Osteoarthritis of the temporomandibular joint: an evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate.
The purpose of this study was to compare the efficacy and the complications of intra-articular temporomandibular joint (TMJ) injections in 40 patients with osteoarthritis of the TMJ. The subjects were randomly divided into two groups, and the patients received either two intra-articular injections with sodium hyaluronate or two intra-articular injections with corticosteroids, 14 days apart. The effect of the treatment was evaluated 14 days, 1 and 6 months after the initial injection and was based on the following measurements: pain intensity, pain localization, joint sounds, mandibular function and complications. Both groups of patients had less pain intensity at the 6-month follow-up, and there was significantly less pain intensity in the group of patients receiving sodium hyaluronate compared with corticosteroids (P = 0.001). A decrease in crepitation was seen in both groups. In the 20 subjects receiving sodium hyaluronate both the mandibular vertical opening and protrusion increased significantly (P < 0.000). Lateral movement from the affected side increased both in subjects injected with sodium hyaluronate (P = 0.024), and those injected with corticosteroids (P = 0.042). In conclusion, this study confirms that injections in the TMJ with sodium hyaluronate or corticosteroids may reduce pain and improve function in patients with osteoarthritis. The injections were more effective in patients with only TMJ pain compared with patients suffering from both TMJ and myofascial pain. Injection with sodium hyaluronate was significantly more effective in decreasing pain intensity than corticosteroids. Temporary pain after injections may be observed.
Bjørnland
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Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway. tore.bjornland@odont.uio.no
Gjaerum
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Møystad
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D000276:Adjuvants, Immunologic / Q000009:adverse effects / Q000627:therapeutic use*; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018771:Arthralgia / Q000188:drug therapy / Q000209:etiology; D004812:Epidemiologic Methods; D005157:Facial Pain / Q000150:complications; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D013705:Temporomandibular Joint Disorders / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D014716:Vertical Dimension
D000276:Adjuvants, Immunologic; D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D006820:Hyaluronic Acid