Temporomandibular disorder

Source: Repatriation Medical Authority Statements of Principles as held by the Veterans Health Centre. SoPs are amended and replaced regularly; always confirm the current instrument at rma.gov.au before relying on it.

RH No. 47 of 2018 · BoP No. 48 of 201842 factors

Meaning of temporomandibular disorder: For the purposes of this Statement of Principles, temporomandibular disorder: (a) means a heterogeneous group of conditions affecting the anatomical and functional characteristics of the temporomandibular joint, masticatory muscles and associated structures of the masticatory system, with: (i) clinically significant pain localised in the temple, front of ear or jaw, that is modified with jaw movement, and which is experienced on more days than not within a continuous six month period; and (ii) clinically significant distress or substantial impairment of social, occupational, educational or other important areas of functioning due to pain, limitation, deviation or other abnormality of jaw motion; and (iii) clinical signs or imaging evidence of myalgia, arthralgia, or another pathological process affecting the temporomandibular joint, muscles of mastication and/or associated structures; and (b) excludes: (i) orofacial pain of dental origin; (ii) headache or pain better accounted for by another pain or headache disorder; and (iii) congenital or developmental orofacial disorders.

Reasonable Hypothesis (RH) — Statement of Principles No. 47 of 2018

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting temporomandibular disorder or death from temporomandibular disorder with the circumstances of a person's relevant service:

(1)
having a specified joint disease involving the affected temporomandibular joint, at the time of the clinical onset of temporomandibular disorder;
Note: specified joint disease is defined in the Schedule 1 - Dictionary.
(2)
having a specified maxillofacial disease involving the affected masticatory muscles and associated structures of the masticatory system, at the time of the clinical onset of temporomandibular disorder;
Note: masticatory muscles and associated structures of the masticatory system and specified maxillofacial disease are defined in the Schedule 1 - Dictionary.
(3)
having an infection as specified of the affected temporomandibular joint, masticatory muscles and associated structures of the masticatory system, at the time of the clinical onset of temporomandibular disorder;
Note: infection as specified and masticatory muscles and associated structures of the masticatory system are defined in the Schedule 1 - Dictionary.
(4)
having orofacial dyskinesia or oromandibular dystonia at the time of the clinical onset of temporomandibular disorder;
(5)
having acute trauma to the affected temporomandibular joint, masticatory muscles and associated structures of the masticatory system, within the 30 days before the clinical onset of temporomandibular disorder;
Note: acute trauma and masticatory muscles and associated structures of the masticatory system are defined in the Schedule 1 - Dictionary.
(6)
having a sudden cervical flexion-extension (whiplash) injury requiring hospitalisation, within the 30 days before the clinical onset of temporomandibular disorder;
(7)
having bruxism at the time of the clinical onset of temporomandibular disorder;
(8)
having fibromyalgia at the time of the clinical onset of temporomandibular disorder;
(9)
having a clinically significant disorder of mental health as specified, within the one year before the clinical onset of temporomandibular disorder;
Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.
(10)
smoking at least two pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of temporomandibular disorder, and: (a) smoking commenced at least one year before the clinical onset of temporomandibular disorder; and (b) where smoking has ceased, the clinical onset of temporomandibular disorder has occurred within three months of cessation;
Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.
(11)
undertaking scuba diving: (a) for a cumulative period of at least 200 hours within a continuous period of six months before the clinical onset of temporomandibular disorder; and (b) where this activity has ceased, the clinical onset of temporomandibular disorder has occurred within 30 days of cessation;
(12)
undertaking an activity involving supporting or holding a tool, device or instrument in a position involving prolonged flexion of the head and shoulder: (a) for a cumulative period of at least 500 hours within a continuous period of six months before the clinical onset of temporomandibular disorder; and (b) where this activity has ceased, the clinical onset of temporomandibular disorder has occurred within 30 days of cessation;
Note: Examples of activities involving prolonged flexion of the head and shoulder include playing a wind instrument, or playing of a viola or violin.
(13)
having a specified joint disease involving the affected temporomandibular joint, at the time of the clinical worsening of temporomandibular disorder;
Note: specified joint disease is defined in the Schedule 1 - Dictionary.
(14)
having a specified maxillofacial disease involving the affected masticatory muscles and associated structures of the masticatory system, at the time of the clinical worsening of temporomandibular disorder;
Note: masticatory muscles and associated structures of the masticatory system and specified maxillofacial disease are defined in the Schedule 1 - Dictionary.
(15)
having an infection as specified of the affected temporomandibular joint, masticatory muscles and associated structures of the masticatory system, at the time of the clinical worsening of temporomandibular disorder;
Note: infection as specified and masticatory muscles and associated structures of the masticatory system are defined in the Schedule 1 - Dictionary.
(16)
having orofacial dyskinesia or oromandibular dystonia at the time of the clinical worsening of temporomandibular disorder;
(17)
having acute trauma to the affected temporomandibular joint, masticatory muscles and associated structures of the masticatory system, within the 30 days before the clinical worsening of temporomandibular disorder;
Note: acute trauma and masticatory muscles and associated structures of the masticatory system are defined in the Schedule 1 - Dictionary.
(18)
having a sudden cervical flexion-extension (whiplash) injury requiring hospitalisation, within the 30 days before the clinical worsening of temporomandibular disorder;
(19)
having bruxism at the time of the clinical worsening of temporomandibular disorder;
(20)
having fibromyalgia at the time of the clinical worsening of temporomandibular disorder;
(21)
having a clinically significant disorder of mental health as specified, within the one year before the clinical worsening of temporomandibular disorder;
Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.
(22)
smoking at least two pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of temporomandibular disorder, and: (a) smoking commenced at least one year before the clinical worsening of temporomandibular disorder; and (b) where smoking has ceased, the clinical worsening of temporomandibular disorder has occurred within three months of cessation;
Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.
(23)
undertaking scuba diving: (a) for a cumulative period of at least 200 hours within a continuous period of six months before the clinical worsening of temporomandibular disorder; and (b) where this activity has ceased, the clinical worsening of temporomandibular disorder has occurred within 30 days of cessation;
(24)
undertaking an activity involving supporting or holding a tool, device or instrument in a position involving prolonged flexion of the head and shoulder: (a) for a cumulative period of at least 500 hours within a continuous period of six months before the clinical worsening of temporomandibular disorder; and (b) where this activity has ceased, the clinical worsening of temporomandibular disorder has occurred within 30 days of cessation;
Note: Examples of activities involving prolonged flexion of the head and shoulder include playing a wind instrument, or playing of a viola or violin.
(25)
inability to obtain appropriate clinical management for temporomandibular disorder;

Balance of Probabilities (BoP) — Statement of Principles No. 48 of 2018

17 factors

At least one of the following factors must exist before it can be said that, on the balance of probabilities, temporomandibular disorder or death from temporomandibular disorder is connected with the circumstances of a person's relevant service:

(1)
having a specified joint disease involving the affected temporomandibular joint, at the time of the clinical onset of temporomandibular disorder;
Note: specified joint disease is defined in the Schedule 1 - Dictionary.
(2)
having a specified maxillofacial disease involving the affected masticatory muscles and associated structures of the masticatory system, at the time of the clinical onset of temporomandibular disorder;
Note: masticatory muscles and associated structures of the masticatory system and specified maxillofacial disease are defined in the Schedule 1 - Dictionary.
(3)
having an infection as specified of the affected temporomandibular joint, masticatory muscles and associated structures of the masticatory system, at the time of the clinical onset of temporomandibular disorder;
Note: infection as specified and masticatory muscles and associated structures of the masticatory system are defined in the Schedule 1 - Dictionary.
(4)
having orofacial dyskinesia or oromandibular dystonia at the time of the clinical onset of temporomandibular disorder;
(5)
having acute trauma to the affected temporomandibular joint, masticatory muscles and associated structures of the masticatory system, within the 30 days before the clinical onset of temporomandibular disorder;
Note: acute trauma and masticatory muscles and associated structures of the masticatory system are defined in the Schedule 1 - Dictionary.
(6)
having a sudden cervical flexion-extension (whiplash) injury requiring hospitalisation, within the 30 days before the clinical onset of temporomandibular disorder;
(7)
having a clinically significant disorder of mental health as specified, within the one year before the clinical onset of temporomandibular disorder; Compilation No. 1 Compilation date: 25/05/2020 Authorised Version F2020C00355 registered 25/05/2020;
Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.
(8)
undertaking scuba diving: (a) for a cumulative period of at least 200 hours within a continuous period of six months before the clinical onset of temporomandibular disorder; and (b) where this activity has ceased, the clinical onset of temporomandibular disorder has occurred within 30 days of cessation;
(9)
having a specified joint disease involving the affected temporomandibular joint, at the time of the clinical worsening of temporomandibular disorder;
Note: specified joint disease is defined in the Schedule 1 - Dictionary.
(10)
having a specified maxillofacial disease involving the affected masticatory muscles and associated structures of the masticatory system, at the time of the clinical worsening of temporomandibular disorder;
Note: masticatory muscles and associated structures of the masticatory system and specified maxillofacial disease are defined in the Schedule 1 - Dictionary.
(11)
having an infection as specified of the affected temporomandibular joint, masticatory muscles and associated structures of the masticatory system, at the time of the clinical worsening of temporomandibular disorder;
Note: infection as specified and masticatory muscles and associated structures of the masticatory system are defined in the Schedule 1 - Dictionary.
(12)
having orofacial dyskinesia or oromandibular dystonia at the time of the clinical worsening of temporomandibular disorder;
(13)
having acute trauma to the affected temporomandibular joint, masticatory muscles and associated structures of the masticatory system, within the 30 days before the clinical worsening of temporomandibular disorder;
Note: acute trauma and masticatory muscles and associated structures of the masticatory system are defined in the Schedule 1 - Dictionary.
(14)
having a sudden cervical flexion-extension (whiplash) injury requiring hospitalisation, within the 30 days before the clinical worsening of temporomandibular disorder;
(15)
having a clinically significant disorder of mental health as specified, within the one year before the clinical worsening of temporomandibular disorder; Compilation No. 1 Compilation date: 25/05/2020 Authorised Version F2020C00355 registered 25/05/2020;
Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.
(16)
undertaking scuba diving: (a) for a cumulative period of at least 200 hours within a continuous period of six months before the clinical worsening of temporomandibular disorder; and (b) where this activity has ceased, the clinical worsening of temporomandibular disorder has occurred within 30 days of cessation;
(17)
inability to obtain appropriate clinical management for temporomandibular disorder;

Aggravation-only factors: the factors in subsections 8(9) to 8(17) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

Temporomandibular disorder — DVA SoP factors