Temporomandibular Disorders and Orofacial Pain
Diagnosis
Understand the biopsychosocial model of temporomandibular disorders and the distinction between muscle disorders, disc displacement, and degenerative joint disease. Know the components of a focused history and examination: palpation, range of motion, joint sounds, and imaging when indicated. Understand the role of the DC/TMD framework and the importance of ruling out non-TMD causes of facial pain.
Management
Know the conservative first-line approach: education, self-care, physical therapy, and short-term use of NSAIDs or muscle relaxants. Understand the role of occlusal appliances and the evidence for their use, and know when referral is appropriate. Understand the relationship between orthodontic treatment and TMD - the evidence does not support a causal link.
Traps
A classic trap is attributing all facial pain to TMD without ruling out dental, sinus, neurologic, or vascular causes. Another trap is promising that orthodontic treatment will cure TMD. Questions may also test the difference between disc displacement with reduction and without reduction.
Worked example
A patient reports clicking and occasional locking of the jaw. Rule of thumb: clicking with reduction is common and often benign; locking suggests disc displacement without reduction and warrants conservative management and possible imaging.