Treatment of Temporomandibular Dysfunction With Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial With Long-term Partial Crossover  Wynand Francois Louw, MBChB, K. Dean Reeves, MD, Stanley K.H. Lam, MBBS (HK), An-Lin Cheng, PhD, David Rabago, MD  Mayo Clinic Proceedings  Volume 94, Issue 5, Pages 820-832 (May 2019) DOI: 10.1016/j.mayocp.2018.07.023 Copyright © 2018 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Injection entry site, located 0.75 to 1 cm below the apex of the zygomatic arch. Mayo Clinic Proceedings 2019 94, 820-832DOI: (10.1016/j.mayocp.2018.07.023) Copyright © 2018 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Injection angle of 45° cranial and 10° posterior, using a 1-in 30-G needle. Mayo Clinic Proceedings 2019 94, 820-832DOI: (10.1016/j.mayocp.2018.07.023) Copyright © 2018 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 CONSORT flow diagram. aControl injection = sterile water + 0.2% lidocaine. bDextrose injection = 20% dextrose + 0.2% lidocaine. cTwo participants, each with 2 qualifying joints, dropped out of the study. Both were from the dextrose group. One participant withdrew because of increasing pain and swelling at 2-month follow-up after having received 2 injections of dextrose and was subsequently diagnosed with a parotid tumor. The second participant moved internationally after 1 treatment. Data on pain at 2- and 1-month follow-up, respectively, and maximal interincisal opening at baseline were carried forward in the analysis, and satisfaction was estimated at 1 of 5 (no satisfaction). Mayo Clinic Proceedings 2019 94, 820-832DOI: (10.1016/j.mayocp.2018.07.023) Copyright © 2018 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 4 Numerical Rating Scale (0-10) change scores for jaw pain and jaw dysfunction through 12 months. aControl group received dextrose injections, as requested, after 3 months, during the open-label period of the study. Mayo Clinic Proceedings 2019 94, 820-832DOI: (10.1016/j.mayocp.2018.07.023) Copyright © 2018 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 5 Numerical Rating Scale (0-10) change scores for jaw pain and jaw dysfunction according to the Research Diagnostic Criteria for Temporomandibular Dysfunction diagnostic group assignment. aControl group received dextrose injections, as requested, after 3 months, during the open-label period of the study. Mayo Clinic Proceedings 2019 94, 820-832DOI: (10.1016/j.mayocp.2018.07.023) Copyright © 2018 Mayo Foundation for Medical Education and Research Terms and Conditions