A patient received a hard occlusal splint 5 months ago and returns with generalized facial muscle pain, maximum opening limited to 15 mm, pain on opening and joint clicking. What is the MOST appropriate next step?

Correct answer: C. Refer for advanced imaging of the joint

• A. Continuing to adjust a splint that has produced no improvement over five months delays diagnosis of an underlying internal derangement or degenerative joint change.
• B. Switching to a soft splint is another conservative appliance; it does not address the failure of conservative therapy or establish a diagnosis, and soft splints can aggravate parafunction in some patients.
• C. Correct. This patient has FAILED conservative therapy — five months of splint use with worsening pain, clicking and severe limitation (15 mm is markedly restricted; normal opening is 40–55 mm). Failure of conservative management with progressive restriction is the indication to escalate to advanced IMAGING (MRI for disc position and soft tissue; CBCT for osseous change) and specialist referral, rather than repeating a therapy that has not worked.
• D. Chronic opioid therapy is inappropriate for TMD — it masks symptoms, carries dependence risk and does not treat the cause.