From the Guidelines
Treatment for an anterior dislocation of the right temporomandibular joint (TMJ) disc should prioritize conservative approaches, including rest, soft diet, and avoiding extreme jaw movements, before considering invasive procedures. Initial management includes pain and inflammation management with NSAIDs such as ibuprofen 400-600mg three times daily for 7-10 days or naproxen 500mg twice daily 1. Muscle relaxants like cyclobenzaprine 5-10mg at bedtime may help with associated muscle spasms. Application of moist heat or ice packs for 20 minutes several times daily can provide symptomatic relief.
Key Considerations
- Physical therapy focusing on gentle jaw exercises and manual mobilization techniques is beneficial for restoring normal disc position and function 1.
- A custom-made occlusal splint worn at night helps reduce joint loading and prevents teeth grinding.
- Cognitive behavioural therapy (CBT) augmented with relaxation therapy or biofeedback, therapist-assisted jaw mobilisation, and manual trigger point therapy provide the largest reduction in chronic pain severity associated with TMD 1.
Treatment Approach
If conservative measures fail after 3-6 months, more invasive options like arthrocentesis, arthroscopy, or open joint surgery may be considered. These interventions work by addressing the underlying pathophysiology of disc displacement, which involves altered biomechanics of the TMJ complex and potential inflammatory changes that can lead to pain and restricted movement if left untreated. It is essential to weigh the potential benefits and harms of each treatment option, considering the certainty of evidence and the possibility of moderate to serious harms associated with invasive procedures 1.
From the Research
Anterior Dislocation of the Right TMJ Disc
An anterior dislocation of the right temporomandibular joint (TMJ) disc indicates a disorder in which the articular disc is dislocated from its correct position relative to the mandibular condyle and mandibular fossa 2. This condition can lead to pain in the affected TMJ and a decreased range of mouth opening.
Treatment Options
The treatment for an anterior dislocation of the right TMJ disc may include:
- Conservative measures, such as education and counseling, mandibular manipulation, splint therapy, exercise therapy, and pharmacotherapy 3
- Arthrocentesis, a minimally invasive treatment method that involves lavage of the joint space to wash out inflammatory mediators, release the disc, break adhesions, eliminate pain, and improve joint mobility 4
- Stabilizing occlusal splint therapy, which can be effective in reducing pain levels and restoring mouth opening 2
- Relocation or reduction methods, which vary depending on the severity of the injury and whether it is an acute or chronic dislocation 5, 6
Key Considerations
- The natural course of closed lock is self-limiting, but if there is no significant improvement after 12 weeks, therapy should be implemented 3
- Surgical management should be considered after unsuccessful conservative therapy 3
- Both arthrocentesis and stabilizing occlusal splint therapy can be effective in reducing pain levels and improving functional parameters, but the stabilizing interocclusal splint treatment may be superior in restoring mouth opening 2