Temporomandibular joint and orofacial pain: clinical and medicolegal management problems.

Idiopathic pain in the face, temporomandibular joint (TMJ), and teeth is common but varied in its duration and severity. Many cases respond to informed reassurance or simple physical therapy using an occlusal splint. Those that do not should be referred for specialist management by medication, and where necessary, arthroscopy or occasionally arthrotomy. Awareness of the underlying psychogenic factors is important at all levels of management, particularly as some patients will benefit from the support of a liaison psychiatrist. The failure to recognise these factors, together with prolonged unsuccessful physical or surgical therapy can render the pain intractable or incite certain patients to seek relief through litigation.