Effects of intra-articular corticosteroid injection on the temporomandibular joint: a narrative review

Introduction

Temporomandibular joint (TMJ) disorders affect a significant portion of the population in the United States that ranging from 5% to 12%. It includes symptoms like jaw clicking and popping, headache, neck pain, and is notably twice as prevalent in females as in males (1). TMJ disorders can be categorized as extra- or intra-capsular. The prevalence of intra-capsular TMJ disorders is about 80% of all the symptomatic cases. Treatment modalities for TMJ disorders include a wide range of therapies from conservative techniques like physiotherapy, occlusal splints and anti-inflammatory drugs, as well as minimally invasive approaches that include arthrocentesis and intra-articular corticosteroid injections (IACIs). In severe cases, invasive techniques such as discectomy, high condylectomy and arthroplasty may be performed; among these treatments, IACIs is one of the most used therapies to manage internal TMJ disorders. IACIs, which were integrated into clinical practice during the 1950s, are esteemed for their robust anti-inflammatory properties, delivering relief in both acute and chronic presentations of TMJ disorders. Steroid injections were first reported for TMJ treatment in the 1950s and 1960s. In the UK, Paul Toller’s early histological studies described the patterns of disc degeneration and osteoarthrosis associated with intra-articular therapies (2,3). Even though these injections are efficient for reducing pain as a short-term goal, studies reveal that long-term administration of corticosteroid injections has led to TMJ bone and disc changes and cartilage destruction, thereby worsening the joint condition. This literature review consolidates current insights regarding both the short-term efficacy and long-term hazards associated with IACIs, with a specific focus on vulnerable populations such as children diagnosed with juvenile idiopathic arthritis (JIA). We present this article in accordance with the Narrative Review reporting checklist (available at https://joma.amegroups.com/article/view/10.21037/joma-25-6/rc).

Methods

This narrative review compiles evidence from peer-reviewed studies and clinical reports on IACIs for TMJ disorders. A literature search was conducted by the authors across PubMed, Scopus, and Google Scholar, focusing on articles published within the last two decades. Search terms included combinations of MeSH and free-text terms such as “corticosteroid”, “intra-articular injection”, “TMJ”, “adverse effects”, “disc degeneration”, “bone resorption”, and “long-term outcomes”. Studies were selected based on relevance to corticosteroid injection outcomes in TMJ disorders, including effects on joint structure, pain, function, and comparative therapies. Clinical trials, cohort studies, case series, retrospective studies, systematic reviews, and key narrative reviews were considered (Tables 1,2). The initial search retrieved 120 articles. After removing duplicates and screening titles/abstracts, 82 full texts were assessed. From these, 55 articles were included in the evidence synthesis, supporting the analysis and summary tables. Of those, 27 articles were directly cited in the final manuscript to represent the most clinically and scientifically impactful findings (Table 3).

Rationale

The current knowledge gap lies in the lack of a comprehensive synthesis distinguishing short-term benefits from long-term risks. Most existing reviews and clinical discussions focus primarily on immediate outcomes such as pain relief and improved mouth opening, often neglecting the structural or developmental implications of repeated or high-dose corticosteroid use. Furthermore, inconsistencies in the study designs, patient populations, corticosteroid types and dosages, and imaging follow up protocols have made it difficult to draw clear evidence-based clinical guidelines. This narrative review aims to address a key gap in the current understanding of IACIs for TMJ disorders by examining their effects over both the short and long term. Drawing from studies involving both adult and pediatric populations, it brings together clinical outcomes and imaging-based evidence—including magnetic resonance imaging (MRI) findings related to joint structure and development. In doing so, it highlights not only the potential benefits of corticosteroid therapy, such as pain relief and improved joint function, but also the possible risks, including heterotopic bone formation (HBF), condylar destruction, and inhibited mandibular growth, especially in younger patients. Unlike earlier reviews that have often focused on either short-term effects or specific subgroups like children with JIA, this review takes a broader view. Evaluating therapeutic outcomes alongside reported complications across a wider time frame offers a more complete picture of how corticosteroid injections affect the TMJ. Additionally, it takes a critical look at the limitations in current research—such as inconsistent study designs, small sample sizes, and varying outcome measures—with the goal of helping clinicians and researchers make more informed decisions moving forward.

Mechanism of action of IACI

Natural steroid

Corticosteroid belongs to the group of hormones produced by the cortex of the adrenal glands. They are further categorized into different types based on their function, i.e., glucocorticoid that helps in regulating carbohydrate metabolism, mineralocorticoids to maintain the electrolyte balance and androgenic sex hormones. The first administration of cortisone happened in 1948, when Dr. Philip S. Hunch injected it into a 29-year-old woman who was bedridden due to active rheumatoid arthritis. The patient showed remarkable improvement in her condition and was able to walk after three days of treatment (4).

Understanding IACIs in TMJ disorders

IACIs represent a well-established therapeutic approach for managing inflammation within the TMJ. Corticosteroids commonly used in intra-articular injections for treatment of TMJ disorders are methylprednisolone, triamcinolone acetonide, and betamethasone, to name a few. They operate by inhibiting the secretion of pro-inflammatory cytokines and enzymes, thereby debilitating the inflammatory response and providing symptomatic relief. These injections are typically administered to individuals afflicted with TMJ osteoarthritis (OA), internal derangement, and systemic inflammatory disorders affecting the TMJ. The TMJ constitutes a complex synovial joint crucial for mastication and phonation. Inflammation within this joint, whether attributable to local mechanical factors or systemic pathology, can result in incapacitating pain and diminished joint mobility. In such instances, corticosteroid injections are utilized to alleviate synovial inflammation and restore joint function. While these injections offer a relatively non-invasive alternative to surgical procedures, their application is frequently constrained by concerns regarding long-term safety, particularly in pediatric patients, in whom the TMJ is vital for mandibular development.

Mechanism of action of corticosteroid injections

The mechanism of action of corticosteroids involves inhibiting the production of inflammatory mediators like prostaglandins and leukotrienes, which are produced through the enzyme phospholipase A2. This enzyme is responsible for the synthesis of arachidonic acid, a precursor for these inflammatory molecules, and by blocking it, corticosteroids help reduce inflammation in the TMJ. In addition to reducing inflammatory mediators, corticosteroids also suppress the activity of immune cells in the TMJ, preventing the release of cytokines and other cells that are responsible for causing inflammation. This decreased immune response helps to prevent further joint damage. The anti-inflammatory and immunosuppressive effects of corticosteroids are dose-dependent, with immunosuppression effects seen at higher doses (29). Another key effect is the reduction in blood vessel permeability, which limits fluid leakage into the surrounding tissues, helping to alleviate swelling and joint stiffness. While corticosteroids can inhibit collagen production and reduce scar tissue formation in the joint, prolonged use can negatively impact joint integrity by impairing the repair process. Finally, by reducing inflammation, corticosteroids help to decrease the stimulation of pain-sensitive nerves in the TMJ, providing relief from both acute and chronic pain.

Genomic and non-genomic effects and glucocorticoid receptor (GR)

The GR has three key domains: N-terminal, DNA-binding, and ligand-binding. Inactive GR resides in the cytoplasm but moves to the nucleus upon ligand binding. Once inside the nucleus, it regulates genes by binding to glucocorticoid response elements or interacting with transcription factors like NF-κB and AP-1, reducing pro-inflammatory mediators. While GR traditionally represses inflammation through transrepression, it can also activate anti-inflammatory genes like IL-10. Additionally, at high doses, glucocorticoids cause rapid non-genomic effects by altering membrane properties or binding to membrane GRs, leading to fast immunosuppressive actions. (4)

Hypothalamus-pituitary-adrenal (HPA) axis suppression and glucocorticoid

The HPA axis is the main stress response system. The primary function of the activated HPA axis is to release glucocorticoids that activate short-term physiological responses to stress (5). These hormones are made on demand since the body doesn’t store them in large amounts. Their production happens in the zona fasciculata of the adrenal cortex and is controlled by adrenocorticotropic hormone (ACTH), which is released from the pituitary gland. ACTH helps convert cholesterol into pregnenolone, a precursor for making various hormones, including glucocorticoids. The HPA axis operates through a negative feedback loop. When glucocorticoids are released, they signal the pituitary and hypothalamus to reduce ACTH and corticotropin-releasing hormone (CRH) production, essentially telling the body to slow down hormone production. This feedback happens in three stages. It starts with a quick response that adjusts hormone levels within 10 minutes and can last up to 24 hours. Late delayed response can also occur a day after high glucocorticoid levels and can last for days or weeks, especially after repeated corticosteroid use. This feedback mechanism keeps hormone production balanced and prevents overproduction of glucocorticoids (4).

Mechanism of potential adverse effects of corticosteroids in TMJ disorder treatments

Repeated IACIs into the TMJ, while effective in reducing inflammation and alleviating symptoms in the short term, may initiate a cascade of pathophysiological events that compromise long-term joint health. These agents inhibit the synthesis of essential extracellular matrix components such as proteoglycans and collagen, leading to progressive thinning and weakening of the articular cartilage. A study found 100% fibrous layer damage, 64% cartilage damage, and 42% subchondral bone damage, confirming that corticosteroid injections can act as a destructive agent within the joint (6). As structural integrity declines, the articular surface becomes more susceptible to erosion and dysfunction. Additionally, corticosteroids can induce vasoconstriction and promote fat embolism, reducing subchondral bone perfusion and potentially resulting in osteonecrosis, particularly in load-bearing regions like the mandibular condyle (7). Corticosteroids also impair fibroblast proliferation, thereby disrupting tissue repair mechanisms. This may contribute to degeneration of the synovial membrane, which plays a critical role in joint lubrication and function as described in other synovial joints such as the knee (30). Concurrently, the weakening of connective tissues due to inhibited collagen remodeling may predispose the articular disc to instability, displacements or perforation—clinical manifestations often observed as clicking, locking, or functional limitations in jaw movements (31). In pediatric patients, particularly those with JIA, repeated corticosteroid exposure has been associated with altered expression of growth mediators and bone morphogenetic proteins, increasing the risk of heterotopic ossification within periarticular soft tissues (8). These aberrant bone formations can result in reduced mandibular mobility and impaired craniofacial development. Thus, although corticosteroid therapy may provide short-term clinical benefits, its long-term application-especially in growing individuals-warrants cautious use due to its potential for irreversible structural and functional joint alterations.

TMJ OA

TMJ OA is a degenerative joint disease characterized by the progressive breakdown of articular cartilage, subchondral bone remodeling, and joint structural changes. Unlike most synovial joints, which are lined with hyaline cartilage, the TMJ is covered with fibrocartilage, which provides greater resistance to mechanical stress but remains susceptible to degenerative processes. The primary pathological changes in TMJ OA include cartilage degradation, bone erosion, osteophyte formation, and condylar flattening, leading to pain, joint stiffness, and impaired function (9).

Parafunctional habits, previous jaw trauma, disc displacement, or systemic inflammatory conditions (10). Studies estimate that degenerative joint disease occurs in approximately 17% of temporomandibular disorders (TMD) cases, often coexisting with myalgia and internal derangements, as defined by the diagnostic criteria for temporomandibular disorders (DC/TMD) (11) Unlike generalized OA, which primarily affects the elderly, TMJ OA can develop earlier due to the unique biomechanical demands placed on the joint.

Complications and adverse effects of corticosteroid injections in TMJ

Corticosteroids commonly used in intra-articular injections for treatment of TMJ disorders are methylprednisolone, triamcinolone acetonide, and betamethasone, to name a few. Corticosteroids have a complex effect on bone biology. They are known to reduce inflammation, but their impact on bone can be both protective and harmful depending on the context and duration of use (32). Corticosteroids have been shown to reduce bone formation by inhibiting osteoblast activity and promoting osteoclast survival, which increases bone resorption (33). The inhibition of bone formation is linked to decreased levels of osteocalcin, a marker of osteoblast activity, as observed in studies where serum osteocalcin levels significantly dropped post-injection. This indicates a reversible suppression of bone formation after corticosteroid administration, especially in the early phases of treatment. Corticosteroids decrease the ratio of receptor activator of nuclear factor kappa-B ligand (RANKL) to osteoprotegerin (OPG), which may contribute to a protective effect on bone (34). RANKL is crucial for osteoclast formation and function, and by reducing its expression without affecting OPG levels, corticosteroids may mitigate the bone resorption typically seen in inflammatory conditions like rheumatoid arthritis.

Corticosteroids also reduce synovial inflammation and vascularity, potentially decreasing the factors that lead to bone degradation in chronic inflammatory conditions (32,33). A study showed diminishing anti-inflammatory effect over time. The authors said that IACI in younger patients may interfere with mandibular growth (median age 17 years). The study also mentions that 21% of treated TMJs developed intra-articular calcification post IACI, potentially reducing joint function (7). Overall, corticosteroids can help protect bones in the short term by reducing inflammation and modulating the balance between RANKL and OPG, but long-term use can result in decreased bone formation, increased bone resorption, and potential bone loss (33).

Effect of IACIs on TMJ (Tables 4,5)

IACIs have been used as a treatment option for TMJ Disorders for over 50 years. While they reduce symptoms, long-term use tends to cause complications like bone necrosis and joint degradation. These injections are usually diluted with a local anesthetic to minimize tissue damage. Some studies have shown that a single injection offers pain relief for 4–6 weeks, while others reveal the multiple doses increase risks and might worsen joint damage, only bringing significant relief with the first injection.

There are concerns about the accuracy of injection placement since incorrectly placed injections could impact their effectiveness. Thus, IACIs have been shown to provide short-term pain relief, but their long-term efficacy remains unclear. Some patients show improvement, but others report disease progression and serious complications like cartilage destruction and disc dislocation (12).

In a study conducted by Stoll et al., children receiving IACS for managing JIA-related TMJ arthritis were examined to evaluate the risk of development of HBF, where bone forms abnormally within soft tissues. It was seen that about 13.9% of the subjects developed HBF. A key finding was that the risk of developing HBF increased with age at diagnosis and the number of injections (31).

Another study conducted by Torres et al., Betamethasone and arthrocentesis plus dexamethasone are likely the most effective in managing short- and medium-term pain when compared with arthrocentesis. However, we can draw no conclusion about the range of motion or QoL outcomes because of the low and very low certainty of evidence. This makes decision-making concerning managing symptomatic internal TMJ disorders with corticosteroids strongly dependent on the clinician’s clinical experience and patient preferences, considering various factors, such as costs, feasibility, and acceptability (13).

Alternative treatment approaches

Hyaluronic acid (HA) injections

HA is an effective alternative to corticosteroids for managing TMJ disorders. HA injections mimic the natural synovial fluid, enhance joint lubrication, reduce friction, and provide anti-inflammatory effects. Unlike corticosteroids, HA injections do not contribute to cartilage degeneration and may promote long-term joint health (19).

Platelet-rich plasma (PRP) therapy

PRP therapy is another emerging treatment option for TMJ disorders. PRP is derived from the patient’s blood and contains high concentrations of growth factors that stimulate tissue repair and cartilage regeneration. PRP has shown promising results in improving TMJ function while avoiding the adverse effects associated with corticosteroids (35).

TMJ arthroscopy

Arthroscopy is a minimally invasive surgical option for managing TMJ disorders, especially in patients unresponsive to conservative measures. Compared to arthrocentesis and conservative therapy, recent meta-analyses confirm that arthroscopy can achieve comparable or superior improvements in maximum mouth opening and pain reduction, particularly in intermediate and long-term follow-up (20). Level II arthroscopy allows for operative maneuvers such as lysis and lavage, synovectomy, and disc repositioning, offering precise treatment of intra-articular pathology (21). Long-term data demonstrate that arthroscopy significantly improves pain and jaw function, with sustained benefits maintained up to 5 years postoperatively. For example, de las Fuentes Monreal et al. (2024) reported stable pain relief and mouth opening improvement in a prospective cohort with a low reoperation rate (22). Although potential complications such as infection or minor structural injury exist, the complication rates remain low (21). Proper patient selection and technique are essential for optimal outcomes. Overall, arthroscopy represents an effective intermediate step between minimally invasive lavage and open joint surgery, with evidence supporting its role in improving patient quality of life.

Comparative efficacy (Table 6)

While corticosteroids offer immediate pain relief, their long-term safety remains questionable. HA and PRP therapies, in contrast, provide sustained symptom relief without the risks of cartilage degradation and bone loss. Thus, alternative therapies may be preferable for patients requiring long-term management of TMJ disorders.

Evaluating benefits vs. potential harms of corticosteroids

The benefits of corticosteroid injections are well-documented, offering significant short-term relief for many patients. People often experience reduced pain and improved joint function within weeks of treatment, making it particularly helpful for those with acute inflammation or cases where systemic treatments fail to address TMJ-specific symptoms. However, this relief is typically short-lived, lasting only a few weeks or months, after which symptoms often return, requiring further treatments. Repeated corticosteroid injections can lead to long-term complications. For instance, in children with JIA, there is a heightened risk of growth abnormalities and permanent joint damage. In such cases, the temporary benefits of pain relief must be carefully weighed against these risks. Some studies suggest that alternative treatments, like HA injections or physical therapy, might offer safer and longer-lasting solutions for managing TMJ disorders. In conclusion, while corticosteroid injections constitute a significant method for the short-term management of TMJ disorders, their prolonged utilization, particularly in pediatric patients, should be approached with vigilance. Healthcare practitioners must judiciously assess the frequency and dosage of corticosteroid injections to mitigate the risk of adverse effects and contemplate alternative therapeutic approaches when deemed suitable.

Discussion and summary

The clinical benefits of IACIs in TMJ disorders are well documented, particularly in reducing pain and inflammation. However, concerns regarding their long-term safety necessitate a cautious approach (23). While single injections may provide temporary relief, repeated use has been associated with adverse effects, including bone resorption, cartilage degradation, and joint instability. The Stoustrup et al. (2015) study followed only 13 children, which restricts statistical power. It lacked a control group and reported only non-significant improvements, with limited information on structural progression (7).

HBF has been reported in approximately 14% of TMJs treated with corticosteroid injections in a large cohort of children with JIA, highlighting another important structural complication to consider (31).

A retrospective series by Lochbühler et al. found that repeated corticosteroid injections in JIA patients increased TMJ ossification rates from 51% to 62% and led to severe condylar destruction in 26% of joints (8).

Alternative treatment options, such as HA and PRP therapy, offer promising results with fewer long-term complications. These therapies may provide a safer and more sustainable approach to managing TMJ disorders, particularly in patients at risk of corticosteroid-related complications. The study by Lochbühler et al. (2015) had stronger imaging-based outcomes, but the sample size was small (n=33), with a mean patient age of 5.2 years, limiting the results to pediatric patients (8).

In the study by Gencer et al., there were no insights into long-term effects or recurrence of symptoms, lacked detailed reporting on randomization or blinding (14).

Historical cohort studies reinforce this risk: a controlled study of adults receiving two betamethasone injections reported subclinical cartilage thinning and subchondral bone changes in approximately 10–20% on follow-up (15). This study involved a small sample size and only assessed outcomes over one month, without a true placebo group or modern diagnostic standards, limiting its relevance to the current practice (15).

Isacsson et al. (2019), though their randomized design, found no significant difference in pain relief between corticosteroid and saline groups and did not explore long-term implications (16).

In the retrospective study by Stoll et al. (2018), treatment regimens varied widely, follow-up period was unclear (17). The study involved a relatively large pediatric cohort, but its retrospective design, variable corticosteroid dosing, and non-standardized imaging follow-up reduced the reliability of its outcome (17).

In rare but severe cases, repeated injections administered within short intervals have resulted in catastrophic condylar necrosis, as reported by Schindler et al. (2005) (18).

While long-term studies provide some important insights into the adverse effects of IACIs in the TMJ, they also present notable limitations. Lastly, the Schindler et al. (2005) report is a single-patient case study, valuable for illustrating severe adverse events (disk dislocation, necrosis), but inherently anecdotal and not generalizable (18).

A Norwegian prospective study involving 15 adolescents and 22 injections reported no severe adverse effects and generally stable condylar bone on MRI over 2 years, supporting the cautious use of limited injections (24).

Preclinical studies corroborate this dose-response relationship: an experimental rat model showed that while a single injection caused only mild changes, two injections produced irreversible condylar damage, and three injections led to massive joint destruction (25).

Modern imaging studies further support these findings: a retrospective MRI cohort study found that up to 18% of patients developed new cartilage thinning or subchondral bone changes following IACIs (26). Together, these studies underscore that while limited injections are generally safe, repeated or closely spaced use significantly increases the risk of irreversible structural joint damage.

Long-term follow-up by Vallon et al. over 12 years showed that while some patients maintained good outcomes, others experienced persistent joint damage, reinforcing the need for continued monitoring (27).

Furthermore, a systematic review by Wernecke et al. confirmed that intra-articular corticosteroids are generally chondrotoxic across joints, with a clear risk of long-term cartilage damage (28). Despite these findings, it is important to recognize that only a limited number of studies provide robust long-term follow-up, and many cohorts lose substantial patient numbers over time. This lack of consistent longitudinal data makes it difficult to precisely quantify how likely patients are to develop severe complications after repeated corticosteroid use (28).

Across these studies, common weaknesses include small sample sizes, lack of controls, inconsistent corticosteroid regimens, and absence of long-term standardized clinical or imaging follow-up, all of which underscore the need for larger prospective, controlled studies to more accurately evaluate long-term risks of corticosteroid use in the TMJ.

Limitations

A key limitation of this review is the absence of standardized protocols for corticosteroid injection in the TMJ. The considerable variability in dosage, frequency, and number of injections across studies makes it challenging to determine an optimal regimen. This heterogeneity underscores the need for further well-designed studies to establish evidence-based guidelines.

Future directions

Further research is needed to determine the optimal frequency and dosage of corticosteroid injections to minimize adverse effects. Additionally, comparative studies evaluating the efficacy of corticosteroids versus alternative therapies will help refine treatment protocols for TMJ disorders.

Conclusions

IACIs are a well-established treatment for reducing inflammation and pain in TMJ disorders. However, repeated use or administration in high doses has been associated with significant long-term risks, including cartilage thinning, subchondral bone changes, HBF, and, in rare cases, severe condylar necrosis (8,15,17,26). These risks are particularly concerning in children, where corticosteroid exposure can disrupt normal jaw development and result in permanent growth disturbances.

While limited use appears generally safe and can offer effective short-term relief (24,25), the lack of robust long-term follow-up in many cohorts makes it difficult to quantify the risk of repeated injections fully. This uncertainty reinforces the need for cautious use and for monitoring patients over time. When repeat injections are necessary, clinicians should consider alternative therapies—such as HA, PRP, or minimally invasive arthroscopy—to minimize structural damage and preserve joint function. Future research should focus on defining optimal injection frequency and developing regenerative treatments that provide similar benefits without harmful side effects.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was commissioned by the Guest Editors (Mythili Kalladka & Ming Xia) for the series “Current status and latest research progress in the pain management of temporomandibular disorders (TMDs)” published in Journal of Oral and Maxillofacial Anesthesia. The article has undergone external peer review.

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://joma.amegroups.com/article/view/10.21037/joma-25-6/rc

Peer Review File: Available at https://joma.amegroups.com/article/view/10.21037/joma-25-6/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://joma.amegroups.com/article/view/10.21037/joma-25-6/coif). The series “Current status and latest research progress in the pain management of temporomandibular disorders (TMDs)” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Matheson EM, Fermo JD, Blackwelder RS. Temporomandibular Disorders: Rapid Evidence Review. Am Fam Physician 2023;107:52-8.
2. Toller PA. Use and misuse of intra-articular corticosteroids in treatment of temporomandibular joint pain. Proc R Soc Med 1977;70:461-3. [Crossref] [PubMed]
3. Toller P. Osteoarthrosis of the mandibular condyle. Br Dent J 1973;134:223-31. [Crossref] [PubMed]
4. Scherer J, Rainsford KD, Kean CA, et al. Pharmacology of intra-articular triamcinolone. Inflammopharmacology 2014;22:201-17. [Crossref] [PubMed]
5. Dunlavey CJ. Introduction to the Hypothalamic-Pituitary-Adrenal Axis: Healthy and Dysregulated Stress Responses, Developmental Stress and Neurodegeneration. J Undergrad Neurosci Educ 2018;16:R59-60.
6. Haddad IK. Temporomandibular joint osteoarthrosis. Histopathological study of the effects of intra-articular injection of triamcinolone acetonide. Saudi Med J 2000;21:675-9.
7. Stoustrup P, Kristensen KD, Küseler A, et al. Temporomandibular joint steroid injections in patients with juvenile idiopathic arthritis: an observational pilot study on the long-term effect on signs and symptoms. Pediatr Rheumatol Online J 2015;13:62. [Crossref] [PubMed]
8. Lochbühler N, Saurenmann RK, Müller L, et al. Magnetic Resonance Imaging Assessment of Temporomandibular Joint Involvement and Mandibular Growth Following Corticosteroid Injection in Juvenile Idiopathic Arthritis. J Rheumatol 2015;42:1514-22. [Crossref] [PubMed]
9. Mélou C, Pellen-Mussi P, Jeanne S, et al. Osteoarthritis of the Temporomandibular Joint: A Narrative Overview. Medicina (Kaunas) 2022;59:8. [Crossref] [PubMed]
10. Al-Ani Z. Temporomandibular Joint Osteoarthrosis: A Review of Clinical Aspects and Management. Prim Dent J 2021;10:132-40. [Crossref] [PubMed]
11. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache 2014;28:6-27. [Crossref] [PubMed]
12. AbdulRazzak NJ. Sadiq JA, Jiboon AT. Arthrocentesis versus glucocorticosteroid injection for internal derangement of temporomandibular joint. Oral Maxillofac Surg 2021;25:191-7. [Crossref] [PubMed]
13. Torres D, Zaror C, Iturriaga V, et al. Corticosteroids for the Treatment of Internal Temporomandibular Joint Disorders: A Systematic Review and Network Meta-Analysis. J Clin Med 2024;13:4557. [Crossref] [PubMed]
14. Gencer ZK, Özkiriş M, Okur A, et al. A comparative study on the impact of intra-articular injections of hyaluronic acid, tenoxicam and betametazon on the relief of temporomandibular joint disorder complaints. J Craniomaxillofac Surg 2014;42:1117-21. [Crossref] [PubMed]
15. Kopp S, Wenneberg B, Haraldson T, et al. The short-term effect of intra-articular injections of sodium hyaluronate and corticosteroid on temporomandibular joint pain and dysfunction. J Oral Maxillofac Surg 1985;43:429-35. [Crossref] [PubMed]
16. Isacsson G, Schumann M, Nohlert E, et al. Pain relief following a single-dose intra-articular injection of methylprednisolone in the temporomandibular joint arthralgia-A multicentre randomised controlled trial. J Oral Rehabil 2019;46:5-13. [Crossref] [PubMed]
17. Stoll ML, Amin D, Powell KK, et al. Risk Factors for Intraarticular Heterotopic Bone Formation in the Temporomandibular Joint in Juvenile Idiopathic Arthritis. J Rheumatol 2018;45:1301-7. [Crossref] [PubMed]
18. Schindler C, Paessler L, Eckelt U, et al. Severe temporomandibular dysfunction and joint destruction after intra-articular injection of triamcinolone. J Oral Pathol Med 2005;34:184-6. [Crossref] [PubMed]
19. Attia AAMM, Awad SS. Hyaluronic Acid and Platelet-Rich Plasma Mixture Versus Hyaluronic Acid and Corticosteroid in the Treatment of Temporomandibular Joint Internal Derangement: A Comparative Randomized Study. J Maxillofac Oral Surg 2023;23:1-7. [Crossref] [PubMed]
20. Tang YH, van Bakelen NB, Gareb B, et al. Arthroscopy versus arthrocentesis and versus conservative treatments for temporomandibular joint disorders: a systematic review with meta-analysis and trial sequential analysis. Int J Oral Maxillofac Surg 2024;53:503-20. [Crossref] [PubMed]
21. Badri O, Davis CM, Warburton G. Arthroscopic management and recent advancements in the treatment of temporomandibular joint disorders. Br J Oral Maxillofac Surg 2024;62:820-5. [Crossref] [PubMed]
22. de Las Fuentes Monreal M, Sanz García A, Muñoz-Guerra MF. Arthroscopic treatment of temporomandibular dysfunction: preliminary results from a prospective follow up of over five years. Br J Oral Maxillofac Surg 2024;62:813-9. [Crossref] [PubMed]
23. Kroese JM, Kopp S, Lobbezoo F, et al. Corticosteroid injections in the temporomandibular joint temporarily alleviate pain and improve function in rheumatoid arthritis. Clin Rheumatol 2021;40:4853-60. [Crossref] [PubMed]
24. Frid P, Augdal TA, Larheim TA, et al. Efficacy and safety of intraarticular corticosteroid injections in adolescents with juvenile idiopathic arthritis in the temporomandibular joint: a Norwegian 2-year prospective multicenter pilot study. Pediatr Rheumatol Online J 2020;18:75. [Crossref] [PubMed]
25. Atef AF. Association between Intra-Articular Corticosteroid Injection and Temporomandibular Joint Structure Changes. Int Arch Oral Maxillofac Surg 2018;2:015.
26. Resnick CM, Vakilian PM, Kaban LB, et al. Quantifying the Effect of Temporomandibular Joint Intra-Articular Steroid Injection on Synovial Enhancement in Juvenile Idiopathic Arthritis. J Oral Maxillofac Surg 2016;74:2363-9. [Crossref] [PubMed]
27. Vallon D, Akerman S, Nilner M, et al. Long-term follow-up of intra-articular injections into the temporomandibular joint in patients with rheumatoid arthritis. Swed Dent J 2002;26:149-58.
28. Wernecke C, Braun HJ, Dragoo JL. The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review. Orthop J Sports Med 2015;3:2325967115581163. [Crossref] [PubMed]
29. Yasir M, Goyal A, Sonthalia S. Corticosteroid Adverse Effects. 2025.
30. Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop 2014;5:351-61. [Crossref] [PubMed]
31. Stoll ML, Amin D, Powell KK, et al. Risk Factors for Intraarticular Heterotopic Bone Formation in the Temporomandibular Joint in Juvenile Idiopathic Arthritis. J Rheumatol 2018;45:1301-7. [Crossref] [PubMed]
32. Canalis E, Mazziotti G, Giustina A, et al. Glucocorticoid-induced osteoporosis: pathophysiology and therapy. Osteoporos Int 2007;18:1319-28. [Crossref] [PubMed]
33. Compston J. Glucocorticoid-induced osteoporosis: an update. Endocrine 2018;61:7-16. [Crossref] [PubMed]
34. Hofbauer LC, Gori F, Riggs BL, et al. Stimulation of osteoprotegerin ligand and inhibition of osteoprotegerin production by glucocorticoids in human osteoblastic lineage cells: potential paracrine mechanisms of glucocorticoid-induced osteoporosis. Endocrinology 1999;140:4382-9. [Crossref] [PubMed]
35. Liu SS, Xu LL, Liu LK, et al. Platelet-rich plasma therapy for temporomandibular joint osteoarthritis: A randomized controlled trial. J Craniomaxillofac Surg 2023;51:668-74. [Crossref] [PubMed]