Persistent pain is different to acute pain. It is important for dentists to understand this difference and to be able to talk to patients about it. Managing this type of pain requires addressing common psychological and social factors in addition to any physical adjustments that are required. Examples of pain and self-care cycles are introduced to illustrate the importance of small changes in multiple areas of life in moving towards negative or positive outcomes. The acronym FLATS can be used to check for common psychological and social factors that can be associated with poor outcome if not addressed—fear, low mood, avoidance of functional activities, thinking the worst and social impact of pain. Simple suggestions regarding management and signposting are offered. The importance of asking about pain elsewhere in the body and sleep is also highlighted. Sensitive communication and validation of pain that can be significant in the absence of physical findings or management options are crucial skills for dentists who see patients with persistent TMD. Patients with persistent painful TMD will often require timely follow-up appointments and may benefit from referral to specialist dental or pain clinics or for psychology. Guidelines are offered regarding follow-up and onward referral. Suggestions are also offered for avoiding common but unhelpful conversations that might arise when treating patients with persistent TMD.