Clinical Evaluation of the Effectiveness of Carboxytherapy in Reducing Pain Syndrome in the Treatment of Internal Disorders of the Temporomandibular Joints

Abstract

According to scientific data from the world literature, temporomandibular joint disease (TMJD) is one of the most common pathologies in dental clinical practice, accounting for 95–98% of patient visits, with an average age of 18–45 years. The disease has a chronic course, which may be accompanied by pain syndrome, impaired chewing function, and a significant decrease in quality of life. Traditional treatment methods, such as orthopedic splints, physiotherapy, and drug therapy, do not always achieve complete effectiveness or provide long-term symptom control.
Objective: to evaluate the clinical effectiveness of carboxytherapy as a minimally invasive method of treating pain syndrome in internal disorders of the temporomandibular joints, to analyze the effect on pain intensity, and the obtained functional indicators.
Aim: to assess the distribution of tongue pressure in the surrounding areas of the oral cavity and analyze the relationships between pressure values in different measurement zones to identify functional muscle features of the tongue in pediatric patients with a distal bite.
Materials and methods. To assess the clinical effectiveness of carboxytherapy in patients with TMJ pain syndrome, a prospective clinical study was conducted at the Department of Surgical Dentistry and Maxillofacial Surgery, Bogomolets National Medical University, from March to October 2025. The study included 30 patients (22 women and 8 men) aged 20 to 42 years (mean age 32.6 ± 6.1 years) with clinically confirmed internal TMJ disorders accompanied by chronic pain syndrome lasting more than 3 months. The diagnosis was established based on clinical examination, axiography, MRI, and the Helkimo dysfunction index.
Carboxytherapy was performed using a certified Medexim INCO₂ device (Slovakia), designed for dosed administration of purified medical carbon dioxide. The results of our study were subjected to statistical analysis. The analysis was performed using the EZR package. The normality of the distribution of quantitative variables (VAS, mouth opening amplitude) was checked using the Shapiro–Wilk test. In the case of a normal distribution, a paired t-test was used to compare indicators before and after treatment, and an independent-samples t-test was used for intergroup comparisons. In cases of deviation from normality, nonparametric methods were used: the Wilcoxon signed-rank test for paired samples and the Wilcoxon rank-sum test for independent samples. The level of statistical significance was p < 0.05.
Results. In this study, we found that a course of carboxytherapy in patients with internal TMJ disorders and pre-existing pain syndrome resulted in decreased pain intensity (VAS) and increased mouth opening amplitude compared with standard drug treatment. Carboxytherapy provides a local metabolic and vascular effect on adjacent tissues; therefore, it corresponds to the expected response of the treatment pattern—the absence of the desired effect on the 3rd day, a pronounced reduction in pain from the 9th day, and the maximum effect on the 15th day with subsequent preservation for 1–3 months. The results obtained are consistent with data from clinical studies and systematic reviews, which show the effectiveness of local physiotherapeutic interventions (injection techniques, PRP, physiotherapy) in reducing pain and improving function in musculoskeletal disorders of the TMJ. Our data strengthen the existing evidence on the feasibility of including carboxytherapy in complex treatment.
Conclusions. Clinical application of carboxytherapy in patients with internal disorders and TMJ pain syndrome results in a statistically and clinically significant reduction in pain intensity (exceeding the MCID on VAS) and an improvement in mouth opening amplitude (exceeding the threshold of 5 mm). The data obtained indicate the feasibility of including carboxytherapy in the complex treatment of TMJ, but for final recommendations, larger, longer-term studies are needed to allow the development of a personalized treatment protocol and a patient profile of recipients.