patients with chronic refractory temporomandibular dysfunction were prescribed home exercise and were followed for 6 months. Pain , mouth opening and Fonseca's were done at day 1 and after 6 months of the study.

Each patient was seen by the rheumatologist who did the following; Full history taking including special habits like chewing gums or biting nails, Pain level measured by visual analogue scale 100 (both at rest and during temporomandibular joint movement) Clinical Examination of the temporomandibular joint including localized tenderness and amount of mouth opening After that the patients were prescribed the rehabilitation program in the form of heat modalities and Transcutaneous electric nerve stimulation on the on the temporomandibular joint, given an individual demonstration of the home based exercises and were given a reminding handout.

The rehabilitation program consisted of the following exercises: lateral deviation, protrusion/retraction and mandibular opening.

Isometric cervical muscle strengthening exercises were also prescribed for the patients.

Assessment of the severity of temporomandibular joint affection using the Fonseca's questionnaire were done twice; the first at the entry point to the study and once again after 6 months.

Inclusion Criteria:

• patients suffering painful temporomandibular joint

Exclusion Criteria:

• Patients with history of face trauma
• Patients with surgery at the temporomandibular joint
• Dental procedure in the last 6 months period
• Patients with rheumatic diseases

patients with chronic Temporomandibular pain refractory to medical treatment

studying the effectiveness of stretching exercises on chronic temporomandibular dysfunction syndrome refractory to medical treatment