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Red Flags in Temporomandibular Dysfunction (TMD) Evaluation

Abigail Nowakowski, PT, DPT, Samuel Park, PT, DPT, OCS, CSCS, CMTPT

February 15, 2025

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Question

What are the key red flags to consider when evaluating patients with Temporomandibular Dysfunction (TMD)?

Answer

When evaluating temporomandibular dysfunction (TMD), recognizing red flags is critical to identifying conditions that may require immediate medical intervention. These red flags can signal underlying systemic, neurological, or cardiac issues that extend beyond musculoskeletal dysfunction. Common red flags include:

  • Constitutional Symptoms: Fever, night sweats.
  • Neurological Indicators: Photophobia, phonophobia, nausea/vomiting, dizziness, central nervous system signs, slurred speech, gait or balance disturbances, ataxia, tremors, vision changes, or sudden-onset "alarm clock" headaches.
  • Trauma and Pain Syndromes: Recent head or neck trauma, dysphagia, or symptoms of numbness, tingling, burning, or shooting pain.
  • Cardiac Symptoms: Sudden burning or tingling chest pain, angina, and other symptoms suggestive of a cardiac event.

These signs necessitate prompt referral to a specialist or emergency care for further evaluation and management.

This Ask the Expert is an edited excerpt from the course, "Temporomandibular Joint Dysfunction Made Simple: A Practical Primer on Evaluation and Treatment," presented by Samuel Park, PT, DPT, OCS, CSCS, CMTPT, and Abigail Nowakowski, PT, DPT.


abigail nowakowski

Abigail Nowakowski, PT, DPT

Abby recently graduated from the University of Wisconsin-Milwaukee Doctor of Physical Therapy program. She gained clinical experience throughout her graduate studies in both outpatient and acute care settings in the Milwaukee area. Abby has also been involved in research and leadership activities through UW-Milwaukee and the American Physical Therapy Association. Through her studies and experiences, Abby has developed interests in the optimization of physical and mental performance in the rehabilitation setting, in addition to community health and injury prevention. Abby is currently in the orthopedics residency program at the Clement J. Zablocki VA Medical Center. 

 


samuel park

Samuel Park, PT, DPT, OCS, CSCS, CMTPT

Sam is a board-certified Orthopedic Specialist practicing in the outpatient orthopedic setting at the Clement J. Zablocki VA Medical Center. He is a Doctor of Physical Therapy with a degree from the University of Kansas. He has worked in the outpatient orthopedic setting and has considerable experience treating musculoskeletal pain. Sam is recognized by the National Strength and Conditioning Association as a Certified Strength and Conditioning Specialist. He has taught continuing education courses through the American Physical Therapy Association, Medical College of Wisconsin, Ascension Healthcare System, and the Midwest Orthopedic Sports Symposium. Sam currently serves as the Residency Clinical Coordinator for Clement J Zablocki, the Orthopaedic Physical Therapy Residency, in affiliation with the University of Wisconsin-Milwaukee Physical Therapy Department. 


Related Courses

Temporomandibular Joint Dysfunction Made Simple: A Practical Primer on Evaluation and Treatment
Presented by Samuel Park, PT, DPT, OCS, CSCS, CMTPT, Abigail Nowakowski, PT, DPT
Recorded Webinar

Presenters

Samuel Park, PT, DPT, OCS, CSCS, CMTPTAbigail Nowakowski, PT, DPT
Course: #5097Level: Introductory1.5 Hours
  'Great videos of the treatments'   Read Reviews
Evaluating and treating temporomandibular joint dysfunction (TMD) can be intimidating for many rehab professionals. This course is designed to simplify the evaluation and treatment process, providing a practical primer that maximizes patient outcomes for those who may be unfamiliar or uncomfortable with TMD.

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Presented by Samuel Park, PT, DPT, OCS, CSCS, CMTPT, Ben Contino, PT, DPT
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Presented by William Rubine, MS PT
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William Rubine, MS PT
Course: #3658Level: Intermediate2 Hours
  'Test was fair'   Read Reviews
This two-hour course will give you a mechanism-based framework for evaluation and treatment of patients with common presentations of persistent pain including fibromyalgia, low back pain, and whiplash-associated disorders (WAD). This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

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Adam Strizak, PT, DPT, OCS
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  'I intuitively knew a lot of this after being a therapist for a long time but this class really made everything click when learning the anatomy and how to work with these clients'   Read Reviews
Pain neuroscience education consists of educational sessions for patients describing in detail the neurobiology and neurophysiology of pain and pain processing by the nervous system. Through Pain Neuroscience Education patients have been found to have a reduction in fear avoidance behaviors and are more able and willing to move. This course is an introduction to Pain Neuroscience Education and the basics to get you started. This course is directly related to the practice of physical therapy and athletic training and is therefore appropriate for the PT/PTA and AT.

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