Assessment of three pharmacological agents following arthrocentesis for the treatment of internal derangement of the temporomandibular joint; a clinical study

Abstract

Temporomandibular disorder (TMD) includes disorders of the temporomandibular joint (TMJ) and masticatory muscles and their associated structures. It is characterized by pain, joint sounds and restricted mandibular movement. Pharmacological agents commonly used for the treatment of TMDs include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, muscle relaxants, antidepressants, anticonvulsants and benzodiazepines. Objectives: In the present study, we compared the clinical outcome of intra-articular injections of NSAIDs, corticosteroids, Hyaluronic acid given after temporomandibular joint arthrocentesis. Materials and methods: Twenty-seven patients suffering internal derangement of the temporomandibular joint and not responding to conservative therapy were randomly classified into three equal groups. In group A joint lavage was followed by 1ml of piroxicam injection. In group B joint lavage followed by 1 ml of dexamethasone injection and in group C joint lavage was followed by 1 ml of Hyalgan injection. The treatment outcome was evaluated clinically by measuring the maximal mouth opening in mm at 2 weeks and 3 months postoperatively. Pain was measured using the Visual Analogue Scale at the study intervals. These data were statistically analyzed. Results: All drugs were able to demonstrate a reduction in pain intensity and improvement in mouth opening at 2 weeks and 3 months postoperatively. No significant differences in treatment success were found among the three groups (P > 0.05) through the study intervals. Conclusion: We concluded that arthrocentesis with Piroxicam, dexamethasone or Hyalgan are similarly effective and are promising methods in relieving the symptoms of TMJ with nonreducing disc displacement. Additional prospective studies are required to confirm the adequate dosage of each treatment protocol, frequency of the injections required and combination between those protocols and other modalities in order to achieve long-term results.

Do intra‐articular injections of analgesics improve outcomes after temporomandibular joint arthrocentesis?: A systematic review and meta‐analysis

“…Two studies were excluded as one study compared two different analgesic drugs, 14 while in another trial, the intra‐articular drug was not an NSAID or opioid 15 . A total of nine studies were included in this systematic review 10,16‐23 …”

“…The technique of arthrocentesis was a double puncture in all trials. Five studies used opioids 10,19‐22 while four used NSAIDs 11,17,18,23 . Only three studies specified the number of operators involved in the arthrocentesis procedure 10,18,21 .…”

“…15 A total of nine studies were included in this systematic review. 10,[16][17][18][19][20][21][22][23] Details of the included studies are presented in Table 1. The sample size of the trials varied from seven to a maximum of 20 patients per arm.…”

“…Five studies used opioids 10,[19][20][21][22] while four used NSAIDs. 11,17,18,23 Only three studies specified the number of operators involved in the arthrocentesis procedure. 10,18,21 In the trials of Sipahi et al 21 and Yavuz et al, 18 a single operator was involved in all procedures while two operators performed the arthrocentesis in the study of Prager et al 10 For this review, we extracted outcome data for 1 week, 1, 3, and 6 months of follow-ups.…”

“…Of the four studies 11,17,18,23 evaluating post-arthrocentesis NSAID injections, Aktas et al 11 did not report pain and MMO outcomes as mean and standard deviation. The authors were contacted via email but no response was received.…”