Advertisement

Lavage treatment of painful jaw movements at disc displacement without reduction. A randomized controlled trial in a short-term perspective

Published:November 09, 2012DOI:https://doi.org/10.1016/j.ijom.2012.10.011

      Abstract

      This study compared the short-term efficacy of two treatments (local anesthetics (A) and local anesthetics and lavage (AL)) in patients with permanently displaced discs and temporomandibular disorder (TMD) pain. 45 patients participated in the single-blind randomized controlled trial. All patients had received: a Research Diagnostic Criteria/TMD diagnosis of disc displacement without reduction; and magnetic resonance imaging confirmation of non-reducing disc displacement. Participants were randomized to treatment with A or AL and were assessed at baseline and at 1 and 3 month follow-ups. The primary outcome measure defining success was reduction in pain intensity of at least 30% during jaw movement. At the 3 month follow-up, the success rate was 76% for A and 55% for AL. Both groups reported similar pain relief with no significant difference between the groups. Similar trends were observed for outcome measures in the physical functioning, emotional functioning, and global improvement domains with no significant difference between the groups. Use of lavage to supplement extra-articular local anesthetic treatment of painful jaw movements at non-reducing discs does not appear to improve TMD pain and mouth opening capacity in the short term.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dworkin S.F.
        • LeResche L.
        • DeRouen T.
        • Von Korff M.
        Assessing clinical signs of temporomandibular disorders: reliability of clinical examiners.
        J Prosthet Dent. 1990; 63: 574-579
        • List T.
        • Dworkin S.F.
        Comparing TMD diagnoses and clinical findings at Swedish and US TMD centers using research diagnostic criteria for temporomandibular disorders.
        J Orofac Pain. 1996; 10: 240-253
        • LeResche L.
        Research diagnostic criteria for temporomandibular disorders.
        in: Fricton J.R. Dubner R. Orofacial pain and temporomandibular disorders. Raven Press, New York1995: 189-203
        • Kurita K.
        • Westesson P.L.
        • Yuasa H.
        • Toyama M.
        • Machida J.
        • Ogi N.
        Natural course of untreated symptomatic temporomandibular joint disc displacement without reduction.
        J Dent Res. 1998; 77: 361-365
        • Schiffman E.L.
        • Look J.O.
        • Hodges J.S.
        • Swift J.Q.
        • Decker K.L.
        • Hathaway K.M.
        • et al.
        Randomized effectiveness study of four therapeutic strategies for TMJ closed lock.
        J Dent Res. 2007; 86: 58-63
        • John M.T.
        • Reissmann D.R.
        • Schierz O.
        • Wassell R.W.
        Oral health-related quality of life in patients with temporomandibular disorders.
        J Orofac Pain. 2007; 21: 46-54
        • Haketa T.
        • Kino K.
        • Sugisaki M.
        • Takaoka M.
        • Ohta T.
        Randomized clinical trial of treatment for TMJ disc displacement.
        J Dent Res. 2010; 89: 1259-1263
        • Al-Belasy F.A.
        • Dolwick M.F.
        Arthrocentesis for the treatment of temporomandibular joint closed lock: a review article.
        Int J Oral Maxillofac Surg. 2007; 36: 773-782
        • Kropmans T.J.
        • Dijkstra P.U.
        • Stegenga B.
        • de Bont L.G.
        Therapeutic outcome assessment in permanent temporomandibular joint disc displacement.
        J Oral Rehabil. 1999; 26: 357-363
        • Reston J.T.
        • Turkelson C.M.
        Meta-analysis of surgical treatments for temporomandibular articular disorders: a reply to the discussants.
        J Oral Maxillofac Surg. 2003; 61: 737-738
        • Nitzan D.W.
        • Samson B.
        • Better H.
        Long-term outcome of arthrocentesis for sudden-onset, persistent, severe closed lock of the temporomandibular joint.
        J Oral Maxillofac Surg. 1997; 55 (discussion 157–158): 151-157
        • Nitzan D.W.
        Arthrocentesis – incentives for using this minimally invasive approach for temporomandibular disorders.
        Oral Maxillofac Surg Clin North Am. 2006; 18 (vi): 311-328
        • Guo C.
        • Shi Z.
        • Revington P.
        Arthrocentesis and lavage for treating temporomandibular joint disorders.
        Cochrane Database Syst Rev. 2009; : CD004973
        • List T.
        • Axelsson S.
        Management of TMD: evidence from systematic reviews and meta-analyses.
        J Oral Rehabil. 2010; 37: 430-451
        • Dworkin R.H.
        • Turk D.C.
        • Farrar J.T.
        • Haythornthwaite J.A.
        • Jensen M.P.
        • Katz N.P.
        • et al.
        Core outcome measures for chronic pain clinical trials: IMMPACT recommendations.
        Pain. 2005; 113: 9-19
        • Dworkin S.F.
        • LeResche L.
        Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique.
        J Craniomandib Disord. 1992; 6: 301-355
        • Seymour R.A.
        • Meechan J.G.
        • Blair G.S.
        An investigation into post-operative pain after third molar surgery under local analgesia.
        Br J Oral Maxillofac Surg. 1985; 23: 410-418
        • Farrar J.T.
        • Young Jr., J.P.
        • LaMoreaux L.
        • Werth J.L.
        • Poole R.M.
        Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale.
        Pain. 2001; 94: 149-158
        • Ohrbach R.
        • Larsson P.
        • List T.
        The jaw functional limitation scale: development, reliability, and validity of 8-item and 20-item versions.
        J Orofac Pain. 2008; 22: 219-230
        • Von Korff M.
        • Ormel J.
        • Keefe F.J.
        • Dworkin S.F.
        Grading the severity of chronic pain.
        Pain. 1992; 50: 133-149
        • Ohrbach R.
        • Turner J.A.
        • Sherman J.J.
        • Mancl L.A.
        • Truelove E.L.
        • Schiffman E.L.
        • et al.
        The Research Diagnostic Criteria for Temporomandibular Disorders. IV: evaluation of psychometric properties of the Axis II measures.
        J Orofac Pain. 2010; 24: 48-62
        • Truelove E.
        • Pan W.
        • Look J.O.
        • Mancl L.A.
        • Ohrbach R.K.
        • Velly A.M.
        • et al.
        The Research Diagnostic Criteria for Temporomandibular Disorders. III: validity of Axis I diagnoses.
        J Orofac Pain. 2010; 24: 35-47
        • Schiffman E.L.
        • Truelove E.L.
        • Ohrbach R.
        • Anderson G.C.
        • John M.T.
        • List T.
        • et al.
        The Research Diagnostic Criteria for Temporomandibular Disorders. I: overview and methodology for assessment of validity.
        J Orofac Pain. 2010; 24: 7-24
        • Sessle B.J.
        Acute and chronic craniofacial pain: brainstem mechanisms of nociceptive transmission and neuroplasticity, and their clinical correlates.
        Crit Rev Oral Biol Med. 2000; 11: 57-91
        • Emshoff R.
        Clinical factors affecting the outcome of arthrocentesis and hydraulic distension of the temporomandibular joint.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100: 409-414
        • Alpaslan C.
        • Dolwick M.F.
        • Heft M.W.
        Five-year retrospective evaluation of temporomandibular joint arthrocentesis.
        Int J Oral Maxillofac Surg. 2003; 32: 263-267
        • Yura S.
        • Totsuka Y.
        • Yoshikawa T.
        • Inoue N.
        Can arthrocentesis release intracapsular adhesions? Arthroscopic findings before and after irrigation under sufficient hydraulic pressure.
        J Oral Maxillofac Surg. 2003; 61: 1253-1256
        • Yura S.
        • Totsuka Y.
        Relationship between effectiveness of arthrocentesis under sufficient pressure and conditions of the temporomandibular joint.
        J Oral Maxillofac Surg. 2005; 63: 225-228
        • Murakami K.
        • Hosaka H.
        • Moriya Y.
        • Segami N.
        • Iizuka T.
        Short-term treatment outcome study for the management of temporomandibular joint closed lock. A comparison of arthrocentesis to nonsurgical therapy and arthroscopic lysis and lavage.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995; 80: 253-257
        • Baad-Hansen L.
        • Leijon G.
        • Svensson P.
        • List T.
        Comparison of clinical findings and psychosocial factors in patients with atypical odontalgia and temporomandibular disorders.
        J Orofac Pain. 2008; 22: 7-14
        • Manfredini D.
        • Winocur E.
        • Ahlberg J.
        • Guarda-Nardini L.
        • Lobbezoo F.
        Psychosocial impairment in temporomandibular disorders patients. RDC/TMD axis II findings from a multicentre study.
        J Dent. 2010; 38: 765-772
        • Kaneyama K.
        • Segami N.
        • Nishimura M.
        • Sato J.
        • Fujimura K.
        • Yoshimura H.
        The ideal lavage volume for removing bradykinin, interleukin-6, and protein from the temporomandibular joint by arthrocentesis.
        J Oral Maxillofac Surg. 2004; 62: 657-661
        • Wong J.K.
        • Haas D.A.
        • Hu J.W.
        Local anesthesia does not block mustard-oil-induced temporomandibular inflammation.
        Anesth Analg. 2001; 92: 1035-1040
        • Murakami K.
        • Segami N.
        • Fujimura K.
        • Iizuka T.
        Correlation between pain and synovitis in patients with internal derangement of the temporomandibular joint.
        J Oral Maxillofac Surg. 1991; 49 (discussion 1162): 1159-1161
        • Ayesh E.E.
        • Ernberg M.
        • Svensson P.
        Effects of local anesthetics on somatosensory function in the temporomandibular joint area.
        Exp Brain Res. 2007; 180: 715-725
        • Danzig W.
        • May S.
        • McNeill C.
        • Miller A.
        Effect of an anesthetic injected into the temporomandibular joint space in patients with TMD.
        J Craniomandib Disord. 1992; 6: 288-295
        • Kimura S.
        • Hatano Y.
        • Yokozuka S.
        The effect of the local anesthesia to the posterior ramus of the mandible in patients with temporomandibular joint problems.
        Shigaku. 1990; 78: 63-82
        • Moher D.
        • Schulz K.F.
        • Altman D.
        The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials.
        JAMA. 2001; 285: 1987-1991
        • Haythornthwaite J.A.
        IMMPACT recommendations for clinical trials: opportunities for the RDC/TMD.
        J Oral Rehabil. 2010; 37: 799-806
        • van Selms M.K.
        • Lobbezoo F.
        • Naeije M.
        Time courses of myofascial temporomandibular disorder complaints during a 12-month follow-up period.
        J Orofac Pain. 2009; 23: 345-352
        • Whitney C.W.
        • Von Korff M.
        Regression to the mean in treated versus untreated chronic pain.
        Pain. 1992; 50: 281-285
        • Currie R.
        Arthroscopy for treating temporomandibular joint disorders.
        Evid Based Dent. 2011; 12: 90-91
        • Eriksson L.
        • Westesson P.L.
        Discectomy as an effective treatment for painful temporomandibular joint internal derangement: a 5-year clinical and radiographic follow-up.
        J Oral Maxillofac Surg. 2001; 59 (discussion 758–759): 750-758