Mouth-Opening Exercise and Patient Control Use of NSAIDs: Preliminary Study of Disk Displacement without Reduction

Abstract

Objectives: Our previous randomized study showed mouthopening exercises with nonsteroidal anti-inflammatory drugs (NSAIDs) therapy to be effective for temporomandibular joint (TMJ) pain and trismus in cases of disk displacement without reduction [1]. The purpose of this study is to determine whether mouth-opening exercises alone without NSAIDs can improve TMJ pain and trismus and to identify which patient requires supplemental administration of NSAIDs during treatment. Methods: Eighty patients with unilateral TMJ pain and trismus were instructed to perform mouth-opening exercises under a patient controlled use of NSAIDs for 1 week. The patients who took NSAIDs were compared with those who were treated with TMJ exercises alone. Results: Out of the 80 patients who performed mouth-opening exercises, 19 (24%) took NSAIDs while the remaining 61 patients (76%) did not take any pain medications. Two of the patients who took analgesics complained of stomach pain. It was noted that patients had reduced pain with mandibular movements and regained normal function during the study. Significant improvement on maximum mouth opening and quality of life was observed on both groups of patients. Improvement rate in patients who took NSAIDs were higher (37%) than those who did not (26%). Patients with smaller maximum mouth opening significantly took pain medications. Degree of pain on chewing before and after treatment was significantly larger in patients who took NSAIDs than those who did not. However, in total only 23 out of the 80 patients (29%) improved based on the classification of TMJ dysfunction criteria for one week. Conclusions: This study showed that mouth-opening exercises alone can improve TMJ pain and trismus but the need for NSAIDs was unavoidable in cases where symptoms were severe. The treatment regimen of mouth-opening exercises and minimal NSAIDs administration is recommended as a primary treatment for patients with TMJ pain and trismus in cases of disk displacement without reduction. More invasive secondary treatment is recommended for the patients who do not improve after the initial primary treatment.