Unified disease criteria are useful for assessing disease severity and treatment outcomes; however, at present, there are no adequate unified criteria for temporomandibular disorders. We conducted a review of articles focused on the assessment of treatment criteria for temporomandibular disorders that appeared in volumes 1 to 23 of the Journal of the Japanese Society for the Temporomandibular Joint. Examination items included the number of articles each year, outcome measures and the studies' assessment criteria and comprehensive assessment criteria.
Thirty-seven articles were extracted and 40 outcome measures were used in the articles. Of these 40 cases, pain was adopted in 36 cases, opening range in 36 cases, disability of daily living in 14 cases, and temporomandibular joint sound in 14 cases. As for pain measures, pain assessment during mandibular movement was selected in 9 cases and mandibular pain assessment during rest was selected in 4 cases. In addition, Visual Analogue Scale (VAS) -based assessment criteria were adopted in 10 cases, and assessment criteria using methods other than VAS were selected in 26 cases. One report proposed that the criteria for a successful treatment outcome should be based on an improvement of all examination items while another study proposed that treatment outcomes should be based on the improvement of at least one examination item.
We found that diverse outcome measures and assessment criteria are used in the treatment of temporomandibular disorders and that, in a number of instances, the same treatment outcome was assessed differently. We hope that The Japanese Society for the Temporomandibular Joint will now go ahead and formulate assessment criteria for temporomandibular disorders.

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The treatment of patients with temporomandibular joint (TMJ) symptoms and mandibular lateral deviation due to premature tooth contact includes the relief and elimination of temporomandibular joint symptoms, determination of therapeutic mandibular position after removing premature contact, and occlusal reconstruction to establish a stable centric stop. In this study, for a case of crowding with mandibular lateral deviation and TMJ symptoms, we identified functional lateral eccentric occlusion due to premature contact using the functional wax bite method, and determined the therapeutic mandibular position using a stabilization type splint before initiating orthodontic treatment. The left anteriorly displaced disc was repositioned while wearing the splint. During the period of orthodontic treatment, the therapeutic mandibular position was maintained as much as possible using a bite block. Although TMJ symptoms, such as temporary restriction of mouth opening and uncomfortable feeling in the preauricular area, occasionally occurred during the period of orthodontic treatment, stable occlusion in the therapeutic mandibular position was established after 4 years and 11 months of dynamic orthodontic treatment. Although temporary disturbance of mouth opening occurred during the retention period, stable occlusion was maintained 2 years after retention. This case report suggests the usefulness of orthodontic treatment by which stable occlusion in the therapeutic mandibular position can be established, although long-term careful observation is necessary to avoid the recurrence of TMJ symptoms.

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This report describes the effectiveness of mouth motion exercise combined with pharmacological therapy for temporomandibular joint disc displacement without reduction with limited mouth opening (closed lock). A total of 48 patients were included in this retrospective study. All patients received a verbal explanation of their pathological conditions and self-care protocols, and were then instructed to perform a 5-minute-long mouth motion exercise 3 times per day combined with oral administration of NSAID and muscle relaxant for 2 weeks. As a result, 35 cases (72.9%) showed complete or partial response, 4 cases (8.3%) showed no improvement, and 9 cases (18.8%) dropped out of our treatment regimen, regardless of whether or not they had achieved complete or partial response. These results suggest that patients with temporomandibular joint disc displacement without reduction will improve with mouth motion exercise combined with oral administration of NSAID and muscle relaxant.

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