Dawaa Reference

acute

Temporomandibular joint disorder (TMJ)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 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 against2 documents
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc

Verified date2026-08

Presentation reference

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

SourceStatPearls "Temporomandibular Syndrome" - disease-level clinical article

Presentation findings are traced to the source above.

1

PARACETAMOL

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

1 g three or four times daily, maximum 4 g in 24 hours - As needed for pain or fever

Paediatric dose

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.)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP
2

IBUPROFEN

add-on - not a substitute

Strength400 mg

Formoral.solid

Adult dose and duration

200 mg-400 mg (10-20 ml), up to three times a day as required. - As needed, shortest effective course

Paediatric dose

For pain and fever 20 mg/kg/day in divided doses (including OTC use).

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.