From the Guidelines
For a patient with degenerative left TMJ with small joint effusion, severely torn fragmented anterior displaced disc, and dislocated right temporomandibular disc who is already in physical therapy, I strongly recommend continuing physical therapy and adding a custom-fitted occlusal splint to reduce joint loading and muscle hyperactivity. Consideration of NSAIDs such as naproxen 500mg twice daily or ibuprofen 600mg three times daily with food for 2-3 weeks to reduce inflammation, as well as muscle relaxants like cyclobenzaprine 5-10mg at bedtime for associated muscle spasm, is also advised 1. For pain management, acetaminophen 500-1000mg every 6 hours as needed can be used. Implementing a soft diet avoiding chewy foods, wide mouth opening, and gum chewing, and applying moist heat for 20 minutes several times daily to reduce pain and improve mobility, are also recommended 1. If these conservative measures fail after 3-6 months, consider referral for arthrocentesis, arthroscopy, or injection therapy with corticosteroids or hyaluronic acid, as suggested by recent guidelines 1. Key points to consider in management include:
- Conservative approaches as first line treatment
- Use of NSAIDs and muscle relaxants for symptom management
- Implementation of a soft diet and avoidance of aggravating activities
- Consideration of arthrocentesis, arthroscopy, or injection therapy if conservative measures fail
- Importance of a comprehensive treatment approach, including physical therapy and occlusal splint therapy, to reduce inflammation, decrease joint loading, relax associated musculature, and prevent further disc displacement. Recent studies support the use of a multidisciplinary approach to managing temporomandibular joint disorders, emphasizing the importance of conservative management and careful consideration of surgical options 1.
From the Research
Treatment Options for Temporomandibular Joint Disorders
- The patient is already undergoing physical therapy (PT), and other treatment options can be considered in conjunction with PT 2, 3, 4, 5.
- Non-invasive modalities such as occlusal splints can be used to manage temporomandibular joint-related conditions, inducing a slight vertical condylar distraction and eliminating the occlusal factor 3.
- Invasive therapies such as arthrocentesis, injections with diverse drugs, or a combination of these may be more effective than non-invasive therapies 4.
- Platelet-rich plasma injection has been shown to be a effective treatment for disc displacement, with anti-inflammatory, analgesic, and lubricating effects 4.
- A multidisciplinary approach to treatment, including self-management strategies, behavioral therapy, physical therapy, and pharmacotherapy, may be beneficial for patients with temporomandibular disorders 5.
Considerations for Disc Displacement and Joint Effusion
- The status of the disc in the temporomandibular joint, as depicted in magnetic resonance images, may be predictive of the presence of temporomandibular joint effusion 6.
- Disc displacement, particularly anterior disc displacement without reduction, may be associated with an increased risk of joint effusion 6.
- However, disc displacement may not be the dominant factor in defining the occurrence of temporomandibular joint effusion, and other local or systemic conditions should be considered 6.