Finding Restorative Treatment for TMJ Disorders

Jonathan Vellinga, MD


What are TMJ disorders?

TMJ disorders are named for the temporomandibular joint, which is the intersection where your jawbone (mandible) and your skull (the temporal bone, specifically) meet near your ear (1). A soft disc made of cartilage and highly innervated tissues act as a barrier between the bones, and multiple small, short muscles on top of this joint allow for movement (2). With all of these small moving parts working together, the jaw is able to open and close, move forward and backward, and side to side (2). The mixture of mobility, so many different moving parts, and the innervated tissue running through the TMJ creates the potential for many avenues of injury and pain. Pain often comes from dysfunction in the muscles that control jaw movement, dislocated jaws or discs, and inflammation (1).



The most common symptoms of TMJ disorders are (1):

  • Pain in the jaw joint or muscles on the side of the face

  • Pain in the face, jaw, or neck

  • Jaw locking and/or reduced mobility

  • Popping, grating, or clicking when opening or closing the mouth

  • A difference in the way your teeth fit together that causes discomfort or pain


What can cause TMJ disorders?

Causes of TMJ disorders (TMD) and pain vary, and in fact, do not always have a singular root cause. Trauma to the jaw, arthritis, night clenching or teeth grinding, and disc erosion or displacement are the most commonly attributed causes (3). However, for many people, symptoms can appear with any obvious origin (1).


Another possible link to the development of temporomandibular joint disorders is female hormones, though the exact role they play is not known (4). Women are 1.5 - 2x more likely than men to develop TMJ problems, and women of reproductive age (20 - 40) bear the highest risk (4).

Diagnosis of TMD

Because the root cause is often unknown or multi-factorial, there is generally an element of difficulty in identifying temporomandibular joint disorders. Due to this lack of clarity, there is not currently a widely-used test to diagnose TMD. Usually, it is recommended that your doctor assess your symptoms, become familiar with your medical history, and examine your head, jaw, neck, and face to determine the severity of the symptoms listed above (1).

Conventional Treatment Options

Doctors often recommend the most conservative, easily reversible treatment plan possible. Surgery on the temporomandibular joint is generally aggressive, invasive, and unsuccessful and can even cause irreversible harm and new dysfunction (1). Even for those with persistent TMJ disorders, simple treatment is generally recommended to minimize the pain. Conventional treatment recommends (1):

  • Using anti-inflammatory compounds combined with a stabilizing splint or bite guard for a short period of time

  • Practicing jaw exercises and stretches to increase jaw mobility

  • Changing to a diet of softer foods

  • Icing the jaw area

  • Avoiding extreme jaw movements like singing or yelling, chewing gum, and wide yawning

  • Mandibular devices (custom made mouthpieces) aimed at improving TMJ alignment.

The conservative treatments listed above can reduce discomfort, but if these do not help, many people are hesitant to turn to surgery given its low rates of effectiveness. This has led to an increase in people looking to alternative options to help heal their TMJ pain and finding that regenerative medicine is an incredible resource for those with TMD.

What is Regenerative Medicine?

Regenerative medicine seeks to treat the root cause by creating functional, living tissue that can repair the existing damaged tissue, allowing the body to heal itself. Beyond that, it doesn’t require surgery and is free of any long-term risks. Regenerative medicine includes stem cell therapy, ozone clot matrix, and pulsed electromagnetic therapies, all of which can be used to treat TMJ disorders.

Stem Cell Therapy

We all have stem cells in our bodies, but over time their ability to reproduce, repair, and heal our bodies drastically decreases. However, when ethically donated stem cells are injected into the body (more info on stem cell therapy here), they can recruit and revitalize your existing stem cells to work more efficiently to repair damaged tissues.

Given that one of the most common known causes of TMD is disc displacement that leads to tissue degeneration, stem cell therapy’s focus on tissue repair, regeneration, and growth makes it a great candidate for TMJ disorders and pain (5). While at this time the FDA has not approved stem cell therapy and it is still considered experimental, multiple studies have shown that stem cell therapy can regenerate degraded cartilage in the jaw joint and improve overall joint function (6, 7). This can make a huge difference to those suffering from TMD. Instead of simply minimizing further damage or acting as pain management, stem cell therapy can truly reverse the damage and bring actual healing in ways that conventional treatment cannot.


PRP (Platelet Rich Plasma) and Ozone

Blood platelets contain a few types of growth factor proteins that each signal for different types of repair in your body. With PRP therapy, your blood is drawn and the platelets are separated from other blood components by a centrifugation process. After this, ozone and B vitamins are added in, and then this mixture is injected into the TMJ area.


Ozone works by safely tricking your body into thinking that it is injured. This triggers the production of antioxidants and an immune response, both of which encourage your body to heal the area more fully than it had previously. It also prevents tissue damage and cell death, prolonging the health of existing tissue (8). The PRP provides growth factors to support the work the ozone is initiating.


Ozone and PRP therapy have both shown positive results in the treatment of TMD (8, 9). In one study, 87% of patients receiving ozone therapy had either a full recovery or improved TMD symptoms (9). For those receiving conventional treatment (NSAIDs and muscle relaxants), only 33% showed any improvement, and none of those patients made a full recovery (9). Similarly, PRP injections can improve pain, increase joint stability, and improve mandibular motion (10). The growth factors in platelet-rich plasma mentioned above can actually restore a degraded TMJ disc and prevent inflammation that can cause pain, damage, and further reduced mobility (10). Ozone and platelet-rich plasma work together to create clear improvement for those suffering from TMJ-related disorders.


Ozone Field Therapy

Pulsed Electromagnetic Field (PEMF) therapy is a type of regenerative therapy that revitalizes damaged tissue by restoring our cells’ magnetic charge to healthy levels. In terms of TMJ, PEMF therapy has been proven to help with pain relief, improve mandibular range of motion, and is actually one of the most effective means of pain relief when compared to other conventional treatments (including low-level lasers, dry needling, and anesthesia) (11). While PEMF is clearly effective on its own, it also helps facilitate the healing process started with the therapies listed above.


At TCIM, we use PEMF therapy in conjunction with the other three therapies listed in order to approach healing from every angle possible. In instances of TMJ pain and disorders, this multi-step treatment can bring real relief, healing, increased range of motion, and improve your overall quality of life. If you would like to hear more about any of these therapies, determine if any of them could be right for you, or talk to someone about your TMJ pain, please reach out to us. We are more than happy to schedule an appointment to talk through therapy options and get you on a path toward regenerated health and healing!



Jonathan Vellinga, M.D. is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.​


Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.

info@tcimedicine.com

951-383-4333

www.tcimedicine.com


  1. U.S. Department of Health and Human Services. (2018). TMJ (Temporomandibular Joint and Muscle Disorders) Causes, Symptoms, Diagnosis, Treatment. National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/health-info/tmj/more-info.

  2. TMJ Anatomy. Physiopedia. https://www.physio-pedia.com/TMJ_Anatomy.

  3. Friedman, M. (2019, March 10). Teeth Grinding (Bruxism): Causes and Treatments. WebMD. https://www.webmd.com/oral-health/guide/teeth-grinding-bruxism.

  4. JL, W. M. P. F. Temporomandibular disorders and hormones in women. Cells, tissues, organs. https://pubmed.ncbi.nlm.nih.gov/11455113/.

  5. WS, Z. S. Y. A. U. T. Stem Cells for Temporomandibular Joint Repair and Regeneration. Stem cell reviews and reports. https://pubmed.ncbi.nlm.nih.gov/26123357/.

  6. Cui, D., Li, H., Xu, X., Ye, L., Zhou, X., Zheng, L., & Zhou, Y. (2017, October 16). Mesenchymal Stem Cells for Cartilage Regeneration of TMJ Osteoarthritis. Stem Cells International. https://www.hindawi.com/journals/sci/2017/5979741/.

  7. Embree, M. C., Chen, M., Pylawka, S., Kong, D., Iwaoka, G. M., Kalajzic, I., … Mao, J. J. (2016, October 10). Exploiting endogenous fibrocartilage stem cells to regenerate cartilage and repair joint injury. Nature News. https://www.nature.com/articles/ncomms13073.

  8. Manoto, S. L., Maepa, M. J., & Motaung, S. K. (2016, February 9). Medical ozone therapy as a potential treatment modality for regeneration of damaged articular cartilage in osteoarthritis. Saudi Journal of Biological Sciences. https://www.sciencedirect.com/science/article/pii/S1319562X16000498.

  9. Daif, E. (2012, June). Role of intra-articular ozone gas injection in the management of internal derangement of the temporomandibular joint. ResearchGate. https://www.researchgate.net/publication/225282088_Role_of_intra-articular_ozone_gas_injection_in_the_management_of_internal_derangement_of_the_temporomandibular_joint.

  10. PF, Z. F. A. M. R. L. F. N. Platelet-Rich Plasma in Treatment of Temporomandibular Joint Dysfunctions: Narrative Review. International journal of molecular sciences. https://pubmed.ncbi.nlm.nih.gov/30641957/.



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