S
upporting
Y
our
P
ractice
Chroniccases
•
Refer thepatient toanoral andmaxillofacial surgeon if he/
shepresentswithachronic “closed lock” and if previously
appliedconservative supportive therapieshave failed.
Theoral andmaxillofacial surgeonwill exploredefinitive
surgical approaches.
•
Involveaphysical therapist knowledgeable inTMDs to
assistwithpaincontrol and regaining rangeof opening.
AlternateTreatments
•
Anauriculotemporal nerveblockmaybeattempted to
differentiateaprimarydiagnosisof joint pain frommuscle
pain.
Advice
•
Patients aremanaged followingprinciplesof orthopedic,
musculoskeletal and rehabilitativemedicine that require
experience inmanagement of TMDs.
•
Patientsneed tobeeducatedabout this condition, as
manypatients attempt to force theirmouths toopen
wider, thus aggravating the intracapsular tissues and
potentiallyproducingmorepain.
•
Patientsneed tobe reassured that the long-term
consequencesof this conditionareminimal,with the
majorityof patients regainingat least someof their original
rangeof opening.
a
SuggestedResources
1.DeLeeuwR,KlasserGD(editors).OrofacialPain:Guidelines forAssessment,Diagnosis,andManagement.
AmericanAcademyofOrofacialPain.5thed.Chicago(IL):Quintessence;2013.
2.OkesonJP.TheClinicalManagementofTemporomandibularDisordersandOcclusion,7thed.St.Louis(MO):
Mosby;2013.
3.NaeijeM,TeVeldhuisAH,TeVeldhuisEC,etal.Discdisplacementwithinthehumantemporomandibular
joint:asystematicreviewofa ‘noisyannoyance’.JOralRehabil2013;40(2):139–58.
4.SchiffmanEL,LookJO,HodgesJS,etal.Randomizedeffectivenessstudyof fourtherapeuticstrategies for
TMJclosed lock.JDentRes2007;86(1):58–63.
5.CraaneB,DijkstraPU,StappaertsK,etal.Randomizedcontrolledtrialonphysicaltherapy forTMJclosed
lock.JDentRes2012;91(4):364–9.
