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Jun 26, 2013

Some health care providers may recommend an injection in the temporomandibular joint to help alleviate TMJ problems. Below we list a number of such treatments.  Few clinical studies on the effects of these treatments on the temporomandibular joint (TM joint) are available. It is important to note that these treatments have NOT been approved by the Food and Drug Administration (FDA) for treating TMJ disorders.  We recommend that you ask your doctor about the basis for recommending the treatment, as well as about the potential risks.

  • Botulinum toxin type A (Botox). Botox is a drug made from the same bacterium that causes food poisoning. Used in small dosages, Botox injections can actually help alleviate some health problems and are approved by the Food and Drug Administration (FDA) for certain disorders. However, Botox is currently not approved by the FDA for use in TMJ disorders.  Results from recent clinical studies are inconclusive regarding the effectiveness of Botox for treatment of chronic TMJ disorders. Additional research is under way to learn how Botox specifically affects jaw muscles and their nerves. The findings will help determine if this drug may be useful in treating TMJ disorders.  
  • Steroid injection (Cortisone). Such injections can be of help in reducing inflammation in cases of an acute flair-up of degenerative joint disease or rheumatoid arthritis. However, it is only a temporary palliative measure and does not address the cause of the problem. Also, if given too often, the injections can actually cause degenerative joint changes. Therefore, if used, it should not be done more than three times a year with at least three month intervals between injections. Controversy still exists regarding steroid injections as a TMJ treatment.
  • Hyaluronan (Hyaluronic acid/Hyaluronate). Although this substance is sometimes used to treat osteoarthritis in the knees or hips, there is not enough evidence to judge whether it is helpful for people with TMJ problems. Even if the patient has osteoarthritis in other joints, it is still open to question as to whether this is the same disease process that affects the TM joints. According to the FDA, hyaluronic acid has not been approved to treat TMJ disorders.
  • Local anesthetics. Local anesthetics are sometimes injected into the TM joint or jaw muscles for diagnostic purposes to determine the source of the pain. They are also used therapeutically to inject trigger points in the muscles. Such procedures do not need FDA approval as long as the anesthetic agent is an approved drug. 
  • Ozone therapy. This treatment involves the injection of ozone gas into the temporomandibular joint. Its use is based on the false theory that ozone can kill such bacteria, viruses and fungi, as well as reduce inflammation and stimulate cartilage growth. Thus, there is no scientific basis for its use in the TM joint.  Moreover, ozone therapy is not approved by the FDA.
  • Prolotherapy (Sclerotherapy). Prolotherapy is a technique in which an irritating solution is injected into a ligament or muscle tendon near a painful area with the intent of inducing the proliferation of new cells and thus strengthening these structures, supporting the weakened muscles, and eliminating the pain. Although it has been used mainly to treat chronic low back pain, it has also been recommended for patients with temporomandibular disorders. However, there is no scientific evidence to show that weakened ligaments and tendons are the cause of pain in TMD patients, or to substantiate the effectiveness of this procedure in eliminating the pain. Moreover, there are no studies to show what these solutions actually do to the tissues. Therefore, prolotherapy should be avoided.

Latest Research/News on Botox

  1. Mandibular loading and bone quality following injection of botulinum neurotoxin type A in the masseter muscle
  2. Efficacy of botulinum toxin type A for treatment of persistent myofascial TMD pain: a randomized, controlled, double-blind multicenter study
  3. Botulinum toxin for masseter hypertrophy (Review)
  4. Allergan, maker of Botox, recieves $600 million fine for off-label marketing 

Latest Research/News on Corticosteroids

  1. Intra-articular steroid injection for temporomandibular joint arthritis in juvenile idiopathic arthritis: A systematic review on efficacy and safety

Latest Research/News on Hyaluronan

  1. A 2003 issue of Cochrane Oral Health Group Newsletter found that "there is insufficient evidence to either support or refute the use of injection of substances such as hyaluronate into the joint."


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