Effects of a single arthrocentesis and a COX-2 inhibitor on disorders of temporomandibular joints

Comparative study in patients with symptomatic internal derangements of the temporomandibular joint: analgesic outcomes of arthrocentesis with or without intra-articular morphine and tramadol

“…13,14 If the drug is given into the joint it avoids the side effects caused by systemic injection, and maximum efficiency is possible as the drug is placed directly on to the damaged tissue. 15 The doses of intra-articular morphine that have been studied are 0.1 mg, l mg, 5 mg, and 10 mg. [16][17][18] An intra-articular dose of morphine 5 mg was satisfactory for arthroscopic meniscectomy. 17 Intra-articular tramadol 50 mg had an effect similar to that of morphine 5 mg in a study of arthroscopic meniscectomy.…”

Intra-articular injection of tenoxicam following temporomandibular joint arthrocentesis: a pilot study

“…Symptomatic temporomandibular disorders (TMDs) are accompanied by accumulation of these mediators in synovial fluid. Once such mediators have accumulated in the intra-articular space, they remain for some time because of the relatively avascular anatomy of the space 12 . Arthrocentesis washes out these inflammatory mediators to relieve pain 8,13 .…”

“…Non-steroidal anti-inflammatory drugs (NSAIDs) have been used to treat acute and chronic inflammatory articular disorders, such as rheumatoid arthritis and osteoarthritis 12 . Their mechanism is thought to be the reduction of biosynthesis of prostaglandins by direct inhibition of cyclo-oxygenase (COX) 27 .…”

“…Prostaglandins also have a role in maintaining normal gastrointestinal, platelet, and renal function 25 . NSAIDs may therefore reduce inflammation in the target tissue, but may increase the risk of complications, such as gastric ulcer, hemorrhagic diathesis and nephrotoxicity when used systemically 12 .…”

“…Combined treatment with arthrocentesis and NSAIDs is logical for an inflamed synovial joint as it removes the inflammatory and associated mediators from the synovial space, alters the intra-articular pressure and thus reduces synovial inflammation 12 .…”