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Table 1 Flow chart describing the standard treatment protocol of patients who have TMJ pain and dysfunction

From: A stepped approach for the management of symptomatic internal derangement of the temporomandibular joint

1. A detailed history, evaluation of head and neck, panoramic films to demonstrate temporal bone and condylar morphology
2. If indicated, consultations with ear, nose and throat surgery; neurology; physical medicine and rehabilitation; internal medicine; and restorative dentistry as appropriate
3. Advices included soft diet, limiting their mouth opening and not to chew gum for 6 weeks
4. Ibuprofen (200 mg tds for 6 weeks) was the drug of choice for TMJ pain, and if necessary muscle relaxants were added (maximum for a period of 10 days)
5. Patients with a clenching habit were provided with mouth guards for use while sleeping
6. Review appointment was within 6 to 8 weeks to monitor the patients’ progress.
7. MRIs were requested from symptomatic patients with a clinical diagnosis of internal derangement. Patients with ongoing symptoms refractory to conservative treatment and MRI confirmed internal derangement were listed for arthrocentesis of the effected joint under local anaesthesia
8. Post-operatively patients were regularly reviewed and those with persisting symptoms beyond 6 months were listed for arthroscopic lysis and lavage
9. Post-operative reviews