5.0 of 1 Ratings
A 33-year-old woman presents to her primary care physician complaining of right jaw pain for the last 3 weeks. She first noticed it while eating a steak dinner but generally feels that it is worse in the morning. She describes the pain as deep and dull, with occasional radiation to the ear and back of her neck. She denies any incidents of jaw locking. The patient also states that her husband has noticed her grinding her teeth in her sleep in the last several months. She has a past medical history of depression, for which she takes fluoxetine, and carpal tunnel syndrome, for which she uses a wrist brace. The patient works as a secretary. Her father passed away from coronary artery disease at the age of 54, and her mother has rheumatoid arthritis. At this visit, her temperature is 98.5°F (36.9°C), blood pressure is 135/81 mmHg, pulse is 70/min, and respirations are 14/min. On exam, there is no overlying skin change on the face, but there is mild tenderness to palpation at the angle of the mandible on the right. Opening and closing of the jaw results in a slight clicking sound. The remainder of the exam is unremarkable. Which of the following is the next best step in management?
Nighttime bite guard
Plain radiograph of the jaw
MRI of the brain
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A 24-year-old woman presents to the emergency department with a severe headache. She states it is 10/10 in intensity and states that it is associated with chewing. She describes it as a dull pain over the sides of her head. The patient is otherwise healthy and is not currently taking any medications. Her temperature is 97.0°F (36.4°C), blood pressure is 111/74 mmHg, pulse is 83/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam is notable for pain and tenderness over the mandibular and temporal region that is worsened when the patient opens and closes their mouth. Which of the following is the most likely diagnosis?
Temporomandibular joint dysfunction