Background
The patient is 39 years old. Cohabitant. Works as a journalist and has a hectic workday. Previously healthy, had braces as a teenager. Has an 11-year-old child being evaluated for ADHD.
The patient has had pain (VAS 4) in the left side of the face for an extended period. The pain is primarily located around the ear but can also radiate to the cheek. The patient has experienced such pain for almost two years, with a clear worsening over the last six months to VAS 5 when chewing. The patient reports teeth grinding and clenching during stress. It is painful to chew, and there are click sounds in the jaw joint.
Consultation video
Medical history
- Doctor
What can I help you with?
- Patient
I have had pain in the face… on the left side… quite a long time actually.
- Doctor
Where do you feel it the most?
- Patient
Around the ear. But it also pulls a little forward into the cheek.
- Doctor
How long has this been going on?
- Patient
Almost two years… but much worse the last six months.
- Doctor
When do you notice it most?
- Patient
When I chew… then it can become quite painful.
- Doctor
Have you noticed anything else in the jaw?
- Patient
Yes… it clicks a little when I open my mouth.
- Doctor
Do you grind your teeth or clench?
- Patient
(a little hesitantly)
Yes… I probably do… especially when I'm stressed.
- Doctor
How is it at work and otherwise these days?
- Patient
It's a lot… both work and home… a bit chaotic actually.
Standard examination
Perform standard examination:
- 1 Inspection
- 2 Active movements
- 3 Passive movements
- 4 Isometric movements
- 5 Palpation
Tentative diagnosis
based on medical history and standard examination- Temporomandibular dysfunction (TMD) with disc damage in the left jaw joint.
Examination
Special tests to strengthen or weaken the likelihood of the tentative diagnosis.
-
1. Sensitivity in the face
Doctor
Tests light touch and pinprick in the face.
Patient
It feels normal.
Findings
- Normal sensation.
-
2. Active jaw function
Doctor
Can you open as wide as you can?
Patient
Starts normally, but stops before full opening.
It tightens… I can't open fully.
Findings
- Reduced opening.
-
3. Pain when biting
Doctor
Can you clench your teeth?
Patient
Bites gently, then clear pain reaction.
Yes… it hurts on the left side.
Findings
- Pain in the left jaw joint.
-
4. Lateral movements (deviation)
Doctor
Move the lower jaw from side to side.
Patient
Attempts to move the lower jaw from side to side.
There you go… it pulls on the left side.
Findings
- Pain in the left jaw joint.
-
5. Palpation of the jaw joint
Doctor
Palpates bilaterally in the jaw joints.
Patient
Clear reaction when the doctor palpates the left side.
Ow… yes, it's exactly there.
Findings
- Pain in the left jaw joint.
- Slight tenderness in m. masseter and m. temporalis.
Learning points
- 1 Mechanical joint disorder in the jaw.
- 2 Association with stress and teeth grinding.
- 3 It is important to rule out neurology. Sensitivity in the face has been examined and found normal.