American Association of Oral and Maxillofacial Surgeons

Position Paper

The Contemporary Management of Temporomandibular Joint
Intra-Articular Pain and Dysfunction
Gary F. Bouloux, DDS, MD, FRACD (OMS),FRCS (Eng.), FACS; J. David Allen Professor
and Division Chief, Division of Oral andMaxillofacial Surgery, Department of Surgery,
Emory University School of Medicine, Atlanta,
Ga.
Joli Chou, DMD, MD, FACS; Associate
Professor, Department of Oral and Maxillofacial
Surgery, Sidney Kimmel Medical College,
Thomas Jefferson University, Philadelphia, Pa.
William Chung, DDS, MD; Clinical Professor,
Residency Program Director, Indiana University
School of Dentistry and Hospital Medicine,
Indianapolis, Ind.
Charles A. Crago, DMD, MD, FACS;
Face and Jaw Surgery Center, Fargo, N.D.
Vince DiFabio, DDS, MS; Associate Clinical
Professor, Oral and Maxillofacial Surgery,
University of Maryland School of Dentistry,
University of Maryland Medical Center,
Baltimore, Md.
Louis Mercuri, DDS, MS; Visiting Professor,
Department of Orthopedic Surgery, Rush
University Medical Center; Adjunct Professor,
Department of Bioengineering, University of
Illinois Chicago, Chicago, Ill.
Greg Ness, DDS, FACS; Emeritus ProfessorClinical, The Ohio State University, Oraland Facial Surgery for Adults and Children,
Columbus, Ohio
Daniel Perez, DDS, MS, FACS; Associate
Professor and Program Director, Oral andMaxillofacial Surgery, University of Texas Health
Science Center at San Antonio, San Antonio,
Texas

The understanding of the causes of temporomandibular
joint pain and dysfunction has evolved over 50 years.
Historically, the term internal derangement has been used
to describe the abnormal relationship between the articular
disc, condyle and glenoid fossa, which was thought tocorrelate with patient symptoms. It is now known that thepathophysiology of intra-articular pain and dysfunction(IPD) involves synovitis, capsular impingement,
symptomatic disc displacement or a combination of these.
Symptomatic disc displacement should only be considered
to be a potential source of IPD after synovitis andcapsular impingement have been treated. This philosophy
provides the opportunity for most patients with IPD to be
initially treated nonsurgically or with minimally invasive
procedures such as arthrocentesis or arthroscopy.
The paradigm for the management of temporomandibular
joint (TMJ) intra-articular pain and dysfunction (IPD) has
undergone a significant transformation over the last three
decades as sufficient data have been reported to allow thedevelopment of evidence-based guidelines that enableboth the provider and the patient to identify best practices.
Recognizing the opportunity for advances in patient care,
the National Academies of Science, Engineering, andMedicine (NASEM) in 2019 convened representatives
from the FDA, Medical Device Epidemiology Network,
patient advocacy groups, oral and maxillofacial surgeons,and orofacial pain experts to identify specific steps toimprove care for patients with TMJ pain and dysfunction.
The final recommendations from NASEM were released
and published in 2022.1,2 In response, the American
Association of Oral and Maxillofacial Surgeons (AAOMS)
created the Special Committee on Temporomandibular
Joint Care whose assignment was to develop contemporary
evidence-based guidelines for the management of patientswith TMJ disorders, including IPD. This position paper
presents the findings and recommendations of thatcommittee.

PAGE 1 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and Dysfunction

Throughout this paper, the term IPD will be used forthe variety of intra-articular conditions that result in
joint pain and/or dysfunction with mandibular motion.
It is recommended that this term be widely adopted as
the preferred replacement for the older terms internal
derangement and anterior disc displacement, which
specify a mechanical finding that alone may not becausative or associated with signs or symptoms. The
latter, when determined to cause pain or dysfunction,
may be more accurately described as symptomatic discdisplacement (SDD), which is discussed more fully within
this paper.

Background
The historical approach to diagnosing the etiology of
IPD was based on assessing the anatomical relationshipbetween the mandibular condyle, the articular disc and the
glenoid fossa. It was thought that disc position was criticalto the development and perpetuation of IPD, ultimately
leading to osteoarthritis (OA). This led to the developmentof the Wilkes staging system for classifying disc position,
disc shape, condyle morphology and the dynamic
relationship between the condyle, disc and glenoid fossa.3,4
The Wilkes classification relies on a history and physicalexamination, radiographic imaging (arthrography ormagnetic resonance imaging) and histological features toenable patients to be staged appropriately. The perceived
mechanical etiology of IPD and OA led to the developmentof several surgical procedures whose purpose was toreposition, reshape or remove the disc. Arthroplasty
with disc plication, discectomy and discectomy withreplacement are all based on the assumption that IPD
is the result of abnormal disc position.3-11
Understanding the cause of IPD has evolved to the pointthat it is now known that excessive mechanical loading
can trigger a cascade of molecular events involving
the TMJ synovial membrane, leading to symptoms
in susceptible individuals. These events involve theproduction and release of free radicals, cytokines, fatty
acid catabolites, neuropeptides and matrix-degrading
enzymes.12 Although the reason for excessive mechanicalloading may vary among patients, there is significant
evidence it results in an initial tissue hypoxia withsubsequent reperfusion leading to inflammatory cell
migration and a sustained inflammatory response.13-17

Position Paper
The initial inflammatory process – which develops as aresult of synovitis – leads to an increase in pain, edema,
disruption of mandibular function and OA.18 The featuresof synovitis include hyperemia and an increased ratio of
both fibroblast-like synoviocytes and macrophage-likesynoviocytes cells. Quantitative and qualitative changes
in the synovial fluid composition also include upregulated
cytokines.19-22 The synovial membrane and the synovial
fluid it produces are critical to maintaining the health andfunction of the intra-articular tissues.23,24 Therefore, if
left untreated, continued progression of the inflammatory
response will lead to cartilage and bone damage. Persistent
inflammation within the TMJ also is known to resultin both neo-angiogenesis and neural sprouting. Thiscan involve the soft tissues of the capsule, including
the retrodiscal tissue and articular disc, as well as the
glenoid fossa and mandibular condyle. Macroscopically,
synovitis also can result in synovial hyperplasia, creeping
synovitis, synovial plica, fibrous adhesions and capsular
impingement.12 Disc displacement may be present
concomitantly, though this should not be taken to mean
the patient’s signs and symptoms are the result of thedisc position.
The recognition that most IPD is secondary to synovitis
and its consequences has led to the development andsuccessful utilization of minimally invasive surgicalprocedures such as arthrocentesis and arthroscopy.
Arthrocentesis has been shown to reduce pain and improverange of motion in 70 to 95 percent of patients.25-30
Arthroscopy has shown similar outcomes with reported
pain reduction and improvement in range of motion in
80 to 90 percent of patients.25,31-36 Arthrocentesis andarthroscopy allow the removal of inflammatory mediatorsand degraded proteins from within the joint, which
otherwise would perpetuate inflammation. Arthroscopy
has the additional advantage of being able to directly
address the physical manifestations of synovitis, including
synovial plica, capsular impingement, fibrous adhesions
and chondromalacia. Comparing outcomes following
arthrocentesis and arthroscopy suggests that arthroscopy
is superior.37

PAGE 2 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and Dysfunction

Recommendations
To optimize patient care, the AAOMS Special Committee
on Temporomandibular Joint Care has identified four key
pillars of patient care:

Position Paper

1. A thorough history, screening and physical examination.
2. Appropriate diagnostic imaging.
3. Make the correct diagnosis.
4. Initiate the least invasive evidence-based nonsurgicalor surgical treatment.
Thorough History, Screening and PhysicalExamination
The art and science of history-taking and examination
are well-delineated in the diagnostic criteria/
temporomandibular disorders (DC/TMD) guidelines,
which enable the recognition of arthralgia with asensitivity and specificity of 89 percent and 98 percent,respectively.38 Unfortunately, the proposed etiology of thearthralgia within the DC/TMD is limited to disc position,
OA or subluxation, and it fails to appreciate the importanceof the synovial molecular events involved in IPD. As aresult, although the DC/TMD can identify IPD, it is unable
to discern whether synovitis, capsular impingement,
fibrous adhesions or SDD is the etiology. This remains
a limitation of the DC/TMD.
The potential etiologies of jaw and facial pain
are numerous. The complexity of the trigeminal
neuroanatomic connections within the central nervous
system and the convergence of afferent fibers fromthe trigeminal and upper four cervical nerves within
the trigeminal spinal nucleus ensures pain referral
patterns may result in perceived TMJ pain that is in fact
unrelated to the TMJ. Screening for the presence of TMD(arthrogenous and myogenous) and cervical pain remains
critical. The sensitivity and specificity of the DC/TMD
screening instrument for identifying TMD is 99 percent
and 97 percent, respectively39 (Table 1).
Although diagnosing TMD is important, the term TMD
remains problematic as it includes both arthrogenous andmyogenous sources of pain. Distinguishing between thetwo can be facilitated by additional questions (Table 2).
Screening for cervical pain and cervicogenic headachealso is important40-43 (Table 3).
The physical examination should be performed in aconsistent and standardized manner. It is prudent toevaluate the external auditory canal and tympanic

membrane to identify any otological sources of pain. Thisshould be followed by manual palpation of the masticatory
and cervical muscles and active range of motion exercisesof the cervical spine. If radiculopathy is suspected,
it is important to assess upper extremity strength andsensation. This should be followed by palpation of the
TMJ capsule both laterally and endaurally. Joint sounds
should be appreciated through both palpation and use ofa stethoscope. The intraoral examination should assess theocclusion, maximum pain-free opening, maximum assisted
opening with pain, lateral excursions and protrusion. In
addition, it is helpful to perform that Mahan test bilaterally
to help identify intra-articular pain sources. When thehistory and examination is performed correctly, it is more
likely that the correct Axis I diagnosis will be obtained38(Figure 1).
Appropriate Diagnostic Imaging
It is recommended that any patient presenting withsymptoms of a TMJ disorder have imaging of the TMJs.
Initial orthopantogram (Panorex) imaging is consideredappropriate. More advanced imaging – such as cone-beamcomputer tomography (CBCT), medical-grade CT andmagnetic resonance imaging (MRI) – should be consideredbased on the history, clinical examination and differential
diagnosis.
Make the Correct Diagnosis
When developing a differential diagnosis, it is importantthat it be comprehensive so as to ensure other sources ofpain and dysfunction are considered.44 It is well-known
that psychosocial factors and comorbid medical conditions
play a significant role in patients who present withtemporomandibular disorders, while also having important
prognostic implications.38,45-47 Comorbid conditions
such as anxiety, depression, catastrophizing, interstitial
cystitis, fibromyalgia and lower back pain are but a few.
The ability to identify and recognize psychosocial factors
and comorbid medical conditions is critical to assuring
patient and surgeon expectations for the outcome of any
surgical procedure are concordant and realistic. The
DC/TMD provides several validated questionnaires andinstruments that allow the surgeon to readily identify

PAGE 3 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and Dysfunction

psychosocial factors and medical comorbid conditions.
These instruments are simple to administer and score
and can effectively screen for the presence of important
psychosocial factors (Figure 2).
The presence of comorbid medical conditions andpsychosocial factors has been qualified further using theBrief Symptom Inventory-18 and pressure pain threshold.
This has allowed all pain patients to be classified into
one of three groups: adaptive, pain sensitive or global
symptoms. There is robust evidence that pain patients
who are classified as global symptoms do poorly.45 It may
be prudent to avoid invasive surgical procedures such asarthroplasty and total joint replacement (TJR) in patientswith comorbid medical conditions and problematic
psychosocial factors. Although the prognosis following
minimally invasive procedures such as arthrocentesisor arthroscopy also is likely to be guarded in this patient
population, they are rarely associated with worsening
symptoms or complications and should be considered
as an alternative to more invasive procedures.
Initiate the Least Invasive Evidence-based
Nonsurgical or Surgical Treatment
Nonsurgical treatment for the management of IPD may
include rest, heat, ice, nonsteroidal anti-inflammatory
drugs, muscle relaxants, physical therapy and orthotics,
which may improve both pain and function. SDD should
only be considered as the cause of the patient’s IPD
once all other potential causes have been treated.44 It is
possible, if not probable, that some patients with IPD havea combination of contributing factors including synovitis,
capsular impingement and SDD (Figure 3).
Synovitis
The potential causes of synovitis include macrotrauma,
microtrauma, autoimmune conditions, reactive arthritis andmetabolic arthritis. The nonsurgical treatment of synovitis
will depend on the cause of the synovitis (Figure 4).
Synovitis is a key feature of IPD and is associatedwith the presence of synovial plica, fibrous adhesions,chondromalacia, impingement and SDD. The surgicalmanagement of patients with IPD is identical regardless.
Nonsurgical treatment with rest, heat, ice, nonsteroidal
anti-inflammatory drugs, physical therapy and orthotics
should be considered. There is good evidence that
nonsurgical treatment will improve pain and function
in most patients. There also is evidence that initiating
minimally invasive procedures earlier in the process will
result in improved surgical outcomes. This likely is to be

Position Paper
the result of limiting the stage and progression of disease
within the TMJ as well as reducing the potential for thedevelopment of peripheral and central sensitization.
If minimally invasive procedures are unsuccessful in
reducing pain and improving function at one month
postprocedure, consideration for arthroplasty or TJR isreasonable providing the diagnosis of IPD remains correct
and patient expectations realistic.
The presence of TMJ OA may be associated withthe presence of synovitis, chondromalacia, capsular
impingement/fibrous adhesions and disc perforation. It
also is evident that OA is associated with subchondralbone loss as well as vascular and neural ingrowth into thesubchondral bone. The presence of OA should therefore be
reason to consider TJR (as opposed to arthroplasty) as all
the pathologically involved tissues can be removed (Figure5). The presence of OA, diagnosed through a medicalgrade CT scan, should influence the decision as to whether
arthroplasty or TJR is indicated, as the latter is more likely
to be successful. Patients who previously have undergone
a single arthroplasty but present with recurrent or
persistent IPD also may be candidates for arthrocentesis or
arthroscopy. Factors that influence the surgeon’s ability toperform these procedures include the specific type of priorarthroplasty and whether the articular disc was maintainedor removed. Prior arthroplasty with disc plication may
maintain the superior joint space to enable arthrocentesisor arthroscopy. If the prior procedure was arthroplasty
with discectomy, with or without replacement, the ability
to perform either procedure is limited. If arthrocentesis isattempted, but irrigation unsuccessful, consideration for
intra-articular injection of corticosteroid should be given.
If a decision to proceed with another open procedure is
made, it is recommended that the open procedure be TJR.
A second arthroplasty is not recommended given that thelikelihood of a good outcome is much less when compared
to proceeding with a TJR.48
Patients having previously undergone TJR, but presenting
with pain and limited function, present a unique challenge.
The etiology of continued or increasing post-TJR pain
can be difficult to discern. It is suggested that there are
two broad categories of continued pain that should beconsidered49 (Table 4).

PAGE 4 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and Dysfunction

The intrinsic sources of pain are more challenging to
identify. Heterotopic bone, dislocation and component
or screw fracture can be appreciated with imaging suchas non-contrast CT scans. Periarticular joint infection(PJI), neuroma, synovial entrapment and material
hypersensitivity remain the most challenging to diagnose.
PJI is the most common complication occurring after any
joint replacement. Definitive diagnosis can be difficult
since obtaining synovial fluid for analysis from a TJR
is difficult. To date, C-reactive protein and erythrocyte
sedimentation rate remain the most ideal test for the
diagnosis of PJIs.49-51 This should be supplemented
with a CT scan with contrast and, on occasion, an
hexamethylpropylene amine oxime technetium 99-labeledwhite blood cell scan. Early-stage PJI (<3 weeks after TJR)
can be treated with debridement, antibiotics and implant
retention.52 Late-stage PJI (>3 weeks after TJR) requires
two-stage removal and replacement with long-term
antibiotic therapy. An intra-articular neuroma can form
following TJR.53 Synovial entrapment, which is thought
to occur from the proliferation of the neosynovium, also
can develop around a TJR.54 A local anesthetic block of
the auriculotemporal nerve can help make these diagnoses.
Careful arthrotomy to remove this tissue from thearticulating surfaces with fat grafting can resolve bothof these issues.
Material hypersensitivity response to TJR materials is
often a diagnosis of exclusion. The two most commonlyused tests are the in vivo skin patch test and in vitro
lymphocyte transformation test.55 The presence ofa positive skin patch test or elevated lymphocytetransformation test may not correlate with device failure or
patient symptoms.49 Device removal should be considereda last resort as the relationship between documented metal
hypersensitivity and patient-reported outcomes has notbeen established. Routine testing for metal hypersensitivity
is not currently recommended.

Position Paper
Summary
Significant advances in the understanding of thepathophysiology of TMJ pain and inflammation, alongwith the application of established principles underlying
joint disease, have enabled IPD to be better diagnosed
and treated. The well-documented success of nonsurgicaltreatment as well as minimally invasive surgicaloptions provides the patient and surgeon with soundtreatment choices. Arthroplasty and TJR are surgicaloptions that should be reserved for patients in whom
minimally invasive procedures have not been successful.
It is incumbent on the oral and maxillofacial surgery
community, which is uniquely positioned to offer relief
to patients suffering from TMJ disease, to treat patients
according to the best available level of evidence and,
where possible, continue to add new knowledge tosupport ongoing improvements in care.

Supplementary Data
Supplementary data associated with this position paper
can be found in the online version, at
10.1016/j.joms.2024.01.003.

PAGE 5 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and Dysfunction

Position Paper

Table 1

Screening Questions to Identify Temporomandibular Disorders
Temporomandibular pain disorder screening instrument
1. In the last 30 days, on average, how long did any pain in your jaw or temple area on either side last?
a. No pain
b. From very brief to more than a week, but it does stopc. Continuous

2. In the last 30 days, have you had pain or stiffness in your jaw on awakening?
a. No
b. Yes

3. In the last 30 days, did the following activities change any pain (that is make it better or worse) in your jaw or
temple on either side?
A. Chewing hard or tough food		 a. No		 b. Yes
B. Opening your mouth or moving your jaw forward or to the side		 a. No		 b. Yes
C. Jaw habits such as holding the teeth together, clenching, grinding or chewing gum
		 a. No		 b. Yes
D. Other jaw activities such as kissing, yawning or talking
		 a. No		 b. Yes
Responses: a = 1 point, b = 2 points, c = 3 points
Bouloux et al. Management of TMJ Pain and Dysfunction. J Oral Maxillofac Surg 2024.

PAGE 6 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and Dysfunction(continued on following page)Position Paper

Table 2

Questions that Distinguish Arthrogenous and Myogenous Sources of Pain
Question
When eating something hard (like a bagel)
do you have pain with the first bite?

Favors arthrogenous

Favors myogenous

Yes

When eating something hard (like a bagel)
do you have pain that worsens with prolonged
chewing?

Yes

Do you have pain with opening your jaw wide
(yawning)?

Yes

Does your jaw ever lock or catch where you
cannot close or open it?

Yes

Does your jaw make any sounds?

Yes

Is there any pain with those sounds?

Yes

Is your pain worse in the morning when you
wake up?
Bouloux et al. Management of TMJ Pain and Dysfunction. J Oral Maxillofac Surg 2024.

PAGE 7 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and Dysfunction

YesPosition Paper

Table 3
Questions to Identify Cervical Sources of Pain
Cervical pain screening
1. Do you have neck pain?
a. No
b. Yes

2. Does neck, shoulder or arm movement aggravate your neck pain?
a. No
b. YesBouloux et al. Management of TMJ Pain and Dysfunction. J Oral Maxillofac Surg 2024.

Table 4
PostTJR Pain
Extrinsic Sources of Pain

Intrinsic Sources of Pain

• Prior misdiagnosis• Heterotopic bone formation• Chronic centrally mediated pain

• Infection• Persistent myofascial/muscular pain

• Dislocation• Complex regional pain syndrome 1• Synovial entrapment syndrome• Complex regional pain syndrome 2• Component or screw fracture• Temporalis tendonitis• Neuroma formation• Coronoid impingement• Material hypersensitivity• Frey syndrome• First bite syndrome
Bouloux et al. Management of TMJ Pain and Dysfunction. J Oral Maxillofac Surg 2024.

PAGE 8 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and Dysfunction

Position Paper

Figure 1
Validated Axis I Pain-related TMD* Diagnoses
DisorderMyalgia†(Sensitivity, 90%; Specificity, 99%)

History
Pain in a masticatory
structure modified
by jaw movement,function orparafunction

Examination Findings
Report of familiar pain‡ in temporalis or massetermuscles with:• palpation of these muscles• maximum unassisted or assisted opening movements
Note: Assessment of other masticatory muscles may be
indicated in some clinical situations.

Myofascial Pain With Referral(Sensitivity, 86%; Specificity, 98%)

Same as for myalgia

Report of familiar pain‡ with palpation of the temporalis
or masseter muscles.
Report of pain at a site beyond the boundary of the muscle
being palpated (for example, referral to a tooth).

Arthralgia(Sensitivity, 89%; Specificity, 98%)

Same as for myalgia

Report of familiar pain‡ in TMJ§ with:• palpation of the TMJ• maximum unassisted or assisted opening, right or leftlateral, or protrusive movements

Headache Attributed to TMD(Sensitivity, 89%; Specificity, 87%)

Headache in temporal
area modified by jaw
movement, function,or parafunction

Report of familiar headache¶ in temple area with:• palpation of temporalis muscles• maximum unassisted or assisted opening, right or leftlateral, or protrusive movements
Note: A diagnosis of pain-related TMD also must bepresent (for example, myalgia, arthralgia).

* TMD: Temporomandibular disorder.
† Myalgia can be subclassified into three disorders: local myalgia, myofascial pain and myofascial pain with referral; only
myofascial pain with referral has been validated. See Schiffman and colleagues9 for diagnostic criteria for local myalgia andmyofascial pain.
‡ Familiar pain is similar to or like the pain the patient has been experiencing. The intent is to replicate the patient’s pain
complaint.
§ TMJ: Temporomandibular joint.
¶ Familiar headache is similar to or like the headache the patient has been experiencing. The intent is to replicate the patient’s
headache complaint.

PAGE 9 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and Dysfunction

Position Paper

Figure 2
Axis II Assessment Protocol
Questionnaire*
Graded Chronic Pain Scale†,‡No. ofitems
7

Usefulness
Pain intensity component: pain amplification and central sensitization
Pain-related disability component: decreased functioning because of pain

Pain Drawing†,‡1

Distinguishes among local, regional and widespread pain; assesses for othercomorbid pain condition; and may indicate pain amplification, sensitizationand central dysregulation

Jaw Functional Limitation Scale†,‡8 or 20

Quantifies effect on jaw mobility, mastication and verbal and emotional
expression

Patient Health Questionnaire-4†

4

Identifies psychological distress (depression and anxiety)

Patient Health Questionnaire-9‡9Identifies depression; contributes to chronicity

Generalized Anxiety Disorder-7‡

7

Identifies anxiety; contributes to stress reactivity and to parafunction

Patient Health Questionnaire-15‡

15

Measures physical symptoms; assesses for specific comorbid functional
disorders

Oral Behaviors Checklist†,‡21

Measures parafunction: contributes to onset and perpetuation of pain
prognosis* Questionnaires to assist in the identification of patients with a range of simple to complex presentations that affect treatment andprognosis.
† Questionnaire included in screening protocol.
‡ Questionnaire included in comprehensive protocol.

PAGE 10 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and Dysfunction

Figure 3

Position Paper

Potential Sources of Intra-articular Pain and Dysfunction

Figure 4
Potential Causes of TMJ Synovitis

PAGE 11 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and Dysfunction

Figure 5

Position Paper

Algorithm for the Management of Intra-articular Pain and Dysfunction

PAGE 12 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and DysfunctionReferences
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temporomandibular joint replacement. J Oral Maxillofac Surg
77:1371–1376, 2019DISCLAIMER
The American Association of Oral and Maxillofacial Surgeons(AAOMS) is providing this position paper on Temporomandibular
Joint (TMJ) Intra-Articular Pain and Dysfunction to inform
practitioners, patients and other interested parties. The position
paper is based on a review of the existing literature and theclinical observations of a Special Committee composed oforal and maxillofacial surgeons.
The position paper is informational in nature and is not intended
to set any standards of care. AAOMS cautions all readers thatthe strategies described in the position paper are not practiceparameters or guidelines and may not be suitable for every, orany, purpose or application. This position paper cannot substitutefor the individual judgment brought to each clinical situation by
the patient’s oral and maxillofacial surgeon. As with all clinicalmaterials, the position paper reflects the science at the time ofthe paper’s development, and it should be used with the clear
understanding that continued research and practice may resultin new knowledge or recommendations. AAOMS makes noexpress or implied warranty regarding the accuracy, content,
completeness, reliability, operability, or legality of information
contained within the position paper, including, without limitation,
the warranties of merchantability, fitness for a particular purpose,and non-infringement of proprietary rights. In no event shall
AAOMS be liable to the user of the position paper or anyone
else for any decision made or action taken in reliance on suchinformation.

PAGE 15 The Contemporary Management of Temporomandibular Joint Intra-Articular Pain and Dysfunction