Temporomandibular Joint Disorders
Emergency department referrals
Advise patient to present to the Royal Brisbane and Women’s Hospital Department of Emergency Medicine.
For emergency referrals the on-call Oral and Maxillofacial Registrar must be contacted through Royal Brisbane and Women’s Hospital switch (07) 3646 8111 to obtain appropriate prioritisation and treatment advice. Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Oral and Maxillofacial Clinic Fax: (07) 3646 3545
Does your patient wish to be referred?
Minimum referral criteria
Does your patient meet the minimum referral criteria?
Category 1
Appointment within 30 days is desirable
- Acute TMJ injuries
- Acute unexplained limitation of mouth opening, with or without associated pain
Category 2
Appointment within 90 days is desirable
- Recurrent dislocation
Category 3
Appointment within 365 days is desirable
- Chronic TMD symptoms persisting for more than three months despite appropriate primary care management or community-based non-surgical care, including behavioural strategies, physiotherapy, dental care and/or psychology care
- Uncertain diagnosis requiring Maxillofacial assessment
- Marked psychological distress associated with symptoms and/or occlusal preoccupation (persistent hyper-awareness or hypervigilance of their bite)
- Chronic TMJ dysfunction (osteoarthropathies)
- Ongoing pain without clear cause, including chronic or widespread discomfort
If your patient does not meet the minimum referral criteria
Consider other treatment pathways or an alternative diagnosis.
If you still need to refer your patient:
- Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
- Please note that your referral may not be accepted or may be redirected to another service
Referral requirements
A referral may be rejected without the following information.
Essential referral information
Referral will be returned without this
- Any obvious known arthropathy
- Plain imaging of OPG open and closed views
- Mouth opening measures* between the teeth (cm/fingers) including whether patient has:
- Pain lateral condyle TMJ
- Masseter pain/tenderness
- Temporalis pain/tenderness
- Headaches
- Neck pain
- Shoulder pain
- Any other history of arthropathy of other joints
- History of autoimmune disorders with joint involvement
- Previous trauma joints
- Previous surgery on TMJ trauma/surgery
- Ear examination
- Previous history of facial pain syndromes
* Mouth opening measurement: Use a ruler to measure the distance (in centimetres or fingers) between the upper and lower front teeth at maximum mouth opening.
Additional referral information
Useful for processing the referral
- CT face results
Other useful information for referring practitioners
not an exhaustive list
- Assessment and management information may be found on a range of conditions at HealthPathways
- Mouth opening measurement is a simple and valuable assessment that involves using a ruler to measure the distance between the upper and lower front teeth at maximum mouth opening. This measurement provides critical information about the severity of the patient’s condition and helps guide appropriate triaging and management.
- Where appropriate and available, non-urgent referrals may be sent to public Physiotherapy-led Screening Clinics for initial assessment and management. A surgical assessment may then be arranged or ruled out.
- Consider referral to dentist if there is poor dental health, suspected malocclusion or dental pathology, or for consideration of an occlusal splint
- Consider referral to Psychology services for Cognitive Behavioural Therapy (CBT), if there is marked psychological distress or to help with pain-related anxiety
- Consider referral to Physiotherapy for advice on passive jaw stretching exercises, posture training, and massage, or acupuncture to help relax muscle spasm
Out of catchment
Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.
Clinical Modifiers (where relevant)
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
Reason for Referral (essential)
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can’t order, or the patient can’t afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
Clinical Information (essential)
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
Patient’s Demographic Details (essential)
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
Referring Practitioner Details (essential)
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
Other Information (where relevant)
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
Send referral
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
Mail:
Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Fax number:
Metro North Central Patient Intake
1300 364 952
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways@brisbanenorthphn.org.au
Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org