Temporomandibular Disorders
This domain tests conservative, evidence-based management and recognition of non-TMD pain.
Core rules
- Common TMD diagnoses include myofascial pain, disc displacement with or without reduction, degenerative joint disease and headache attributed to TMD.
- History covers pain, clicking, locking, limited opening, bruxism, trauma and psychosocial factors. Examine range of motion, deviation, joint sounds, muscles and occlusion.
- Imaging: OPG first; CBCT for bone; MRI for disc position and soft tissue.
- First-line care is education, self-care, soft diet, NSAIDs, muscle relaxation, occlusal splint and physical therapy. Avoid irreversible occlusal adjustment.
- Arthrocentesis is useful for closed lock; open joint surgery is rare.
Worked example
A patient has limited opening and deviation to the affected side, with a history of clicking that stopped. This suggests disc displacement without reduction. Trial conservative care and obtain MRI if persistent; do not adjust occlusion immediately.
Traps
Overdiagnosing TMD when pain is odontogenic; using irreversible splints; missing cancer with referred pain; ignoring psychological comorbidity.