Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN
While we do offer stem cell therapy for some of 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 for TMJ 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.
Mesenchymal stem cell-based treatments (MSCs) have become a very popular treatment option. Research is coming in. Stem cell therapy can involve the use of bone marrow aspiration (or also concentrated) to get the stem cells to the site of the injury.
An April 2021 study in the journal Stem Cells International (1) described the possible use of stem cells in TMJ cases: “Current treatments for Temporomandibular joint osteoarthritis are mainly symptomatic therapies without reliable long-term efficacy. . . Recently, there has been increased interest in cellular therapies for osteoarthritis and TMJ regeneration. Mesenchymal stem cells (MSCs), self-renewing, and multipotent progenitor cells play a promising role in Temporomandibular joint osteoarthritis. Derived from a variety of tissues, MSCs exert therapeutic effects through diverse mechanisms, including chondrogenic differentiation; fibrocartilage regeneration; and trophic, immunomodulatory, and anti-inflammatory effects.”
National University of Singapore doctors (2) 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.
- Temporomandibular Disorders (TMD) represent a group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint (TMJ), masticatory muscles, and/or associated structures.
- They are a major cause of non-dental-related face and jaw pain.
- The most common type of TMJ disorder involves displacement of the TMJ articular disc that precedes progressive degenerative changes of the joint leading to osteoarthritis.
We would like to point out again, that you cannot grow something out of nothing in the current mode of stem cell therapy. If the TMJ meniscus is removed, stem cells cannot regrow a new one.
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 to cell-based therapeutics, tissue engineering, and drug discovery in treatment. This supports earlier research from the same researchers who stated that stem cells could help regenerate bone and soft tissue. (3)
This was followed by similar research published in 2017 (4) which suggested: “Given the limited self-healing potentials of avascular cartilage, little effective therapy is available for the repair of normal TMJ tissues in osteoarthritis disease. Although conventional nonsurgical or surgical treatments can relieve joint pain to some extent, they cannot completely restore the TMJ function and reverse disease progression. MSCs, which have the multilineage differentiation potentials, may provide an alternative treatment for the cartilage degradation in TMJ osteoarthritis.”
Conversely, an August 2022 paper in the journal Cells (5) examining the outcomes of the treatment of temporomandibular joint (TMJ) articular pain and restricted maximum mouth opening with intra-articular administration of mesenchymal stem cells (MSCs), suggested that while the treatment may be helpful, studies talking of the treatments benefits are based on weak evidence.
Stem cell therapy remains controversial. For most, in our opinion, stem cell therapy is not some type of miracle, single-shot cure. Thinking it is, indeed, is an over-expectation of what the treatment can do.
Prolotherapy for Temporomandibular Joint Pain and Dysfunction
References
1 Zhao Y, Xie L. An Update on Mesenchymal Stem Cell-Centered Therapies in Temporomandibular Joint Osteoarthritis. Stem Cells Int. 2021 Apr 1;2021:6619527. [Google Scholar]
2 Zhang S, Yap AU, Toh WS. Stem Cells for Temporomandibular Joint Repair and Regeneration. Stem Cell Rev. 2015 Jun 28. [Google Scholar]
3 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. [Google Scholar]
4 Cui D, Li H, Xu X, Ye L, Zhou X, Zheng L, Zhou Y. Mesenchymal Stem Cells for Cartilage Regeneration of TMJ Osteoarthritis. Stem Cells International. 2017;2017. [Google Scholar]
5 Chęciński M, Chęcińska K, Turosz N, Kamińska M, Nowak Z, Sikora M, Chlubek D. Autologous stem cells transplants in the treatment of temporomandibular joints disorders: A systematic review and meta-analysis of clinical trials. Cells. 2022 Aug 30;11(17):2709. [Google Scholar]