TMJ Dislocation in Dependent Older Adults in PA/LTC: A Recognition-to-Maintenance Framework

To reframe temporomandibular joint dislocation as a potentially reversible oral-function emergency in post-acute and long-term care (PA/LTC) and propose a recognition-to-maintenance framework for older adults unable to reliably report symptoms.

Problem-based narrative review and commentary, illustrated by deidentified composite vignettes.

Older adults in PA/LTC, rehabilitation, nursing home, and LTC hospital settings, particularly those with communication impairment, neurologic disease, frailty, edentulism, denture use, enteral feeding, or recent airway manipulation.

PubMed was searched from inception, with the search updated on September 8, 2026, using 3 complementary strategies (755 records; 466 unique after deduplication). The updated search results were reviewed for relevance against predefined inclusion and exclusion criteria, and clinically informative sources meeting these criteria were incorporated into the narrative synthesis to identify PA/LTC recognition and maintenance gaps.

Available evidence, consisting mainly of reviews, retrospective series, and case reports, suggests 3 PA/LTC-relevant vulnerabilities: presentation that is silent or absorbed into neurologic or frailty-related explanations, uncertain onset, and failure to verify maintained reduction or detect recurrence. During neurologic workup, dysarthria, drooling, facial asymmetry, feeding decline, and apparent dysphagia may trigger stroke-oriented assessment while mouth closure may not be deliberately assessed, and dislocation may both mimic and be mimicked by dystonic conditions. The proposed "last-known-normal jaw closure" question is intended as a practical bedside prompt, not a validated triage metric.

In PA/LTC, temporomandibular joint dislocation should be approached as a recognition-to-maintenance problem. Same-day assessment of oral-function change, avoidance of repeated forceful attempts, maintained-reduction verification, and caregiver-facing recurrence surveillance warrant validation.