Clicking and painful jaw in a young woman
26-year-old female
§Chief complaint
Clicking and pain in front of the ear when chewing for 8 months
§Medical & dental history
- 01Anxiety, high work stress
- 02No arthritis or systemic disease
- 03Reports night-time clenching; wear facets on canines
§Clinical examination
- 01Reciprocal click of the right TMJ on opening at 22 mm and on closing
- 02Maximum opening 44 mm with deviation to the right during opening
- 03Tenderness of the right masseter and lateral pterygoid area
- 04No locking, no crepitus, occlusion stable
§ figuresFigures (3)
Fig. 1Conjunto de síntomas y signos principalmente sensitivos, dolor de cabeza (cefalea), y vegetativos, inestabilidad (mareos, vértigos), ocasionados por el impacto o choque de la mandíbula contra el maxilar superior durante
“COMPROMISO ARTICULAR TEMPOROMANDIBULAR (CAT)” · Jose Larena · CC BY-SA 3.0 · Wikimedia Commons
Fig. 2Arthroscopy and arthroscopic surgery are performed using a small diameter endoscope that is inserted into the joint through a preauricular approach.
“Arthroscopy of the temporomandibular joint” · Dithkar · CC BY-SA 4.0 · Wikimedia Commons
Fig. 3Temporomandibular joint
“Temporomandibular joint” · Anatomist90 · CC BY-SA 3.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Temporomandibular Disorders figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Right anterior disc displacement with reduction and coexisting masticatory myofascial pain
A reciprocal click with a normal range of motion is the signature of a disc that displaces and recaptures. Absence of crepitus and normal imaging exclude degenerative disease; muscle tenderness explains the pain component.
§Investigations
- 01Clinical examination using DC/TMD criteria
- 02MRI (open and closed mouth) — anterior disc displacement reducing on opening
- 03OPG to exclude bony pathology
§Treatment plan
- 01Reassurance and explanation — the natural history is usually favourable
- 02Soft diet, jaw rest, heat, avoidance of wide opening and gum chewing
- 03NSAIDs for 2 weeks
- 04Stabilisation splint at night
- 05Physiotherapy and stress management; surgery only if conservative care fails
§Follow-up & outcome
- 01Pain scores reduced from 7/10 to 2/10 at 3 months
- 02Click persists but is asymptomatic — no further treatment required
§Clinical pearls / learning points
- 01A painless click needs no treatment.
- 02Most TMD improves with conservative care; irreversible occlusal adjustment is not first-line.
- 03Escalate imaging only when it will change management.
§References
- Schiffman E et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).
§Similar cases
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