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Objectives: This randomized clinical trial study aims to compare ultrasound‐guided versus non‐guided Dextrose 10% injections in patients suffering from internal derangement in the temporomandibular joint (TMJ). Material and Methods: The study population included 22 patients and 43 TMJs suffering from unilateral or bilateral TMJ painful clicking, magnetic resonance imaging (MRI) proved disc displacement with reduction (DDWR), refractory to or failed conservative treatment. The patients were divided randomly into two groups (non‐guided and ultrasound (US)‐guided groups). The procedure involved injection of 2 mL solution of a mixture of 0.75 mL 0.9% normal saline solution, 0.3 mL 2% lidocaine and 0.75 mL dextrose 10% using a 25G needle in the joint and 1 mL intramuscular injection to the masseter muscle at the most tender point. The Visual Analogue Score (VAS) was used to compare joint pain intensity over four different periods, beginning with pre‐injection, 1‐, 2‐, and 6‐months postinjection. Results: Twenty‐two patients 5 males (n = 5/22, 22.7%) and 17 females (n = 17/22, 77.2%) were included in this study. The mean age was 27.3 ± 7.4 years (30.2 ± 7.0) for the non‐guided group and 24.3 ± 6.9 for the US‐guided group. The dextrose injection reduced intensity over time in both groups with statistically significant improvement (P value <.05) at 2 and 6 months in both groups. There was no statistically significant difference in VAS assessment between both groups. Conclusion: Intra‐articular injection of dextrose 10% for patients with painful clicking and DDWR resulted in reduced pain intensity in both US‐guided and non‐guided groups with significant symptomatic improvement over time in both groups. US guidance allowed accurate anatomical localization and safe procedure with a single joint puncture. [ABSTRACT FROM AUTHOR]