J Korean Assoc Oral Maxillofac Surg.  2024 Oct;50(5):259-264. 10.5125/jkaoms.2024.50.5.259.

Efficacy of dextrose prolotherapy on temporomandibular disorder: a retrospective study

• Park JS
• Ku JK
• Kim YK
• Yun PY

• KMID: 2560821
• DOI: http://doi.org/10.5125/jkaoms.2024.50.5.259

Abstract

Objectives
Dextrose prolotherapy is one of the most promising minimally invasive interventions for temporomandibular disorder (TMD), particularly in refractory cases where other conservative treatments have failed. The purpose of this study was to demonstrate the efficacy of a new treatment, temporomandibular joint (TMJ) prolotherapy, in patients with TMD to alleviate symptoms.
Materials and Methods
A retrospective analysis was conducted on TMD patients with chronic pain who did not respond to conventional treatments. TMJ prolotherapy was performed using hypertonic dextrose in the TMJ area, targeting the retrodiscal attachment tissue, anterior disc attachment tissue, lateral capsule, origin of the masseter muscle, and the stylomandibular ligament. Pain or discomfort intensity in the TMJ was evaluated using a numerical rating scale (NRS). Maximum mouth opening and subjective satisfaction were also analyzed.
Results
Nineteen patients (6 males, 13 females, average age 43 years) participated in this study. All patients experienced pain improvement with a maximum of three prolotherapy sessions. The initial mean NRS was 5.7, which ultimately decreased to a final mean TMJ discomfort score of 1.7 postintervention. The patients’ maximum mouth opening increased from an initial 34.5 mm to 38.8 mm, and they reported positive satisfaction with the prolotherapy treatment. The clinical outcomes were positive regardless of main origin of TMD symptoms.
Conclusion
Hypertonic TMJ prolotherapy is an effective minimally invasive intervention for TMJ disorders with chronic pain.

Keyword

Prolotherapy; Temporomandibular joint disorders; Chronic pain; Minimally invasive surgical procedures

Figure

• 

  Fig. 1 Distribution in temporomandibular joint (TMJ) sound symptoms.

• 

  Fig. 2 Mean temporomandibular joint pain score in different time intervals during the prolotherapy sessions.

• 

  Fig. 3 Mean maximum mouth opening at different time intervals during the prolotherapy sessions.

• 

  Fig. 4 Overall patient satisfaction with prolotherapy.

• 

  Fig. 5 Distribution of types of temporomandibular disorder (TMD) in patients.

Reference

References

1. Rajapakse S, Ahmed N, Sidebottom AJ. 2017; Current thinking about the management of dysfunction of the temporomandibular joint: a review. Br J Oral Maxillofac Surg. 55:351–6. https://doi.org/10.1016/j.bjoms.2016.06.027. DOI: 10.1016/j.bjoms.2016.06.027. PMID: 28341275.

2. Abouelhuda AM, Khalifa AK, Kim YK, Hegazy SA. 2018; Non-invasive different modalities of treatment for temporomandibular disorders: review of literature. J Korean Assoc Oral Maxillofac Surg. 44:43–51. https://doi.org/10.5125/jkaoms.2018.44.2.43. DOI: 10.5125/jkaoms.2018.44.2.43. PMID: 29732308. PMCID: PMC5932270.

3. Yilmaz O, Candirli C, Balaban E, Demirkol M. 2019; Evaluation of success criteria for temporomandibular joint arthrocentesis. J Korean Assoc Oral Maxillofac Surg. 45:15–20. https://doi.org/10.5125/jkaoms.2019.45.1.15. DOI: 10.5125/jkaoms.2019.45.1.15. PMID: 30847292. PMCID: PMC6400701.

4. Hakala RV. 2005; Prolotherapy (proliferation therapy) in the treatment of TMD. Cranio. 23:283–8. https://doi.org/10.1179/crn.2005.040. DOI: 10.1179/crn.2005.040. PMID: 16353469.

5. Dasukil S, Shetty SK, Arora G, Degala S. 2021; Efficacy of prolotherapy in temporomandibular joint disorders: an exploratory study. J Maxillofac Oral Surg. 20:115–20. https://doi.org/10.1007/s12663-020-01328-9. DOI: 10.1007/s12663-020-01328-9. PMID: 33584052. PMCID: PMC7855124.

6. Moon SY, Lee ST, Ryu JW. 2014; Ultrasound-guided platelet-rich plasma prolotherapy for temporomandibular disorders. J Oral Med Pain. 39:140–5. https://doi.org/10.14476/jomp.2014.39.4.140. DOI: 10.14476/jomp.2014.39.4.140.

7. Zhou H, Xue Y, Liu P. 2021; Application of auriculotemporal nerve block and dextrose prolotherapy in exercise therapy of TMJ closed lock in adolescents and young adults. Head Face Med. 17:11. https://doi.org/10.1186/s13005-021-00261-7. DOI: 10.1186/s13005-021-00261-7. PMID: 33773589. PMCID: PMC8004452.

8. Refai H, Altahhan O, Elsharkawy R. 2011; The efficacy of dextrose prolotherapy for temporomandibular joint hypermobility: a preliminary prospective, randomized, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg. 69:2962–70. https://doi.org/10.1016/j.joms.2011.02.128. DOI: 10.1016/j.joms.2011.02.128. PMID: 21757278.

9. Mustafa R, Güngörmüş M, Mollaoğlu N. 2018; Evaluation of the efficacy of different concentrations of dextrose prolotherapy in temporomandibular joint hypermobility treatment. J Craniofac Surg. 29:e461–5. https://doi.org/10.1097/scs.0000000000004480. DOI: 10.1097/SCS.0000000000004480. PMID: 29533255.

10. Louw WF, Reeves KD, Lam SKH, Cheng AL, Rabago D. 2019; Treatment of temporomandibular dysfunction with hypertonic dextrose injection (prolotherapy): a randomized controlled trial with long-term partial crossover. Mayo Clin Proc. 94:820–32. https://doi.org/10.1016/j.mayocp.2018.07.023. DOI: 10.1016/j.mayocp.2018.07.023. PMID: 30878157.

11. Reeves KD, Hassanein KM. 2003; Long-term effects of dextrose prolotherapy for anterior cruciate ligament laxity. Altern Ther Health Med. 9:58–62.

12. Reeves KD, Hassanein K. 2000; Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med. 6:68–74. 77–80.

13. Khan SA, Kumar A, Varshney MK, Trikha V, Yadav CS. 2008; Dextrose prolotherapy for recalcitrant coccygodynia. J Orthop Surg (Hong Kong). 16:27–9. https://doi.org/10.1177/230949900801600107. DOI: 10.1177/230949900801600107. PMID: 18453654.

14. Rabago D, Slattengren A, Zgierska A. 2010; Prolotherapy in primary care practice. Prim Care. 37:65–80. https://doi.org/10.1016/j.pop.2009.09.013. DOI: 10.1016/j.pop.2009.09.013. PMID: 20188998. PMCID: PMC2831229.

15. Siadat AH, Isseroff RR. 2019; Prolotherapy: potential for the treatment of chronic wounds? Adv Wound Care (New Rochelle). 8:160–7. https://doi.org/10.1089/wound.2018.0866. DOI: 10.1089/wound.2018.0866. PMID: 31646060. PMCID: PMC6804793.

16. Hauser RA, Hauser MA, Blakemore KA. 2007; Dextrose prolotherapy and pain of chronic TMJ dysfunction. Pract Pain Manag. 7:49–55.

17. Hakala RV, Ledermann KM. 2010; The use of prolotherapy for temporomandibular joint dysfunction. J Prolotherapy. 2:439–46.