Conservative management of degenerative temporomandibular joint disease in the elderly

Degenerative arthropathy and rheumatoid disease produce significant morbidity in elderly dental patients. Clinical and radiographic examination usually indicates the nature and extent of the disease in the temporomandibular joints and provides the basis for graduated treatment. Conservative measures are generally more acceptable and most successful in the elderly patient with pain, limitation of opening and grating of the joint. Acute-onset arthritis is relieved by local anaesthetics, non-steroidal anti-inflammatory drugs and occlusal adjustment. Occasionally, intra-articular steroids are needed; these provide prolonged relief from pain and stiffness. Remedial exercises, in conjunction with physical therapy, should be continued after resolution of the acute attack or used as primary treatment for chronic arthropathy. A small proportion of cases remain resistant to conservative treatment; blind condylotomy (surgical sectioning) of the affected condylar neck is a safe, effective procedure for refractory cases which do not respond to the conservative regimen described. This procedure may be used for degenerative arthropathy and also for chronic dislocation which has failed to respond to peri-articular injection of sclerosing agents. Rheumatoid disease in the jaw should be treated in conjunction with the medical therapist when other joints are involved.