Category
Threshold Criteria
Temporo-mandibular joint disorder (TMD), or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporo-mandibular joint, which connects the mandible to the skull.
TMJ surgery referred to in this document excludes arthroscopy as it may be performed for diagnostic reason.
Eligibility
| LLR ICB will only fund treatment if the following criteria is met Before any dentist or surgeon commences any plan or approach involving surgery, a thorough search for inciting para-functional jaw habits have been performed with the correction of any discrepancies from normal as the primary goal. Referrals must evidence the following treatments: 1. Jaw rest AND 2. Medications: non-steroidal Anti-inflammatory medications such as aspirin, ibuprofen to control inflammation. Muscle relaxants, such as diazepam may decrease muscle spasms AND 3. Physiotherapy AND 4. Local anaesthetic AND 5. Occlusal therapy: a custom made acrylic appliance which fits over the teeth prescribed for night and day to balance the bite, reduce and eliminate teeth grinding or clenching (bruxism) AND 6. Botulinum toxin injections. |
| Surgery is only indicated after these medical therapies have failed and is done as a last resort. TMJ ligament tightening, joint restructuring, and joint replacement are only considered in the most severe cases of joint damage or deterioration. Absolute contraindications to surgery are: · Active or chronic infection; · Insufficient quantity or quality of bone to support the components; · Systemic disease with increased susceptibility to infection; · Patients with extensive perforations in the mandibular fossa and/or bony deficiencies in · the articular eminence or zygomatic arch that would severely comprise support for the · artificial fossa component; · Partial TMJ joint reconstruction; · Known allergic reaction to any materials used in the components; · Patients with mental or neurological conditions who are unwilling or unable to follow · post-operative care instructions; · Skeletally immature patients · Patients with severe hyper-functional habits (e.g. clenching, grinding etc.) |
Guidance
| ARP 92 Review Date:2026 |
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