skip to main content

TMD Conservative Management — ORE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

ModerateOral MedicineTMD Conservative ManagementORE Part 1

A 40-year-old woman presents with painful bilateral TMJ clicking and a maximum mouth opening of 28 mm. She reports daytime tooth clenching and sleep bruxism. MRI confirms bilateral anterior disc displacement with reduction. There is no history of persistent closed locking, trauma or systemic arthropathy. What is the most appropriate initial management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Supported self-management with jaw exercises, short-term analgesia and review

**A is correct.** Painful clicking with MRI-confirmed disc displacement **with reduction** and a 28 mm opening does not indicate persistent closed lock. Initial UK management is supported self-management: explanation and reassurance, avoiding aggravating parafunction, jaw exercises/physical therapy measures, and short-term analgesia where suitable. A stabilisation splint can be considered as an adjunct after dental assessment, particularly where bruxism coexists, but it should not replace self-management. **B** and **C** are minimally invasive procedures, but not first-line in this scenario. **D** and **E** are open surgical approaches and are inappropriate without a specific severe arthrogenous indication or failure of conservative care. UK guidance states that, where surgery is indicated, it should complement rather than replace conservative treatment.

Reference: Royal College of Surgeons of England Faculty of Dental Surgery. Management of painful temporomandibular disorder in adults, sections on splint therapy and surgical management, 2025. https://www.rcseng.ac.uk/-/media/FDS/Comprehensive-guideline-Management-of-painful-Temporomandibular-disorder-in-adults.pdf