For colleagues

1. Temporomandibular Disorders (TMD) and Orofacial Pain

• Myogenous and arthrogenous pain of the masticatory system
• Disorders of mandibular mobility, including limited mouth opening, deviations and jaw locking
• Temporomandibular joint sounds, including clicking and crepitus
• Persistent or idiopathic orofacial pain, including differential diagnosis from pain of odontogenic origin
• Associated symptoms, such as tension-type headache, otalgia or tinnitus potentially related to TMD

2. Bruxism and Parafunctional Behaviours

• Assessment and management of sleep and awake bruxism
• Muscle overactivity and associated pain
• Parafunctional behaviours, such as cheek or lip biting

3. Tooth Wear

• Differential diagnosis of attrition, erosion and abrasion
• Assessment of possible associations with bruxism and/or extrinsic or intrinsic acid exposure, such as gastro-oesophageal reflux or the consumption of acidic drinks
• Guidance on conservative or restorative management, in collaboration with the patient’s general dentist

4. Snoring and Obstructive Sleep Apnoea (OSA)

• Management with mandibular advancement devices
• Care provided in collaboration with sleep physicians, following a formal diagnosis based on a sleep study

5. Evidence-Based Biopsychosocial Approach

• Assessment based on validated, evidence-based diagnostic criteria and instruments, such as the DC/TMD, STAB and DN4
• Evaluation of psychosocial factors, including anxiety, depression and stress-related parafunctional behaviours
• Assessment of associations with sleep disorders and central sensitisation
• Consideration of comorbidities, such as fibromyalgia and other chronic pain conditions

When to refer:

• Persistent pain without a clear odontogenic cause
• Lack of improvement following conventional dental treatment
• Suspected TMD or bruxism accompanied by musculoskeletal pain and/or dysfunction
• Extensive tooth wear with functional consequences
• Suspected snoring or OSA where an oral appliance may be appropriate

Each referral is approached as part of a meaningful collaboration with the patient’s general dentist or physician. I place particular importance on prompt and clear communication regarding every case. With the patient’s consent, the referring clinician is informed of the assessment findings, diagnosis, proposed management plan and the patient’s progress.

My aim is to provide a specialist assessment of the presenting problem using current, evidence-based diagnostic criteria, while remaining fully coordinated with the patient’s existing dental or medical care. When treatment or restorative care by the referring clinician is required, collaborative planning helps ensure that interventions are appropriately timed and tailored to the patient’s individual needs.

I would be pleased to discuss any case that raises concerns, even before a formal referral is made, so that we can consider together whether a specialist assessment would be appropriate.