From the Guidelines
Management of an anterior dislocation of the right temporomandibular joint (TMJ) disc with early degenerative changes should prioritize a conservative, multidisciplinary approach before considering surgical options. Initial treatment should focus on pain management with NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 2-3 weeks, as recommended by the Temporomandibular disorder: a guide for general dental practitioners guideline 1. Muscle relaxants like cyclobenzaprine (5-10mg at bedtime) may help reduce muscle spasm.
Key Components of Conservative Management
- Physical therapy is essential and should include jaw exercises, manual mobilization techniques, and posture correction, typically 2-3 sessions weekly for 4-6 weeks.
- A custom-made occlusal splint worn at night (and during the day if needed) helps reposition the disc and reduce joint loading.
- Patients should follow a soft diet and avoid extreme jaw movements like wide yawning or gum chewing.
- Stress management techniques are important as psychological factors can exacerbate TMJ disorders, and techniques such as mindfulness, yoga, meditation, and cognitive behavioral therapy can be beneficial 1.
- Heat or cold packs applied for 15-20 minutes several times daily can provide symptomatic relief.
Consideration for Surgical Options
If conservative measures fail after 3-6 months, more invasive treatments like arthrocentesis, arthroscopy, or open joint surgery might be considered, as suggested by the American Association of Oral and Maxillofacial Surgeons guideline 1. However, it's crucial to weigh the potential benefits against the risks, including the risk of surgical site infection, which can be significant, as highlighted in the study on the evolution of temporomandibular joint reconstruction 1.
Prevention of Surgical Site Infections
Preoperative assessment and management of host comorbidities, such as metabolic diseases, high inflammatory arthritis, anxiety, and depression, can reduce the risk of surgical site infection 1. Additionally, strategies like antimicrobial photo-disinfection therapy, prophylactic antibiotics, and innovative coatings on TMJ implant surfaces can help prevent infections. Timely and accurate diagnosis of prosthetic joint infections is crucial for successful management, and emerging techniques like the leukocyte esterase test and next-generation sequencing may aid in diagnosis 1.
From the Research
Management Options
- The management of anterior dislocation of the right Temporomandibular Joint (TMJ) disc with early degenerative changes can involve various conservative and minimally invasive approaches 2, 3, 4, 5.
- Conservative management methods include education and counseling, mandibular manipulation, splint therapy, exercise therapy, and pharmacotherapy, with the first choice method being minimally invasive 2.
- A sequential combination of arthrocentesis, mandibular manipulation, and anterior repositioning splint (ARS) has been shown to be effective in managing acute TMJ disc displacement without reduction 3.
Treatment Effectiveness
- Betamethasone and arthrocentesis plus dexamethasone have been found to be effective in reducing pain in the short and medium term compared to arthrocentesis 4.
- Intra-articular corticosteroids, such as methylprednisolone, may be associated with adverse effects and their use should be considered carefully 4.
- The effectiveness of different intra-articular corticosteroids for the treatment of internal disorders of the TMJ is being evaluated in ongoing research 5.
Considerations
- The duration of acute disc displacement without reduction appears to be critical for the success of treatment 3.
- Decisions about the use of corticosteroids and other minimally invasive therapies should consider factors such as costs, feasibility, and acceptability 4.
- Future research should consider quality of life as an outcome and assess participants at longer follow-up periods 4, 5.