Stage V of the Piper Classification includes those patients who have perforated their retrodiscal attachment. These patients will fall into Stage Va, so-called acute patients and Stage Vb, so-called chronic patients. Stage Va patients have developed an acute perforation in their retrodiscal attachment. They tend to have a very inflamed temporomandibular joint. They may have significant effusion and significant alteration in breakdown which progresses rather rapidly along the articular surfaces. Because of the generally increased level of inflammation, they typically have higher levels of pain.