Submit Manuscript | http://medcraveonline.com Abbreviations: TMDs, temporomandibular disorders; PD, panic disorder; GAD, generalized anxiety disorder; GCPS, graded chronic pain scale; MRI, magnetic resonance imaging; PHQ, patient health questionnaire; PMR, progressive muscle relaxation Introduction “Temporomandibular disorders” (TMDs) is a collective term for conditions that involve pain and/or dysfunction of the temporomandibular joint (TMJ), and the related structures”. 1 The degenerative changes in the TMJ are due to the inability of the TMJ to withstand the dynamic forces with the help of fexibility of its specifc structure, tissue repair and functional remodeling. 2 The development of revised RDC/TMD Axis I, II diagnostic algorithms were subsequently demonstrated to be valid for the most common temporomandibular joint disorders. The RDC/TMD are based on a biobehavioral model of pain, including two main axes: physical signs and symptoms (axis I) and psychological and disability factors (axis II). 3 The Revised RCD/ TMD suggested a ‘Diagnostic Criteria for the Most Common Intra-articular Temporomandibular Disorders’ as follows- 1. Disc Displacement with Reduction 2. Disc Displacement with Reduction with intermittent locking 3. Disc Displacement without reduction with limited mouth opening 4. Disc Displacement without reduction without limited mouth opening 5. Degenerative joint disease 6. Subluxation 1,3 . Conservative treatments for TMD include medication, occlusal splints, physiotherapy, self-management strategies, and interventions based on cognitive behavioral approaches. 4,5 At present, conservative treatment is preferred over surgery as two have comparable treatment outcomes. Relaxation therapy involves self-regulation techniques to reduce stress, pain and muscle tension. 6 Progressive Muscle Relaxation adapted from Edmund Jacobson (1938) is easy to learn and has been advocated to manage dental anxiety. 7 The process of Progressive Muscle Relaxation is based on the basic principle of muscle physiology, that when a muscle is tensed, releasing the tension will lead to relaxation in the muscle 7 . Muscle Relaxation Techniques have been found to be effective and have been used successfully in the past for providing relief in panic disorder (PD) and generalized anxiety disorder (GAD). 8 Relaxation techniques have been advocated as a strategy for the management of Temporomandibular Disorders and could have a positive infuence on maximal mouth opening and pain, but there is limited evidence for the same. 9 This case report demonstrates this less conventionally used strategy i.e. Progressive Muscle Relaxation Therapy to conservatively manage Non-Reducing Disc Derangement in a young female patient with limited mouth opening. Case report A 15-year-old female patient reported to the Department of Pedodontics and Preventive Dentistry with the chief complaint of pain in front of right ear region and diffculty in eating since 6 months. A detailed case history record was prepared. The patient reported episodes of pain of moderate intensity in the right pre-auricular region since 6months which exacerbated during wide mouth opening and lateral and protrusive movements of the mandible. The pain was relieved slightly with medication. Pain was found to be referred to the jawline and ear region. No headaches were reported. The temporal region, temporalis and trapezius muscles were non-tender on palpation. The masseter and sternocleidomastoid muscles were tender on palpation. Clicking sounds were present during opening movements of the jaw (Figures 1A-1G). Associated reduction in mouth opening was present with vertical incisor overlap of 27mm (Figure 2A). Based on the above-mentioned history and clinical examination a diagnosis of Disc Displacement without reduction with limited mouth opening associated with local myalgia was made (Axis I) [ICD-9 524.63; ICD-10 M26.63]. 3 To establish a baseline for Axis II (Psychosocial parameters) the Patient Health Questionnaire-4 (PHQ- Int J Complement Alt Med. 2020;13(4):180‒183. 180 ©2020 Tyagi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Management of non-reducing disc derangement in a young patient using progressive muscle relaxation technique Volume 13 Issue 4 - 2020 Rishi Tyagi, Namita Kalra, Amit Khatri, Puja Sabherwal, Padma Yangdol Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, India Correspondence: Puja Sabherwal, University College of Medical Sciences, GTB Hospital, Delhi-110095, India, Tel 9999859513, Email Received: May 01, 2019 | Published: August 10, 2020 Abstract Internal derangements of the temporomandibular joint are conditions in which the articular disc has become displaced from its original position over the condylar head. Pain, stress, functional and social handicap are the common reasons for which the patients seek treatment. Various modalities for management include medication, physiotherapy, occlusal splints, self-management strategies, and interventions based on cognitive behavioral approaches. At present, conservative means are preferred to surgical modalities as they are less-aggressive, economical and have comparable successful outcomes. Progressive Muscle Relaxation adapted from Edmund Jacobson (1938) is easy to learn and has been advocated to manage dental anxiety in the past. This article presents a unique case report where this novel technique has been used to manage a young patient with articular disc derangement with a 6-month follow-up showing successful functional and psycho-social rehabilitation of the young patient. Keywords: pain, stress, articular disc derangement, progressive muscle relaxation, novel technique International Journal of Complementary & Alternative Medicine Case Report Open Access