Arthrocentesis vs nonsurgical methods in the treatment of temporomandibular joint pain and closed lock. A randomized controlled trial

INTERVENTION: 60 individuals with internal joint disorders with pain and mouth opening limitation will be random in 4 groups of 15 patients each for treatment of joint disorder: 1. Control group; Exclusive conservative treatment consisting of pasty diet, compresses, physiotherapy and habit control. 2. Joint washing; In addition to conservative treatment, a single wash of the affected temporomandibular joint with 200 ml of saline will be performed. 3. Wash with 200 ml of saline, conservative treatment and therapy with non‐steroidal anti‐inflammatory drugs for 30 consecutive days. 4. Nonsteroidal anti‐inflammatory drugs. for 30 consecutive days and conservative treatment. All patients will be aspirated 2 ml synovial fluid preoperatively and one month after treatment. All patients receive medicines to protect the intestinal mucosa. Follow up will be for six months. Anti‐Inflammatory Agents, Non‐Steroidal Arthrocentesis Drug Physical Therapy Modalities Procedure/surgery CONDITION: M00‐M99 Temporomandibular Joint Dysfunction Syndrome Temporomandibular Joint Dysfunction Syndrome, Diseases of the musculoskeletal system and connective tissue ; Temporomandibular Joint Dysfunction Syndrome PRIMARY OUTCOME: To evaluate the effectiveness of each treatment in increasing the mandibular opening verified by the interincisal distance in millimeters over a period of six months To evaluate the effectiveness of each treatment in reducing temporomandibular pain during mandibular opening using the visual analog scale (VAS) method, where we will observe on a scale from 0 to 10 the rate of auricular pain decrease over a period of six months. SECONDARY OUTCOME: To evaluate the effectiveness of each treatment in reducing temporomandibular pain during mandibular protrusion and laterality using the analogous visual scale (VAS) method, where we will observe on a scale from 0 to 10 the rate of pre‐auricular pain decrease over a period of six months To evaluate the influence of changes in the position of the articular disc in the treatment to reduce temporomandibular pain and increase mandibular opening using the analogous visual scale (VAS) 0 to 10 and interincisal distance in millimeters comparing the the presence or absence of any internal joint change. To evaluate the influence of the instituted treatments on the reduction of inflammatory agents (immunoglobulins) in the synovial fluid, comparing the preoperative samples and one month after treatment. ; ; ; Identify the inflammatory molecules present in temporomandibular disorders. INCLUSION CRITERIA: Patients older than 18 years and younger than 67; presenting at least 4 points corresponding to joint pain in the visual analogue scale (VAS); with mouth opening at less or equal than to 35 mm; with a history of joint locking; progressive decrease of mouth opening and joint noises