Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN
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 led 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.
Because the cure for TMD has been so elusive, perhaps no other disorder involves so many allied healthcare professionals including pain clinicians, dentists, physical therapists, psychologists, mental health professionals, speech-language pathologists, physiatrists, radiologists, internists, family physicians, endodontists, orofacial surgeons, otolaryngologists, neurologists, and craniofacial specialists.
Later in this article, we will show that 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. 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.
In this article, we will discuss these treatments and the possible solutions regenerative medicine injections may offer.
Part 1: 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? Was it Inflammation?
Symptom suppression is successful, BUT the underlying problem is still there
The above heading is taken in part from the title of a paper from University medical researchers in Turkey published in the International Journal of Oral and Maxillofacial Surgery. (1)
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. Patients were divided into four groups according to the treatment method:
- Splint therapy, (various devices put into the mouth to stabilize the jaw joint).
- Arthrocentesis, (aspiration of fluid in the jaw)
- Medical therapy, (a medical treatment possibly involving arthroscopic procedures).
- and low-level laser therapy (LLLT). LLLT stimulates the immune responses to heal joints by themselves.
Magnetic resonance imaging (MRI) was performed before treatment and at the 1-month follow-up. Patients were followed up after treatment for 6 months.
- Mouth opening increased and pain scores decreased at 1, 3, and 6 months after treatment in all groups.
- No statistically significant difference in the improvements in clinical symptoms was observed between the groups.
Note: All these treatments worked well, except in our opinion the very ominous problem of effusion.
Symptom suppression is 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.
There is currently no consensus on the best treatment for painful temporomandibular disc displacement with reduction.
In January 2024, an international team of doctors wrote in the International Journal of Oral and Maxillofacial Surgery (2): “There is currently no consensus on the best treatment for painful temporomandibular disc displacement with reduction, and no network meta-analysis of randomized clinical trials (RCTs) comparing all types of treatment for this condition has been conducted.”
The team then set out to “compare and rank all treatments for temporomandibular disc displacement with reduction, including conservative treatments, occlusal splints, low-level laser therapy (LLLT), manual therapy, no treatment (control), arthrocentesis alone, arthrocentesis plus intra-articular injection of platelet-rich plasma (arthrocentesis-PRP) or hyaluronic acid (arthrocentesis-HA), and arthrocentesis plus occlusal splint.”
Reviewing 20 previously published random control studies, the researchers collected 980 patient’s data.
A review of the results:
- Arthrocentesis-PRP significantly reduced pain intensity compared to arthrocentesis alone.
- Occlusal splint and manual therapy were superior to conservative treatment (all very low-quality evidence).
- Arthrocentesis with intra-articular injection of PRP/HA ranked as the most effective treatment in terms of pain reduction
- Low-Level Laser Therapy ranked as the best choice for increasing maximum mouth opening for patients with temporomandibular disc displacement with reduction.
- However, it is important to note that the evidence for the superiority of these treatments is generally of very low quality.
Low-level Light Laser Therapy (LLLT) or Photobiomodulation therapy
An August 2023 paper in the Journal of Lasers in Medical Sciences (3) writes: “Photobiomodulation therapy (PBMT) is a conservative way to improve function and reduce symptoms in TMD patients” and sought to “update evidence about the effects of PBMT on pain intensity, TMJ movements, electromyography (EMG) activity, pressure pain threshold (PPT), and TMJ sound in patients with TMDs.”
Photobiomodulation therapy is a broad term to describe treatments using Low-level Light Laser Therapy, or “Red Light Therapy.”
In this review study, the data from forty previously published studies were assessed for outcomes:
- Pain intensity: 27 studies showed a reduction in pain intensity in Photobiomodulation therapy groups compared to control groups.
- Seven out of 15 studies showed a greater maximum mouth opening (MMO) in Photobiomodulation therapy groups than in placebo groups.
- In addition, the figures for passive maximum mouth opening (PMMO) and active maximum mouth opening (AMMO) in all the studies reporting PMMO and AMMO were higher in Photobiomodulation therapy groups.
- In eight out of ten studies, lateral movement was greater in Photobiomodulation therapy groups.
- In three studies out of four, protrusive movement (PM) was reported to be greater in the Photobiomodulation therapy groups.
- Reduced TMJ sounds in the Photobiomodulation therapy groups were reported in two out of five studies.
A September 2023 paper in the journal Medicine (4) reviewed the data of 22 previously published studies on the effects of acupuncture in adults with TMD. In all, reviews of 471 cases were used. The researchers found “acupuncture significantly improved outcomes versus active controls… acupuncture significantly improved the effect rate and pain intensity, however, the quality of evidence was determined to range from low to very low.
Duloxetine
A November 2023 paper in the Journal of Oral Rehabilitation (5) reported on a randomized, double-blind, placebo-controlled trial (RCT) of duloxetine in addition to self-management strategies to investigate its efficacy in reducing pain intensity in painful TMD patients.
Duloxetine is an anti-depressant that is thought to help relax the TMJ muscles and thereby relieve pain.
What the researchers found was of eighty participants who were randomized to duloxetine 60 mg or placebo for 12 weeks, pain intensity decreased in both groups but did not differ between groups. “This study failed to provide evidence of a beneficial effect of adding duloxetine to self-management strategies for the treatment of painful TMD. . . ”
Craniocervical physical therapy in patients with myofascial temporomandibular pain disorders. Focus on muscle spasms
In a 2017 study (66) 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:
- The group of patients diagnosed with myofascial dysfunctional pain syndrome contained 98 patients out of which 79 patients (81 %) were females and 19 patients (19 %) were males.
- The majority of the patients were aged between 26 and 35 years; the total age range was 14-77 years with an average of 38 years.
- Observed patients were subdivided into three groups.
- Standard therapeutic methods aimed at the temporomandibular joint were provided to the patients of the first group.
- The second group of patients received therapy aimed at cervical muscles only.
- Complex rehabilitation was applied in the third group of patients.
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 simple relaxing and stretching exercises of cervical muscles with a standard method used in the therapy of masticatory muscles that 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 will 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.
Physical therapy can help people with TMJ disorders by reducing jaw and TMJ joint pain. Mouth opening can be helped with manual therapy and exercises which address the jaw, neck, and shoulders.
Acupuncture for TMJ
A May 2024 study in the journal Clinical Rehabilitation (69) examined the effects of temporomandibular disorder in the treatment of tension-type headaches with acupuncture and therapeutic exercises. Ninety-six patients with frequent episodic or chronic tension-type headaches were divided into one of four treatment groups. Six weeks of acupuncture or therapeutic exercise either as monotherapies or in combination, or usual care. Follow-up at 3 and 6 months.
Results: Temporomandibular dysfunction score improved in all intervention groups at 3-month follow-up the usual care; acupuncture; therapeutic exercise; combination of treatment groups. After 6 months, only acupuncture had long-lasting positive effects on the symptoms of temporomandibular dysfunction. Significant dental problems inhibited the effectiveness of acupuncture for tension-type headaches.
The evidence and comparisons of TMJ injection treatments
Injections into the masticatory muscles, injections into the temporomandibular joints
A December 2023 paper in the medical journal Drugs (12) reported on medical use and treatments in masticatory muscles, and TMJ patients. They write that while there are more than 50% of the patients with TMD report regular drug usage, there is still no consensus, nor is there any evidence-based support for clinicians when choosing between different drugs.
- When it comes to discomfort in the masticatory muscles, evidence arises for Botulinum toxin injections, granisetron (as an anti-inflammatory), and Platelet-Rich Plasma injections as well as muscle relaxants. For temporomandibular joint pain, evidence points toward pharmacological treatment approaches including non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticosteroids (for inflammatory conditions) as well as hyaluronic acid and dextrose (prolotherapy).
The researchers conclude: “The evidence clearly indicates that the pharmacological treatment approaches differ between TMD-masticatory muscles and TMD-temporomandibular joint pain. Therefore, it is of great importance to first try to uncover each patient’s individual and multifactorial etiology and then employ a multifaceted treatment strategy, including pharmacological treatment approaches.”
A February 2022 review in the journal Oral and Maxillofacial Surgery Clinics of North America (13) offers us this summary of the myriads of treatments available to TMJ patients.
“Treatments include noninvasive pharmacologic therapies, minimally invasive muscular and articular injections, and surgery. Conservative therapies include nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants.
Minimally invasive injections include botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and Prolotherapy with hypertonic glucose. With many pharmacologic treatment options and modalities available to the oral and maxillofacial surgeon, mild to moderate temporomandibular joint disorder can be managed safely and effectively to improve symptoms of pain and function of the temporomandibular joint.”
“Nonsteroidal anti-inflammatory drugs (with proton pump inhibitors) and muscle relaxants are first-line therapies shown to improve symptoms of temporomandibular joint disorder. Oral benzodiazepines, tricyclic antidepressants, and anticonvulsants are alternative therapies that may be considered in resistant or refractory temporomandibular joint disorder, in consultation with the patient’s physician. Botox injections have been shown to be a safe and effective treatment for myofascial temporomandibular joint disorder as intramuscular injections. Intra-articular injections have shown marked improvement in symptoms. Evidence suggests they share similar effectiveness. Prolotherapy with hypertonic glucose is effective for treating hypermobility and subluxation of the temporomandibular joint.”
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 (14) from 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.
More recently in November 2022 in the medical journal Life (15), researchers compared the long-term effect on pain of intra-articular TMJ injections of betamethasone (corticosteroid), sodium hyaluronate, and platelet-rich plasma. The study group was made up of 114 patients, who were randomly distributed into three groups at least three years prior to completion of the study and who achieved a total remission of pain after treatment.
- The researchers found the average number of months without pain was, according to each group, as follows:
- Platelet-rich plasma: 33 months;
- Sodium hyaluronate: 28 months
- Betamethasone 19 months.
- The researchers concluded: “Both platelet-rich plasma and sodium hyaluronate lead to significant pain-free time after treatment; when we compare betamethasone with the two other substances, it proved to be very ineffective.”
A December 2023 systematic review in the Journal of Oral Rehabilitation (68) looked at the data of 18 previously published articles and found no statistically significant differences between injections of hyaluronic acid and corticosteroids, whereas platelet derivates (PRP therapy) seem to have good results in pain relief. Overall, however, the researchers did find “intriguing effects of intra-articular injections of hyaluronic acid in terms of reduction of pain intensity and improvement of functioning in patients affected by TMD.”
Moving away from hyaluronic acid to PRP
The effectiveness of PRP has led to more research on PRP for various musculoskeletal disorders. A July 2023 paper in the Journal of Clinical Medicine (16) in fact states, that medical research has swung away from hyaluronic acid research. The researchers write: “In the years 2017–2023, hyaluronic acid was the most common topic of scientific publications among injectables administered into temporomandibular joint cavities (26 randomized controlled trials and 30 other clinical studies). In the same period, there was a significant upward trend in the number of published primary studies focused on centrifuged blood preparations used in the treatment of TMDs. As of 2021, blood products (such as PRP) administered into TMJ cavities have become a more popular topic for professional medical articles than hyaluronic acid.”
A November 2023 study in the Journal of Cranio-Maxillo-Facial Surgery (17) compared the efficacy of platelet-rich plasma (PRP) injections for the treatment of temporomandibular joint osteoarthritis with hyaluronic acid therapy. This randomized controlled trial included 70 patients with temporomandibular joint osteoarthritis, randomly divided into either a PRP or hyaluronic acid therapy group. The pain intensity, maximum mouth opening (MMO), TMJ sound score, and proportion of crepitus were recorded and compared at baseline, one, three, and six months.
Both groups showed statistically significant improvements in pain intensity, maximum mouth opening, TMJ sound, and scale scores during the 6-month follow-up period. The improvements in pain intensity during mouth opening at 1 month, maximum mouth opening at one, three, and six months, TMJ sound score at one and three months, and GAD-7 (General Anxiety Disorder survey) score at 6 months in the PRP group were greater than in the hyaluronic acid group.
The researchers concluded: “Compared with the hyaluronic acid therapy group, imaging improvement in the PRP group was also higher. Within the limitations of the study, it seems that the application of PRP therapy in TMJ-osteoarthritis should be considered whenever possible.”
Steroids, Hyaluronic acid injections, and Platelet Rich Plasma Therapy
An April 2023 paper (18) from the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, at Mansoura University compared the outcomes in patients of different intra-articular injections using a mixture of hyaluronic acid (HA) and platelet-rich plasma (PRP) versus hyaluronic acid and corticosteroid in the management of TMJ internal derangement with reduction (dislocation.) The research was published in the Journal of maxillofacial and oral surgery.
In this study: Sixty patients were randomly divided into two equal groups.
- Group I was injected with hyaluronic acid and PRP.
- Group II was injected with hyaluronic acid and corticosteroid.
Pain intensity according to the visual analog scale (0 no pain to 10 unbearable pain), maximum inter-incisal opening (MIO – Mouth opening ability), lateral movement, and joint sound were measured pre-operatively and at 1 week, 1 month, and 6 months post-operatively.
Mouth opening ability and lateral movements were improved in both groups, with a reduction in the number of patients suffering from clicking sounds during the follow-up periods with both groups showing significant results.
- Regarding pain, the group injected with hyaluronic acid (HA) and platelet-rich plasma (PRP) achieved the best results after six months, while patients treated with hyaluronic acid and corticosteroids obtained the best results at the end of the 1st week.
Hyaluronic acid injections and steroid injection
In September 2018, in the Hungarian Medical Weekly, (19) researchers at the world-renowned Semmelweis University’s Faculty of Dentistry published their findings comparing hyaluronic acid injections and steroid injections.
They found:
- Comparing the two treatments, three hyaluronic acid injections were significantly more effective than cortisone in relieving patients’ symptoms.
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.”
Beyond our opinion, there is good debate in the medical community There is debate in the medical community over the effectiveness of hyaluronic acid injections for pain relief and functional improvement in patients with temporomandibular disorders. This is discussed in an August 2023 paper (20) published in the International Journal of Molecular Sciences. Here doctors in Romania conducted an umbrella review of previously published papers. In their examination of the data they suggest: “no statistically significant differences between hyaluronic acid injections and corticosteroids, whereas platelet (PRP) derivates seem to have good results in pain relief. . . Furthermore, there is no agreement on the effectiveness of a combination of arthrocentesis or arthroscopy with hyaluronic acid injections.” The researchers warned that “Although the literature showed these positive results after hyaluronic acid injections, the overlapping of primary studies in the systematic reviews included might have affected our results, such as the very low quality of the papers.” In other words, the positive effects of hyaluronic acid injections were not definitively shown.
Hyaluronic injections vs. glucosamine and oral NSAID
An October 2021 study in the Journal of Clinical Oral Investigations (21) compared the effects of 4 biweekly hyaluronan (Hyaluronic injections) injections with glucosamine and diclofenac oral administration on TMJ osteoarthritis patients. These are the paper’s learning points:
- This study included TMJ osteoarthritis patients who had four biweekly hyaluronan injections or oral glucosamine hydrochloride for 3 months and diclofenac sodium for 2 weeks (group and had complete data at the first visit, three months, six months, and 12 months.
Results:
- “Hyaluronan injections alleviated signs and symptoms of TMJ osteoarthritis rapidly and presented superior clinical effects over oral glucosamine with diclofenac. However, both treatments did not limit the bone destruction of TMJs significantly.” In other words, the degenerative joint, the TMJ, disease continued. Below we will cite one possible reason as already discussed, for TMJ ligament laxity and TMJ instability.
PROLOTHERAPY
Prolotherapy is the injection of simple sugar, dextrose. The idea is that 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, 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 other injections. We have an extensive article on this treatment option below
Prolotherapy for Temporomandibular Joint Pain and Dysfunction
Hypermobility, disc displacement, effusion or swelling, and instability of the TMJ.
Hypermobility of the TMJ means that the joint is loose and that the jaw is floating abnormally within the head causing grinding and degeneration at the joint. The TMJ discs and meniscus can be displaced causing the onset of osteoarthritis and the development of pain and bone spurs. Omnipresent in this situation is the problem of effusion or swelling adding pressure to the joint. The swelling and inflammation are there to try to stabilize the joint and the fluid is trying to provide a cushion from the degenerative process.
TMJ, Joint Hypermobility Syndrome and Ehlers-Danlos syndrome.
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.
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, 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.
More on “blood injections”
Platelet Rich Plasma is a blood injection, the blood is taken from you and spun in a centrifuge to separate the blood platelets. It is this separated fluid with concentrated platelets that gives Platelet Rich Plasma its name, and the injection of plasma rich in platelets. There are also autologous blood injections where the blood is taken from one part of the body and simply put back into the painful area, in this case, the jaw and TMJ joint.
“Blood injections” can be somewhat painful, as the blood is very thick. This is why Platelet Rich Plasma injections started to gain popularity because they could offer the healing factor benefits of blood in a less thick injectable.
We are going to look at a January 2020 systematic review paper from the Department of Orofacial Pain and Jaw Function, Malmö University in Sweden published in the journal Clinical Oral Investigations (59) here the doctors looked at a comparison of autologous blood injection and a TMJ Prolotherapy treatment program.
To assess these treatments in comparison, the doctors examined previously published research on randomized controlled trials on TMJ luxation treatment.
- Results: In the absence of randomized studies on surgical techniques (none of the papers directly compared autologous blood injections, Prolotherapy, and surgery), autologous blood injection in the superior joint space and pericapsular tissues with intermaxillary fixation seems to be the treatment for recurrent TMJ luxation that at present has the best scientific support. (In other words, the most supportive research was found on autologous blood injections/PRP injections).”
- However, the researchers did point out that “These studies reported that mouth opening after treatment was reduced and that independent of the type of injection (autologous blood injections/PRP injections or Prolotherapy), recurrences of TMJ luxation were rare in most patients. (Dislocations became rare).”
A December 2022 paper (60) published in the National Journal of Maxillofacial Surgery (of India) compared autologous blood (your blood) prolotherapy and 25% dextrose prolotherapy for the treatment of chronic recurrent temporomandibular joint dislocation.
- In this study, 20 patients with chronic recurrent TMJ dislocation were treated with either autologous blood (Group A) or 25% dextrose Prolotherapy (Group B). After prolotherapy, the patients were kept on follow-up and evaluated for maximum mouth opening (MMO), pain at visual analog scale (VAS), mandibular movements, frequency of dislocation, and TMJ sound.
Results: Group A, the autologous blood prolotherapy patients showed better results in terms of reduction in maximum mouth opening (MMO), and mandibular movements as compared to Group B (the 25% dextrose Prolotherapy), and a statistically significant difference was found starting from 2 weeks post prolotherapy till 6 months follow-up. Whereas 25% of dextrose Prolotherapy patients showed better results regarding reduction in pain intensity on the visual analog scale (VAS) at all follow-up visits. No statistically significant difference was found between both groups regarding reduction in the frequency of dislocation and TMJ sounds.
A January 2023 paper in the Journal of Maxillofacial and Oral Surgery (61) divided thirty-two patients into autologous blood injections and dextrose prolotherapy injections. Pain level, joint hypermobility, maximal mouth opening, and frequency of dislocations were recorded at various follow-up intervals up to one year post-treatment. The researchers found both, autologous blood injections and dextrose prolotherapy, proved effective in reducing the pain and joint hypermobility associated with chronic recurrent TMJ dislocation within a week. ABI proved to be more efficient in reducing the mouth opening and limiting the dislocation of TMJ as compared to dextrose therapy.
In a September 2023 paper in the Journal of Clinical Medicine (62), researchers however wrote: “The allegedly superior efficacy of blood to hypertonic dextrose (prolotherapy) in dislocation relief is based on only one study of 32 patients. (The above study). Both therapies are probably highly effective, however, based on the collected material, no further conclusions can be drawn and this issue undoubtedly requires further research.
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:
- 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.
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 from inflammation, Prolotherapy stimulates healing.
The Physical and emotional aspects of TMJ
In our 2007 study, we noted:
- Prior to Prolotherapy, 56% of patients reported feelings of depression and 64% reported feelings of anxiety.
- After treatments, only 28% reported depressed feelings and 36% reported feelings of anxiety.
- Patients reported that on average 86% of the improvements in depression and anxiety have at least somewhat continued.
- Seventy-eight percent of these patients reported 75% continuing improvement at the time of follow-up.
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. (63) Here is a review of that study:
- Chronic pain is the overwhelming reason that patients with TMD seek treatment.
- TMD can associate with impaired general health, depression, and other psychological disabilities, and may affect the quality of life of the patient.
- The most common types of TMD,
- include pain-related disorders (e.g., myalgia, headache attributable to TMD, and jaw joint pain) as well as disorders associated with the TMJ (primarily disc displacements and degenerative disease).
- As peripheral mechanisms (nerve and pain signals) most likely play a role in the onset of TMD, a detailed muscle examination is recommended.
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).
Because the cure for TMD has been so elusive, perhaps no other disorder involves so many allied healthcare professionals including pain clinicians, dentists, physical therapists, psychologists, mental health professionals, speech-language pathologists, physiatrists, radiologists, internists, family physicians, endodontists, orofacial surgeons, otolaryngologists, neurologists, and craniofacial specialists. Exploring treatment options such as Prolotherapy may offer benefits not offered by these specialties. Prolotherapy can be an effective treatment for chronic neck, head, TMJ, facial, ear, and mouth pain because it strengthens the structures that are causing the pain.
An October 2022 paper in the journal Cureus (63) helps sum this article up this way: “TMJ prolotherapy, like other joint treatments, can be beneficial to individuals who have a temporomandibular disorder (TMD) that is resistive to or has demonstrated only limited improvement with physical medicine, dietary restrictions, and home care. It can also benefit patients who have not improved sufficiently with oral appliances, or who are unable or unable to wear such equipment, and who are unsuitable or unwilling candidates for TMJ surgery.”
We hope you found this article informative and that 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
Further reading
Ernest Syndrome | Is this the answer to unresolved TMJ, facial, ear and throat pain?
Our published research
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]
Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction Hauser R., Hauser H, Blakemore KA. Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction. (2007) [Google Scholar]
References
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