ABSTRACT
Temporomandibular Joint (TMJ) arthritis affects the joint and the surrounding musculature. Like any other joints, causes of temporomandibular joint arthritis could be rheumatoid arthritis, osteo arthritis, or psoriatic arthritis. Severity of the disease differs from each other ranging from mild to severe. In case of temporomandibular joint trauma, it may lead to degeneration of the joint which may result in ankylosis of the joint if it is left untreated. In case of inflammatory arthropathies, even after the treatment, inflammation of the joint still persists. To suppress the inflammation, patients can be prescribed immunosuppressive treatment. Long term use of immunosuppressants is deleterious and may lead to failure of organs. One more adverse effect of immunosuppressive drugs is that it makes the patient prone for infections if the patient undergoes surgery. Symptoms of temporomandibular joint arthritis include pain on involved side, restricted mouth opening, and difficulty in eating. Origin of pain may be from the joint itself or from the muscles attached to it or from both. The patient will complain of mild to severe pain. The objective of this study is to assess TMJ arthritis in those with above said inflammatory arthropathies. This article is to highlight the peculiarities of TMJ arthritis secondary to those inflammatory arthropathies and how to best manage these ailments, which should guide when referral to a specialist TMJ surgeon is appropriate. The aim of this review is to discuss about the various causes of TMJ arthritis, etiopathogenesis, clinical features, investigations and the management of temporomandibular joint Arthritis.
ABSTRACT
Application of arch bar is considered as a gold standard for intermaxillary fixation (IMF) in the management of mandibular fractures. Both the application and removal of arch bars can inflict pain for patients who require IMF. For removal of the arch bars, local anaesthesia (local infiltration or conduction block) is often indicated. The study aimed at comparing and validating the efficacy of topical lidocaine spray and benzocaine gel in patients undergoing removal of arch bars. METHODS30 subjects were included in this prospective randomized controlled trial. Maxillary arch was chosen as the test site. 10 patients (Group A) were anaesthetized in the upper gingiva with 15 % lidocaine spray and remaining 10 patients (Group B) were anaesthetized with 20 % benzocaine gel, following which removal of arch bar was done. 10 patients were included in the control group (Group C) where 2 % lignocaine infiltration was offered only on request. Visual analog scale and Wong-Baker Faces Pain Rating Scale was used to measure the pain perceived by the patient during the procedure. RESULTSThe mean and standard deviation of the pain scores of Group A was 2.5 ± 0.70, Group B was 2.7 ± 0.67 and Control group was 5.5 ± 0.85. Both the test groups had a significant pain reduction when compared with the control group. CONCLUSIONSTopical application of both 15 % lidocaine spray and 20 % benzocaine gel provided equally efficient analgesia and can be useful alternatives to conventional local anaesthetic infiltration during arch bar removal.