Pain perception and patient tolerance to intra-articular ozone-oxygen injections in the treatment of temporomandibular joint osteoarthritis.

This study aimed to investigate pain perception and patients’ tolerance to intra-articular medical ozone (IA-MO) injection for treating temporomandibular joint osteoarthritis (TMJ-OA), and to examine their associations with clinical symptoms and with CBCT and MRI findings. In 49 patients with TMJ-OA, IA-MO injections were administered to 74 degenerative joints, using a 15 μg/ml dose for four weekly sessions. Pain severity and patients’ tolerance immediately post-injections, radiological findings, and clinical evaluations were recorded. Post-injection pain was moderate or high in 33 patients. Tolerance was low in 27 patients. In most cases, the most and least painful sessions were recorded at the first and fourth injections, respectively. Lateral/posterior palpation pain of the TMJ and joint sound decreased, and masticatory efficiency increased significantly post-treatment (p = 0.001). Negative correlations were found between painful MIO and post-injection pain (p = 0.040) and positive correlations between the severity of condylar erosion and patient tolerance (p = 0.009). Although ozone therapy produced significant clinical improvements and functional recovery, most of the patients reported moderate to severe post-injection pain and low tolerance to intra-articular medical ozone-oxygen gas injections. Specific clinical symptoms and radiological findings were associated with patients’ tolerance to IA-MO treatment and post-injection pain.