Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN

Jaw pain can interfere with eating, speaking, yawning, and sleep. For some people, the jaw catches or locks. Others experience repeated episodes in which it moves too far forward and becomes difficult to close. These symptoms may all be described as “TMJ,” but they do not necessarily reflect the same problem.

At Caring Medical, our interest in Prolotherapy centers on the soft tissues that support joint stability. However, a useful discussion of jaw injections must begin with the diagnosis. Muscle pain, disc displacement, arthritis, and recurrent dislocation have different features, and findings from one group should not automatically be applied to another.

What is the difference between TMJ and TMD?

The temporomandibular joints, or TMJs, connect the lower jaw to the skull, immediately in front of the ears. The term temporomandibular disorders, or TMDs, refers to conditions affecting these joints, their discs, and the muscles involved in chewing. Joint movement combines rotation and forward sliding. A disc between the joint surfaces helps coordinate that movement. (1)

Symptoms can include pain with chewing, painful clicking, stiffness, limited opening, or episodes of locking. A click alone does not identify a damaged ligament or establish a need for injections. Painless clicking is common and usually does not require treatment. (2)

The distinction between the following conditions helps make sense of the research:

These categories can overlap. The clinical history and examination remain central; imaging can help answer selected questions about disc position, bone changes, or other pathology. An imaging abnormality alone does not explain every symptom. (1)

What is dextrose Prolotherapy intended to do?

Prolotherapy involves injections used to address painful musculoskeletal conditions. Dextrose is a sugar solution. In TMJ studies, injections have been placed inside the joint, around its capsule, or near other supporting structures.

Hypertonic dextrose is more concentrated than ordinary body fluids. Proposed effects include a local tissue response that could promote collagen production and improve ligament or capsular support. Pain-modulating mechanisms may also contribute. A 2025 comprehensive review discusses these biological explanations and clinical applications, while acknowledging the need for controlled studies of long-term clinical and structural outcomes. (3)

Improved pain or jaw function does not, by itself, prove that an injection rebuilt a ligament, regenerated cartilage, or permanently repositioned a disc. Those structural claims require their own evidence.

Concentration also matters. A study using 5% dextrose for restricted opening does not evaluate the same approach as one using hypertonic dextrose around the capsule for recurrent dislocation. Injection location, solution, frequency, and additional procedures vary considerably across the literature. (4)

New 2026 review: Excessive jaw movement and restricted opening are different problems

An August 2026 scoping review mapped dextrose injections across TMJ mobility disorders. It included 18 reports: 14 reports describing 13 primary clinical studies, plus four systematic reviews used to map the evidence. Two reports came from the same pilot trial and should not be counted as separate patient populations. Twelve primary studies concerned excessive movement, while one addressed disc displacement without reduction with limited opening. (4)

Many hypermobility studies reported less pain, excessive opening, or recurrence after treatment. However, comparisons with placebo or other treatments did not consistently favor dextrose. The small restricted-opening study reported improvement with 5% dextrose, but the review could not identify an optimal protocol because the studies differed substantially. (4)

For patients, the key lesson is that more mouth opening is not always the desired result. A person whose jaw repeatedly dislocates may benefit from control of excessive opening. A person with a closed lock may need improved opening. Changes in mouth opening must therefore be interpreted alongside diagnosis, pain, chewing ability, and recurrence.

What randomized studies show about pain and jaw function

A 42-participant trial: Short-term benefit, with an important crossover limitation

A 2019 randomized trial assigned 42 participants, representing 54 joints, to three monthly injections of either 20% dextrose with lidocaine or lidocaine alone. At three months, the dextrose group had larger improvements in pain and jaw dysfunction. Pain decreased by an average of 4.3 points versus 1.8 points on a 10-point scale; dysfunction decreased by 3.5 versus 1.0 points. Mouth opening also favored dextrose. (5)

Improvements continued through one year, but control participants were allowed to receive dextrose after three months. The later results therefore show persistence of improvement after treatment, rather than a full year of comparison against an unchanged control group. Baseline differences between the small groups were another limitation. (5)

A 29-participant trial: Some outcomes favored dextrose, others did not

A 2020 randomized trial compared dextrose with lidocaine against lidocaine in sterile water in 29 participants, representing 43 joints. At three months, average pain and dysfunction improvements were similar, although more dextrose-treated joints achieved at least 50% pain improvement. Mouth opening improved in both groups without a significant between-group difference. (6)

At 12 months, pain and dysfunction favored the original dextrose group. However, participants had been unblinded and could request dextrose after month three. The findings are encouraging, but that design and the small sample limit the strength of the long-term comparison. (6)

What earlier reviews contribute

A 2021 systematic review included ten randomized trials involving 336 participants. Its pooled analysis of five trials favored dextrose over placebo for pain at 12 weeks. It did not find statistically significant pooled differences in mouth opening or functional scores. The underlying trials had some to high risk of bias. (7)

A separate review, published online in 2023, included eight randomized studies with 286 patients and reported favorable pain and opening outcomes in internal derangement. Its findings support continued investigation, but should be read alongside the newer reviews’ emphasis on differing diagnoses and inconsistent comparative results. (8)

Recurrent dislocation and symptomatic hypermobility

Repeated dislocation can affect confidence in eating or yawning. In this setting, Prolotherapy studies often examine tissues around the capsule, with the goal of controlling excessive movement.

A 2017 clinical study treated 23 patients with recurrent dislocation or subluxation using 25% dextrose around the capsule together with a local nerve block. Twenty-one met the study’s success criteria; some required two or three injections. Because there was no randomized comparison group, the reported 91.3% success rate cannot be treated as a predictable result for all patients. (9)

A separate series of 45 patients reported that 41 had no further dislocation or subluxation for more than six months. Among those 41, 26 needed one injection, 11 needed two, and four needed three. This is the source of the frequently cited 91% result. It is not the outcome of the separate ten-patient study sometimes discussed alongside it. (10)

That ten-patient retrospective study reported less pain and improved quality of life, with no locking during follow-up. Clicking did not significantly change, and the reduction in maximum opening was not statistically significant. (11)

A prospective single-arm study followed 61 patients for one to four years and reported sustained improvement in pain and other symptoms. Nevertheless, imaging continued to show excessive forward movement of the condyle, the rounded end of the lower jaw, without a change in bony morphology. Symptom improvement did not demonstrate normalization of every anatomical finding. (12)

The controlled evidence is less decisive than these series might suggest. A 2018 review of three randomized trials found less pain and reduced maximum opening with dextrose, but the trials reporting recurrence did not show a difference from placebo. It could not establish that dextrose reduced dislocation or subluxation episodes. (13)

New July 2026 review: Comparing injection options for recurrent dislocation

The July 2026 mapping review examined studies in which the injection’s effect could be assessed separately from simultaneous non-injection procedures. It included five primary clinical studies and eight secondary sources used for mapping or reference checking. Treatments included dextrose Prolotherapy, autologous blood injections, and sodium morrhuate or other sclerosing agents. (14)

Most studies reported fewer recurrent episodes or better stability. However, small samples, different injection sites and protocols, and limited comparative evidence prevented a conclusion that any injection was superior. Autologous blood uses the patient’s own blood; sclerosing agents are intended to produce a local tissue response that restricts excessive movement. These options are not interchangeable. (14)

This review adds context rather than a new treatment trial. Its conclusions should not be counted as an independent set of newly treated patients alongside the studies it reviews.

Disc displacement, painful clicking, and closed lock

Disc displacement with reduction

A randomized, double-blind study of 30 patients with bilateral disc displacement with reduction compared 25% dextrose with saline. Pain, mouth opening, and satisfaction favored dextrose. Joint sounds did not show a significant difference, illustrating that pain improvement and elimination of clicking are separate outcomes. (15)

An uncontrolled 20-patient study of internal derangement reported less pain, increased opening, and fewer patients with clicking or deviation after injections near disc attachments and the masseter muscle. The masseter is a major chewing muscle. Follow-up extended to 12 weeks. Average pain scores decreased from 6 before treatment to 3.75 at two weeks and 1.9 at four weeks. Because there was no comparison group, these changes cannot establish superiority over another treatment. (16)

The 2025 pilot study of closed lock

Twenty women with limited opening from disc displacement without reduction were randomized to 5% dextrose or saline after symptoms had persisted despite medication and physical therapy. Both groups gradually improved opening, with a difference favoring dextrose at the final assessment. Pain generally favored dextrose earlier, but the between-group pain difference was not statistically significant at 12 months. (17)

This is preliminary evidence from a small, female-only sample. It does not establish that 5% dextrose consistently restores disc position or that the same result applies to all causes of restricted opening.

A combined approach followed for five years

A retrospective study of 40 adolescents and young adults combined a nerve block, guided jaw movement exercises, and hypertonic dextrose injections. It reported a high success rate maintained through five years. Because all three components were used together without a randomized control group, the contribution of dextrose alone cannot be isolated. (18)

Can improvements last, and do they affect quality of life?

An exploratory study of 25 patients reported reduced joint and muscle tenderness, better opening, and improvements in clicking and deviation after a series of injections. Its short follow-up and lack of a comparison group limit conclusions about durability and comparative benefit. (19)

A separate quality-of-life report involving 25 patients assessed seven areas, including pain, functional limitations, psychological discomfort, and social effects. The total questionnaire score improved from 21.20 to 13.08 at two years. This provides information beyond mouth-opening measurements, but an uncontrolled before-and-after report cannot establish how much improvement was caused by the injections. (20)

The outcomes that matter to patients include tolerating meals, speaking comfortably, and experiencing fewer painful or disruptive episodes. A favorable average score in a study does not mean every participant improved or that another patient will have the same result.

Prolotherapy compared with splints and other conservative care

An occlusal splint is an oral appliance used for selected TMD problems. A randomized study of 34 patients compared splints with dextrose Prolotherapy for internal derangement. At one year, nine injection-group patients reported complete absence of pain compared with one splint-group patient. Pain, opening, and clicking favored injections, while jaw deviation did not significantly differ. (21)

The participants had Wilkes stage II or III internal derangement. These stages describe increasing complexity of disc-related joint disease; they are not a universal classification for all facial pain. Stage II can involve intermittent clicking or locking, while stage III generally involves more established displacement, pain, and movement restriction. (1)

One small trial cannot establish that Prolotherapy is preferable to every type of splint or conservative treatment. General TMD care can include education, temporary modification of painful activities, physical therapy, and selected medication or oral appliances. Irreversible changes to the bite and surgery require particular consideration of indications and risks. (2)

For a broader discussion, see our article on TMJ injections and conservative care treatments.

Arthrocentesis with or without Prolotherapy

Arthrocentesis is a procedure that washes out the joint space. It is more accurately described as joint lavage than simply aspiration or fluid drainage. Research has examined it alone, with splints, and with dextrose injections.

A ten-patient case series combined arthrocentesis and Prolotherapy in one session. Pain and subluxation improved, while clicking did not significantly change. Maximum opening decreased, an important distinction in this hypermobility population. There was no separate group receiving only one component. (22)

A 24-patient comparison found less pain in both the Prolotherapy-only and combined-treatment groups, with a greater decrease in locking episodes when arthrocentesis was added. (23)

A 2025 retrospective comparison involved 26 patients: 15 received combined treatment and 11 received Prolotherapy alone. Pain decreased more in the combined group over three months. Maximum opening decreased in both groups, rather than increased. Temporary dizziness and facial nerve weakness were reported in some cases and resolved. The small, nonrandomized design limits conclusions about superiority. (24)

A separate 35-patient study reported improvements after arthrocentesis plus an anterior repositioning splint for painful disc displacement with intermittent locking. It did not test Prolotherapy and therefore supports discussion of another treatment approach, not the effectiveness of dextrose. (25)

Does ultrasound guidance improve results?

A 2024 randomized trial compared ultrasound-guided and nonguided dextrose injections in 22 patients with painful clicking and MRI-confirmed disc displacement with reduction. Both groups improved, with no statistically significant difference in pain scores between them. Ultrasound aided anatomical localization and allowed a single joint puncture. (26)

The study provides information about injection technique, but does not establish that guidance produces greater pain relief or eliminates procedural risk.

Newer evidence on dextrose and PDRN

A 2026 retrospective chart review examined 66 patients whose TMD symptoms had persisted despite conventional treatment. Patients received hypertonic dextrose or polydeoxyribonucleotide, known as PDRN, a preparation of DNA fragments. The study reported improved pain and function after an average of 2.3 treatment sessions. (27)

PDRN and dextrose are different substances. The combined results of this chart review should not be described as outcomes of dextrose alone. Without a randomized untreated or placebo comparison, the study cannot establish which agent was better or isolate the effects of injections from other influences.

Bone changes, PRP, and cell-based research

A 2022 study compared radiographic changes in 45 dextrose-treated patients with 15 controls. It found changes in a mathematical measure called fractal dimension, which describes aspects of the bone’s internal pattern. This indirect imaging measure does not establish cartilage regrowth, stronger ligaments, or prevention of arthritis progression. (28)

TMJ osteoarthritis can involve cartilage, the bone beneath it, the joint lining, and surrounding tissues. Research has investigated platelet-rich plasma, hyaluronic acid, and mesenchymal cell-based approaches. A review of potential regenerative strategies described promising findings but also conflicting results and a continuing need for research. Some regenerative evidence comes from experimental models and should not be presented as established clinical joint regeneration. (29)

PRP, dextrose, and cell-based preparations have different compositions and proposed actions. Evidence supporting one does not automatically validate another, and symptom relief alone does not demonstrate repair of the entire joint.

Caring Medical’s perspective on the jaw and neck

Our clinical perspective includes considering the relationship between jaw support and neighboring head and neck structures. Our published literature review discusses dextrose Prolotherapy across musculoskeletal conditions. It provides broader background rather than TMJ-specific proof of effectiveness. (30)

A 2023 editorial coauthored by Ross Hauser, MD discusses observations concerning mandibular position, cervical structures, and internal jugular vein dimensions. It raises possible mechanisms worthy of investigation. It is an editorial, not a randomized TMJ treatment trial, and does not establish that venous compression or cervical instability causes most jaw pain. (31)

Patients interested in associated symptoms can read our discussions of TMJ and tinnitus and Ernest syndrome and unresolved facial, ear, or throat pain. These topics should complement, rather than replace, assessment for dental disease, primary joint disorders, muscle pain, and neurological causes.

Video: TMJ dysfunction, neck symptoms, and airway considerations

For additional discussion, see why TMJ treatments may fail. Our separate article on TMJ and Lyme disease addresses a specific differential diagnosis; jaw pain alone does not establish Lyme disease.

Safety, alternative diagnoses, and when jaw symptoms need prompt attention

Small studies often report few or no serious adverse events. That does not establish that rare complications cannot occur. The recent combined-treatment series documented transient dizziness and facial weakness, illustrating why the details of adverse-event reporting matter. (24)

Dental infection, inflammatory arthritis, trauma, and nerve-related pain can mimic or accompany TMD. A jaw that remains stuck open needs prompt professional assessment; forceful attempts to manipulate it yourself can cause injury. Facial swelling with fever, inability to drink, significant trauma, or new neurological symptoms also warrant prompt evaluation. Trouble breathing or swallowing is an emergency.

Jaw discomfort occurring with chest pressure, shortness of breath, sweating, or exertion should not be assumed to be TMJ pain; it can signal a medical emergency.

What the research means for patients

We see a reasonable basis for discussing dextrose injections as a potential option for selected TMJ conditions. Some randomized trials favor dextrose for pain or function, and observational studies report improvements in recurrence and quality of life. However, benefit varies across diagnoses, and favorable case series do not resolve the uncertainties in controlled comparisons.

The new reviews strengthen the need for diagnosis-specific interpretation. Recurrent dislocation, painful reducible disc displacement, and closed lock are different clinical problems. A meaningful result is improved comfort and usable jaw function for the condition being treated—not simply a larger or smaller opening measurement.

Further reading

Temporomandibular disorders – TMJ and Lyme Disease

TMJ and Tinnitus: Should we explore the ligament chain from the cervical spine through the neck to the jaw to the ear?

Ernest Syndrome | Is this the answer to unresolved TMJ, facial, ear and throat pain?

Why do TMJ treatments fail?

Caring Medical published research

Evidence-Based Use of Dextrose Prolotherapy for Musculoskeletal Pain: A Scientific Literature Review: This paper has been cited by 45 research studies as we were able to demonstrate level 1 and 2 evidence to support the use of dextrose Prolotherapy for osteoarthritic pain and function, tendinopathies, myofascial pain syndrome, sacroiliac pain, and myofascial pain syndrome. There is level 3 evidence in support of the use of dextrose Prolotherapy for diffuse muscusloskeletal pain involving the spine, pelvis and peripheral joints. Dextrose Prolotherapy should be recommended for such musculoskeletal conditions as tendinopathy, ligament sprains, Osgood-Schlatter disease and degenerative joint disease, including osteoarthritis.

The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology?

Lockerman LZ, Hauser R. The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology? Cranio. 2023 Sep;41(5):403-406. [Google Scholar]

Medical disclaimer: This article provides general educational information and is not a diagnosis or a recommendation for a particular injection or procedure. Treatment benefits, risks, and suitability depend on the underlying condition.

References

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• We concluded that Prolotherapy has a promising role in the improvement of quality of life in patients with TMD, and its beneficial effects persist at least two years after treatment.

“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 (6) 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.

• Prolotherapy with 25 % dextrose being injected into the posterior pericapsular tissues is one such treatment modality with favorable outcomes.

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.

• The overall success rate in the study was 91.3 % (21/23) with a minimum follow-up period of 13.9 months.
• The number of successfully treated patients requiring one injection was 7 (30.4 %), two injections were 8 (34.7 %), and requiring three injections was 6 (26.1 %). There were no permanent complications.

An April 2023 paper in the journal Cranio (7) from Alexandria University in Egypt reviewed data from eight previously published studies testing the effectiveness of prolotherapy on TMJ, In total 286 cases were reviewed  72% were females, and 28% were males. “The extracted data showed positive effects of dextrose on joint pain and maximum mouth opening with high patient satisfaction.” The researchers concluded that prolotherapy “can be effective in relieving TMD symptoms as it reduces pain, improves joint dysfunction, and increases maximum mouth opening up to 12 months.”

Prolotherapy reports on Hypermobility, disc displacement/dislocation

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

• Doctors writing in the British Journal of Oral and Maxillofacial Surgery found that Prolotherapy injections were 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 at the University of Karadeniz Technical University (9) 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.

In the July 2018 edition of the Journal of Oral Rehabilitation, (10) Military doctors in India compared Prolotherapy to Placebo injections. They found: “Within the limitations of the study, dextrose Prolotherapy may cause significant reduction in mouth opening and pain associated with TMJ hypermobility. Conclusions concerning the reduction of episodes of subluxation/dislocation cannot be drawn. ” In their study, they could not give good evidence that TMJ subluxations or dislocations were reduced.

A February 2022 study (11) evaluated the effects of prolotherapy on condyles (wear and tear on the bone) in temporomandibular joint hypermobility. In this study, the researchers acknowledged that prolotherapy has gained popularity in recent years and has been reported to have positive short-term and long-term. Their study aimed to evaluate the changes in the trabecular (bone) structure of mandibular condyles in patients who underwent prolotherapy due to TMJ hypermobility.

• Forty-five patients who received dextrose prolotherapy at a concentration of 20% and fifteen control patients were included in the study.

Result:

• Dextrose prolotherapy without the effect of the number of injections caused a decrease in Fractal Dimensions (A computer-based scoring system) values in the mandibular condyles over time. Prolotherapy lessened the effects of degenerative wear and tear on the TMJ.

A May 2025 study in the journal Scientific reports (12) evaluated the effectiveness of intra-articular injection of 5% Dextrose prolotherapy in 20 female patients with Disc Displacement without Reduction with limited mouth opening, These patients had not responded to pharmacological and physical therapy.

The measured symptoms included pain intensity on mouth opening and closing, and ability to open the mouth. Standard scores were measured before and four times after injection (2 weeks, 2 months, 6 months, and 12 months). The patients noted gradual improvements in mouth opening and pain reduction, The researchers concluded that prolotherapy “significantly affects relieving pain in female closed-lock patients.”

Intra-articular injection of 25% dextrose is effective in the treatment of pain and dysfunction of TMJ disc displacement with reduction as shown by significant improvement in pain and mouth opening and patient satisfaction.

A March 2022 study published in the Journal of Cranio-Maxillo-Facial Surgery (13) comes to us from the Faculty of Dentistry, Mansoura University, Egypt. In this research, doctors assessed the effectiveness of dextrose prolotherapy on the clinical signs and symptoms of patients having TMJ disc displacement with reduction.

• “This prospective, randomized, double-blind clinical study included thirty patients suffering from bilateral disc displacement with reduction. The patients were randomly divided into two equal groups. Group I = 25% dextrose solution and normal saline in Group II.
• Pain intensity, maximal interincisal opening (mouth opening), and joint sounds were evaluated:
  • preoperatively,
  • one week after each injection, and three months and six months after the last injection.
• Patients in group I (Prolotherapy group) showed significant improvement in pain and maximal interincisal opening, and higher satisfaction with treatment than patients in group II (Saline group). Compared to saline injection, dextrose injection resulted in an improvement in joint sounds but without significant differences within and between groups.
• Intra-articular injection of 25% dextrose is effective in the treatment of pain and dysfunction of TMJ disc displacement with reduction as shown by significant improvement in pain and mouth opening and patient satisfaction. The technique is simple, easy to do, safe, and should be adopted whenever appropriate.”

March 2021 paper in the journal Head and Face Medicine (14) examined and treated 40 adolescents and young adults, aged 16 to 30 years old, with a distinct combination of symptoms of TMJ “closed lock”. Patients received anesthetic blockages of the auriculotemporal nerve, then performed mandibular condylar movement exercise for 10 min, and subsequently received hypertonic dextrose prolotherapy in the retro-discal area of TMJ. Clinical assessments at baseline and at follow-up (2 weeks, 2 months, 6 months, and 5 years) included intensity and frequency of TMJ pain, mandibular range of motion, TMJ sounds, and impairment of chewing.

Results: Cone beam CT images of the TMJs revealed joint space changes in all patients and degenerative bone changes in 20% (8/40) of the patients. The patients were diagnosed as having disc displacement without reduction with limited opening. Successful reduction of the displaced disc had been achieved in the treatment. Pain at rest and pain on mastication had substantially decreased in all patients and mandibular function and mouth opening had significantly improved since 2 weeks’ follow-up. The overall success rate was kept at a high level of 97.5% (39/40) at 6 months and 5 years’ follow-up.

More research published in The British Journal of Oral & Maxillofacial Surgery. (15)

Dr. Refai of Cairo University reported in the British Journal of Oral and Maxillofacial Surgery:

• Sixty-one patients with symptomatic hypermobility of the TMJ were each given four sessions of intra-articular and pericapsular Prolotherapy injections six weeks apart.
• Each injection comprised 10% dextrose/mepivacaine solution 3ml.
• Clinical outcomes include:
  • the severity of pain on movement according to the numerical rating scale (NRS),
  • maximal interincisal opening,
  • clicking,
  • and frequency of locking was measured before treatment (T1), during treatment (T2) (just before the third session of injections), at the short-term follow-up (T3) (three months after treatment), and at the long-term follow-up (T4) (1-4 years after treatment).
• Condylar translation (movement of the TMJ joint) and osseous (bony) changes of each joint were evaluated at T1 and T4 using tomography.
  • There was a significant reduction in all variables by T2
  • The pain scores and clicking had decreased significantly by the short-term follow-up (T3).
  • Linear tomograms of each joint at T1 and T4 showed no alteration in the morphology of the bony components of the joint, and at the long-term follow-up (T4), tomographic open views of all joints showed condylar hyper-translation.

A June 2023 study in the European Review for Medical and Pharmacological Sciences (16) evaluated the effect of dextrose prolotherapy in treating internal derangement of the temporomandibular joint. A total of 20 patients with temporomandibular joint internal derangement were enrolled in the study. “The posterior and anterior disc attachment, as well as the most tender part of the masseter muscle, were injected with 12.5% dextrose. Pain, maximum mouth opening, clicking, and deviation were assessed immediately before treatment, as well as at two, four, and twelve- weeks post-treatment.

Results: There was a significant improvement in the four clinical variables at the three-time intervals.

• Pain at two weeks was reduced by 60% and by 200% at 4 weeks.
• The maximum mouth opening was increased by 6.4 mm at 2 weeks and 7.85 mm at 4 weeks.
• The percentage of patients with clicking decreased from 70%, preoperatively- to 50% at 2 weeks, 15% at 4 weeks, and 5% at 12 weeks.
• The ratio of patients with deviation was decreased from 80% preoperatively to 35% at 2 weeks, 15% at 4 weeks, and 5% at 12 weeks.

An April 2024 paper in the Journal of Ultrasound in Medicine (17) compared ultrasound-guided versus non-guided Dextrose 10% prolotherapy injections in patients suffering from internal derangement in the temporomandibular joint (TMJ).

• The study population included 22 patients and 43 TMJs suffering from unilateral or bilateral TMJ painful clicking, magnetic resonance imaging (MRI) proved disc displacement with reduction (DDWR), refractory to or failed conservative treatment.
• The patients were divided randomly into two groups (non-guided and ultrasound (US)-guided groups).
• Twenty-two patients 5 males and 17 females were included in this study. Average age about 27 years old

The researchers found both US-guided and non-guided groups with significant symptomatic improvement over time in both groups. US guidance allowed accurate anatomical localization and safe procedure with a single joint puncture.

Prolotherapy Injections versus the TMJ splint

A July 2021 paper in the journal Scientific Reports (18) 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. The secondary outcome they were looking for was mouth-opening ability.

Here are their results:

In a meta-analysis of 5 randomized controlled trials, 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 shows that dextrose prolotherapy conferred a large positive effect that met the 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 (19) compared the effectiveness of  Dextrose Prolotherapy and occlusal (mouth) splints in treating internal derangement of the temporomandibular joint.

• A total of 34 patients with temporomandibular joint internal derangement classed as Wilkes stages II or III were recruited for the study and were randomly divided into study and control groups with 17 patients each.
  • Wilkes stages for TMJ assessment
    • If you have been diagnosed with TMJ disorders you are probably aware of the Wilkes stages of TMJ assessment:
    • Wilkes stage II is typically characterized by a normal or seemingly normal range of jaw motion with intermittent episodes of pain, jaw locking, and clicking.
    • Wilkes stage II is typically characterized by more pain, frequent headaches, loss of range of motion, onset or development of TMJ disc damage, and deformity.
• The patients in these control and study groups were treated with splints and Prolotherapy, respectively.
• The patients were then monitored for pain, mouth opening range, clicking, and other deviations in proper jaw movement. These patients were followed for 0ne year.

Results: Nine patients in the (Prolotherapy) study group had a 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.

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.

A December 2023 paper (20) did suggest that “simultaneous arthrocentesis and anterior repositioning splint therapy is effective in alleviating pain and improving mouth opening without discomfort in patients with unilateral painful TMD showing disc displacement with reduction with intermittent locking.”

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 (21) 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.

• Arthrocentesis and Prolotherapy were consecutively performed using a 30% dextrose solution that was simultaneously injected into five areas: posterior disc attachment, superior joint space, superior and inferior capsular attachments, and stylomandibular ligament.

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, 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 September 2023 study in the medical journal Cranio, Journal of Craniomandibular Practice (22) 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.

• Twenty-four patients suffering from TMJ symptomatic hypermobility received 10% dextrose injections for three sessions at four-week intervals. (Three treatments, one every four weeks).
• Twelve patients received Prolotherapy alone; the other 12 received Prolotherapy and arthrocentesis The arthrocentesis was only performed once.
• Patients were evaluated for maximal incisal opening, maximal incisal opening without pain, pain at rest, pain during chewing function, TMJ sound, and locking episode frequency.
• Results: Pain scores were significantly reduced in both groups, and the locking episode frequency was decreased to a greater extent in the Prolotherapy and arthrocentesis than in the Prolotherapy group, in both the short and long terms.
• Conclusion: Prolotherapy is effective in the management of TMJ hypermobility. However, Prolotherapy with arthrocentesis may be superior to Prolotherapy alone in the management of TMJ hypermobility.

A December 2025 study in the Journal of cranio-maxillo-facial surgery (23) divided 26 patients (average age: 33.7 years) into two treatment groups:

• 15 patients received combined prolotherapy with arthrocentesis  and
• 11 patients received traditional prolotherapy.

Clinical outcomes were measured by mouth opening, pain intensity, and the presence of joint clicking, at 1 week, 1 month, and 3 months post-treatment.

Both groups demonstrated a statistically significant improvement in mouth opening. Better reduction in pain intensity was observed in the combined therapy group. Although clicking sounds decreased in both groups, the differences were not statistically significant. The study suggested that the integration of arthrocentesis with prolotherapy may enhance pain relief and improve clinical outcomes in the management of TMJ hypermobility, offering a promising minimally invasive option for clinicians.

Prolotherapy, PRP, and mesenchymal stem cell-based treatment

In a December 2022 paper cited above, researchers writing in the International Journal of Molecular Sciences (24) summarized the problems of degenerative TMJ and possible solutions:

• TMJ osteoarthritis affects all (of the TMJ) joint structures, including the articular cartilage, synovium, subchondral bone, capsule, ligaments, periarticular muscles, and sensory nerves that innervate the tissues. . . Chondrocyte loss, extracellular matrix (ECM) degradation, and subchondral bone remodeling are important factors in TMJ osteoarthritis.”
• “In recent years, such therapies as intraarticular platelet-rich plasma (PRP), hyaluronic acid (HA), and mesenchymal stem cell-based treatment (MSCs) have shown promising results concerning the regeneration of joint structures or the protection against further damage in TMJ osteoarthritis. Nevertheless, PRP and MSCs are more frequently associated with cartilage and/or bone repair than hyaluronic acid. According to recent findings, hyaluronic acid could enhance the restorative potential of other therapies (PRP, MSCs) when used in combination, rather than repair TMJ structures by itself.

Further reading

Temporomandibular disorders – TMJ and Lyme Disease

TMJ and Tinnitus: Should we explore the ligament chain from the cervical spine through the neck to the jaw to the ear?

Ernest Syndrome | Is this the answer to unresolved TMJ, facial, ear and throat pain?

Why do TMJ treatments fail?

Caring Medical published research

Evidence-Based Use of Dextrose Prolotherapy for Musculoskeletal Pain: A Scientific Literature Review: This paper has been cited by 45 research studies as we were able to demonstrate level 1 and 2 evidence to support the use of dextrose Prolotherapy for osteoarthritic pain and function, tendinopathies, myofascial pain syndrome, sacroiliac pain, and myofascial pain syndrome. There is level 3 evidence in support of the use of dextrose Prolotherapy for diffuse muscusloskeletal pain involving the spine, pelvis and peripheral joints. Dextrose Prolotherapy should be recommended for such musculoskeletal conditions as tendinopathy, ligament sprains, Osgood-Schlatter disease and degenerative joint disease, including osteoarthritis.

The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology?

Lockerman LZ, Hauser R. The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology? Cranio. 2023 Sep;41(5):403-406. [Google Scholar]

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