Document Type : Original Article

Authors

Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Objective: Ibuprofen – a non‑steroidal anti‑inflammatory drug (NSAID)‑ and glucosamine
sulfate – a natural compound and a food supplement‑ are two therapeutic agents which have
been widely used for treatment of patients with temporomandibular joint (TMJ) disorders.
This study was aimed to compare the effectiveness and safety of these two medications in
the treatment of patients suffering fromTMJ disorders.
Methods: After obtaining informed consent, 60 patients were randomly allocated to two
groups. Patients with painful TMJ,TMJ crepitation or limitation of mouth opening entered
the study. Exclusion criteria were history of depressive disorders, cardiovascular disease,
musculoskeletal disorders, asthma, gastrointestinal problems, kidney or liver dysfunction
or diabetes mellitus, dental diseases needing ongoing treatment; taking aspirin or warfarin,
or concomitant treatment of TMJ disorder with other agents or methods.Thirty patients
were treated with ibuprofen 400  mg twice a day,  (mean age 27.12  ±  10.83  years) and
30 patients (mean age 26.60 ± 10) were treated with glucosamine sulfate 1500 mg daily.
Patients were visited 30, 60 and 90 days after starting the treatment, pain and mandibular
opening were checked and compared within and between two groups.
Findings: Comparing with baseline measures, both groups had significantly improved
post‑treatment pain (P < 0.0001 for both groups) and mandibular opening (P value: 0.001
for glucosamine sulfate and 0.03 for ibuprofen).Post treatment pain and mandibular opening
showed significantly more improvement in the glucosamine treated patients (P < 0.0001 and
0.01 respectively).Rate of adverse events was significantly lower in the P value glucosamine
sulfate group (P < 0.0001).
Conclusion: This investigation demonstrated that comparing with a commonly prescribed
NSAID – ibuprofen‑, glucosamine sulfate is a more effective and safer therapeutic agent for
treatment of patients with TMJ degenerative join disorder.

Keywords

  1. Guarda‑Nardini L, Ferronato G, Favero L, Manfredini D. 
    Predictive factors of hyaluronic acid injections short‑term 
    effectiveness for TMJ degenerative joint disease. J Oral Rehabil 
    2011;38:315‑20.
    2. Milam SB. Pathophysiology and epidemiology of TMJ. 
    J Musculoskelet Neuronal Interact 2003;3:382‑90.
    3. Tanaka E, Detamore MS, Mercuri LG. Degenerative disorders 
    of the temporomandibular joint: Etiology, diagnosis, and 
    treatment. J Dent Res 2008;87:296‑307.
    4. Bessa‑Nogueira RV, Vasconcelos BC, Niederman R. The 
    methodological quality of systematic reviews comparing 
    temporomandibular joint disorder surgical and non‑surgical 
    treatment. BMC Oral Health 2008;8:27.
    5. Fricton J. Current evidence providing clarity in management 
    of temporomandibular disorders: Summary of a systematic 
    review of randomized clinical trials for intra‑oral appliances 
    and occlusal therapies. J Evid Based Dent Pract 2006;6:48‑52.
    6. Hersh EV, Balasubramaniam R, Pinto A. Pharmacologic 
    management of temporomandibular disorders. Oral 
    Maxillofac Surg Clin North Am 2008;20:197‑210.
    7. Mujakperuo HR, Watson M, Morrison R, Macfarlane TV. 
    Pharmacological interventions for pain in patients with 
    temporomandibular disorders. Cochrane Database Syst Rev 
    2010;10:CD004715.
    8. Steinmeyer J, Konttinen YT. Oral treatment options for 
    degenerative joint disease: Presence and future. Adv Drug 
    Deliv Rev 2006;58:168‑211.
    9. Steinmeyer J. Pharmacological basis for the therapy of 
    osteoarthritis. Osteoarthritis‑Fundamentals and Strategies for 
    Joint‑Preserving Treatment. Berlin: Springer; 2000. p. 54‑65.
    10. Institute of Medicine and National Research Council. 
    Prototype monograph on glucosamine. Dietary Supplements: 
    A framework for evaluating safety. Washington DC: Institute 
    of Medicine and National Research Council; 2005. p. 363‑6.
    11. Cibere J, Kopec JA, ThorneA, SingerJ, Canvin J, Robinson DB, 
    et al. Randomized, double‑blind, placebo‑controlled 
    glucosamine discontinuation trial in knee osteoarthritis. 
    Arthritis Rheum 2004;51:738‑45.
    12. Cordoba F, Nimni ME. Chondroitin sulfate and other sulfate 
    containing chondroprotective agents may exhibit their 
    effects by overcoming a deficiency of sulfur amino acids. 
    Osteoarthritis Cartilage 2003;11:228‑30.
    13. Hughes R, Carr A. A randomized, double‑blind, 
    placebo‑controlled trial of glucosamine sulphate as an 
    analgesic in osteoarthritis of the knee. Rheumatology (Oxford) 
    2002;41:279‑84.
    14. Rindone JP, Hiller D, Collacott E, Nordhaugen N, Arriola G. 
    Randomized, controlled trial of glucosamine for treating 
    osteoarthritis of the knee. West J Med 2000;172:91‑4.
    15. Thie NM, Prasad NG, Major PW. Evaluation of glucosamine 
    sulfate compared to ibuprofen for the treatment of 
    temporomandibular joint osteoarthritis: A randomized 
    double blind controlled 3 month clinical trial. J Rheumatol 
    2001;28:1347‑55.
    16. 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;111:13‑21.
    17. Bruyere O, Pavelka K, Rovati LC, Gatterová J, Giacovelli G, 
    Olejarová M, et al. Total joint replacement after glucosamine 
    sulphate treatment in knee osteoarthritis: Results of a mean 
    8‑year observation of patients from two previous 3‑year, 
    randomised, placebo‑controlled trials. Osteoarthritis Cartilage 
    2008;16:254‑60.
    18. Davis S, Papalia MA, Norman RJ, O’Neill S, Redelman M, 
    Williamson M, et al. Safety and efficacy of a testosterone 
    metered‑dose transdermal spray for treating decreased sexual 
    satisfaction in premenopausal women: A randomized trial. 
    Ann Intern Med 2008;148:569‑77.
    19. Muniyappa R, Karne RJ, Hall G, Crandon SK, Bronstein JA, 
    Ver MR, et al. Oral glucosamine for 6 weeks at standard 
    doses does not cause or worsen insulin resistance or 
    endothelial dysfunction in lean or obese subjects. Diabetes 
    2006;55:3142‑50.
    20. Persiani S, Rotini R, Trisolino G, Rovati LC, Locatelli M, 
    Paganini D, et al. Synovial and plasma glucosamine 
    concentrations in osteoarthritic patients following oral 
    crystalline glucosamine sulphate at therapeutic dose. 
    Osteoarthritis Cartilage 2007;15:764‑72.
    21. Pham T, Cornea A, Blick KE, Jenkins A, Scofield RH. Oral 
    glucosamine in doses used to treat osteoarthritis worsens 
    insulin resistance. Am J Med Sci 2007;333:333‑9.
  2. 22. Rozendaal RM, Koes BW, van Osch GJ, Uitterlinden EJ, 
    Garling EH, Willemsen SP, et al. Effect of glucosamine sulfate 
    on hip osteoarthritis: A randomized trial. Ann Intern Med 
    2008;148:268‑77.
    23. Stumpf JL, Lin SW. Effect of glucosamine on glucose control. 
    Ann Pharmacother 2006;40:694‑8.
    24. Tannock LR, Kirk EA, King VL, LeBoeuf R, Wight TN, ChaitA. 
    Glucosamine supplementation accelerates early but not 
    late atherosclerosis in LDL receptor‑deficient mice. J Nutr 
    2006;136:2856‑61.
    25. Muller‑Fassbender H, Bach GL, HaaseW, Rovati LC, SetnikarI. 
    Glucosamine sulfate compared to ibuprofen in osteoarthritis 
    of the knee. Osteoarthritis Cartilage 1994;2:61‑9.
    26. Qiu GX, Gao SN, Giacovelli G, Rovati L, SetnikarI. Efficacy and 
    safety of glucosamine sulfate versus ibuprofen in patients with 
    knee osteoarthritis. Arzneimittelforschung 1998;48:469‑74.
    27. Harris ED, Budd RC, Firestein GS, Genovese MC, Sergent JS, 
    Ruddy S, et al. Kelley’s Textbook of Rheumatology. 7th ed, 
    Philadelphia; Elsevier; 2005