Steroid Treatment for Temporomandibular Joint (TMJ) Disorder
Intra-articular glucocorticoid injections are not recommended as first-line treatment for TMJ disorders but may be indicated in arthritis-induced refractory and symptomatic TMJ dysfunction, particularly in skeletally mature patients. 1
First-Line Treatment Approach
- NSAIDs are conditionally recommended as initial therapy for TMJ pain and inflammation, though trials should be brief due to potential adverse effects 1, 2, 3
- Occlusal splints/mouthguards are beneficial for patients with TMJ dysfunction as a reversible, safe, and low-cost intervention 1, 2, 3
- Physical therapy and jaw exercises are recommended to improve range of motion and reduce stiffness in TMJ disorders 1, 3
- Conservative measures including jaw rest, soft diet, and heat/cold application should be implemented during acute flare-ups 3
When to Consider Steroid Treatment
- Intra-articular glucocorticoid injections should be considered only after failure of conservative measures 1
- Steroids are indicated specifically for arthritis-induced refractory and symptomatic TMJ dysfunction 1
- The decision to use intra-articular steroids must consider the patient's skeletal maturity, as they are not recommended as first-line management in skeletally immature patients 1, 2
Steroid Administration for TMJ
- For intra-articular TMJ injections, triamcinolone acetonide is commonly used at doses of 5-15 mg depending on joint size 4
- Careful technique must be employed to avoid entering blood vessels or introducing infection 4
- Prior use of a local anesthetic may be desirable before intra-articular injection 4
- Strict aseptic technique is mandatory for all intra-articular injections 4
Expected Outcomes and Duration of Effect
- Methylprednisolone injections in the TMJ alleviate pain and improve mouth opening capacity for approximately 3 weeks 5
- The effects of intra-articular glucocorticoid injections on TMJ dysfunction are highly variable and temporary 1, 6
- Complete resolution of orofacial pain after steroid injection is rare, suggesting a palliative rather than curative effect 6
- The short-term improvements in signs and symptoms are often partly resolved at long-term follow-up 6
Alternative Approaches
- Intra-articular lavage (without steroids) may be beneficial for TMJ arthritis-related symptoms and dysfunction in both growing and skeletally mature patients 1
- Recent research suggests betamethasone may be among the most effective corticosteroids for reducing TMJ pain at one and three months 7
- For patients with juvenile idiopathic arthritis affecting the TMJ, conventional synthetic DMARDs are strongly recommended for inadequate response to NSAIDs and/or intra-articular glucocorticoids 1, 2
Important Considerations and Pitfalls
- Intra-articular steroid injections can cause potential adverse effects including tissue atrophy if not properly administered 4
- Some studies suggest corticosteroids may have negative effects on articular cartilage 8
- Arthrocentesis alone effectively reduces pain and improves jaw function in patients with TMJ osteoarthritis, with additional steroid injections not necessarily improving final clinical outcomes 8
- Injection into an infected site should be avoided, and appropriate examination of joint fluid is necessary to exclude septic processes 4