When should injections or surgical options be considered in TMD management?

• A. Only after conservative care has failed.
• B. As first-line therapy.
• C. In all patients regardless of response.
• D. Only if the patient requests.

Answer: (B)

In managing TMJ disorders, the approach is guided by how severe the symptoms are and what the joint looks like on exam and imaging. Many cases improve with conservative care first, but there are situations where directly addressing the joint with injections or surgical options can be appropriate early in the plan. When there is clear joint pathology (for example, inflammatory or degenerative changes) and significant pain or functional limitation that is unlikely to respond quickly to noninvasive measures, interventional treatments can provide more rapid relief and restore function. This is especially true if conservative options have been tried or are limited by patient factors, and after a careful discussion of risks, benefits, and alternatives. In short, injections or surgery may be considered early in selected patients who have objective joint pathology and substantial symptoms, rather than applying them universally.