Treatment of Temporomandibular Dysfunction With Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial With Long-term Partial Crossover

Abstract

Objective: To assess the efficacy and longer-term effectiveness of dextrose prolotherapy injections in participants with temporomandibular dysfunction. Patients and Methods: A randomized controlled trial with masked allocation was conducted from January 14, 2013, through December 19, 2015. Forty-two participants (with 54 joints) meeting temporomandibular dysfunction criteria were randomized (1:1) to 3 monthly intra-articular injections (20% dextrose/0.2% lidocaine or 0.2% lidocaine) followed by as-needed dextrose/0.2% lidocaine injections through 1 year. Primary and secondary outcome measures included a 0 to 10 Numerical Rating Scale score for facial pain and jaw dysfunction; maximal interincisal opening (MIO) measured in millimeters, percentage of joints with 50% or more change (improvement) in pain and function, and satisfaction.

Application of auriculotemporal nerve block and dextrose prolotherapy in exercise therapy of TMJ closed lock in adolescents and young adults

“…Temporomandibular joint (TMJ) closed lock is a clinical condition that is mostly attributed to anterior or anteromedial disc displacement without reduction (DDwoR). DDwoR can be a quite debilitating intra-articular disorder, causing significant pain and dysfunction that disturbs the patient's quality of life with the potential for persistence of symptoms and degenerative joint diseases (DJD) [1][2][3][4][5][6][7][8]. The possible mechanism for jaw locking and DDwoR progression has been proposed to begin as a displaced disc obstructing the forward condylar translation, and direct mechanical injury from joint overloading and hypoxia-reperfusion injury would result in release of free radicals into the synovial fluid causing degradation of hyaluronic acid and eventually a vacuum effect (suction cup effect).…”

“…The reduction of signs and symptoms of TMJ closed lock seems to be related more to the passage of time, but not to the exercise. Further, some long-term survey data indicate that temporomandibular dysfunction remains a recurrent or persistent condition in 50% of symptomatic patients diagnosed with TMD even after successful physical therapy [4][5][6][7][18][19][20].…”

Application of Auriculotemporal Nerve Block and Dextrose Prolotherapy in Exercise Therapy of TMJ Closed Lock in Adolescents and Young Adults

“…Temporomandibular dysfunction might become a recurrent or persistent condition for a long time. [4][5][6][7] Anesthetic block of auriculotemporal nerve can effectively numb TMJ and reduce protective muscle splinting. [21,22] Subsequently, patients can quickly increase the range of jaw movement through painfree exercise in several minutes.…”

“…Further, some long-term survey data indicate that temporomandibular dysfunction remains a recurrent or persistent condition in 50% of symptomatic patients diagnosed with TMD even after successful physical therapy. [4][5][6][7][18][19][20] By contrast, in designing this study we scheduled anesthetic block of auriculotemporal nerve to numb TMJ area before exercise procedures. The regional anesthesia can reduce pain and protective muscle splinting, increase the mandibular range of motion, and assist in providing a more manageable treatment.…”

“…DDwoR can be a quite debilitating intraarticular disorder, causing signi cant pain and dysfunction that disturbs the patient's quality of life with the potential for persistence of symptoms and degenerative joint diseases (DJD). [1][2][3][4][5][6][7][8] The possible mechanism for jaw locking and DDwoR progression has been proposed to begin as a displaced disc obstructing the forward condylar translation, and direct mechanical injury from joint overloading and hypoxia-reperfusion injury would result in release of free radicals into the synovial uid causing degradation of hyaluronic acid and eventually a vacuum effect (suction cup effect). The end result of these proposed pathological processes leads to anchored disc phenomenon, and degenerative progression in the longer term.…”