Temporomandibular Joint Syndrome – TMJ
In this article Tim Speciale DO, discusses TMJ treatments including Prolotherapy and Stem Cell Therapy.
In recent research doctors have found a significant association between Temporomandibular Joint Syndrome, joint hypermobility syndrome and symptoms of anxiety.1
What does this mean? That problems of jaw pain (TMJ) may be an indication of a body wide problem with loose joints and further, joint hypermobility syndrome and TMJ may manifest themselves as a potential link to the neural bases of anxiety and related somatic symptoms (pain that causes major emotional distress) 2. What does this mean? TMJ is more than a physical problem related to the jaw.3
The temporomandibular joint
The temporomandibular joint connects the mandible (lower jaw) to the part of the skull known as the temporal bone. The joint allows the lower jaw to move in all directions so that the teeth can bite off and chew food efficiently.
Temporomandibular joint ( TMJ ) syndrome occurs when the joint, muscles and ligaments involved do not work together properly, resulting in pain.
Temporomandibular Joint Syndrome
Temporomandibular joint syndrome is caused by ligament weakness, often as a result of clenching the jaw or grinding the teeth, sleeping position or a forward positioned mandible (lower jaw). Malocclusion, or a poor bite, places stress on the muscles and may also lead to temporomandibular joint syndrome, as may an injury to the head, jaw or neck that causes displacement of the joint. If left untreated, osteoarthritis can result.
The head and neck pain associated with temporomandibular joint syndrome (TMJ) has received a myriad of traditional treatments, many of which involve surgery. They include:
- Temporomandibular joint (TMJ) surgery which can be divided into 3 types of surgery: Arthroscopy, arthroplasty, and total joint replacement. The complications associated with these procedures increase with complexity. They all include injury to adjacent structures, infections, and bleeding problems.4
- TMJ implants,
- cervical spine surgery,
- botulinum toxin injections into muscles. In recent research doctors noted that patients with temporomandibular muscle and joint disorder (TMJD) are increasingly seek and receive treatment for their pain with botulinum toxin and that these treatments creates risk of reduced bone mineral density, or osteopenia (bone loss) 5
- surgical cauterization, which treats the bones with a radio frequency wave destroying the treated area. Although the pain is temporarily eliminated, the fibro-osseus junction, where the pain originated, is destroyed in the process.
The problem with any of these approaches is that they do not repair the weakened TMJ ligament and, thus, does not alleviate the chronic pain that people with this condition experience. And thus, most dentists and oral surgeons believe that TMJ cannot be cured and the best hope is for temporary symptom relief.
A standard practice is the use of steroids and anti-inflammatory medications. However, in the long run, these treatments do more damage than good. Cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain benefit, but both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration.
Prolotherapy and Stem Cell Therapy for Temporomandibular Joint Pain and Dysfunction
New research suggests that stem cells are an exciting and extremely promising treatment in TMD and TMJ.
Doctors out of Singapore have just released their report on stem cell therapy for TMJ and TMD. Here are summary facts on their paper.
- Temporomandibular Disorders (TMD) represent a group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint (TMJ), masticatory muscles and/or associated structures.
- They are a major cause of non-dental related face and jaw pain.
- The most common type of TMJ disorders involves displacement of the TMJ articular disc that precedes progressive degenerative changes of the joint leading to osteoarthritis.
In the past decade, progress made in the development of stem cell-based therapies and tissue engineering have provided alternative methods to attenuate the disease symptoms and even replace the diseased tissue in the treatment of TMJ disorders. This represents innovative approaches of cell-based therapeutics, tissue engineering and drug discovery in treatment.1 (Stem cells)
This supports earlier research which found
- Doctors found that they could regenerate the cartilage of the TMJ joint with a stem cell therapy solution.6
- Stem Cells could regenerate bone and soft tissue.7
In Prolotherapy research, doctors say that they see appreciable improvements in the number of episodes of dislocation and clicking after Prolotherapy treatment.
- In other research doctors found that Prolotherapy injections was curative in preventing recurrent TMJ dislocations. In fact nearly 2 of 3 of these patients achieved this result with a single treatment.8
In supportive research doctors say that they see appreciable improvements in the number of episodes of dislocation and clicking after Prolotherapy treatment.
- The overall success rate, defined as the absence of any further dislocation or subluxation for more than 6 months, was 91%.
- Of the 41 rehabilitated patients, 26 (63%) required a single injection, 11 (27%) had 2 treatments, and 4 (10%) needed a third injection.
- All patients tolerated the injections well. The modified dextrose prolotherapy is simple, safe, and cost-effective for the treatment of recurrent dislocation of the TMJ. 9
In research published here at Caring Medical, our doctors reported on successful dextrose prolotherapy for patients with chronic neck pain. In this study, fourteen patients who suffered from TMJ pain for an average of 5.4 years and had seen, on average, four medical doctors—including half who were told that no other treatment options were available.
Overall, substantial improvements were reported in:
- range of motion,
- pain medicine utilization,
- quality of life,
- and patient satisfaction.
These improvements persisted through follow up at eighteen months after the conclusion of prolotherapy treatments.10
Prolotherapy is a safe and effective natural medicine treatment for repairing tendon, ligament and cartilage damage. In simple terms, Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments and cartilage. Since the body heals by inflammation, Prolotherapy stimulates healing.
1. Chang TH, Yuh DY, Wu YT, Cheng WC, Lin FG, Shieh YS, Fu E, Huang RY. The association between temporomandibular disorders and joint hypermobility syndrome: a nationwide population-based study. Clin Oral Investig. 2015 Feb 17. [Epub ahead of print]
2. Mallorquí-Bagué N, et al . Emotion processing in joint hypermobility: A potential link to the neural bases of anxiety and related somatic symptoms in collagen anomalies. Eur Psychiatry. 2015 Feb 12. pii: S0924-9338(15)00048-6. doi: 10.1016/j.eurpsy.2015.01.004. [Epub ahead of print]
3. Reissmann DR, John MT, Seedorf H, Doering S, Schierz O. Temporomandibular disorder pain is related to the general disposition to be anxious. J Oral Facial Pain Headache. 2014 Fall;28(4):322-30. doi: 10.11607/ofph.1277.
4. Hoffman D, Puig L. Complications of TMJ surgery. Oral Maxillofac Surg Clin North Am. 2015 Feb;27(1):109-24. doi: 10.1016/j.coms.2014.09.008.
5. Raphael KG, Tadinada A, Bradshaw JM, Janal MN, Sirois DA, Chan KC, Lurie AG. Osteopenic consequences of botulinum toxin injections in the masticatory muscles: a pilot study. J Oral Rehabil. 2014 Aug;41(8):555-63. doi: 10.1111/joor.12180. Epub 2014 May 17.
6. Zhang S1, Yap AU, Toh WS. Stem Cells for Temporomandibular Joint Repair and Regeneration. Stem Cell Rev. 2015 Jun 28. [Epub ahead of print]
7. Zhang J, Guo F, Mi J, Zhang Z. Periodontal ligament mesenchymal stromal cells increase proliferation and glycosaminoglycans formation of temporomandibular joint derived fibrochondrocytes. Biomed Res Int. 2014;2014:410167. doi: 10.1155/2014/410167. Epub 2014 Nov 10.
8. Zhou H, Hu K, Ding Y. Modified dextrose prolotherapy for recurrent temporomandibular joint dislocation. Br J Oral Maxillofac Surg. 2014 Jan;52(1):63-6. doi: 10.1016/j.bjoms.2013.08.018. Epub 2013 Sep 21.
9. Ungor C, Atasoy KT, Taskesen F, Cezairli B, Dayisoylu EH, Tosun E, Senel FC. Short-term Results of Prolotherapy in the Management of Temporomandibular Joint Dislocation. J Craniofac Surg. 2013 Mar;24(2):411-5. doi: 10.1097/SCS.0b013e31827ff14f.