The Examination of the Patient with Facial Pain and/or Mandibular Dysfunction

Abstract

In the examination of patients presenting the signs and symptoms of facial pain and mandibular dysfunction, a complete but not necessarily time consuming history is essential. The clinical examination should be comprehensive, including: the noting of facial deformities; the range and character of mandibular movements; the range of condylar motion and the nature of joint sounds, if present; the size, state of the masticatory musculature, and the location of painful areas; dental findings, including the occlusion of the teeth. X-ray examination of the temporomandibular joints is a useful adjunct. With a history of trauma, it is essential and precedes the physical examination. If a temporomandibular joint pain-dysfunction syndrome is suspected as a result of the examination, the use of physical treatment of the musculature by providing an index of treatment response is an important diagnostic aid. In the differential diagnosis of temporomandibular joint pain and dysfunction, the problem of pain is the more difficult. The organic causes of dysfunction are rheumatic disease, trauma, neoplasms, neurologic disorders, infections, and congenital deformities. The most common cause is nonorganic in the form of a pain-dysfunction syndrome. In reaching a diagnosis, one must be on guard against interpretation of data obtained by the examination according to some rigid mechanistic concept. Perhaps the most important consideration in the examination is that expressed in an article by an internist.3 In it, he asks colleagues to remember that all patients, even nervous ones, have a right to a complete examination, and quotes the admonition of Sir William Osier to his students: “Listen to the patient; he is giving you the diagnosis.”