Prolotherapy for TMJ and TMD

Temporomandibular Joint Syndrome - TMJ

In this article Ross Hauser, MD discusses Temporomandibular Joint (TMJ) Syndrome/ TMD (Temporomandibular Joint Disorder) treatments including Prolotherapy and Stem Cell Therapy.

In 2007, researchers here at Caring Medical published our findings in the medical journal Practical Pain Management that “Many of the subjective symptoms of pain, stiffness, and crunching sensation in patients with TMJ dysfunction were reduced greater than 50% in 92% of the prolotherapy patients.”(1)

So back then we were able to show at least 50% reduction in pain in more then 9 out of 10 patients with simple dextrose Prolotherapy. What has happened in the ten years since we first published this study? More good results and a better understanding within the medical community of the complexity of TMJ/TMD.

In 9 out of 10 patients with TMD diagnosed patients with Joint Hypermobility Syndrome – pain does not come from degenerated discs

We are going to make some fascinating connections here to show that TMJ and jaw related pain are much more than disc degeneration in many patients.

Like any joint, excessive movement in the Temporomandibular joint and/or chronic subluxation/dislocations of the Temporomandibular is caused by weakness of the connective tissue that hold the joint in place. In the jaw important connective tissue include the Temporomandibular ligament, and the stylomandibular ligament, and sphenomandibular ligament which provide limitation of mandibular movements.

In a late 2015 publication date, national defense and university medical researchers in Taiwan combined to release their research finding in the journal Clinical oral investigations on the TMJ/TMD –  Joint Hypermobility syndrome connection.

The research aimed to investigate the risk factors of temporomandibular disorders, including disc or non-disc-related disorders, and joint hypermobility syndrome retrospectively and to analyze the association between the two conditions.

The temporomandibular joint

Temporomandibular Joint Syndrome

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.

TMJ/TMD

Temporomandibular joint syndrome and disorders have been demonstrated to be caused by ligament weakness in many patients, 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, jaw osteoarthritis can result.

As we wrote back in 2007:

“Symptoms commonly associated with TMD include pain at the TMJ, generalized orofacial pain, chronic headaches and ear aches, jaw dysfunction including hyper- and hypo-mobility and limited movement or locking of the jaw, painful clicking or popping sounds with opening or closing of the mouth, and difficulty chewing or speaking.”

“While pain is the most common symptom, some people report no pain, but still have problems using their jaws. Sometimes the bite just feels “off.” Additional symptoms may include ringing in the ears, ear pain, decreased hearing, dizziness, and vision problems.”

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:

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.

A comparison of the outcomes of four minimally invasive treatment methods for anterior disc displacement of the temporomandibular joint

The above heading is taken from the title of a new paper from University medical researchers in Turkey publishing in the International journal of oral and maxillofacial surgery.

As the researchers point out, the purpose of this study was to compare the effectiveness of four non-surgical conservative treatment methods for temporomandibular disorders. We are going to examine the phenomena of effusion and swelling in this study and compare it to another new study.

Patients were divided into four groups according to the treatment method:

Magnetic resonance imaging (MRI) was performed before treatment and at the 1-month follow-up. Patients were followed up after treatment for 6 months.

Note: So all these treatments worked well, except in our opinion the very ominous problem of effusion.

Symptom suppression successful, BUT the underlying problem is still there

Back to the research and why we consider this ominous.

A positive correlation was found between pain and effusion. A significant positive relationship was also found between internal derangement (structural problems) and effusion.

It was determined that the effusion demonstrated on MRI was associated with pain. Although the symptoms improved after treatment, joint effusion did not show any decrease in the 1-month follow-up MRI.(5)

In other words, the underlying problem was still there.

In 2017 study, doctors publishing in The journal of headache and pain made these observations:

The aim of their study was to investigate cytokine levels in the masseter muscle (inflammation of the jaw muscle), and the response to tooth-clenching. The response the researchers were looking for was if tooth clenching caused inflammation and accompanying pain, fatigue and psychological distress in patients with temporomandibular disorders (TMD) myalgia (pain).

What does this mean?

According to the researchers, “This implies that subclinical muscle inflammation may be involved in TMD myalgia pathophysiology (The process of TMD), but that there is no direct cause-relation between inflammation and pain.” (6)

What does this mean?

Subclinical means something not detected or understood. There is a chronic inflammatory response because something is not healing. In our experience that something is that the entire TMJ is in degenerative disease state, it is dying. This is a problem of whole jaw joint disease and treatments must address the entire jaw joint.

Prolotherapy and Stem Cell Therapy for Temporomandibular Joint Pain and Dysfunction

Treating the whole joint. Comprehensive Prolotherapy for TMJ. 

In this section we will discuss how to turn a degenerative TMJ environment into a healing environment through the use of Comprehensive Prolotherapy. The basic concepts are discussed in the video above.

Indian doctors writing in the Journal of maxillofacial and oral surgery found positive results utilizing Prolotherapy injections for TMJ in new research (June 2017). Here is what they said:

Hypermobility disorders of the Temporomandibular joint (TMJ) can be treated by both conservative and surgical approaches. Conservative approaches should be considered as first line treatment for such disorders.

In their study, the researchers examined 23 patients suffering from either chronic recurrent dislocation or subluxation of the TMJ who were treated with the single injection technique prolotherapy with 25 % dextrose into the pericapsular tissues along with auriculotemporal nerve block.

National University of Singapore doctors found that they could regenerate the cartilage of the TMJ joint with a stem cell therapy solution and have recently released their report on stem cell therapy for TMJ and TMD. Here are summary facts on their paper.

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.10

This supports earlier research from the same researchers which stated: Stem Cells could regenerate bone and soft tissue.11

Prolotherapy reports on TMJ disc dislocation

In Prolotherapy research, doctors say that they see appreciable improvements in the number of episodes of dislocation and clicking after Prolotherapy treatment.

In supportive research doctors at the University of Karadeniz Technical University say that they see appreciable improvements in the number of episodes of dislocation and clicking after Prolotherapy treatment.

Dr. Refai of Cairo University reported in the British journal of oral and maxillofacial surgery:

Doctors at Ordu University in Turkey published in The Journal of alternative and complementary medicine suggesting that Prolotherapy and aspiration (Arthrocentesis) provided significant relief for TMJ patients.

In this October 2017 study, 10 adults with disc displacement and painful, hypermobile TMJ were selected.

Scoring tests were used to assess the maximum mouth opening, clicking sounds, pain, and subluxation of the TMJ. Patients with rheumatoid arthritis and parafunctional habits such as teeth clenching and grinding and biting of the cheeks or any other objects and those who had undergone surgery were excluded from this study.

The ten patients, 7 women and 3 men average age 36 received a single treatment session of combined arthrocentesis and prolotherapy at the same office visit. Subluxation frequency and pain significantly decreased after the first week of treatment. Subluxation also decreased at the 3-month follow-up.

Clicking sound values did not significantly change at any of the follow-up time points. Maximum mouth opening values improved at all follow-up time points compared to baseline.16

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:

These improvements persisted through follow up at eighteen months after the conclusion of prolotherapy treatments.1

Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction

Hauser R, Hauser M, Blakemore K. Dextrose prolotherapy and pain of chronic TMJ dysfunction. Practical Pain Management. 2007; November/December:49-55. Many of the subjective symptoms of pain, stiffness, and crunching sensation in patients with TMJ dysfunction were reduced greater than 50% in 92% of the Prolotherapy patients in this study. In the last issue, Dr. Hauser et al reported on a retrospective study on successful dextrose prolotherapy for patients with chronic neck pain. In this study, the authors report on 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, disability, depression/anxiety, quality of life, and patient satisfaction. These improvements persisted through follow up at eighteen months after the conclusion of prolotherapy treatments. As Dr. Hauser at al report, these positive outcomes resulted despite the inability to individualize treatment protocols since they were done at a charity clinic having limited resources. According to the American Dental Association, more than 15% of American adults suffer from chronic facial pain.1 One of the most common causes is Tempomandibular Joint Disease (TMD), a collective term used to describe a group of medical disorders causing temporomandibular joint (TMJ) pain and dysfunction, and is estimated by The National Institute of Dental and Craniofacial Research of the National Institutes of Health to affect 10.8 million people in the United States at any given time.2 It occurs predominantly in women, with the female to male ratio ranging from 2:1 to 6:1, with 90% of those seeking treatment being women in their childbearing years.3,4 The TMJ is often predisposed to similar degenerative changes and pathologies seen in other synovial joints as a consequence of the frequent and repetitive stresses that the TMJ undergoes.5 Symptoms commonly associated with TMD include pain at the TMJ, generalized orofacial pain, chronic headaches and earaches, jaw dysfunction including hyper- and hypo-mobility and limited movement or locking of the jaw, painful clicking or popping sounds with opening or closing of the mouth, and difficulty chewing or speaking.6 While pain is the most common symptom, some people report no pain, but still have problems using their jaws. Sometimes the bite just feels “off.” Additional symptoms may include ringing in the ears, ear pain, decreased hearing, dizziness, and vision problems.7 Read full Article

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.

The Physical and emotional aspects of TMJ

In our 2007 study we noted:

Let’s move to a 2017 study from a team of Swedish and Danish researchers writing in the medical journal Cephalalgia : an international journal of headache. Here is a review of that study:

Conclusion: The persistence of pain involves more central factors, such as sensitization of the supraspinal neurons and second-order neurons at the level of the spinal dorsal horn/trigeminal nucleus (central neural pathways relevant to TMJ/TMD pain),  imbalanced antinociceptive activity (the ability to block pain), and strong genetic predisposition (family history).(3)

TMJ is more than a physical problem related to the jaw

Do you have a question about Temporomandibular Joint Syndrome or need help? Get help and Information from our Caring Medical staff

1. Hauser R, Hauser M, Blakemore K. Dextrose prolotherapy and pain of chronic TMJ dysfunction. Practical Pain Management. 2007; November/December:49-55.

2. 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. [Google Scholar]

3. Hoffman D, Puig L. Complications of TMJ surgery. Oral Maxillofac Surg Clin North Am. 2015 Feb;27(1):109-24. [Google Scholar]

4. 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. [Google Scholar]

5. Hosgor H, Bas B, Celenk C. A comparison of the outcomes of four minimally invasive treatment methods for anterior disc displacement of the temporomandibular joint. International Journal of Oral and Maxillofacial Surgery. 2017 Jun 9. [Google Scholar]

6. Jounger SL, Christidis N, Svensson P, List T, Ernberg M. Increased levels of intramuscular cytokines in patients with jaw muscle pain. The journal of headache and pain. 2017 Dec 1;18(1):30. [Google Scholar]





3. List T, Jensen RH. Temporomandibular disorders: Old ideas and new concepts. Cephalalgia. 2017 Jun;37(7):692-704.

4. Mallorquí-Bagué N, Bulbena A, Roé-Vellvé N, Hoekzema E, Carmona S, Barba-Müller E, Fauquet J, Pailhez G, Vilarroya O. Emotion processing in joint hypermobility: A potential link to the neural bases of anxiety and related somatic symptoms in collagen anomalies. European Psychiatry. 2015 Jun 30;30(4):454-8.

5. 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.

9. Majumdar SK, Krishna S, Chatterjee A, Chakraborty R, Ansari N. Single Injection Technique Prolotherapy for Hypermobility Disorders of TMJ Using 25 % Dextrose: A Clinical Study. J Maxillofac Oral Surg. 2017 Jun;16(2):226-230.

10. Zhang S, Yap AU, Toh WS. Stem Cells for Temporomandibular Joint Repair and Regeneration. Stem Cell Rev. 2015 Jun 28.

11. 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.

12. 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.

13. 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.

14. Refai H. Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint: a single-arm study with 1-4 years’ follow up. Br J Oral Maxillofac Surg. 2017 Apr 28.

16. Cezairli B, Sivrikaya EC, Omezli MM, Ayranci F, Cezairli NS. Results of Combined, Single-Session Arthrocentesis and Dextrose Prolotherapy for Symptomatic Temporomandibular Joint Syndrome: A Case Series. The Journal of Alternative and Complementary Medicine. 2017 Oct 10.

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