TEMPOROMANDIBULAR DISORDERS AND PRINCIPLES OF REHABILITATION

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USAGE OF INJECTION TECHNIQUES IN TEMPOROMANDIBULAR DISORDERS

Selin Özen1
Deniz Bulut2

1Başkent University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Türkiye
2Alanya Alaaddin Keykubat University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Antalya, Türkiye

Özen S, Bulut D. Usage of Injection Techniques in Temporomandibular Disorders. In: Coşar SN, Afşar Sİ editors. Temporomandibular Disorders and Principles of Rehabilitation. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.115-126.

ABSTRACT

The temporomandibular joint (TMJ) is a synovial bicondylar joint with 3 degrees of freedom. Onethird of the adult population reportedly suffers from temporomandibular joint dysfunction. Females are more commonly affected than males. Temporomandibular joint disorder is defined by pain and/or loss of function of the temporomandibular joint and its associated muscles and structures. Temporomandibular disorders affect between 5% and 12% of the population and present with symptoms such as headache, bruxism, pain at the temporomandibular joint, jaw popping or clicking, neck pain, tinnitus, dizziness, decreased hearing, and hyperacuity to sound. The diagnosis is based on history and physical examination; however, use of computed tomography or magnetic resonance imaging is recommended if the diagnosis is in doubt.

Treatments include noninvasive therapies, minimally invasive muscular and articular injections, and surgery. Noninvasive therapy includes patient education (e.g., good sleep hygiene, soft food diet), cognitive behavioral therapy, physical therapy, and pharmacological treatment. Minimally invasive injections include arthrocentesis, botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, prolotherapy with hypertonic glucose, ozone injection and dry needling. Arthrocentesis is the process of irrigation of the temporomandibular joint with isotonic or Ringer’s lactate. These fluids are administered into the joint to ensure joint irrigation and removal of inflamed synovial fluid. It may be applied as monotherapy or combination therapy with local anesthetic or steroids. Steroid injection is generally preferred in inflammatory or acute pathologies. Hyaluronic acid, which is also found in the structure of synovial fluid, penetrates into the joint when applied intra-articularly, provides nutrition and lubrication to the articular surface, and allows much more comfortable joint movement. Platelet-rich plasma (PRP) is an autologous blood product containing a three-to eight-fold concentration of platelets that are rich in growth factors. PRP applications may be preferred in temporomandibular joint disorder. Dextrose prolotherapy is considered one of the most promising approaches to the treatment of TMJ disorders, especially in refractory cases where other conservative treatments have failed. The use of ozone therapy is supported as an alternative treatment method to reduce pain in temporomandibular disorders.

Keywords: Conservative treatment; Intra-articular injections; Ozone; Prolotherapy; Temporomandibular joint; Temporomandibular joint disorders

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