The Use of a New Clinical Reasoning Framework to Facilitate The Assessment and Management of Temporomandibular Disorders

Background: Temporomandibular Disorders (TMDs) are the most common form of non-odontogenic orofacial pain. TMDs are considered a biopsychosocial disorder with a multifactorial pathogenesis. Patients with TMDs frequently present with cervical spine disorders, headaches and otological complaints. Physiotherapists are often sought to assess and treat TMDs. The use of a radar graph and triangulation to represent phenotyping patients with complex pain presentations has been discussed in the literature with the aim of supporting the best course of treatment for patients with complex and enigmatic pain presentations. Objective: This paper presents the adaptation and development of the radar graph model for the assessment and management of TMDs. It was developed in a Maxillofacial service in the United Kingdom and has been used to support the assessment and physiotherapeutic management of patients with a TMD since 2019. Herein we describe the different domains we prioritise in the assessment and the means by which they are assessed. It is hoped by presenting our radar graph in the literature other clinicians may find it helpful or adapt it as they see fit. For illustrative purposes, we also describe two case studies of patients who underwent assessment and treatment with us using the radar graph model. Conclusion: Assessing and treating complex conditions such as TMD poses many challenges. The radar model discussed has been of value in our service and we believe this paper demonstrates its adaptability to TMDs. Evaluation of its ability to augment tre