This article will discuss the use of Prolotherapy injections for the treatment of difficult to treat temporomandibular joint (TMJ) syndrome.
Positive research reported on the benefits of Prolotherapy on problems of TMJ
A new study in the Journal of oral rehabilitation demonstrates the effectiveness of prolotherapy treatments for the problems of TMJ. In this study from the Indian military, the researchers concluded that “dextrose prolotherapy (A simple sugar that is the basis of the Prolotherapy treatment) may cause significant reduction in mouth opening and pain associated with TMJ hypermobility.”(1)
Research reported The Journal of craniofacial surgery, March 2018
In this study, doctors acknowledge that Prolotherapy injections are an effective treatment for patients with TMJ. The purpose of the study was to determine the effective amounts of the dextrose injections. The doctors examined patients with chronic jaw subluxation or jaw dislocation. In testing 40 patients, whether the patients received 10% dextrose Prolotherapy, 20% dextrose Prolotherapy, and 30% dextrose Prolotherapy group. Each group showed significant improvement in TMJ pain, significant decrease in both maximum mouth opening and joint sound.(2)
Research reported in The journal of alternative and complementary medicine from the Department of Oral Maxillofacial Surgery, Ordu University in Turkey made these findings:
Arthrocentesis (joint aspiration) and prolotherapy which was injected into five areas: posterior disc attachment, superior joint space, superior and inferior capsular attachments, and stylomandibular ligament. Following this one time treatment, arthrocentesis and prolotherapy significantly improved the subluxation and pain after 1 week and subluxation after 3 months. The maximum mouth opening significantly decreased at all follow-up time points.(3)
Prolotherapy addresses ligament weakness in the TMJ as opposed to disc disease.
Typically in TMJS the lower jaw (mandible) is extended forward. A head forward posture exaggerates the problem. This forward mandible aggravates the cervical ligament laxity, which increases the neck pain. Again, an endless cycle of pain and disability is created in the neck, head, and face region. Prolotherapy injections to strengthen both the cervical vertebrae and the temporomandibular joint will solve this problem.
Eventually, the mandible moves forward to the extent that it will stretch the lateral TMJ ligament and produce pain. Once the lateral TMJ ligament becomes lax, the joint will click. It is important to note that clicking in any joint is an indication of ligament laxity of that joint. Joint clicking is never normal or a good sign. Joint clicking, whether it is in the TMJ, knee, neck, or lower back is always abnormal. It is a sign that the bones are beginning to rub against each other. The body’s compensatory mechanism for such a situation is to tighten muscles and to grow more bone. The end result will be degeneration, arthritis, and stiffness in that joint. Prolotherapy can stop this process. Prolotherapy will stop a joint from clicking and stop the arthritic process from continuing.
Research reported in The British journal of oral & maxillofacial surgery, June 2017.
- “Dextrose prolotherapy provided significant and sustained reduction of pain and recovery of constitutional symptoms associated with symptomatic hypermobility of the TMJ.”(4)
In a definitive study on the topic published in Practical Pain Management, Caring Medical researchers reported on 14 patients with TMJ pain. The average number of treatments received was 4.6, and the average pain level decreased from 5.9 to 2.5, on a scale of 1-10.
In this study Ross Hauser, MD noted:
“The results of this retrospective, uncontrolled, observational study, demonstrated that prolotherapy helps decrease pain and improve the quality of life of patients with chronic temporomandibular joint symptoms. Decreases in pain, stiffness, and crunching levels of the TMJ were seen, even in patients who were told by their physicians that no other treatment options were available.”
- Fifty-seven percent of the patients achieved greater than 75% pain relief with prolotherapy and 93% of patients stated prolotherapy relieved them of at least 50% of their pain.
- In regard to quality of life issues prior to receiving treatment, 50% had an overall disability of at least 50% (jaw motions restricted by about half). This decreased to 7% after prolotherapy. Prolotherapy also caused clinically relevant improvements in patients’ TMJ range of motion, sleep, depressive and anxious feelings.
- Ninety percent of patients on medications at the start of prolotherapy were able to decrease them by 75% or more. One hundred percent of patients said that dextrose prolotherapy changed their life for the better. Eighteen months, on average, after their last prolotherapy treatment, one hundred percent of patients said they had retained the majority of their benefits from the treatment.(5)
Positive results reported by Dentists
Prolotherapists have a long history treating TMJ since the time of Louis W. Schultz, MD, DDS in the 1930’s. Dr. Schultz was unique in that he was both a dentist and a medical doctor. In 1956 Dr. Schultz reported that after 20 years of experience in treating hypermobile temporomandibular joints with Prolotherapy, the clicking, grating, or popping was controlled in all of the several thousand patients that had been under his care, without any reported complications or deleterious effects.(6,7)
In 2010, more than 5 decades later, Roy V. Hakala, DDS and Kim M. Ledermann, DDS reported on these three case histories in the Journal of Prolotherapy:
- Case #1 is a 49-year-old female.
- Patient suffered from temporalis-area headaches one to two times per week, bilateral facial pain that was worse on the left side, and bilateral TMJ clicking.
- Symptoms were not known to be related to any particular incident or injury and had been present for about four years prior to her initial examination in our office.
- She had a good range of mandibular motion at baseline.
- She was treated with a home care program, therapy, and wore an intraoral orthosis for four months with some success. The most significant improvement was reduction of her headaches, but TMJ clicking indicative of persistent disc displacement, and intermittent facial pain remained.
- A series of four Prolotherapy appointments was carried out over twelve weeks
- On follow-up 11 weeks later, her mandibular range of motion remained good and her maximum mandibular protrusion had increased from five millimeters to 10 millimeters. The patient reported that she was feeling much better as her facial pain and TMJ clicking had dissipated.
- Very minimal masseter discomfort was elicited on firm palpation. Mild intermittent clicking was palpable in the left TMJ but the patient reported that this was steadily diminishing.
- Case #2 is a 56-year-old female who presented to our clinic in chronic closed lock (Disc Displacement). She had TMJ clicking for several years and her jaw became locked four months prior to her initial examination at our clinic. Chief complaints include limited ROM and throbbing pain in the left TMJ, which had begun spreading over her lower face and into both temples. Her maximum opening at the initial exam was about half of normal at only 29 millimeters with deflection of her jaw to the left on opening. Use of an intraoral orthosis along with home care and physical therapy over three months produced only minor improvement with myalgia and slight improvement in range of movement.
A series of Prolotherapy appointments was carried out as described above but only to the left TMJ and masseter muscle. By the fourth visit, maximum opening had improved to 38 millimeters and lateral and protrusive range of movement had improved as well. Headache and facial pain had resolved and no significant tenderness was reported on palpation of the left TMJ or temporalis or masseter muscles.
Case #3 is a 23-year-old male who presented with audible and palpable clicking in the left TMJ, accompanied by pain that he rated at 3-4 on a scale of 5. Treatment alternatives were presented and treatment with an intraoral orthosis to be worn full-time for four to six months was recommended. The patient declined this treatment plan as he worked as a professional model and was concerned that wearing a dental appliance would adversely affect his facial appearance. He opted for Prolotherapy, which was done at four separate appointments over a 12-week interval. At three-month recall, both the TMJ clicking and the joint pain were completely gone.(8)
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1 Nagori SA, Jose A, Gopalakrishnan V, Roy ID, Chattopadhyay PK, Roychoudhury A. The efficacy of dextrose prolotherapy over placebo for temporomandibular joint hypermobility: a systematic review and meta‐analysis. Journal of oral rehabilitation. 2018 Jul 19. [Google Scholar]
2 Mustafa R, Güngörmüş M, Mollaoğlu N. Evaluation of the Efficacy of Different Concentrations of Dextrose Prolotherapy in Temporomandibular Joint Hypermobility Treatment. The Journal of craniofacial surgery. 2018 Mar. [Google Scholar]
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4 Refai H. Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint: a single-arm study with 1-4 years’ follow up. British Journal of Oral and Maxillofacial Surgery. 2017 Jun 1;55(5):465-70.
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6. Schultz LW. A treatment for subluxation of the temporomandibular joint. Journal of the American Medical Association. 1937 Sep 25;109(13):1032-5.
7. Schultz LW. Twenty years’ experience in treating hypermobility of the temporomandibular joints. The American Journal of Surgery. 1956 Dec 1;92(6):925-8.
8 Hakala RV, Ledermann KM. The use of prolotherapy for temporomandibular joint dysfunction. Journal of Prolotherapy. 2010;2(3):439-46.