dental disorders
Internal Temporomandibular Joint (TMJ) Derangement
Treatment of Internal TMJ Derangement
Analgesics as needed Sometimes nonsurgical treatments such as exercising devices (eg, passive jaw-motion devices) or anterior repositioning appliances Surgery if conservative treatment fails Sometimes corticosteroid injection for capsulitis Disk derangement with reduction does not require treatment if the patient can open reasonably wide (about 40 mm or the width of the index, middle, and ring fingers) without discomfort. If pain occurs, mild analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs;ibuprofen400 mg orally every 6 hours), can be used. Some patients benefit from doing passive jaw-motion exercises using commercially available mechanical devices. If onset is<6 months, an anterior repositioning appliance may be used to move the mandible forward, repositioning the condyle on the disk. This oral appliance is horseshoe-shaped, hard, transparent acrylic (plastic) made to fit snugly over the teeth of one arch. Its occlusal surface is designed to hold the mandible forward when the jaw closes on the appliance. In this position, the disk is always on the condyle (ie, the normal condyle-disk relationship is reestablished). The oral appliance is gradually adjusted to allow the mandible to move posteriorly. If the disk stays with the condyle, the disk is said to be captured. However, the longer the disk is displaced, the more deformed it becomes and the less likely its repositioning will succeed. Surgical plication of the disk may be done, with variable success. Disk derangement without reduction may not require treatment other than analgesics. Oral appliances may help if the disk has not been significantly deformed and may reduce forces on the retrodiskal tissues, thereby encouraging adaptation of these tissues to form a pseudodisk. However, long-term use may result in irreversible changes in oral architecture. In some cases, the patient is instructed to slowly stretch the disk out of position, which allows the jaw to open normally. Various arthroscopic and open surgical procedures are available when conservative treatment fails. Capsulitis is initially treated with NSAIDs or oral corticosteroids, jaw rest, and muscle relaxation. Sometimes an oral appliance worn during sleep or while awake may be used briefly until the inflammation decreases. If these treatments are unsuccessful, corticosteroids may be injected into the joint, or arthroscopic joint lavage and debridement are used. 