Temporomandibular Joint Disorders and Facial Pain
Temporomandibular Joint Disorders and Facial Pain
This domain tests non-surgical and surgical management of TMJ disorders and the separation of joint, muscular, dental, neuropathic, and systemic pain. The exam emphasizes conservative care and red-flag recognition.
Core rules
- Use a focused history and examination: pain location, clicking, locking, range of motion, deviation, and bruxism.
- Disc displacement with reduction often produces a reproducible click; disc displacement without reduction produces limited opening and deviation.
- Imaging is not routine for typical TMD; MRI is useful for suspected disc displacement or pathology, and CBCT for bony disease.
- First-line care includes reassurance, soft diet, analgesics, physiotherapy, and occlusal splint therapy where indicated.
- Arthrocentesis or arthroscopy is considered when conservative care fails; open joint surgery is reserved for selected cases.
Worked example
A patient has jaw pain, a reciprocal click, and normal opening. Reasoning: this suggests disc displacement with reduction and muscular pain. Initial care is conservative, with NSAIDs, soft diet, and a stabilization splint. MRI is not required unless symptoms persist or locking develops. Irreversible occlusal adjustment is inappropriate.
Traps
Treating neuropathic pain as TMD; missing temporal arteritis, sinusitis, or malignancy; overusing MRI; performing irreversible occlusal therapy without diagnosis; ignoring sleep and psychological factors.