Case 1

Head/jaw

1 Background
2 Medical history
3 Standard examination
4 Tentative diagnosis
5 Special tests

Background

The patient is 39 years old. Partner. Works as a journalist, hectic workday. Previously healthy, had braces as a teenager. One child, 11 years old. The child is being evaluated for ADHD.

The patient has for a long time had pain (VAS 4) in the face on the left side, the pain is primarily located around the ear, but the pain can also radiate forward into the cheek. The patient has had such pain for almost two years, but clear worsening in the last six months to VAS 5 when chewing. The patient reports teeth grinding and clenching when stressed. States that it is painful to chew and that there are clicking sounds in the jaw joint.

Medical history

Doctor
What can I help you with?
Patient
I have had pain in the face… on the left side… quite a long time actually.
Doctor
Where do you feel it the most?
Patient
Around the ear. But it also pulls a little forward into the cheek.
Doctor
How long has this been going on?
Patient
Almost two years… but much worse the last six months.
Doctor
When do you notice it most?
Patient
When I chew… then it can become quite painful.
Doctor
Have you noticed anything else in the jaw?
Patient
Yes… it clicks a little when I open my mouth.
Doctor
Do you grind your teeth or clench?
Patient (a little hesitantly)
Yes… I probably do… especially when I'm stressed.
Doctor
How is it at work and otherwise these days?
Patient
It's a lot… both work and home… a bit chaotic actually.