Pathology · single question
A patient received a hard occlusal splint 5 months ago. They return with diffuse facial muscle pain, limited mouth opening of 15 mm, and TMJ clicking. What is the MOST appropriate next step?
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Correct answer: B. Refer to an oral radiologist for imaging studies
The patient has significantly worsened (15 mm opening is severely limited — normal is ≥40 mm) 5 months after splint therapy. This represents possible internal derangement, disc displacement, or structural TMJ pathology not responding to conservative management. The next step is imaging via referral to an oral radiologist (MRI for soft tissue assessment, CBCT for bony changes) to identify the cause before modifying treatment.
- A. Symptomatic medication may be adjunctive but does not identify or address the underlying cause of worsening TMJ dysfunction.
- B. CORRECT. With worsening TMJ symptoms and severely limited opening (15 mm) despite 5 months of splint therapy, referral for imaging is the next step to identify structural pathology.
- C. Switching to a soft splint without imaging is premature and potentially counterproductive when the cause of worsening is unknown.
- D. Simply adjusting the splint is inappropriate when the patient has severely worsened — the underlying cause must be identified through imaging before treatment modification.