Occlusion and Temporomandibular Disorders
Occlusion and Temporomandibular Disorders tests centric relation, maximum intercuspation, articulator use, occlusal schemes, and conservative TMD diagnosis. The exam expects DC/TMD-style reasoning and reversible first-line care.
Core rules
- Distinguish centric relation from maximum intercuspation; record both when reconstruction requires it.
- A facebow and articulator help relate the maxillary cast to the hinge axis, but clinical verification remains essential.
- Occlusal adjustment should be precise and limited; avoid irreversible grinding for vague symptoms.
- TMD diagnosis uses history, clinical examination, and DC/TMD criteria; imaging is not routine for every click.
- First-line TMD care is conservative: education, self-management, soft diet, and an occlusal splint when indicated.
Worked example
A patient reports jaw clicking, mild pain on opening, and no locking. Reasoning: this suggests a disc displacement with reduction rather than a primary occlusal disease. Do not perform irreversible occlusal adjustment. Screen for red flags, provide conservative care, and reassess. If limited opening or persistent pain develops, refer for specialist evaluation. The occlusion should be documented, but it is not automatically the cause.
Traps that cost marks
- Equating every TMD symptom with malocclusion.
- Performing irreversible occlusal adjustment without a clear diagnosis.
- Missing red flags such as trauma, swelling, or progressive limitation.
- Using imaging indiscriminately.
- Forgetting to document centric relation and excursive contacts.