PubMed Central, : RMMJ Rambam Maimonides Medical Journal Rambam Health Care Campus 2026; 17(4): e0023. ISSN: 2076-9172Published online 2026 October 26. doi: 10.5041/RMMJ.10584

Presenting Pattern	Principal Possibilities	Suggested Disposition
Pain triggered by exertion or stress	Cardiac ischemia	Emergency cardiovascular evaluation
Age ≥50 with new headache or jaw claudication	Giant cell arteritis	Same-day ED or rheumatology
Acute painful trismus over hours to days	Deep-space infection; septic TMJ; trauma	Urgent hospital-based OMFS/ENT
Progressive restriction, asymmetry, deviation, or occlusal change	Ankylosis; coronoid hyperplasia; condylar growth; mass	Prompt OMFS/ENT referral
Preauricular pain, clicking, locking, or pain with jaw function	TMJ internal derangement; osteoarthritis; inflammatory arthritis	Conservative care; refer if persistent or locking
Diffuse jaw or facial pain with stiffness or fatigue	Masticatory myalgia; myofascial pain; sleep-related contributors	Conservative care; refer if persistent
Brief electric-shock pain triggered by touch, eating, or speaking	Trigeminal neuralgia; glossopharyngeal neuralgia	Neurology referral
Numbness, tingling, or sensory loss in V2/V3	Traumatic neuropathy; perineural spread; skull-base or CNS lesion	OMFS or neurology referral
Burning oral pain with normal-appearing mucosa	Burning mouth syndrome; secondary oral burning	Treat cause; oral medicine if persistent
Bilateral jaw pain with widespread pain, fatigue, or poor sleep	Fibromyalgia or nociplastic pain	Primary care or pain management
Ear fullness, tinnitus, or otalgia modified by jaw function	TMD/myalgia; primary otologic disease	ENT if otologic findings; otherwise TMD evaluation
Meal-related preauricular or submandibular pain or swelling	Sialolithiasis; duct stenosis; sialadenitis	ENT/OMFS referral
Cheek or maxillary pressure with nasal symptoms	Maxillary sinusitis, including odontogenic sinusitis	ENT or dental referral by suspected source
Recurrent pulsating facial or jaw pain with nausea or photo/phonophobia	Orofacial migraine	Headache management; neurology if atypical
Persistent poorly localized facial or dentoalveolar pain without findings	PIFP; PIDP; nociplastic pain	Orofacial-pain or oral medicine referral

Urgent red flags and escalation pathways are summarized in Table 2; selection of imaging modalities is presented in Table 3.

CNS, central nervous system; ED, emergency department; ENT, otolaryngology; OMFS, oral and maxillofacial surgery; PIDP, persistent idiopathic dentoalveolar pain; PIFP, persistent idiopathic facial pain; TMD, temporomandibular disorder; TMJ, temporomandibular joint.