The evidence and comparisons of TMJ injection treatments

Ross A. Hauser, MD. Danielle R. Steilen-Matias, MMS, PA-C.

The evidence and comparisons of TMJ injection treatments

We often see patients with varying degrees of, and medical histories of, TMJ syndrome or TMD (Temporomandibular joint dysfunction). They tell us about how their TMJ developed, whether it was from extensive dental work, a traumatic injury suffered in an accident, or other reasons such as a history of teeth grinding that has lead to degenerative joint disease of the jaw. They may also tell us about frequent jaw dislocations and problems with their neck. They also tell us about a lot of treatments that did not work for them. In this article, we will discuss these treatments and the possible solutions regenerative medicine injections may offer.

Problems that are far beyond a disc or a TMJ appliance problem


For some of these people, their doctors may have found it inconceivable that they did not respond to the treatments they offered and may recommend a psychiatric examination.

Someone who has been suffering from long-term TMJ problems, at some point, starts to realize that their challenges are challenges far beyond a disc or a TMJ appliance problem. When this person then has a failed TMJ surgery, these challenges they face become that much greater and their jaw problem that started out as an annoyance has turned into years of searching for anything that will help them with the new cascade of symptoms they suffer from beyond opening their mouths without pain.

TMJ surgery and appliances do help people. But these are not the patients we see in our clinic. We see the people TMJ surgery and appliances did not help. These are people, perhaps like yourself, whose TMJ has turned into a problem of headaches, neck pain, difficulty swallowing, and dizziness. For some of these people, their doctors may have found it inconceivable that they did not respond to the treatments they offered and may recommend a psychiatric examination. Generally speaking, if you are searching for a cure for your problem, your problem is not “all in your head.”


Introduction video: Unresolved chronic TMJ pain may be coming from your neck

Danielle R. Steilen-Matias, MMS, PA-C

Summary highlights:

At 1:53 of the video, the question is asked: “How do you determine if neck instability is involved in a case of chronic TMJ pain?”

At 2:47 of the video, the question is asked: “How many Prolotherapy treatments are needed to resolve TMJ Pain”

TMJ is a problem. The medical community is responding by pumping out a lot of research. Let’s look at some of these new studies to see what is benefiting patients and what is not.


The steroid injection made the TMJ pain worse

Steroids / Anti-inflammatories – research questions effectiveness and worthiness in helping TMJ patients.

In September 2018, in the Journal of Oral Rehabilitation, (1) researchers from leading medical universities in Sweden looked at steroid injection, specifically Methylprednisolone as a means to help alleviate TMJ patient symptoms.

In this study, the researchers looked at inflammation as a symptom problem in the TMJ. Clearly, they hypothesized, an anti-inflammatory would help with the inflammatory pain the patient was suffering from. What they found was the exact opposite, the steroid injection made the pain worse.

Hyaluronic acid injections and steroid injection

Also in September 2018, in the Hungarian Medical Weekly, (2) researchers at the world-renowned Semmelweis University’s Faculty of Dentistry published their findings comparing hyaluronic acid injections and steroid injection.

They found:

We have looked at Hyaluronic injections at length. The injections are a lubricating gel designed to help with pain-free movement in the joint. We have examined research on these injections and wrote of our findings. In our article on knee injections, Are Hyaluronic injections low-value health care? -we wrote “It should be noted that we see many patients who have tried hyaluronic acid injections. These injections have worked for these people in the short term. These patients are now in our office because the short-term has not transpired to the long-term and now  a different treatment approach needs to be undertaken.”

Steroids, Hyaluronic acid injections, and Platelet Rich Plasma Therapy

Platelet Rich Plasma Therapy is a treatment that utilizes your blood platelets as a healing injectable. This treatment will be explained later in this article.

A June 2019 study published in The Journal of Craniofacial Surgery (3) from Turkish a team of hospital and university researchers in Turkey evaluated the use of intra-articular corticosteroids, hyaluronic acid, and platelet-rich plasma in patients with temporomandibular joint (TMJ) pain and clinically diagnosed with TMJ-osteoarthritis. They found that intra-articular PRP injections decreased TMJ palpation pain more effectively compared with the hyaluronic acid and corticosteroid groups.

Non-surgical conservative treatment methods for TMJ


A comparison of the outcomes of four minimally invasive treatment methods for anterior disc displacement of the temporomandibular joint. Why didn’t they help some people?

The above heading is taken in part from the title of a paper from University medical researchers in Turkey publishing in the International Journal of Oral and Maxillofacial Surgery. (4)

As the researchers point out, the purpose of this study was to compare the effectiveness of four non-surgical conservative treatment methods for temporomandibular displacement 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 TMJ 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.

In other words, the underlying problem was still there and the symptom relief could only be temporary


The problem of fluid buildup, a jaw joint trying to stabilize by swelling is a chronic and long-term problem of the degenerative joint disease

In a 2017 study, doctors publishing in The Journal of Headache and Pain (5) 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.”

What does this mean?


TMJ and Joint Hypermobility Syndrome. This could be you all along and undiagnosed.

We are going to make some fascinating connections here to show that TMJ and jaw-related pain are much more than TMJ 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 holds the joint in place. In the jaw important connective tissue include the Temporomandibular ligament, and the stylomandibular ligament, and the 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 findings in the journal Clinical Oral Investigations (6on the TMJ/TMD –  Joint Hypermobility Syndrome connection.

What is Joint Hypermobility Syndrome? It is a common musculoskeletal disorder that makes your joints too flexible. For some people, this is very advantageous, especially in gymnastics, dance, and swimming. For others, it leads to chronic dislocations.

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.

What is so fascinating about this study is that in patients who had TMJ and were found to have Joint Hypermobility Syndrome, 9.52% of JHS patients have disc disorders and 90.48% of JHS patients do not. In 9 out of 10 patients with TMJ diagnosed patients with Joint Hypermobility Syndrome – pain does not come from degenerated discs.

TMJ is more than a physical problem related to the jaw

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.”(9) We will examine this research below in greater detail.

So back then we were able to show at least a 50% reduction in pain in more than 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.

TMJ is a cause of cervical neck instability and poor posture

In our article on Cervicogenic dysphagia, swallowing difficulties as being caused by problems in the neck and brain, we explored research that noted that TMJ patients and cervical neck instability patients have difficulties in swallowing.

TMJ and neck problems have long been linked together, however, it is not often that a patient will report to us that their previous health care providers made this link and offered treatments addressing both concerns. In the following research the links and the treatments for both TMJ and cervical neck instability point to a problem in the neck.

In many patients, we see with primary problems related to neck pain and cervical instability see problems of TMJ. In many patients that we see with problems of TMJ, we see cervical neck pain. Surprisingly, despite the research suggesting the connection, many patients were not made aware that their jaw pain could be a problem originating in the neck.

In the medical journal Clinical Oral Investigations, (10) oral surgeons in Belgium made a connection between TMJ and cervical instability.

They conducted a study looking for possible correlations between clinical signs of temporomandibular disorders (TMD) and cervical spine disorders.

In the European Journal of Orthodontics, (11) doctors in Japan made a connection:

What? The TMJ altered your posture by stressing your cervical spine? Isn’t posture a problem of swallowing difficulties? Isn’t posture a problem of everything?

Craniocervical physical therapy in patients with myofascial temporomandibular pain disorders. Focus on muscle spasms

In a 2017 study (12) from researchers at the University of Comenius’ Faculty of Medicine in Slovakia, doctors suggested that physical therapy could improve craniocervical dysfunction and myofascial pain symptoms in the head and neck. Here are the highlights of this study:

According to the study’s results, all three groups of patients saw an improvement in pain perception, but the overall subjective remission of painful sensations in the third group took place in as many as 88 % of patients. In this group, there was a significant decrease in the tenderness of trigger points in the trapezius and sternocleidomastoid muscles. This was achieved by a combination of simply relaxing and stretching exercises of cervical muscles with a standard method used in the therapy of masticatory muscles are significantly more efficient.

In this study, the focus was on muscle spasms and the pain they cause. If you can relax the muscles of the TMJ and cervical neck region, you would have less pain. For some people, this will be very effective. For others, it will not. Typically, the people who will not find success will be people who have ligament damage or weakness and tendon attachment weakness or damage. For muscle techniques to work, there needs to be a resistance that allows the muscles to strengthen. If ligaments and tendons are damaged, there is lesser resistance and the treatment will not succeed as wished. We address this problem below.

What are we seeing in this image? The close anatomical association between temporomandibular joint TMJ in the upper cervical vertebrae

It is easy to visualize how injury to the ligaments that support the atlas and axis could cause pain to travel to the head face and TMJ area through the nervous system likewise TMJ instability can affect the same areas including the neck and upper cervical region

Craniocervical muscle problems in older patients with myofascial temporomandibular pain disorders

A 2019 study from Orthopedic and Oral and Maxillofacial Surgeons in South Korea published in the journal Archives of Gerontology and Geriatrics (13) demonstrated the associations among degenerative changes in the cervical spine, head and neck postures, and myofascial pain in the craniocervical musculature in elderly with myofascial temporomandibular disorders (TMDs).

In this research:

RESULTS:

Cervical Muscle Tenderness in Temporomandibular Disorders

A 2020 study appearing in the Journal of Oral & Facial Pain and Headache (14) examined 192 patients with TMD and cervical muscle tenderness. What they found was cervical muscle tenderness was notable only in those with a myogenous (muscle problems) TMD diagnosis, but not in arthrogenous (degenerative TMJ disc disease). (Our note: the problem was not in the TMJ joint but likely a problem of cervical spine instability). This is something the researchers concluded as well:

“cervical muscle tenderness differentiated between TMD patients and controls and between TMD diagnoses. Specific patient and pain characteristics associated with poor outcome in terms of cervical muscle tenderness included effects of interactions between myogenous TMD, female sex, whiplash history, comorbid body pain and headaches, and pain on opening. It can, therefore, be concluded that routine clinical examination of TMD patients should include assessment of the cervical region.”

Understanding the TMJ temporomandibular joint itself. What are we seeing in this image?

In this simplified view of the TMJ, we can get an understanding of the mechanisms behind TMJ disc displacement. When this person would close their mouth, they would get the characteristic clicking sound and accompanying “pop” or feeling of displacement. See that the disc in this image has ligaments behind it. The ligaments are there to provide structural stability between the jaw bone at the skull. The ligaments are holding the jaw to the skull. In front of the disc towards the face are the powerful jaw muscles. Attaching these power muscles to the jaw are the muscle tendons. Notice how the muscle turns white as they approach the bone. The tendons are the muscles attached to the bones and they are white in color. They hold the muscles to the jaw. If the ligaments or tendons are weak, damaged, stretched out, or lax, the jaw is floating, the disc can be displaced.

In this simplified view of the TMJ, we can get an understanding of the mechanisms behind TMJ disc displacement. When this person would close their mouth, they would get the characteristic clicking sound and accompanying "pop" or feeling of displacement. See that the disc in this image has ligaments behind it. The ligaments are there to provide the structural stability between the jaw bone at the skull. The ligaments are holding the jaw to the skull. In front of the disc towards the face are the powerful jaw muscles. Attaching these power muscles to the jaw are the muscle tendons. Notice how the muscle turns white as they approach the bone. The tendons are the muscles attachments to the bones and they are white in color. They hold the muscles to the jaw. If the ligaments or tendons are weak, damaged, stretched out, or lax, the jaw is floating, the disc can be displaced.

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 joints, muscles, and ligaments involved do not work together properly, resulting in pain.

Temporomandibular joint syndrome and TMD or TemporoMandibular 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:

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, do 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. This takes us back to the research we cited earlier on physical therapy. If you do not look for tendon attachment and ligament damage in the jaw and cervical neck areas, the patient’s TMJ/TMD-related pain will be considered difficult to treat and the treatments will move onto symptom suppression, not disorder healing. This will include the standard practice 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 benefits, 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.

Injections versus the splint

Prolotherapy is the injection of simple sugar, dextrose. The idea is that the dextrose will cause a strengthening and rebuilding of the soft tissue holding the jaw in place. Strengthened soft tissue, i.e, ligaments, will stabilize the jaw joint and pull things back into place and reduce degenerative disc and destructive joint forces in the jaw. In this next section we will discuss the research and clinical outcomes of this injection treatment and compare these treatments to cortisone.

A July 2021 paper in the journal Scientific reports (17) tackled the problem of assessing consistent effective outcomes in patient treatment results utilizing Prolotherapy. The study authors write:

“Hypertonic dextrose prolotherapy (a higher concentration of dextrose is being injected) has been reported to be effective for temporomandibular disorders (TMDs) in clinical trials but its overall efficacy is uncertain.”

To assess this problem the researchers then conducted a systematic review (they looked at previously published studies) and analyzed those randomized controlled trials that met their criteria to synthesize evidence on the effectiveness of Prolotherapy for temporomandibular disorders. What they were looking for as good outcomes were levels of pain intensity. Secondary outcomes they were looking for was mouth opening ability.

Here are their results:

In a meta-analysis of 5 randomized controlled trial, dextrose prolotherapy was significantly superior to placebo injections in reducing TMJ pain at 12 weeks. In this systematic review and meta-analysis, evidence from low to moderate quality studies show that dextrose prolotherapy conferred a large positive effect which met criteria for clinical relevance in the treatment of TMJ pain, compared with placebo injections.

In November  2020: Published in the Journal of Cranio-Maxillo-Facial Surgery (18) compared the effectiveness of  Dextrose Prolotherapy and occlusal (mouth) splints in treating internal derangement of the temporomandibular joint.

Results: Nine patients in the (Prolotherapy) study group had complete absence of pain, compared with only one (splint group) patient in the control group. The results showed that patients who received prolotherapy demonstrated improvement in pain, mouth opening, and clicking, but no significant difference in deviation was observed between the groups after 1 year (p = 0.862).

Conclusion: Prolotherapy was found to be superior in providing long-term clinical relief, with a reduction in pain and clicking along with improved mouth opening.

The research on Prolotherapy for Temporomandibular Joint Pain and Dysfunction


Treating the whole joint. Comprehensive Prolotherapy for TMJ. 

“Dextrose prolotherapy is one of the most promising approaches in the management of TMD”

A March 2021 study in the Journal of Maxillofacial and Oral Surgery (19) writes:

“Temporomandibular joint (TMJ) disorders can be treated by both conservative and surgical approaches. Conservative interventions with predictable benefits can be considered as first-line treatment for such disorders. Dextrose prolotherapy is one of the most promising approaches in the management of TMDs, especially in refractory (difficult) cases where other conservative management has failed.

(The researchers) conducted a study on 25 patients suffering from various TMJ disorders who were treated with prolotherapy. . . The standard program is to repeat the injections three times, at 2-week intervals, which totals four injection appointments over 6 weeks with a 3-month follow-up.

Results: There was an appreciable reduction in tenderness in TMJ and masticatory muscles with significant improvement in mouth opening. The effect of the treatment in improving clicking and deviation of TMJ was found to be statistically significant. There were no permanent complications.

Conclusion: (This) study concluded that prolotherapy is an effective therapeutic modality that reduces TMJ pain, improves joint stability and range of motion in a majority of patients. It can be a first-line treatment option as it is safe, economical and an easy procedure associated with minimal morbidity.”

In March 2019, doctors tested this idea. Publishing in the journal Mayo Clinic Proceedings (20)  these doctors from the University of British Columbia, University of Missouri-Kansas City, School of Medicine, the University of Wisconsin School of Medicine and Public Health, and the Chinese University of Hong Kong announced these findings in their study to assess the LONG-TERM effectiveness of dextrose prolotherapy injections in study participants with temporomandibular dysfunction.

Here is the research review:

RESULTS:

Study – Dextrose injections (Prolotherapy): Clinically important and statistically significant improvement in pain and maximal jaw opening.

An August 2020 study in the Journal of Alternative and Complementary Medicine (21) whose authors included noted Prolotherapy researchers, friends, and colleagues Kenneth Dean Reeves, MD and David Rabago, MD noted:

Patient profile:

Patient treatments:

Outcomes:

Comparison between Prolotherapy vs. lidocaine


Prolotherapy has a promising role in the improvement of oral health-related quality of life of patients with TMD, and its beneficial effects persist at least two years after treatment.

An August 2020 study in The British Journal of Oral & Maxillofacial Surgery (22) wrote: “In the present study we have assessed the influence of prolotherapy in patients with TMD by the subjective measurement of Quality of Life using the Oral Health Impact Profile-14 (OHIP-14). Twenty-five patients diagnosed with TMD (mean (range) age 38 (18 – 70) years) were included. They had all undergone dextrose prolotherapy to the TMJ at regular time intervals (four times at intervals of two weeks).”

“I would consider referring a patient with chronic temporomandibular pain for dextrose injection if a clinician with experience in this procedure were available.”

In May 2019 editor Allan S. Brett, MD  reviewed this study for his colleagues, here is what he wrote in the New England Journal of Medicine:

Injection of hypertonic dextrose was quite effective in a randomized trial.

“In this double-blind randomized trial from British Columbia, researchers identified 42 patients with chronic temporomandibular joint pain and dysfunction. Patients received either 20% dextrose plus lidocaine (Prolotherapy) or lidocaine alone, injected into the temporomandibular joint three times at monthly intervals. At baseline, the mean pain score was 8, and the mean jaw dysfunction score was 7 (on 0–10-point scales). At 3 months, a decrease in mean pain score was significantly greater in the dextrose group (Prolotherapy) than in the control group (−4.3 vs. −1.8 points). A decrease in jaw dysfunction also was significantly greater in the dextrose group (−3.5 vs. −1.0 points).

“These results are quite impressive; the study methods are described in great detail, which increases my confidence in the findings. Although the results should be corroborated in another randomized trial, I would consider referring a patient with chronic temporomandibular pain for dextrose injection, if a clinician with experience in this procedure were available.

Indian doctors writing in the Journal of Maxillofacial and Oral Surgery (23) found positive results utilizing Prolotherapy injections for TMJ in recent 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.

In a December 2018 study in the Journal of Oral Rehabilitation, (24)  military Oral and Maxillofacial Surgeons in India proposed that dextrose prolotherapy may cause a significant reduction in mouth opening and pain associated with TMJ hypermobility.

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 (26) 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:

In the July 2018 edition of the Journal of Oral Rehabilitation, Military doctors in India compared Prolotherapy to Placebo injections. They found:

Prolotherapy and aspiration (arthrocentesis) provided significant relief for TMJ patients.

Doctors at Ordu University in Turkey published in The Journal of Alternative and Complementary Medicine (29) 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.

A December 2020 study in the medical journal Cranio, Journal of Craniomandibular Practice (30) also compared the effectiveness of dextrose Prolotherapy in conjunction with arthrocentesis (fluid draining of the TMJ) and dextrose prolotherapy alone in the management of symptomatic TMJ hypermobility.

Twelve years after our own research on TMJ patients

In the research mentioned above from our Caring Medical research team and published in 2007, 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.

We found:

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). (31)

Platelet Rich Plasma Therapy for TMJ

In patients where TMJ symptoms are more advanced. We may also use Platelet Rich Plasma therapy in addition to the Prolotherapy treatments. Here we extract a patient’s blood and spin out the healing platelets and growth factors and inject that into the jaw/mandible area.

PRP application differs from office to office and in fact from research study to research study. In our office, we combine PRP treatments with Prolotherapy treatments to offer the patient a more comprehensive treatment. PRP injections in our office are typical “injections,” at each treatment, not a single injection.

A 2020 study published in the Journal of Oral & Facial Pain and Headache (32) examined the effect of Platelet-Rich Plasma Injections on pain reduction in patients with Temporomandibular Joint Osteoarthritis. In this paper, the research team examined 6 study outcomes and found according to the results of these trials, intra-articular injections of PRP were more effective than placebo for pain reduction (6 months postinjection and 12 months postinjection. Further: “Based on current evidence, PRP injections may reduce pain more effectively than placebo injections in Temporomandibular Joint Osteoarthritis at 6 months (level of evidence: moderate) and 12 months (level of evidence: moderate) postinjection. This significant difference in pain reduction could also be seen when PRP was compared to hyaluronic acid at 12 months postinjection (level of evidence: low). It can be cautiously interpreted that PRP has a beneficial effect on the relief of Temporomandibular Joint Osteoarthritis pain.

A 2015 study in the Journal of Oral and Maxillofacial Surgery (33) shows emerging evidence suggested platelet-rich plasma (PRP) might be of assistance in the treatment of degenerative conditions of the jaw joint.

In this study, PRP and hyaluronic acid treatments in temporomandibular joint (TMJ) osteoarthritis patients were compared over a long-term follow-up.

A total of 50 patients with TMJ-osteoarthritis were enrolled in the study (29 women and 21 men, age range 31 to 49 years, mean age 38.6).

The hyaluronic acid group showed significant improvements at 1 and 3 months. However, at At 6 and 12 months, the PRP group exhibited better performance compared with the hyaluronic acid group in terms of the recurrence of pain and joint sounds.

The PRP group performed better than the hyaluronic acid group in the treatment of TMJ-osteoarthritis during long-term follow-up in terms of pain reduction and increased interincisal distance.

Researchers at the Department of Oral and Maxillofacial Surgery, Jaipur Dental College, in India published their findings in the National Journal of Maxillofacial Surgery (34) of their assessment of the effectiveness of PRP injections compared to hydrocortisone with local anesthetic in the conservative management of anterior disc displacement with reduction. If you have been diagnosed with TMJ you know that this is the displacement of the TMJ disc and the clicking noises that accompany the displacement.

The researchers found: “In the group of PRP injection, the pain was markedly reduced than the group of hydrocortisone with a local anesthetic; mouth opening was increased similarly in both groups and TMJ sound was experienced lesser in patients who received PRP.”

PRP and hyaluronic acid injections

A 2019 study from the University of Verona in Italy published in the International Journal of molecular sciences (35) evaluated the effectiveness of arthrocentesis (TMJ aspiration) or injections with platelet-rich plasma in temporomandibular affections and compare them to arthrocentesis alone or with hyaluronic acid or to hyaluronic acid injections.

The researchers found:

Stem Cell Therapy for TMJ

While we do offer stem cell therapy for our patients, this is not a treatment we often utilize as a first-line treatment. The documented results of the success of simple dextrose Prolotherapy have shown us that this treatment is effective and can result in significant enough improvement that stem cell therapy will not be offered. However, many people ask us about stem cell therapy.

Stem cell therapy has become a very popular treatment option. Research is coming in.

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 has 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. (36) This supports earlier research from the same researchers which stated: Stem Cells could help regenerate bone and soft tissue. (37)

Summary and contact us. Can we help you?

We hope you found this article informative and it helped answer many of the questions you may have surrounding your TMJ issues.  If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff

This is a picture of Ross Hauser, MD, Danielle Steilen-Matias, PA-C, Brian Hutcheson, DC. They treat people with non-surgical regenerative medicine injections.

Brian Hutcheson, DC | Ross Hauser, MD | Danielle Steilen-Matias, PA-C

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This article was updated July 26, 2021

 

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