# Temporomandibular joint disorder (TMJ) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Maini K, Dua A. Temporomandibular Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last update January 30, 2023. - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) - SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid ## Complete treatment card ```text TEMPOROMANDIBULAR JOINT DISORDER (TMJ) Sources: Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Maini K, Dua A. Temporomandibular Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last update January 30, 2023. Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (12) - Take a medical and dental history: where the pain is, when it began, what worsens or eases it, and past treatments [joint pain] - The core complaints are pain, clicking or grating in the joint, and limited jaw movement [crepitus] - Using the jaw brings the pain on; pain arriving out of nowhere suggests a different cause - Pain can spread to neck and scalp and worsens with chewing, yawning or long conversations - A click, grating or pop on opening or closing points to a forward-slipped disc or an arthritic joint [crepitus · disc herniation] - Ear symptoms are common: earache, tinnitus, vertigo, a blocked feeling and muffled hearing [ear pain · tinnitus · vertigo] - Ear symptoms belong more to the muscle type, from shared embryology of middle ear and chewing muscles - A dull ache over the joint, ear and temple, either steady or coming and going [joint pain] - It is worse on moving the jaw or when the area is pressed - Movement may be limited on opening, closing, pushing the jaw forward or moving it sideways - In dislocation the condyle leaves its socket, and closing the mouth may become impossible - Tenderness in the temple muscles is felt as headache, and may run alongside migraine [headache] SIGNS - what you find (7) - Look for worn teeth, grinding, abnormal jaw movement and postural asymmetry - Feel for tenderness in the chewing muscles, neck and shoulders, and pain on loading the joint - Palpate the chewing and neck muscles for trigger points, spasm and referred pain [referred pain · spasm] - Check the cranial nerves to exclude a neurological cause - Clicking comes from condyle and disc moving out of step; grating comes from roughened joint surfaces [crepitus] - Restriction may be muscular, ligamentous, or from a displaced disc - Joint pain around the ear is felt most towards the back of it [joint pain] TESTS (8) - Pain on jaw movement, headache and referred pain all point to a muscle cause - Tenderness on pressing the joint, plus joint sounds, point inside the joint instead - Examine the mouth, do otoscopy and palpate the neck muscles to exclude other causes of face pain - MRI is the imaging of choice, showing joint fluid, disc displacement and soft tissue - A panoramic x-ray is quick, checks teeth and joint together, and is often the first investigation - Plain films and CT show severe joint degeneration, fracture and dislocation - Ultrasound shows where the disc lies but cannot diagnose osteoarthritis - CT and MRI earn their place in severe, long-standing or suspected structural disease IF NOT THIS - what else fits (5) - Facial pain also comes from trigeminal, glossopharyngeal and post-herpetic neuralgia - Sinusitis, salivary gland disease and carotidynia are other facial pain causes - Dental decay, a dental abscess and a tooth erupting cause pain in the mouth and face - Migraine, cluster headache and temporal arteritis account for most headaches - Ear pain or blockage may come from middle ear infection, injury, barotrauma or a blocked Eustachian tube Source StatPearls "Temporomandibular Syndrome" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 1 g three or four times daily, maximum 4 g in 24 hours - As needed for pain or fever Peds 15 mg/kg/dose [child max 500 mg] (Child 1 month and over: 15 mg/kg per dose, 3 or 4 times daily, maximum 60 mg/kg daily. Child under 1 month: 10 mg/kg per dose, 3 or 4 times daily, maximum 40 mg/kg daily. MSF's own weight table gives one 500 mg tablet three times daily from 30 kg to under 50 kg, so 500 mg is the per-dose ceiling; the 60 mg/kg daily total still applies.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Symptomatic relief of the pain and fever only. It does not treat the cause, and the dose is the same whatever the cause is. Caution Relief only - it does not treat what is causing the pain or fever. Check every other product the patient is taking for paracetamol; combination cold and flu preparations are the usual route to an accidental overdose. Reduce the dose in significant liver disease, chronic alcohol use, or low body weight. RED FLAG - Jaw locking with inability to open or close the mouth, a history of significant facial trauma, severe trismus, or signs of joint infection. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. IBUPROFEN [add-on - not a substitute] Adult 200 mg-400 mg (10-20 ml), up to three times a day as required. - As needed, shortest effective course Peds For pain and fever 20 mg/kg/day in divided doses (including OTC use). Source SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc Why An anti-inflammatory analgesic for the pain and any inflammatory component. Symptomatic only; the dose does not change with the underlying diagnosis. Caution Relief only - it does not treat what is causing the pain. Take with or after food, and give gastroprotection if it is needed for more than a short course or the patient is over 65. Avoid in dehydration and in anyone not drinking - the kidney risk is highest there. Avoid in active peptic ulcer, significant kidney disease, and heart failure. CONTRAINDICATED in the third (last) trimester of pregnancy. In the first and second trimesters, do not give unless clearly necessary, at the lowest dose for the shortest time. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)