was not fixed, and I did not see the right providers in the right sequence. I probably was overtreated, but that was hard for me to appreciate at the time.
Patients are susceptible to mistakes when seeking jaw pain help
I take responsibility for the mistakes I made in choosing providers.
- I had limited options in some places where I lived.
- I didn’t understand the field of TMJ dentistry, and the internet was not a resource to me at critical junctions.
- Several of the dentists I consulted with had limited training or ability to coordinate care with others and as a result I was treated for one condition instead of several interrelated conditions. I didn’t know this, and at the time, neither did they.
- I had demanding jobs and little free time, and I was not of a mindset to question expert advice.
- I wasn’t knowledgeable about the “differential diagnoses process” or different treatment options. Defined in the Oxford Language as “the process of differentiating between two or more conditions which share similar signs or symptoms” as applied to TMD diagnosis, this generally means that a patient is offered simple treatment first, to either confirm or rule out a specific diagnosis criterion. Nor was I offered a conservative treatment option before the recommendation of aggressive treatment.
- I was embarrassed trying to explain the objectives of the treatment I was receiving to my doctors and my family. Even now, few patients have documentation of TMD diagnosis and treatment results available in their medical records. As a result, the patient is the one defending the decisions of their dentist
- I had the money but not the time for phases of treatment, and I fit the high-stress female profile that is so often referred to as a common TMJ patient.
Many dentists wanted to fix me (persuade me to make the time, sign up for the program) and I was susceptible.
Patients need current, proven methods when seeking jaw pain help.
Twenty-five years ago, I was treated with methods that were popular in the 90’s. Now, the medical and dental profession no longer recommends the jaw repositioning I signed up for. I had orthodontics twice but expanding my airway (through expansion, rather than retraction) was not considered in the dental scope of practice at the time.
If I had waited and signed up for the best available methods available now, would I have been better off? Should I have chosen years back to do nothing? I have no way of knowing whether the progression of my jaw-occlusal-cranial problems would have gotten worse over twenty-five years or not.
I’m not Fixed, but I am Relatively Stable
My posture, range of motion and jaw are adapting with age and changes in my lifestyle. Sometimes I am symptom-free, sometimes I have flare-ups. I try to use hot/cold therapy and gentle exercises that I have learned to manage the flare-ups. When dentists offer suggestions of the latest types of surgery, orthodontics, or treatment with cosmetic and/or functional dental restorations, I am not prepared to sign up for “more.”
These are generally valid suggestions to optimize jaw function, improve breathing and posture and even appearance. It’s hard to sign up for more treatment though and it’s equally hard to choose a provider. Experts tell you about their successful patients, but don’t tell you about others for whom their conditions were harder to treat, and this concerns me about doing “more”.
It was confusing to make decisions in my 30’s and 40’s to pursue treatments offered by dentists. It was costly, time-consuming, and disorienting. Changes were painful, irreversible, and possibly inappropriate. I hoped for major relief and when it didn’t happen, then what? I now understand why TMJ pain can becomes a catastrophe if someone is trying to manage it alone. The last straw was signing up for an expensive and extensive treatment that did not (as represented) qualify for medical insurance; instead, this created a “pre-existing condition” on my medical records.
You may have many additional questions like: Who can help you identify the condition of your jaw function? Should you be treated for pain, or underlying functional conditions (often referred to as bio-mechanical)? Should you be treated by one provider first or an integrated team? Should you be guided by your medical insurance? We’ll continue to help you determine how to address your need for TMJ care by answering the following question.
How Should you Pursue Treatment for TMJ?
Is your jaw pain acute, persistent, or reoccurring? Are you suffering from jaw pain after whiplash from a car accident? In Part 1, I suggested that you take the time to document your symptoms and your medical history before you start your search or complete a chart in someone’s office. This is a significant factor in the level of expertise you require and your own willingness to financially invest in your care and make the time to follow through.
TMD patients seek treatment from a broad array of differing professionals. This is a result of the uncertainty and controversy that abounds in this field and the failure of therapies to address the pain and dysfunction that accompany this condition. Additionally the complexity and multi-system aspects of TMD go beyond the jaw joint and requires the inclusion of the numerous medical disciplines/specialties, preferably through a team-based or medical home approach, to effectively diagnose and treat this condition.” – TMJ Patient RoundTable Briefing Report 9.25.2018 [3]
Shown below is a decision tree for you to estimate the level of care that may be appropriate for your pain, or difficulty with jaw function. This decision tree is a modified version of how some TMD providers will triage their patients at the point of initial evaluation. Are you contending with pain or disability that had a sudden onset (meaning that you don’t have a prior history of jaw-related problems.)?
The suggestion to develop a “Problem List” is to consider whether you have overlapping pain in other parts of your body, other medical conditions that may be related (such as headache, irritable bowel syndrome, fibromyalgia, arthritis). Are you contending with stressful situations in your life, or have you experienced emotional or physical trauma in your past?
Some TMJ patients have good access to care
Whether or not a patient’s jaw pain is acute, persistent, reoccurring may be a factor in the level of expertise you require. For some individuals, its best to tackle several problems at once because the jaw pain may have several interrelated sources.
TMJ disorders can take some extra diagnostic detective work because jaw and facial pain have many causes. Part of the reason TMJ disorders used to be overtreated with surgery and dental work is that doctors and dentists thought they had an objective means of diagnosis, in the form of imaging tests (x-rays, CT scans). The pictures showed what looked to be abnormalities in the joint and bite, so doctors and dentists set about to fix them when they weren’t necessarily the source of the problem. Now imaging tests are usually ordered only after some initial treatment hasn’t worked.” – A new way for TMJ by Dr. Jeffrey Shaefer, an Orofacial Pain Specialist at the Harvard School of Dental Medicine
Questions to ask yourself when seeking TMJ care
Consider the table below and ask yourself: Does this apply to you? Does your personal situation fall in any of these categories?
People who experience continuity of care with one dentist, one MD, or one alternative medicine provider over the course of their adult life. | Having electronic medical records in one place and consistent medical and dental insurance coverage is exceptionally fortunate. If you are seeking treatment for a TMJ disorder, you are fortunate if your doctor understands your medical history and you have a relationship built on trust and confidence that you will not be overtreated. |
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People who live in a metropolitan area with a plethora of experts to consult with. | This means that you can do your research, get more than one opinion, and find a provider with a treatment philosophy that works best for you. If the experts in your community know each other, you are exceptionally fortunate, especially if these experts can squeeze you into their schedules. |
People who have the time and financial means to try multi-modal treatment options spanning weeks or months of rest, recovery, focus and modification to your lifestyle. | This is obvious. If you have time and/or financial means, chances are that you have less stress than the typical TMJ patient. This statement is not meant to diminish your pain and suffering, but you have the luxury of choosing an optimal treatment plan. Some people are fortunate to be able to travel to see an expert. |
Challenges for Patients with TMJ Disorders
As a TMJ patient, you may experience these challenges:
1. You might have to meet with more than one provider or try more than one conservative treatment option. This is time consuming but might be necessary before you decide who you feel comfortable working with, based on some of the issues discussed in Part 1.
2. Reading websites and reviews on Yelp can be misleading and stressful. It is equally confusing to have friends diagnose you based on their symptoms.
3. Speaking to the front desk of many dental offices can be time consuming and it is hard to rely on the information provided by the person that answers the phone.
4. The terminology that dentists are using on websites is changing, expanding, and morphing into cosmetic and wellness and integrative medicine and airway. You may find that some providers offer a “new” type of comprehensive care on a flat rate basis (unlike physical therapy, where you pay per session, or the traditional model in dentistry, which is based on each procedure provided).
5. Expect to find more and more of the treatment plans to be cash based. This may be a good thing because a provider is trying to keep their costs down, or it may be a sign that they are offering treatment that is not considered medically necessary or is less proven. It could also be that a medical insurance plan was unwilling to contract with a dentist regardless of whether the dentist was a board-certified orofacial pain specialist.
Why Jaw Patients often go to a Medical Provider First?
Jaw sprain/strain or JAMSS, joint arthritis, and degeneration all are conditions that can manifest as headache, sinus, ear, eyes, neck and other symptoms. We guess that more than 50% of the patients with acute TMDs seek treatment from a medical provider first. Having an acute TMD means that your jaw has functioned adequately throughout your life until now.
You have a “sudden onset” of pain or difficulty chewing, opening and closing your mouth, headache and jaw pain or other symptoms that are not getting better in a few days. Do you go to a dentist, urgent care or your primary care provider?
There are several reasons why people pursue either the DIY (do it yourself) approach or medical route.
Why pain patients try the DIY approach to TMJ:
- Health Insurance suggests going to a doctor or physical therapist.
- People go to urgent care and the ER for medical screening from accidents or injuries, to rule out ENT, traumatic brain injuries, or cardiac conditions (jaw pain is a symptom,) to access care on a weekend, to get pain medication or because they don’t know where to go first.
- Some people don’t see a dentist on a regular basis or don’t have a strong relationship with their dentist.
- Some of the symptoms of acute TMD don’t appear to be dental (head, neck and jaw, not teeth).
- Some people want to avoid mentioning a jaw problem to their dentist because the term TMD has such negative connotations of costly and complex treatment.
Why are medical providers unable to give TMJ referrals?
It would be great if MD’s provided referrals, but most do not. Sometimes the recommendation is to go to an oral surgeon or look for care by perusing an assortment of institutional websites (suggesting that you do your own research).
Here are some other explanations:
- Lack of clarity between medical and dental scope of care for TMDs.
- Most MDs are not trained (but could be) to identify and differentiate between the most common of the 30 categories of TMJ disorders.
- MDs tend to be reluctant to recommend a TMD dental specialist in their local area. This is because many dentists describe their practice using terms that are not well understood and are not consistently employed. It is as hard for an MD to research local providers as it is for patients.
Different Approaches for TMJ Disorder Treatment
The NASEM report outlines the science of temporomandibular disorders as it has progressed over decades. Research has led to a growing understanding of the causes of common TMDs (referred to as etiology), and this has resulted in improved diagnostic classifications and targeted treatment strategies. Here are some key concepts that may be useful in differentiating treatment strategies. In a 2013 publication by the NIH entitled “TMJ Disorders”, the concept of conservative reversible treatment versus aggressive, irreversible treatment options is explained this way:
The Committee advocates for a “biopsychosocial” versus a “biomedical” approach to management and treatment of most TMDs. These are fundamentally different approaches to care and most patients are unaware of the differences.
Here are some key concepts that may be useful in differentiating treatment strategies. In a 2013 publication by the NIH entitled “TMJ Disorders, the authors introduce the concept of conservative reversible treatment versus aggressive, irreversible treatment options.
Experts strongly recommend using the most conservative, reversible treatments possible. Conservative treatments do not invade the tissues of the face, jaw or joint, or involve surgery. Even when TMJ disorders have become persistent, most patients still do not need aggressive types of treatment.” – TMJ Disorders by The National Institute of Health[4]
Examples of conservative, reversible options include:
- Self-care measures such as soft diet, jaw exercises, using hot/cold therapy and relaxation
- Splint therapy with oral appliances that do not reposition teeth
- Pain medication
- Botox
Examples of irreversible treatments include:
- Orthodontics
- Occlusal adjustments
- Repositioning oral appliances
- Surgery
- Jaw joint implants
TMJ Dentists
The chart below is an attempt to illustrate the different types of dentists who treat common TMDs and will appear in google search results under TMJ dentists. Most of these providers provide a range of treatment options. They will take a medical and dental history to determine if any trauma has occurred in the facial area, perform a physical examination to examine jaw musculature and joints, and may use various imaging or jaw tracking technologies. Group A will schedule treatment on a fee for service and staged basis – this means that they will suggest trying the most conservative treatment option and monitor your response to each treatment step in order to confirm their diagnosis of your condition and customized a treatment plan.
Here is a suggested way to look at the different types of dental practices that treat patients with TMDs. We have created this chart and diagram below to help patients understand some of the differences in dentistry that are not readily apparent when you search online. I am not recommending a particular group or philosophy. Any providers in these categories that dedicate all or a portion of their practices to TMD patients are presumed to be well trained and qualified, depending case by case on your condition. I encourage you to do your own systematic evaluation of the providers you are considering and consider your own unique medical history and preferences.
Types of Dental Practices Treating TMD Patients | |
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GROUP | DESSCRIPTION |
Group A | Includes general dentists that treat patients with TMDs as a portion of an overall comprehensive, restorative or cosmetic dentistry practice. They will schedule treatment on a fee for service and staged basis – this means that they will suggest trying the most conservative treatment option and monitor your response to each treatment step to confirm their diagnosis of your condition. Dentists in Group A would identify and refer a complex patient to a specialist. |
Group B | Includes some of the Orofacial Pain Specialists, and other TMJ Dentists who exclusively treat patients with TMDs, sleep disorders and some orofacial pain conditions. Dentists may indicate that they are neuromuscular, craniofacial, airway and other named type of TMJ dentist. They conduct a detailed examination, often perform extensive testing or imaging: and recommend an outlined, multiphase treatment plan.
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Group C | Includes specialists who are board-certified Prosthodontists, Oral Surgeons, Orthodontists, and Orofacial Pain Specialists who I am referring to as “Hybrid Providers” because treatment of TMD patients is a portion of their services in addition to other procedures such as implants, surgery, orthodontics and general dentistry. |
I imagine that you are realizing how confusing this is. How can this be?
Dental Organizations focused on TMD
So that you can find a dentist in your area that is an TMD organization member, we have complied the following list.
Organizations that represent dentists who treat TMJ disorders and maintain directories:
- American Academy of Orofacial Pain
- American Equilibration Society
- American Academy of Craniofacial Pain
- International College of Cranio-Mandibular Orthopedics
- American Academy of Oral and Maxillofacial Surgeons
- American Academy of Orthodontists
- Academy of Orofacial Myofunctional Therapy
- International Association of Oral Myology
Conclusion
Most patients who have common TMDs will improve with care from a dentist trained to diagnose and treat TMDs. If you are undergoing treatment, it’s important for you to slow down and pay attention to your body and your stress level. Stress is a risk factor for delayed recovery or reinjury. Oral habits and poor posture are also risk factors. Take care of yourself with any supportive activities that help you to feel rested, relaxed, and predisposed to healing. A dental or medical provider is trying his/her best to help you recover from painful injury or disability and get you back to normal function. It’s a misnomer to expect to be fixed by a provider.
If you are just beginning your search for a TMJ Dentist or Orofacial Pain Specialist, the considerations raised here are helpful.
Orofacial Therapetuics will continue to publish helpful articles.
References
[1]
Temporomandibular Disorders (TMD): From Research Discoveries to Clinical Treatment, https://www.nationalacademies.org/our-work/temporomandibular-disorders-tmd-from-research-discoveries-to-clinical-treatment, March 2019
[2] Definitions and Scope: What Are TMDs? https://www.ncbi.nlm.nih.gov/books/NBK557995/, Page 35-36 chapter 2, March 2019
[3] The TMJ Patient-Led RoundTable:
A History and Summary of Work, http://mdepinet.org/wp-content/uploads/TMJ-Patient-RoundTable-Briefing-Report_9_25_18.pdf, 2018
[4] TMJ Disorders, https://www.nidcr.nih.gov/sites/default/files/2017-12/tmj-disorders.pdf, 2017