Orofacial 2 Final Questions and Correct Answers (100%
COMPLETE ANSWERS) ALREADY GRADED A+
Instructions: This practice exam is designed for dental hygiene and dental
students preparing for an Orofacial Pain final examination. The exam covers
orofacial pain syndromes, temporomandibular disorders (TMD), neuropathic pain,
headache disorders, diagnostic criteria, and treatment approaches. The correct
answer is in bold. The rationale is in italics.
Section 1: Temporomandibular Disorders (TMD) – Questions 1–20
Q1. According to the DC/TMD (Diagnostic Criteria for Temporomandibular
Disorders), what is the most common type of disc displacement?
• A) Disc displacement with reduction
• B) Disc displacement with reduction with intermittent locking
• C) Disc displacement without reduction with limited opening
• D) Disc displacement without reduction without limited opening
Disc displacement with reduction is the most common type. The disc is displaced
anteriorly or anteromedially, and the patient typically reports a click or pop on
opening and closing. Intermittent locking may occur when the disc catches
temporarily .
Q2. During a TMD examination, the patient reports a loud "thud" or "clunk"
upon opening, which is not present on closing. This is most consistent with:
• A) Reciprocal clicking
• B) Crepitus
, • C) Disc displacement without reduction that just reduced
• D) Capsulitis
A disc that has been displaced without reduction (closed lock) may suddenly
reduce with a loud, single thud or clunk upon wide opening. This is different from
reciprocal clicking (click on opening and closing). After reduction, the patient may
have increased opening .
Q3. The normal range of motion for vertical opening (interincisal distance) in an
adult is approximately:
• A) 20-30 mm
• B) 30-35 mm
• C) 35-45 mm
• D) 45-55 mm
*Normal maximal incisal opening (MIO) ranges from 35-45 mm, with an average
of about 40 mm. Opening should also be pain-free. Less than 35 mm is considered
limited opening; greater than 45 mm may indicate hypermobility .*
Q4. Reciprocal clicking of the temporomandibular joint is defined as:
• A) A single click upon opening only
• B) A click upon opening and a click upon closing
• C) A grating sound on movement
• D) A thud upon maximum opening
Reciprocal clicking occurs when the disc reduces (clicks) as the condyle moves
forward onto the disc during opening, then the disc displaces again (clicks) as the
condyle moves backward off the disc during closing. This creates a click in both
directions .
Q5. Crepitus on TMJ auscultation indicates:
• A) Disc displacement
, • B) Degenerative joint disease (osteoarthritis)
• C) Muscle spasm
• D) Normal joint function
Crepitus is a grating, gravelly, or crunching sound and sensation that indicates
roughening of the articular surfaces, most commonly from degenerative joint
disease (osteoarthritis) or, less commonly, rheumatoid arthritis. It indicates intra-
articular pathology .
Q6. Which muscle is most frequently involved in myofascial pain of the
masticatory system?
• A) Medial pterygoid
• B) Masseter
• C) Temporalis
• D) Lateral pterygoid
The masseter muscle is the most frequently involved muscle in myofascial pain.
Referred pain from masseter trigger points often radiates to the maxillary and
mandibular teeth and the eyebrow region. The temporalis is second most common
.
Q7. A patient presents with limited opening, deviation of the jaw toward the
affected side upon opening, and a history of sudden onset of locking after a
wide yawn. This is most consistent with:
• A) Myofascial pain with limited opening
• B) Disc displacement without reduction (closed lock)
• C) Capsulitis
• D) Coronoid impingement
*Disc displacement without reduction (closed lock) occurs when the disc is
displaced anteriorly and does not reduce upon opening. The patient has limited
, opening (typically 25-30 mm) and deviation toward the affected side due to the
condyle moving around the displaced disc .*
Q8. What is the first-line imaging modality for suspected TMJ osseous changes?
• A) MRI
• B) Cone beam computed tomography (CBCT)
• C) Panoramic radiograph
• D) Ultrasound
CBCT is the gold standard for imaging osseous changes of the TMJ, including
osteophytes, erosions, flattening, and subcortical cysts. MRI is preferred for
evaluating the disc position and soft tissues but not bony changes. Panoramic
radiographs have limited sensitivity for TMJ osseous detail .
Q9. According to the DC/TMD, a diagnosis of myalgia requires:
• A) Pain in the joint only
• B) Pain in the jaw muscles that is modified by jaw function, and
reproduction of pain with palpation of the affected muscle(s)
• C) Clicking on opening
• D) Crepitus
Myalgia (muscle pain) requires jaw muscle pain that is modified by jaw
movement, function, or parafunction, AND reproduction of the patient's pain with
palpation of at least one masticatory muscle site. Joint noise alone does not
indicate myalgia .
Q10. Which of the following is NOT a recommended initial conservative
treatment for acute TMD pain?
• A) Soft diet
• B) Moist heat
• C) NSAIDs
COMPLETE ANSWERS) ALREADY GRADED A+
Instructions: This practice exam is designed for dental hygiene and dental
students preparing for an Orofacial Pain final examination. The exam covers
orofacial pain syndromes, temporomandibular disorders (TMD), neuropathic pain,
headache disorders, diagnostic criteria, and treatment approaches. The correct
answer is in bold. The rationale is in italics.
Section 1: Temporomandibular Disorders (TMD) – Questions 1–20
Q1. According to the DC/TMD (Diagnostic Criteria for Temporomandibular
Disorders), what is the most common type of disc displacement?
• A) Disc displacement with reduction
• B) Disc displacement with reduction with intermittent locking
• C) Disc displacement without reduction with limited opening
• D) Disc displacement without reduction without limited opening
Disc displacement with reduction is the most common type. The disc is displaced
anteriorly or anteromedially, and the patient typically reports a click or pop on
opening and closing. Intermittent locking may occur when the disc catches
temporarily .
Q2. During a TMD examination, the patient reports a loud "thud" or "clunk"
upon opening, which is not present on closing. This is most consistent with:
• A) Reciprocal clicking
• B) Crepitus
, • C) Disc displacement without reduction that just reduced
• D) Capsulitis
A disc that has been displaced without reduction (closed lock) may suddenly
reduce with a loud, single thud or clunk upon wide opening. This is different from
reciprocal clicking (click on opening and closing). After reduction, the patient may
have increased opening .
Q3. The normal range of motion for vertical opening (interincisal distance) in an
adult is approximately:
• A) 20-30 mm
• B) 30-35 mm
• C) 35-45 mm
• D) 45-55 mm
*Normal maximal incisal opening (MIO) ranges from 35-45 mm, with an average
of about 40 mm. Opening should also be pain-free. Less than 35 mm is considered
limited opening; greater than 45 mm may indicate hypermobility .*
Q4. Reciprocal clicking of the temporomandibular joint is defined as:
• A) A single click upon opening only
• B) A click upon opening and a click upon closing
• C) A grating sound on movement
• D) A thud upon maximum opening
Reciprocal clicking occurs when the disc reduces (clicks) as the condyle moves
forward onto the disc during opening, then the disc displaces again (clicks) as the
condyle moves backward off the disc during closing. This creates a click in both
directions .
Q5. Crepitus on TMJ auscultation indicates:
• A) Disc displacement
, • B) Degenerative joint disease (osteoarthritis)
• C) Muscle spasm
• D) Normal joint function
Crepitus is a grating, gravelly, or crunching sound and sensation that indicates
roughening of the articular surfaces, most commonly from degenerative joint
disease (osteoarthritis) or, less commonly, rheumatoid arthritis. It indicates intra-
articular pathology .
Q6. Which muscle is most frequently involved in myofascial pain of the
masticatory system?
• A) Medial pterygoid
• B) Masseter
• C) Temporalis
• D) Lateral pterygoid
The masseter muscle is the most frequently involved muscle in myofascial pain.
Referred pain from masseter trigger points often radiates to the maxillary and
mandibular teeth and the eyebrow region. The temporalis is second most common
.
Q7. A patient presents with limited opening, deviation of the jaw toward the
affected side upon opening, and a history of sudden onset of locking after a
wide yawn. This is most consistent with:
• A) Myofascial pain with limited opening
• B) Disc displacement without reduction (closed lock)
• C) Capsulitis
• D) Coronoid impingement
*Disc displacement without reduction (closed lock) occurs when the disc is
displaced anteriorly and does not reduce upon opening. The patient has limited
, opening (typically 25-30 mm) and deviation toward the affected side due to the
condyle moving around the displaced disc .*
Q8. What is the first-line imaging modality for suspected TMJ osseous changes?
• A) MRI
• B) Cone beam computed tomography (CBCT)
• C) Panoramic radiograph
• D) Ultrasound
CBCT is the gold standard for imaging osseous changes of the TMJ, including
osteophytes, erosions, flattening, and subcortical cysts. MRI is preferred for
evaluating the disc position and soft tissues but not bony changes. Panoramic
radiographs have limited sensitivity for TMJ osseous detail .
Q9. According to the DC/TMD, a diagnosis of myalgia requires:
• A) Pain in the joint only
• B) Pain in the jaw muscles that is modified by jaw function, and
reproduction of pain with palpation of the affected muscle(s)
• C) Clicking on opening
• D) Crepitus
Myalgia (muscle pain) requires jaw muscle pain that is modified by jaw
movement, function, or parafunction, AND reproduction of the patient's pain with
palpation of at least one masticatory muscle site. Joint noise alone does not
indicate myalgia .
Q10. Which of the following is NOT a recommended initial conservative
treatment for acute TMD pain?
• A) Soft diet
• B) Moist heat
• C) NSAIDs
