Randomized clinical trial of primary treatment for temporomandibular joint disk displacement without reduction and without osseous changes: A combination of NSAIDs and mouth-opening exercise versus no treatment

doi:10.1067/moe.2001.114005

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 91, Issue 6, June 2001, Pages 671-675

https://doi.org/10.1067/moe.2001.114005 Get rights and content

Abstract

Objective. The effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy for disk displacement without reduction is unknown. This study compared this treatment method with nontreatment controls. Methods. Sixty patients with painful disk displacement without reduction and without osseous changes were randomly divided in 2 groups, consisting of NSAID and physical therapy and a nontreated control group. Both groups were observed at 2 weeks and, for those patients who did not show any improvement, again at 4 weeks. Results. There was 60% improvement in the treatment group compared with 33% in the control group during the entire 4 weeks of the study. The number needed to treat for benefit was 3.75, with a 95% CI 2.103 to 65.935. Conclusions. A combination of NSAID and physical therapy for 4 weeks is effective as a primary treatment of patients with disk displacement without reduction and without osseous changes. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:671-5)

Section snippets

Subjects

This study was conducted at our institution during a 15-month period. From a consecutive series of 662 new patients seen during this period with temporomandibular joint (TMJ) disk displacement, 60 patients were selected. We classified the degree of TMJ dysfunction in 4 categories—no dysfunction, slight dysfunction, moderate dysfunction, or severe dysfunction (Table I).¹²This classification is a modification of the TMJ criteria established by the American Association of Oral and Maxillofacial

Results

According to the classification of TMJ dysfunction, there was no statistically significant difference between the 2 groups on the second week of follow-up. However, at the end of the 4-week period of the study, the treatment group improved by 60% compared with 33% in the control group (Table III, P <.019).

. Changes in TMJ dysfunction in treatment and control groups

Empty Cell	Initial registration	2nd week	2nd and 4th weeks*	Initial registration	2nd
Empty Cell	Treatment group (no. of patients)			Control group (no. of patients)

Discussion

This study proved that a combination of NSAIDs and physical therapy administered for 4 weeks was effective as a primary treatment for patients with disk displacement without reduction and absence of osseous changes. This treatment significantly reduced pain and interference with daily life and improved maximal mouth opening.

In a randomized study, it is important to select patients with TMD on the basis of both clinical and MRI findings. According to our previous study,¹⁶ clinical examination

Conclusion

The combination of NSAIDs and physical therapy administered for 4 weeks proved to be an effective primary treatment for disk displacement without reduction and without osseous changes. The results of this study are applicable to any patient group, because the sex ratio was similar to the incidence of TMD as previously reported.

Acknowledgements

We thank Nobuyuki Hamajima, MD, MPH, of the Aichi Cancer Center Research Institute Laboratory of Epidemio-logy, and Per-Lennart Westesson, MD, DDS, PhD, of the Department of Radiology, University of Rochester School of Medicine and Dentistry, for their assistance.

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^*: Reprint requests: Hidemichi Yuasa, DDS, PhD, The Second Department of Oral and Maxillofacial Surgery, Aichi-Gakuin University, Suemori-Dori, Chikusa-ku, Nagoya 464-8651 Japan, [email protected]

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Oral MedicineRandomized clinical trial of primary treatment for temporomandibular joint disk displacement without reduction and without osseous changes: A combination of NSAIDs and mouth-opening exercise versus no treatment*

Abstract

Section snippets

Subjects

Results

Discussion

Conclusion

Acknowledgements

Temporomandibular disorders: a clinical update

BMJ

The role of pharmacy in the management of patients with temporomandibular disorders and orofacial pain

J Am Pharm Assoc (Wash)

Outcome of 6-week treatment with transcutaneous electric nerve stimulation compared with splint on symptomatic temporomandibular joint disk displacement without reduction

Acta Odontol Scand

Physiotherapy in the treatment of temporomandibular joint disorders: a comparative study of four treatment methods

Br Dent J

The role of the randomized clinical trial in evaluating management strategies for temporomandibular disorders

Temporo-mandibular joint disk displacement without reduction. Treat-ment with flat occlusal splint versus no treatment

Oral Surg Oral Med Oral Pathol

Clinical evaluation of physical therapy in the management of internal derangement of the temporomandibular joint

J Oral Maxillofac Surg

Use of sodium hyaluronate in treating temporomandibular joint disorders: a randomized, double-blind, placebo-controlled clinical trial

J Oral Maxillofac Surg

Temporomandibular joint arthrocentesis and lavage for the treatment of closed lock: a follow-up study

Br J Oral Maxillofac Surg

Oral Medicine
Randomized clinical trial of primary treatment for temporomandibular joint disk displacement without reduction and without osseous changes: A combination of NSAIDs and mouth-opening exercise versus no treatment*