Two Different Injections for Jaw Joint Pain
Patients with temporomandibular joint (TMJ) dysfunction are increasingly offered platelet-rich plasma (PRP) or hyaluronic acid (HA) injections as part of their treatment. Both are commonly used alongside TMJ arthrocentesis and both have been shown to improve pain and jaw function in appropriately selected patients. However, they work in very different ways and current evidence does not demonstrate a clear overall winner.
Patients are often unsure which treatment is better for their jaw joint. The short answer is that the best treatment depends on the underlying cause of the problem. Hyaluronic acid primarily improves the mechanical environment of the joint, whereas PRP primarily aims to improve the biological environment of the joint.
What Is Hyaluronic Acid?
Hyaluronic acid is a naturally occurring component of healthy joint fluid. Within the TMJ, it acts as a lubricant and shock absorber, helping the joint surfaces move smoothly during talking, chewing, and mouth opening.²
In patients with TMJ inflammation, internal derangement, or osteoarthritis, the quality and concentration of hyaluronic acid within the joint may be reduced. Injection of hyaluronic acid into the TMJ, a procedure often known as viscosupplementation, aims to restore lubrication, reduce friction, improve movement, and reduce pain associated with mechanical loading of the joint.
Because of this mechanism, hyaluronic acid is best thought of as a treatment that primarily improves joint mechanics.
What Is PRP?
Platelet-rich plasma (PRP) is prepared from a sample of your own blood. The blood is centrifuged to concentrate the platelets, which contain growth factors and signalling proteins involved in tissue repair and inflammation control. The resulting PRP is injected directly into the TMJ.
Unlike hyaluronic acid, PRP is considered a regenerative treatment. Rather than acting primarily as a lubricant, it aims to modify inflammation within the joint and potentially support tissue healing and repair processes.
For this reason, PRP is best viewed as a treatment that primarily targets joint biology.
PRP vs Hyaluronic Acid: What Is the Difference?
A simple way to understand the difference is:
| Hyaluronic Acid | Platelet-Rich Plasma |
|---|---|
| Improves lubrication | Influences joint biology |
| Restores some properties of normal joint fluid | Uses growth factors derived from your own blood |
| Primarily focuses on joint mechanics | Primarily focuses on inflammation and tissue repair |
| Manufactured medical product | Autologous treatment (prepared from your own blood) |
| Often provides earlier symptomatic improvement | Benefits may develop more gradually |
Both treatments are administered into the TMJ itself and are commonly combined with arthrocentesis.
What Does the Scientific Evidence Show?
The evidence base for both treatments has expanded considerably over the last decade. Contemporary systematic reviews suggest that both PRP and hyaluronic acid improve pain and jaw function in patients with TMJ disorders (1-3). However, two randomised controlled trials directly comparing PRP and hyaluronic acid in TMJ osteoarthritis reported superior medium- and long-term outcomes with PRP, including improved pain control, greater mouth opening, improved joint sounds, and, in one study, superior radiological improvement (4,5).
Despite these promising findings, systematic reviews continue to conclude that the evidence remains heterogeneous and insufficient to declare PRP universally superior across all forms of TMJ dysfunction (1,2).
What Are the Advantages of PRP?
PRP may appeal to patients who favour a regenerative approach because it is derived from their own blood and may influence biological healing processes within the joint. Potential advantages include reduced inflammation, a favourable safety profile, and the potential to support tissue repair processes.
What Are the Advantages of Hyaluronic Acid?
Hyaluronic acid has a long history of use in orthopaedic and TMJ practice and is supported by a substantial body of clinical evidence.
Potential advantages include a well-established safety profile, the absence of blood sampling, immediate restoration of joint lubrication, and a strong rationale for use in patients whose symptoms arise from joint degeneration or mechanical dysfunction.
What About Steroid Injections and Morphine Injections?
Corticosteroid Injections
Corticosteroid injections have been used for many years in the treatment of TMJ inflammation. Their principal effect is suppression of inflammation within the joint, which can provide relatively rapid pain relief.
However, corticosteroids are generally considered a symptom-suppressing treatment rather than a regenerative treatment. Repeated injections are approached cautiously because there is concern that frequent steroid exposure may contribute to cartilage degeneration and adverse joint changes over time. For this reason, many surgeons now avoid steroid injections except in carefully selected patients with significant inflammatory symptoms.
Opioid (morphine) Injections
Opioid-containing injections have been investigated historically as a method of reducing TMJ pain. The rationale was that opioid receptors are present within inflamed joint tissues and may provide local analgesic effects.
Although some studies reported temporary pain relief, opioid injections have not become part of modern TMJ management. They do not address the underlying mechanical or biological causes of TMJ dysfunction, have little evidence of durable benefit, and are overshadowed by more effective options such as PRP and hyaluronic acid viscosupplementation.
Which Treatment Do I Recommend?
I do not view PRP and hyaluronic acid as competing treatments. Instead, I consider symptoms, examination findings, imaging/scan findings, the degree of inflammation or degeneration present, and whether arthrocentesis is being performed. Patients with predominantly inflammatory symptoms may be better candidates for PRP, whereas patients with predominantly mechanical symptoms may be particularly suitable for hyaluronic acid viscosupplementation. In many cases, a combination of treatments is appropriate.
References
- Haddad C, Zoghbi A, El Skaff E, Touma J. Platelet-rich plasma injections for the treatment of temporomandibular joint disorders: A systematic review. J Oral Rehabil. 2023;50(11):1330-1339. doi: 10.1111/joor.13545
- Li C, Wang X, Zhao Y, et al. Comparative effectiveness of hyaluronic acid, platelet-rich plasma, and platelet-rich fibrin for temporomandibular disorders: a systematic review and network meta-analysis. Head Face Med. 2023;19:53. doi: 10.1186/s13005-023-00369-y
- Jacob SM, Bandyopadhyay TK, Chattopadhyay PK, Parihar VS. Efficacy of Platelet-Rich Plasma Versus Hyaluronic Acid Following Arthrocentesis for Temporomandibular Joint Disc Disorders: A Randomized Controlled Trial. J Maxillofac Oral Surg. 2022;21(4):1199-1204. doi: 10.1007/s12663-021-01519-y
- Hegab AF, Ali HE, Elmasry M, Khallaf MG. Platelet-Rich Plasma Injection as an Effective Treatment for Temporomandibular Joint Osteoarthritis. J Oral Maxillofac Surg. 2015;73(9):1706-1713. doi:10.1016/j.joms.2015.03.045
- Liu SS, Xu LL, Liu LK, Lu SJ, Cai B. Platelet-rich plasma therapy for temporomandibular joint osteoarthritis: A randomized controlled trial. J Craniomaxillofac Surg. 2023;51(11):668-674. doi:10.1016/j.jcms.2023.09.014
