• Amna Liaqat Avicena Medical and Dental College, Lahore-Pakistan
  • Rubina Sheikh Laiba Dental Clinic Lahore-Pakistan
  • Fatimah Zahra Zia Armed Forces Institute of Dentistry, Rawalpindi-Pakistan
  • Muhammad Umar Rawal Institute of Health Sciences, Islamabad-Pakistan
  • Hina Jabeen Alam Hospital



Key words: s-Temporomandibular joint disorders, intra-articular, corticosteroids, NSAIDs


Background: Temporomandibular disorders (TMD) are a diverse set of musculoskeletal and neuromuscular problems involving the temporomandibular joint complex and surrounding muscles 1. TMD prevalence has varied from one location to the next, with estimates ranging from 6 to 68 % in various types Objectives were to compare the efficacy of NSAIDs with intra-articular injection of corticosteroids in patients suffering from temporomandibular disorders (TMD) due to disc displacement without reduction in terms of mean pain score and mean mouth opening. This Randomized control trial was conducted at the Oral & Maxillofacial Surgery Department, PMC Dental institute, Faisalabad Medical University, Faisalabad, Pakistan, from 6th April 2018 to . 6th April 2019. Methods: All the diagnosed cases of temporomandibular disorder due to disc displacement without reduction were included. Study group (Group1) was injected with 1ml of Triamcinolone acetonide 40mg/ml once, every three weeks & Control group (Group 2) was given Naproxen 550 mg two times a day for 3 weeks. Pain and mouth opening were assessed at initial presentation & then after 3 weeks interval. Results: Total 80 patients were enrolled in the study (40 in each group). The mean age of patients in Control group was 28.73±4.88 years and in study group was 28.68±4.89 years. From 80 patients, 51 (63.80%) were females and 29 (36.20%) were males with 3:1 female to male ratio. Mean pain score was 4.18±0.93 in group 1 and 2.65±0.74 in group 2 after 3 weeks with p-value of 0.0011. Mean mouth opening after 3 weeks was seen as 34.93±1.82 mm in group 1 and 32.28±1.75 mm in group 2 with p-value of 0.0015. Conclusion: Intra-articular injections of corticosteroids are better than NSAIDs in reducing pain and improving mouth opening in patients suffering from TMD due to DDwoR.


Bouchard C, Goulet J-P, El-Ouazzani M, Turgeon AF. Temporomandibular lavage versus nonsurgical treatments for temporomandibular disorders: a systematic review and meta-analysis. J Oral Maxillofac Surg. 2017;75(7):1352-62.

Aldhalai M, Alyami Y, Al Haider Y. Prevalence and severity of temporomandibular joint disorders among populations in Najran Province. World J Dent. 2017;8(2):90-5.

Grossmann E, Poluha RL, Iwaki LCV, Santana RG, Iwaki Filho L. The use of arthrocentesis in patients with temporomandibular joint disc displacement without reduction. PLoS One. 2019;14(2):e0212307.

Doetzer AD, Herai RH, Buzalaf MAR, Trevilatto PC. Proteomic Expression Profile in Human Temporomandibular Joint Dysfunction. Diagnostics. 2021; 11(4):601.


Monaco A, Cattaneo R, Marci MC, Pietropaoli D, Ortu E. Central sensitization-based classification for temporomandibular disorders: a pathogenetic hypothesis. Pain Res Manag. 2017.

Abouelhuda AM, Kim Y-K, Hegazy SA. Non-invasive different modalities of treatment for temporomandibular disorders: review of literature. J Korean Assoc Oral Maxillofac Surg. 2018;44(2):43-51.

Poluha RL, Canales GDlT, Bonjardim LR, Conti PCR. Oral behaviors, bruxism, malocclusion and painful temporomandibular joint clicking: is there an association? Braz Ora Res. 2021;35.

Derwich M, Mitus-Kenig M, Pawlowska E. Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis—A Systematic Review. Int J Mol Sci. 2021;22(14):7405.

Davoudi A, Khaki H, Mohammadi I, Daneshmand M, Tamizifar A, Bigdelou M, et al. Is arthrocentesis of temporomandibular joint with corticosteroids beneficial? A systematic review. Med Oral Patol Oral Cir Bucal. 2018;23(3):e367.

Bordoni B, Varacallo M. Anatomy, head and neck, temporomandibular joint. 2019.

Gil-Martínez A. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res. 2018;11:571-87.

Ouanounou A, Goldberg M, Haas DA. Pharmacotherapy in temporomandibular disorders: a review. J Can Dent Assoc. 2017; 83(7):1-8.

Hersh E, Moore P, Grosser T, Polomano R, Farrar J, Saraghi M, et al. Nonsteroidal anti- inflammatory drugs and opioids in postsurgical dental pain. J Dent Res. 2020; 99(7):777-86.

Kulkarni S, Thambar S, Arora H. Evaluating the effectiveness of nonsteroidal anti‐inflammatory drug (s) for relief of pain associated with temporomandibular joint disorders: a systematic review. : Clin Exp Dent Res. 2020;6(1):134-46.

Pozzi A, Gallelli L. Pain management for dentists: the role of ibuprofen. Annali di stomatologia. 2011;2(3-4 Suppl):3.

Lee MW, Katz PO. Nonsteroidal antiinflammatory drugs, anticoagulation, and upper gastrointestinal bleeding. Clin Geriatr Med. 2021;37(1):31-42.

Ta LE, Dionne RA. Treatment of painful temporomandibular joints with a cyclooxygenase-2 inhibitor: a randomized placebo-controlled comparison of celecoxib to naproxen. Pain. 2004;111(1- 2):13-21.

Machado E, Bonotto D, Cunali PA. Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular joint disorders: a systematic review. Dental Press J Orthod. 2013;18(5):128-33.

Yilmaz O, Korkmaz YT, Tuzuner T. Comparison of treatment efficacy between hyaluronic acid and arthrocentesis plus hyaluronic acid in internal derangements of temporomandibular joint. J Craniomaxillofac Surg. 2019;47(11):1720-7.

Abdrabuh A, Baljon K, Alyami Y. Impact of estrogen therapy on temporomandibular joints of rats: Histological and hormone analytical study. Saudi Dent J. 2021;33(7):608-13.

Thompson NM. The relationship between the use of hormonal contraceptives and ligamentous knee injury in the female collegiate athlete: Rowan University; 2020.

Caldas W, Conti ACdCF, Janson G, Conti PCR. Occlusal changes secondary to temporomandibular joint conditions: a critical review and implications for clinical practice. J Appl Oral Sci. 2016;24:411-9.

Samiee A, Sabzerou D, Edalatpajouh F, Clark GT, Ram S. Temporomandibular joint injection with corticosteroid and local anesthetic for limited mouth opening. Journal of oral science. 2011;53(3):321-5.

Kurita Varoli F, Sucena Pita M, Sato S, Issa JPM, do Nascimento C, Pedrazzi V. Analgesia evaluation of 2 NSAID drugs as adjuvant in management of chronic temporomandibular disorders. Sci World J. 2015;2015.

Derwich M, Mitus-Kenig M, Pawlowska E. Orally administered NSAIDs—general characteristics and usage in the treatment of temporomandibular joint osteoarthritis—a narrative review. Pharmaceuticals. 2021;14(3):219.

Santagata M, De Luca R, Lo Giudice G, Troiano A, Lo Giudice G, Corvo G, et al. Arthrocentesis and sodium hyaluronate infiltration in temporomandibular disorders treatment. Clinical and MRI evaluation. J Funct Morphol Kinesiol. 2020;5(1):18.