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Volume 2 Issue 5
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S
upporting
Y
our
P
ractice
Chronic cases
•
Refer the patient to an oral and maxillofacial surgeon if he/
she presents with a chronic “closed lock” and if previously
applied conservative supportive therapies have failed.
The oral and maxillofacial surgeon will explore definitive
surgical approaches.
•
Involve a physical therapist knowledgeable in TMDs to
assist with pain control and regaining range of opening.
Alternate Treatments
•
An auriculotemporal nerve block may be attempted to
differentiate a primary diagnosis of joint pain from muscle
pain.
Advice
•
Patients are managed following principles of orthopedic,
musculoskeletal and rehabilitative medicine that require
experience in management of TMDs.
•
Patients need to be educated about this condition, as
many patients attempt to force their mouths to open
wider, thus aggravating the intracapsular tissues and
potentially producing more pain.
•
Patients need to be reassured that the long-term
consequences of this condition are minimal, with the
majority of patients regaining at least some of their original
range of opening.
a
Suggested Resources
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’.
JOralRehabil
2013;40(2):139–58.
4.SchiffmanEL,LookJO,HodgesJS,etal.Randomizedeffectivenessstudyof fourtherapeuticstrategies for
TMJclosed lock.
JDentRes
2007;86(1):58–63.
5.CraaneB,DijkstraPU,StappaertsK,etal.Randomizedcontrolledtrialonphysicaltherapy forTMJclosed
lock.
JDentRes
2012;91(4):364–9.
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