Sir, pain from the temporomandibular joint (TMJ) is a common reason for referral to the secondary care setting by general medical and dental practitioners alike.

I had the pleasure of meeting a 19-year-old gentleman who presented with a two-year history of pain from his left TMJ which was not subsiding. The patient denied clenching or grinding his teeth; however, when asked about habits he revealed the specimen shown in Figure 1.

Figure 1
figure 1

Extensively chewed pen lid

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Further questioning revealed the patient was chewing this pen lid for up to 12 hours a day. He further mentioned chewing his headphone wires when he misplaced his pen lid (Fig. 2).

Figure 2
figure 2

Patient demonstrating headphone wire in between his teeth

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Needless to say, the cause of his pain was obvious and part of his care plan involved elimination of these detrimental habits. He was surprised to hear that persistent chewing of pen lids was likely contributing to his pain, which reaffirms to all clinicians: when there is pain from the TMJ, make it a habit of asking about habits.