Painful clicking jaw with intermittent locking

§Chief complaint

Clicking and pain in front of the right ear, jaw sometimes locks closed

§Medical & dental history

• 01Generalised anxiety, high stress at work
• 02No arthritis, no trauma
• 03Nocturnal bruxism, worn incisal edges
• 04No recent dental treatment

§Clinical examination

• 01Reciprocal click on the right at 28 mm opening and again on closing
• 02Maximum opening 38 mm with deviation to the right at the click
• 03Tenderness of the right lateral pole and masseter; no joint effusion
• 04No crepitus, occlusion stable, teeth show attrition facets

§ figuresFigures (3)

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 temporomandibular disc displacement with reduction and concurrent myofascial pain

Reciprocal clicking with deviation that corrects at the click, normal opening range and MRI showing an anteriorly displaced disc that recaptures on opening fits DC/TMD criteria for disc displacement with reduction.

§Investigations

• 01DC/TMD clinical protocol including palpation and range-of-motion measurement
• 02MRI of both joints in open and closed positions
• 03Pain diary and parafunction assessment

§Radiology

• 01MRI closed mouth — anterior disc displacement on the right; normal left joint
• 02MRI open mouth — disc recaptures over the condyle; no effusion or bone marrow oedema
• 03OPG — condylar morphology normal

§Treatment plan

• 01Reassurance and explanation of the benign natural history
• 02Soft diet, jaw rest, heat and NSAIDs for 2-3 weeks
• 03Stabilisation splint worn nightly
• 04Physiotherapy with controlled opening exercises; stress management and bruxism counselling
• 05Escalate to arthrocentesis only if conservative care fails

§Follow-up & outcome

• 016 weeks — pain reduced from 7/10 to 2/10, click persists but painless
• 023 months — opening 44 mm, no locking episodes
• 0312 months — stable, splint use continued at night

Outcome: Symptom control achieved with conservative therapy alone; no surgery required.

§Discussion

• 01Over 80% of internal derangements respond to conservative therapy; a painless click alone needs no treatment.
• 02Progression from reduction to closed lock is not inevitable; arthrocentesis is effective when it occurs.
• 03Irreversible occlusal adjustment for TMD is not evidence based and should be avoided.

§Clinical pearls / learning points

• 01Treat pain and function, not the click.
• 02Start with reversible therapy — splint, physiotherapy, medication.

§Viva questions

§MCQs

§Related diseases

§Similar cases