Differential Diagnosis for Jaw Pain

The patient's symptoms of jaw pain on the left side for the last 2 weeks, combined with a history of grinding his teeth in his sleep, suggest several possible diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Temporomandibular Joint (TMJ) Disorder: This is the most likely diagnosis given the patient's history of teeth grinding, which is a common cause of TMJ disorders. The pain on one side of the jaw is consistent with this diagnosis, and the use of a mouthguard suggests an attempt to mitigate the effects of grinding, which may not have been entirely successful.

• Other Likely Diagnoses

  • Bruxism: Although the patient wears a mouthguard, which is typically used to protect the teeth from the effects of bruxism (teeth grinding), the jaw pain could still be a result of this condition, especially if the mouthguard does not fit properly or if the grinding is severe.
  • Dental Problems (e.g., abscess, impacted tooth): Dental issues can cause localized pain that might be perceived as jaw pain. Given the patient's history of grinding, there could be underlying dental problems that need to be addressed.
  • Myofascial Pain Syndrome: This condition involves pain in the muscles of the face and jaw, which could be exacerbated by or related to the patient's grinding habit.

• Do Not Miss Diagnoses

  • Temporal Arteritis: Although less common, especially in a young patient, temporal arteritis can cause jaw pain, particularly when chewing. It's a condition that requires prompt diagnosis and treatment to prevent serious complications like vision loss.
  • Trigeminal Neuralgia: This condition involves sudden, severe, shock-like pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head. Jaw pain could be a part of the presentation, especially if the pain radiates to the jaw area.

• Rare Diagnoses

  • Osteonecrosis of the Jaw: This is a rare condition that could be associated with jaw pain, especially in patients with a history of bisphosphonate use or other specific risk factors. It's less likely given the patient's age and presentation but should be considered if other diagnoses are ruled out and the pain persists.
  • Neoplastic Conditions: Tumors of the jaw or surrounding tissues are rare but could cause persistent pain. These would be considered if the patient does not respond to initial treatments and if imaging studies are warranted based on clinical findings.

Next Steps

Given the differential diagnoses, the next steps should include:

• A thorough dental and medical history, including the use and fit of the mouthguard.
• A physical examination to assess the TMJ, facial muscles, and dental health.
• possibly, imaging studies (like an X-ray or MRI) if a dental or TMJ issue is suspected and not responsive to initial treatment, or if a "Do Not Miss" diagnosis is considered based on the patient's presentation.
• Referral to a dentist or an oral surgeon for further evaluation and treatment of any underlying dental issues.
• Consideration of pain management strategies, including medication for pain and muscle relaxation, and potentially a referral to a specialist for further management of bruxism or TMJ disorder.