🧠 Orofacial Pain Diagnosis Tool
5-step clinical assessment — answer questions about location, character, TMJ examination, muscle palpation, and associated features to identify the most likely diagnosis with differential diagnoses and management guidance.
RED FLAG — Possible Temporal Arteritis (Giant Cell Arteritis)
Temporal artery tenderness in a patient over 50 — risk of irreversible blindness if untreated.
Do not wait for biopsy results before starting steroids. Refer to rheumatology / medicine same day.
Possible Herpes Zoster (Shingles) — Act Within 72 Hours
Skin rash or blisters on the face in a dermatome distribution. Antiviral treatment is time-critical.
1 Pain Location & History
Where is the pain located? (select all that apply)
How long has this pain been present?
How did it start?
2 Pain Character
Best describes the quality of pain? (select one)
Pain pattern?
What makes it worse? (tick all that apply)
3 TMJ Examination
Palpate both TMJs and assess mandibular movement
Joint sounds on mandibular movement?
Maximum unassisted mouth opening (inter-incisal distance)?
Jaw deviation on opening?
Preauricular tenderness on lateral pole palpation?
Pain reproduced on maximum mouth opening attempt?
4 Muscle Palpation & Occlusal History
Palpate masticatory muscles bilaterally with firm, sustained pressure for 2 seconds
Masseter muscle tender to palpation?
Temporalis muscle (temple) tender?
Lateral pterygoid region tender? (behind upper molars / retromolar area)
Pain, fatigue, or soreness when patient clenches teeth?
Patient reports headaches in the temple or forehead region?
Parafunctional history (tick all that apply)
5 Additional Clinical Features
Answer all questions — these narrow the differential diagnosis significantly
🧠 Diagnostic Assessment
Based on clinical findings entered. Verify with full clinical examination. Not a substitute for specialist consultation where indicated.
⚠️ Clinical Decision Support — Important Notice
This tool provides decision support based on the DC/TMD criteria (Schiffman et al. 2014), IASP orofacial pain classification, and published clinical guidelines. It does not replace clinical examination, imaging, or specialist consultation. Always correlate results with the full clinical picture. For red flag features (progressive neurological signs, unexplained trismus, suspected malignancy, temporal arteritis), refer without delay.
DC/TMD Diagnostic Criteria Reference
Arthralgia (sensitivity 89%, specificity 98%)
Preauricular pain, modified by jaw movement, function, or parafunction; pain with lateral pole palpation or maximum unassisted opening.
DDwR (sensitivity 34%, specificity 92%)
Clicking/popping in joint during ≥1 of 3 opening or closing movements on exam; clicking eliminated on protrusive opening.
DDwoR / Closed Lock (sensitivity 80%, specificity 97%)
Maximum unassisted opening <40mm; condylar translation absent on palpation during opening on the affected side; deviation to the affected side.
Myalgia (sensitivity 90%, specificity 99%)
Pain in jaw, temples, face, or preauricular area modified by jaw movement; familiar pain with masseter or temporalis palpation.
Source: Schiffman E et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications. J Oral Facial Pain Headache. 2014;28(1):6–27.