Joint Intracapsular Disorders: Diagnostic and Nonsurgical Management Considerations

The treatment goals for managing intracapsular disorders of the temporomandibular joint have changed over the past 20 years. There is no longer an attitude that all discs must be properly positioned to maintain a healthy joint. Therapies for re-establishing disc position, for the most part, have failed. On the other hand, patients seem to adapt to abnormal disc positions and function relatively normally. Intracapsular disorders seem to follow a natural course that is influenced by many factors. Therapy does not seem to radically change this course. However, therapy can reduce the suffering that accompanies some of the stages of these disorders. It is the therapist's role to intervene when possible to decrease suffering. Reversible therapies are often adequate and should be attempted first. Only when reversible therapies fail to adequately reduce suffering should more aggressive therapies be considered. When suffering continues, re-evaluation of the clinical condition is necessary to assure that more aggressive therapy effectively alters the symptoms.