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
- 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. - 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