Nitrous Oxide-Oxygen Sedation in the Diagnosis and Treatmentof Temporomandibular Joint Locking: A Clinical and Methodological Study

Abstract

Temporomandibular joint locking due to anterior disk displacement may be associated with pain and discomfort. One way to correct this condition clinically is to manipulate the mandible. Manipulation is often simple and relatively painless. Sometimes, however, it is so painful and/or the patient is so anxious that sedation must be given. Nitrous oxide/oxygen (N₂O/O₂) produces a state of sedation with complete or partial analgesia but with maintenance of consciousness and adequate protective reflexes.

Anterior disk displacement with locking may sometimes be difficult to distinguish from restricted mobility due to other causes. Nitrous oxide, with its sedative and analgesic effect under full communicability between patient and operator, is then a useful aid to differential diagnosis.

This clinical study concerns the methods and results of diagnosis and treatment of temporomandibular joint locking under N₂O/O₂ sedation. The study includes 10 patients with reduced opening and a subjective feeling of locking in one or both temporomandibular joints. After a thorough case history, including the location and onset of symptoms, and clinical and radiological examination, the mandible was manipulated under N₂O/O₂ sedation. After sedation manipulation could be performed without difficulty in all cases. The average opening increased dramatically after treatment in six patients, and the cause of the patients' symptoms could be established.

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Notes on contributors

Martti Helkimo

Martti Helkimo, D.D.S., Odont. Dr.

Dr. Helkimo received his D.D.S degree in 1966 from the University of Umeȧ. He received his Odont. Dr. in 1974 from the University of Göteborg, where he later became associate professor of the Department of Stomatognathic Physiology. He spent one year as a visiting associate professor atthe University of Michigan before accepting the position of professor and chairman of the Department of Stomatognatic Physiology at the University of Umeȧ. Since 1979, he has served as head of the Department of Stomatognathic Physiology at the Institute for Post-Graduate Dental Education in Jönköping, Sweden. He has given lectures in Europe, North America, and South America, has published numerous papers, and is a member of severalprofessional organizations, including the Swedish Dental Association, Swedish Society of Prosthetic Dentistry and Stomatognathic Physiology, and the Society for Oral Physiology.

Anders Hugoson

Anders Hugoson, D.D.S. Odont. Dr.

Dr. Hugoson received his D.D.S. degree in 1962 from the University of Umeȧ, School of Dentistry, Sweden. He received his Odont. Dr. in 1970 after presenting his thesis “Gingival inflamation and female sex hormones.”

He has worked in private practice, and on the faculties at the University of Umeȧ and Göteborg as associate professor of the Department of Periodontology. Since 1972 he has served as head of the Department of Periodontology at the Institute for Postgraduate Dental Education in Jönköping, Sweden, and since 1975 he has also been the Director of the Institute.

He has given numerous postgraduate courses and lectures in Scandinavia, Europe, North and South America. He has published about 80 papers and is a member of several professional organizations including the Swedish Dental Association, the Swedish and Scandinavian Societies for Periodontology and the Federation Dentaire Internationale.