ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title TMJ Injection Of Local Anesthetic And Corticosteroid Is Effective In The Management Of Limited Mouth Opening For A Patient With Acute TMJ Disc displacement (closed-lock)
Clinical Question For a patient with an acute TMJ disc displacement (closed-lock), would TMJ injections with local anesthetic and corticosteroid result in less pain and more mouth opening when compared to no injections?
Clinical Bottom Line Injection of local anesthetic and corticosteroid is an effective treatment option for patients with acute TMJ disc displacement (closed-lock) in increasing mouth opening. Results in the management of pain reported with visual analog scores were not statistically significant.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21959659Samiee/201117 patients between ages 16 and 70 years with a diagnosis of disc displacement without reductionRetrospective Chart Review
Key resultsActive mouth opening before injection ranged from 15 to 40 mm (average 20 mm; SD 6.51), and active mouth opening after injection and manual mobilization ranged from 25 to 50 mm (average 39 mm; SD 6.54). Average increase in mouth opening was 10 mm (P=0.0004). Visual analog scales for pain were only available for 14 patients. VAS score ranged from 4 to 10 (average 8) on a scale of 10 before injection and from 2 to 7 (average 4) after injection; the difference was not statistically significant.
Evidence Search ("Temporomandibular Joint Disorders"[Mesh]) AND "Anesthetics, Local"[Mesh]
Comments on
The Evidence
The Samiee retrospective chart review had clearly identified similar patients at the start of the study. Exposure and outcomes of the patients selected were measured identically and the only follow-up noted was one week after TMJ injections. Treatment with TMJ injections resulted in statistically significant evidence of improved mouth opening (P=0.0004), while the VAS pain scores were statistically insignificant. The major limitation of the evidence presented is lack of controlled trials comparing TMJ injections relative to no TMJ injections and other proven therapies such as hyaluronic acid or arthrocentesis.
Applicability The evidence indicates that it will benefit a patient suffering from TMJ disc displacement without reduction, as a conservative treatment approach to receive TMJ injections of local anesthetic and corticosteroids in improving mouth opening especially before consideration of more invasive surgical techniques.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords temporomandibular joint, temporomandibular joint disorder, local anesthetic, TMJ injection, lidocaine, triamcinolone acetonide, corticosteroid
ID# 2222
Date of submission: 04/26/2012spacer
E-mail nguyenhoang@livemail.uthscsa.edu
Author Luong Nguyen-Hoang
Co-author(s) Ernest Valdez, DDS
Co-author(s) e-mail ValdezE@uthscsa.edu
Faculty mentor/Co-author Edward F. Wright, DDS, MS
Faculty mentor/Co-author e-mail WrightE2@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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