What are the effects of different interventions used in the management of TMJ DDwoR? A systematic review

This summary is based on the article published in the Journal of Dental Research: TMJ Disc Displacement without Reduction Management: A Systematic Review (2014)

This article is made available for download free of charge by Sage Publications: Click here

Context

Temporomandibular joint (TMJ) disc displacement without reduction (DDwoR) is a specific temporomandibular disorder (TMD) that can cause TMJ pain and limited mouth opening (painful locking), sometimes called a “closed lock.” (1) DDwoR can be acute or chronic depending on the duration of locking. (2, 3)  

Various interventions have been used for the management of patients with temporomandibular joint (TMJ) disc displacement without reduction (DDwoR), but their clinical effectiveness remains unclear. This may result in management being based more on experience than evidence. (4) 

Purpose of the Review

To investigate the effects of different conservative and surgical interventions used in the management of TMJ DDwoR.

Key Findings

The comparable therapeutic effects of reviewed interventions suggest using the simplest, least costly, and least invasive interventions for the initial management of DDwoR, including patient education, self-management, and early mandibular manipulation.

Currently, there is insufficient evidence supporting or refuting the use of minimally invasive and invasive surgical interventions for DDwoR. However, there may well be specific clinical cases where a surgical intervention may help, but the body of evidence does not give a clear indication of when this may be.

References

1. Okeson JP (2007). Joint intracapsular disorders: diagnostic and nonsurgical management considerations. Dent Clin North Am 51:85-103, vi.
2. Sembronio S, Albiero AM, Toro C, Robiony M, Politi M (2008). Is there a role for arthrocentesis in recapturing the displaced disc in patients with closed lock of the temporomandibular joint? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:274-280.
3. Saitoa T, Yamadaa H, Nakaokaa K, Horiea A, Mishimab A, Nomurac Y, et al. (2010). Risk factors for the poor clinical outcome of visually guided temporomandibular joint irrigation in patients with chronic closed lock. Asian J Oral Maxillofac Surg 22:133-137.
4. Durham J, Exley C, Wassell R, Steele JG (2007). ‘Management is a black art’—professional ideologies with respect to temporomandibular disorders. Br Dent J 202:E29.

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