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Temporomandibular Joint Dysfunction and Platelet Rich Plasma

By June 9, 2022No Comments

Temporomandibular Joint Dysfunction are a group of disorders affecting the jaw and surrounding muscles and ligaments.

TMJ causes pain and compromised movement of the jaw. The TMJ (temporomandibular joint) connects the jaw to the skull. Temporomandibular Joint Dysfunction is also called Temporomandibular Joint Disorder (TMD). This condition is very common and there are reported more than 3 million cases per year in the US alone.

The National Institute of Dental and Craniofacial Research estimates there are around 10 million Americans who have been diagnosed with TMJ and are active in treatment. There are many more patients who suffer with this problem who remain undiagnosed.

Etiology

TMJ. Dysfunction is most common in the age group 20-40

More common in women than men

Common TMJ symptoms

  • Jaw Pain
  • Pain at the insertion of the jaw into the skull
  • Headaches
  • Ear Pain
  • Ringing in the ears (tinnitus)
  • Pain in the neck and shoulders
  • Clicking, popping or grating sounds when the jaw is opened and closed
  • Jaw locking in open position
  • Chewing pain
  • Swelling in the area
  • Tooth pain
  • Malocclusion of teeth fitting together properly

Causes

The temporomandibular joint combines a hinge like action with sliding motions. The parts of the bones that interact are covered in cartilage and separated by a disc that absorbs shock and functions to keep the movement smooth. Any trauma or disease state that degrades the disc or moves it out of position will precipitate painful TMJ disorders.

Causes include;

  • Trauma such as a blow to the jaw
  • Dislocation of the joint
  • Arthritis of the joint
  • Grinding/clenching of the teeth called bruxism
  • Stress
  • Improper fitting bite caused by teeth or dentures
  • Tooth pain for any reason
  • Certain connective tissue diseases

Diagnosis

Temporomandibular Joint Dysfunction/ Disorder is usually diagnosed by dental exam with observation of the motion of the jaw and palpation over the TMJ and surrounding tissues

Diagnostic Testing

  • Panoramic X-rays- These x-rays are normally done in the dental office to obtain a broad view of the teeth and jaw
  • Cone Beam CT- Scans- Very detailed view of facial anatomy, teeth, jaw and TMJ
  • MRI- Excellent views of the joint space and surrounding anatomy
  • TMJ Arthroscopy- Tube is inserted into the TMJ area to directly visualize the pathology

Non-Surgical Treatments

Moist heat or cold packs applied to the area

Medications

  • NSAIDS to relieve pain and reduce inflammation
  • Muscle Relaxants to relieve tight muscles especially in people who grind their teeth
  • Tricyclic antidepressants used in low doses to relieve pain, stress and bruxism

Oral appliances or mouth guards , mouth guards are worn only at night and oral splints throughout the day.

Corrective dental treatments to replace missing teeth or bite. Crowns, bridges or braces to correct the overall bite.

Physical Therapy to stretch the jaw muscles and strengthen the same. Counseling on diet and at home program.

Injection therapy

  • A. Steroids or other anti-inflammatories to reduce inflammation and pain
  • B. Hyaluronic acid for cushioning and lubrication
  • C. Platelet Rich Plasma

Surgical Procedures

Arthrocentesis is minimally invasive and consists of needles being inserted into the joint for irrigation and anti-inflammatory delivery of drugs or others.

TMJ Arthroscopy is where a lighted flexible tube is inserted into a joint and instrumentation is then accomplished depending on the pathology found. This is less invasive than an open surgical procedure.

Open Surgery used to repair or replace the joint when other therapies fail. As in other invasive procedures the risks are the greatest with this therapy.

Back in the 1980’s , researchers developed a spacer, made out of Teflon, to be inserted but those broke into pieces and caused major problems. Research is now ongoing for a bio-engineered disc like material, grown in a lab, to be inserted into the area. Animal studies are ongoing and currently the results have been promising.

Alternative Treatments

A. Acupuncture

B. Relaxation Techniques

C. Transcutaneous Electrical Nerve Stimulation where a current is places on the surrounding muscles and muscles become relaxed

D. Ultrasound Treatments

E. Trigger Point injections and Botulinum Toxin to reduce spasticity of the muscles

Platelet Rich Plasma is an autologous blood derived biologic that provides super physiologic amounts of cytokines and growth factors needed to repair, rejuvenate and regenerate tissue. Studies have shown the use of PRP for TMJ provides excellent results superior to other injectables.

Studies

Platelet Rich Plasma in Treatment of Temporomandibular Joint Dysfunctions: Narrative Review

Int J Mol Sci 2019 Jan 11;20(2):277 PMID 30641957

Background: The aim of this narrative review was to examine up-to-date literature in order to evaluate the effectiveness of arthrocentesis or injections with platelet rich plasma in temporomandibular afflictions and to compare them to arthrocentesis alone or with hyaluronic acid injections.

Results: Arthrocentesis with platelet rich plasma and platelet rich plasma injections in temporomandibular disorders were found to be effective in reducing pain and joint sound as well as improving mandibular motion in a maximum follow up of 24 months

Conclusion: Comparison to arthrocentesis alone or to use HA in arthrocentesis provided encouraging results in terms of effectiveness of platelet rich plasma

 

Effect of Arthrocentesis Plus Platelet Rich Plasma and Platelet Rich Plasma Alone in the Treatment of Temporomandibular Joint Arthritis: A Retrospective Matched Cohort Study

Medicine (Baltimore) 2018 Apr;97(16):e0-477. PMID 29668626

 

Background: This study aimed to compare the efficacy of 2-TMJ-OA treatment approaches, arthrocentesis plus platelet rich plasma and PRP alone

Conclusion: Both arthrocentesis with PRP and PRP alone can effectively improve multiple symptoms of TMJ-OA. Based on the results from this study, we recommend a single injection of high concentration of PRP for TMJ-OA treatment

 

Effect of Platelet Rich Plasma Injection Combined with Individualized Comprehensive Physical Therapy on Temporomandibular Joint Osteoarthritis: A Prospective Cohort Study

J Oral Rehabil 2022 Feb;49(2):150-159 PMID 34502321

 

Background: The effectiveness of platelet rich plasma injection combined with physical therapy for the treatment of temporomandibular joint osteoarthritis has not been identified. This study is to assess the effectiveness

Conclusions: Platelet Rich Plasma injection can significantly improve pain, mouth opening, abnormal joint sound and mandibular function in patients with TMJ-OA and has good repair effect on condylar bone defects. PRP injection combined with individualized comprehensive physical therapy can effectively control the medium- and- long term pain of patients.

 

Platelet Rich Plasma in Treatment of Temporomandibular Joint Dysfunctions: Narrative Review

Int J Mol Sci 2019 Jan;20(2):277 doi: 10.3390/jms20020277

 

Background: The aim of this narrative review was to examine up-to-date literature in order to evaluate the effectiveness of arthrocentesis of injections with platelet rich plasma in temporomandibular affections and to compare them to arthrocentesis alone or with hyaluronic acid injections.

Conclusions: In accordance with the literature, PRP was found to have relevant anti-inflammatory and regenerative properties, capability of modulating synovial cell biology, increasing HA concentration and stabilizing angiogenesis and these peculiar features probably provided PRP with higher efficacy also in the treatment of TMJ/TMD compared to arthrocentesis and HA injections.

PRP use, by injection or combined with arthrocentesis, in the treatment of TMJ/TMD was found to be more effective than arthrocentesis alone or combined with hyaluronic acid.

 

Juventix Regenerative Medical is and industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA approved and designed for safety and effectiveness. They are cost effective and easy to use. Our Kits provide consistency of concentrated product when obtained from the same source.

 

Juventix Regenerative Medical offers a patent pending LED Activator to activate the platelets and begin the regenerative process. The activation, a critical step in the release of cytokines and growth factors, is accomplished with light and not with the addition of other chemicals such as Calcium Chloride of Thrombin.

 

Juventix Regenerative Medical supplies a Bio-Incubator that transforms the Platelet Rich Plasma to Platelet Rich Fibrin. The PRF, commonly referred to as the “second generation of platelet products” has a broader range of clinical applications and provides outstanding outcomes.

 

Juventix Regenerative Medical has a Platelet Rich Plasma Kits that contains non-cross linked hyaluronic acid for added benefit in the use for temporomandibular joint dysfunction patients.

 

RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL

 

Regenerative Regards,

 

Dr. Robert McGrath

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