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
PubMed ID Author / Year Patient Group Study type (level of evidence) 21959659 Samiee/2011 17 patients between ages 16 and 70 years with a diagnosis of disc displacement without reduction Retrospective Chart Review Key results Active 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	(General Dentistry) (Oral Surgery)
Keywords	temporomandibular joint, temporomandibular joint disorder, local anesthetic, TMJ injection, lidocaine, triamcinolone acetonide, corticosteroid
ID#	2222
Date of submission	04/26/2012
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	Edward F. Wright, DDS, MS
Faculty mentor 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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available