From the Guidelines
There is limited evidence supporting the use of cortisone (corticosteroid) injections for treating temporomandibular joint (TMJ) dysfunction, and they should only be considered in skeletally mature patients with active TMJ arthritis and orofacial symptoms who have had an inadequate response to other treatment modalities. These injections may provide short-term pain relief and reduced inflammation in some patients with inflammatory conditions of the TMJ, but their long-term effectiveness remains questionable 1. When used, methylprednisolone (20-40mg) or triamcinolone (10-20mg) are typically injected directly into the joint space, often combined with a local anesthetic like lidocaine. The procedure should be performed by specialists experienced in TMJ injections using proper anatomical landmarks or imaging guidance.
Some key points to consider when using corticosteroid injections for TMJ dysfunction include:
- They should be used with caution, especially in skeletally immature patients, due to potential side effects including cartilage damage, facial skin atrophy, and joint deterioration with long-term use 1.
- Patients might experience temporary relief lasting several weeks to months, but repeated injections are generally not recommended 1.
- Corticosteroid injections work by suppressing inflammatory mediators within the joint, potentially reducing pain and improving function temporarily 1.
- These injections should be considered as part of a comprehensive treatment approach that includes physical therapy, occlusal splints, and addressing contributing factors like bruxism rather than as a standalone treatment for TMJ dysfunction 1.
It is essential to weigh the potential benefits and risks of corticosteroid injections for TMJ dysfunction and to consider alternative treatment options before making a decision. The use of corticosteroid injections should be individualized and based on the specific needs and circumstances of each patient.
From the Research
Evidence for Cortisone Injections in TMJ Dysfunction
- There is evidence to suggest that cortisone injections can be effective in treating Temporomandibular Joint (TMJ) dysfunction, particularly in reducing pain and improving function 2, 3, 4.
- A systematic review and network meta-analysis found that betamethasone and arthrocentesis plus dexamethasone were the most effective in managing pain in the short and medium term compared to arthrocentesis 2.
- An observational study found that injections of triamcinolone acetonide and hyaluronic acid were effective in relieving pain and clicking sounds in patients with TMJ arthritis 3.
- A study on patients with rheumatoid arthritis found that corticosteroid injections in the TMJ alleviated pain and improved function, with the clinical improvement lasting for approximately 3 weeks 4.
Types of Corticosteroids Used
- Different types of corticosteroids have been used in the treatment of TMJ dysfunction, including betamethasone, dexamethasone, methylprednisolone, and triamcinolone acetonide 2, 3, 4.
- The choice of corticosteroid may depend on the specific condition being treated and the individual patient's response to treatment.
Comparison with Other Treatments
- Corticosteroid injections have been compared to other treatments, such as hyaluronic acid injections and arthrocentesis, with varying results 2, 3, 5.
- A study found that sodium hyaluronate injections were more effective in decreasing pain intensity than corticosteroids in patients with osteoarthritis of the TMJ 5.