TMJ Pain

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍rightleft TMJ pain

Onset was ‍gradualsuddentraumatic, started ‍whileafter ‍

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍dullaching

Pattern ‍persistentintermittent

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍swelling

‍warmth

‍redness

‍clicking sounds

‍limited range of motion

‍difficulty chewing

‍locking of the jaw

‍malocclusion of teeth

‍inability to fully open mouth

‍earache

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills



Contributing factors:

‍stress

‍jaw clenching

‍teeth grinding

‍poor fitting denture

no history of: ‍chronic inflammatory disorders, ‍temporomandibular joint disorder, ‍jaw injury, ‍bruxism, ‍osteoarthritis, ‍rheumatoid arthritis, ‍anxiety disorder





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: ‍normocephalicatraumatic, scalp ‍normalrashlesion

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍





ASSESSMENT:

‍Temporomandibular joint disorder ‍likelysuspectedpossible

DDx: temporomandibular joint disorder, osteoarthritis of the TMJ, myofascial pain syndrome, dental issues, acute otitis media, otitis externa, Eustachian tube dysfunction, sinusitis, trigeminal neuralgia, migraine, tension headache, maxillary osteomyelitis, giant cell arteritis





PLAN:

Investigations:

- TMJ X-ray

- MRI of the TMJ

- Blood work: ‍CBC, ‍CRP

Treatments:

- ‍Acetaminophen

- ‍NSAIDs

- ‍Muscle relaxants

- Avoidance of hard or chewy foods, large bites of food, gum chewing, wide yawning, nail biting, teeth grinding

- Stress management techniques

Further care:

- Referral to dentist

- Referral to maxillofacial surgeon

- Follow-up in ‍ ‍weeksmonths

- Return if pain worsens, if new symptoms develop such as difficulty opening mouth or jaw locking, or if symptoms do not improve with treatment