A patient with chronic TMJ dysfunction was given a hard occlusal splint 5 months ago. They return with facial muscle pain in all areas, limited opening of 15mm, and TMJ clicking. What is the NEXT most appropriate step?

Correct answer: A. Refer for imaging studies (MRI/CT)

• A. Correct. The patient's significant functional decline (15mm opening, facial pain, clicking after 5 months of splint therapy) warrants imaging to evaluate the TMJ structures. MRI is the gold standard for soft tissue (disc position), while CBCT/CT is used for bony changes.
• B. Adjusting the splint without knowing the current joint status is inappropriate given significant clinical changes.
• C. Tooth extraction is not appropriate and may worsen the occlusal situation.
• D. Muscle relaxants may provide temporary symptom relief but do not address the underlying structural issue.