M Franklin Dolwick1, Daili Diaz2, Danielle L Freburg-Hoffmeister3, Charles G Widmer4. 1. Professor and Academy 100 Eminent Scholar, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Florida, Gainesville, FL. 2. Resident, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Florida, Gainesville, FL. 3. Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Florida, Gainesville, FL. 4. Associate Professor and Parker E. Mahan Facial Pain Endowed Professor, Department of Orthodontics, College of Dentistry, University of Florida, Gainesville, FL. Electronic address: widmer@dental.ufl.edu.
Abstract
PURPOSE: In patients with unilateral intra-articular temporomandibular joint (TMJ) pain, the efficacy of steroid supplementation compared with placebo after TMJ arthrocentesis was examined in a randomized, double-blind, placebo-controlled clinical trial. PATIENTS AND METHODS: Female patients unsuccessfully treated by usual therapy were recruited. After informed consent was obtained, 24 patients were randomly assigned to either the experimental group or placebo group. After local anesthesia, TMJ arthrocentesis, consisting of joint lavage using 100 mL of lactated Ringer solution, was performed by a single investigator. Depending on group assignment, triamcinolone acetonide (steroid) or lactated Ringer solution (placebo) was infused into the superior joint space. Patients, blinded to the procedure, were evaluated at baseline and 2, 6, and 12 weeks after arthrocentesis using a visual analog scale for primary outcome pain measures (pain intensity, pain unpleasantness, and chewing pain). A clinical examination using the Research Diagnostic Criteria for Temporomandibular Disorders was performed at each time point by a separate calibrated, blinded examiner. Data were analyzed using an intention-to-treat model. RESULTS: Significant decreases in visual analog scale pain scores over time were found between baseline and the post-arthrocentesis time points for both groups. The steroid group had significantly less chewing pain at 6 and 12 weeks than the placebo group. Mean maximum mandibular openings without pain or with pain were significantly greater at all post-arthrocentesis time points than at baseline in the steroid group, whereas the placebo group had a larger mandibular opening at 6 weeks. At 12 weeks, significantly more patients in the steroid group (75%) had a nearly normal mandibular opening without pain (38 mm) compared with the placebo group (20%). In addition, the proportion of patients with a greater than 50% improvement in chewing pain in the steroid group (90%) was significantly higher than that in the placebo group (<40%). CONCLUSIONS: The results of this randomized controlled trial support steroid supplementation after TMJ arthrocentesis to achieve longer-lasting pain management and increased pain-free mandibular mobility.
RCT Entities:
PURPOSE: In patients with unilateral intra-articular temporomandibular joint (TMJ) pain, the efficacy of steroid supplementation compared with placebo after TMJ arthrocentesis was examined in a randomized, double-blind, placebo-controlled clinical trial. PATIENTS AND METHODS: Female patients unsuccessfully treated by usual therapy were recruited. After informed consent was obtained, 24 patients were randomly assigned to either the experimental group or placebo group. After local anesthesia, TMJ arthrocentesis, consisting of joint lavage using 100 mL of lactated Ringer solution, was performed by a single investigator. Depending on group assignment, triamcinolone acetonide (steroid) or lactated Ringer solution (placebo) was infused into the superior joint space. Patients, blinded to the procedure, were evaluated at baseline and 2, 6, and 12 weeks after arthrocentesis using a visual analog scale for primary outcome pain measures (pain intensity, pain unpleasantness, and chewing pain). A clinical examination using the Research Diagnostic Criteria for Temporomandibular Disorders was performed at each time point by a separate calibrated, blinded examiner. Data were analyzed using an intention-to-treat model. RESULTS: Significant decreases in visual analog scale pain scores over time were found between baseline and the post-arthrocentesis time points for both groups. The steroid group had significantly less chewing pain at 6 and 12 weeks than the placebo group. Mean maximum mandibular openings without pain or with pain were significantly greater at all post-arthrocentesis time points than at baseline in the steroid group, whereas the placebo group had a larger mandibular opening at 6 weeks. At 12 weeks, significantly more patients in the steroid group (75%) had a nearly normal mandibular opening without pain (38 mm) compared with the placebo group (20%). In addition, the proportion of patients with a greater than 50% improvement in chewing pain in the steroid group (90%) was significantly higher than that in the placebo group (<40%). CONCLUSIONS: The results of this randomized controlled trial support steroid supplementation after TMJ arthrocentesis to achieve longer-lasting pain management and increased pain-free mandibular mobility.