Clicking and painful jaw in a young woman

§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)

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§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.

§Related diseases

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