Over the years we have received our fair share of emails from patients seeking treatment for their TMJ.
They will often write of a traumatic injury such as a jaw dislocation during a hockey game or a dislocation or a fractured jaw from a motorcycle accident. Some will write that they had some wisdom teeth removed, a few of them will talk about dry socket syndrome from the extraction. There are those who write in that they play a trumpet, saxophone or clarinet and can no longer play their instrument. Some write in that they have been given steroids but are seeking a solution, not a temporary pain fix.
Some tell their story of having suffered with TMJ related pain for decades and how the pain and problems in their jaw have accelerated much more rapidly in recent months. There are people who write in that they are on soft foods only, they have a history of bite guards, TMJ appliances and orthodics.
What they all write in about is that they are seeking a solution to their problems of jaw pain,popping, clicking and difficulty in chewing. They are tired of their jaw locking and the spasms it causes.
When TMJ is not the result of an acute injury or event
TMJ can also develop from a combination of inter-related factors, sometimes starting with poor head posture that contributes to the stretching and weakening of the cervical ligaments and lateral TMJ ligaments. As a result, the lower jaw slips forward, aggravating the situation further by putting additional stress on the ligaments and the joints. Like the people above who had an acute event, people who develop TMJ overtime can also experience loud popping or clicking of bones rubbing together in the loosened joint, accompanied by pain and stiffness as the muscles tighten, trying to compensate for the instigating laxity.
Conventional and non-conventional treatments for TMJ: A comparison of Platelet Rich Plasma injections other treatments
Conventional treatments include TMJ arthroscopy and various types of surgery, TMJ implants, injections of botulinum toxins, and cauterization. All of these are invasive and somewhat risky, and treat the immediate problem while largely ignoring future consequences. Research suggests platelet-rich plasma (PRP) might be of assistance in the treatment of degenerative conditions of the joints. Doctors began testing it for TMJ.
In the first study, doctors at Al-Azhar University, Faculty of Dental Medicine, Cairo in Egypt studied 50 patients with TMJ-osteoarthritis, they found that PRP performed better than hyaluronic acid during long-term follow-up in terms of pain reduction and increased interincisal distance (the ability to open their mouth).(1)
This was a influential study in that it is cited by newer research. Here are some of those studies:
A 2019 study in the International journal of molecular sciences,(2) found that aspiration or arthrocentesis of the jaw joint and platelet-rich plasma injections in temporomandibular disorders’ management were found to be effective in reducing pain and joint sound as well as in improving mandibular motion in a maximum follow-up of 24 months. A 2015 study in the Journal of cranio-maxillofacial surgery concluded that patients suffering from TMJ disc dislocation benefited more from PRP injections than from arthrocentesis to manipulate the jaw back in place. Clearly PRP stabilized the joint and reduced chronic instability.(3)
A 2018 study in the National journal of maxillofacial surgery,(4) researchers compared PRP injections and hydrocortisone with local anesthetic injections in temporomandibular disorders: Here twenty patients with internal derangements of the TMJ were divided in two groups.
- One group received PRP injection and the other received hydrocortisone with local anaesthetic.
- In the group of PRP injection, pain was markedly reduced than the group of hydrocortisone with local anesthetic; mouth opening was increased similarly in both groups and TMJ sound was experienced lesser in patients who received PRP.
Doctors from Jagiellonian University, Medical College in Poland (5) found that platelet-rich plasma injections into the temporomandibular joints has a positive impact on the reduction of the intensity of pain experienced by patients treated for temporomandibular joint dysfunction.
Stem cells and TMJ
In the journal Stem Cells International, October 2017, (6) research suggests that Mesenchymal stem cells, derived from the bone marrow play a role as seed cells for the cartilage regeneration of TMJ osteoarthritis. In addition to addressing abnormal remodeling of the subchondral bone (the jaw bone under the TMJ cartilage). The study notes research that has revealed the interaction between chondrocyte (cartilage makers) and adjacent osteoclast or osteoblast (bone makers) to regulate the bone-remodeling process during stem cell repair.
Bisphosphonate-associated osteonecrosis of the jaw shows stem cells can repair damage
We receive many emails from patients with bone loss in the jaw along with TMJ problems. One factor is that they were prescribed Bisphosphonates – drugs to PREVENT bone loss. Doctors at combined university hospitals in Spain published findings that stem cells may offer an answer. “The main challenge in treating bisphosphonate-related osteonecrosis of the jaw (BRONJ) is the absence of an effective established treatment.” (7)
The doctors compared different potentially preventive treatments for BRONJ after dental extractions in zoledronic acid (a drug for bone loss) treated animals. Stem cells stimulated with and without blood proteins and and platelet-rich plasma (PRP) in rats.
Stem cell based treatments seem to prevent BRONJ. The combination of stem cells and PRP appears to be synergistic.
These results should not be surprising to doctors already experienced in regenerative medicine. For the patients suffering from TMJ problems, PRP and Stem Cells may provide the answer. Are you a candidate? The answer starts with an email, contact us.
Ask Dr. Darrow about TMJ
A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
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1. Hegab AF et al. Platelet-Rich Plasma Injection as an Effective Treatment for Temporomandibular Joint Osteoarthritis. J Oral Maxillofac Surg. 2015 Sep;73(9):1706-13. doi: 10.1016/j.joms.2015.03.045. Epub 2015 Mar 24.
2 Zotti, F., Albanese, M., Rodella, L. F., & Nocini, P. F. (2019). Platelet-Rich Plasma in Treatment of Temporomandibular Joint Dysfunctions: Narrative Review. International journal of molecular sciences, 20(2), 277. doi:10.3390/ijms20020277
3 Gupta S, Sharma AK, Purohit J, Goyal R, Malviya Y, Jain S. Comparison between intra-articular platelet-rich plasma injection versus hydrocortisone with local anesthetic injections in temporomandibular disorders: A double-blind study. Natl J Maxillofac Surg. 2018;9(2):205-208.
4. Hancı M, Karamese M, Tosun Z, Aktan TM, Duman S, Savaci N. Intra-articular platelet-rich plasma injection for the treatment of temporomandibular disorders and a comparison with arthrocentesis. J Craniomaxillofac Surg. 2015 Jan;43(1):162-6. doi: 10.1016/j.jcms.2014.11.002. Epub 2014 Nov 15.
5 Pihut M, Szuta M, Ferendiuk E, Zeńczak-Więckiewicz D. Evaluation of pain regression in patients with temporomandibular dysfunction treated by intra-articular platelet-rich plasma injections: a preliminary report. Biomed Res Int. 2014;2014:132369. doi: 10.1155/2014/132369. Epub 2014 Aug 3.
6 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.
7 Barba-Recreo P, Del Castillo Pardo de Vera J, Georgiev-Hristov T et al. Adipose-derived stem cells and platelet-rich plasma for preventive treatment of bisphosphonate-related osteonecrosis of the jaw in a murine model. J Craniomaxillofac Surg. 2015 Sep;43(7):1161-8. doi: 10.1016/j.jcms.2015.04.026. Epub 2015 May 9.