Patient-Reported Quality of Life versus Physical Examination in Treating Temporomandibular Disorders with Intra-Articular Platelet-Rich Plasma Injections: An Open-Label Clinical Trial

Abstract

Temporomandibular disorders, often manifested by articular pain, limitation of the mouth opening range, and unpleasant acoustic symptoms originating from inside the joint, have been associated with reduced quality of life. These symptoms, among others, can be treated with intra-articular injections of various substances, including repeated platelet-rich plasma (PRP) administration. The reported study was designed as an uncontrolled open-label clinical trial of consecutive cases. The participants completed a Fonseca questionnaire and evaluated acoustic symptoms, and spontaneous and provoked pain on VAS, and were subjected to a physical examination before, during, and after PRP therapy. The total Fonseca questionnaire results were statistically significantly (p < 0.05) correlated with 340 out of 348 (98%) other variables. The fully subjective assessment of the presence and intensity of acoustic symptoms coming from the temporomandibular joints was correlated with the physical examination results (0.45–0.63) and the maximum mouth opening with the maximum pain-free mouth opening (0.73–0.87). There were no correlations observed between the patient’s and the physician’s assessment of mandibular mobility. The Fonseca questionnaire seems to cover the entire spectrum of temporomandibular disorders, making it a balanced tool for assessing the quality of life in TMDs. However, it is worth considering extending the standard 3-point response scale to an 11-point one. The patient is somewhat able to perform a self-diagnosis with regard to the acoustic symptoms, but it is not possible for them to determine without measurement whether the range of mandibular mobility is appropriate..

Intra-Articular Injections into the Inferior versus Superior Compartment of the Temporomandibular Joint: A Systematic Review and Meta-Analysis

“…The full assessment of the complexity of these movements is still pending, but it is assumed that hinge or rotational movements take place below the articular disc, and translation or gliding movements above it [ 37 , 38 , 39 ]. Mastication capacity, resulting from a combination of the movements described above, translates into an overall assessment of the quality of life [ 7 , 40 ]. Based on subdiscal arthroscopy, the role of the inferior compartment for the proper functioning of the TMJ and the hitherto underestimated role of abnormalities below the articular disc in the etiopathogenesis of internal disarrangement are regarded to be greater than previously thought [ 39 ].…”

“…The more significant role of the inferior TMJ compartment for the initial phase of mouth opening encourages the consideration of inferior compartment intra-articular injections as potentially more efficient in relieving articular pain, reducing the overall severity of internal disarrangement expressed by the Helkimo index, and improving mandibular mobility [ 37 , 38 , 39 , 40 , 42 ]. The comparison of the effects of inferior or both compartments versus superior intra-articular injections was the subject of a systematic review with meta-analysis published in 2012 by Li et al [ 42 ].…”

Intra-Articular Local Anesthetics in Temporomandibular Disorders: A Systematic Review and Meta-Analysis

“…The severity of articular pain is measured primarily on a visual analog scale [ 8 , 9 ]. Painful reduction of jaw mobility, and thus difficulty with food intake, is a significant factor in deteriorating the patient’s quality of life [ 10 , 11 , 12 , 13 , 14 ]. In cases of severe articular pain with limited mouth opening, the main cause may be difficult to determine, and the therapy undertaken is sometimes empirical [ 1 , 15 ].…”

“…In cases of severe articular pain with limited mouth opening, the main cause may be difficult to determine, and the therapy undertaken is sometimes empirical [ 1 , 15 ]. The range of methods for treating articular pain and limited mandibular mobility is very wide and combination therapies are often used [ 3 , 4 , 5 , 6 , 7 , 10 ]. Depending on the specific diagnosis and the severity of the symptoms, psychotherapy, physiotherapy, systemic pharmacotherapy, splint therapy, dry needling and intramuscular injections, intra-articular injections, arthrocentesis, arthroscopy, open joint surgery, and joint replacement are used [ 3 , 4 , 5 , 6 , 7 , 10 ].…”

“…The range of methods for treating articular pain and limited mandibular mobility is very wide and combination therapies are often used [ 3 , 4 , 5 , 6 , 7 , 10 ]. Depending on the specific diagnosis and the severity of the symptoms, psychotherapy, physiotherapy, systemic pharmacotherapy, splint therapy, dry needling and intramuscular injections, intra-articular injections, arthrocentesis, arthroscopy, open joint surgery, and joint replacement are used [ 3 , 4 , 5 , 6 , 7 , 10 ]. Due to their minimal invasiveness, intra-articular administration of drugs, hyaluronic acid, and blood products are the subject of current scientific research [ 5 , 10 ].…”