Use and misuse of intra-articular corticosteroids in treatment of temporomandibular joint pain.

In certain cases of intractable pain in the temporomandibular joint after conservative treatments have been unsuccessful, a single intra-articular injection of up to 40 mg of prednisolone trimethylacetate has been shown to be useful for permanent relief. This treatment has most success in patients over the age of 30 years; the older the patient the greater likelihood of clinical improvement. It is not to be recommended in the younger age groups. There is no evidence that a single intra-articular injection of any such corticosteroid causes damage that can be detected radiographically to an apparently sound articular surface. But it is still possible that multiple injections can cause damage, and they should not be used for any age group. In some cases where there is radiographic evidence of articular erosion before treatment, an advance of the lesion with reduction of the size of the mandibular condyle can be expected but is consistent with a reduction of the symptoms. The final result may be said to resemble a pharmacologically-achieved arthroplasty. Judgment of the success of the treatment by symptomatic assessment has proved to be entirely satisfactory, since the majority of patients have been grateful for the initial and continued relief of their pain and dysfunction. They have, in fact, avoided surgery to their joints and have no untoward side-effects.