Arthrosis of the temporomandibular joint (TMJ)

What is arthrosis of the TMJ

Arthrosis of the TMJ is a disease that destroys the components that form the joint (Greek arthron joint, suffix oz - destruction). First, the articular cartilage is destroyed, then the following occurs in the articular elements:

proliferation (tissue growth);
calcification (calcium redistribution) and ossification of cartilage;
hyperplastic (proliferation) and destructive (destruction) processes in the epiphyseal parts of bones (these are the rounded ends of the bones - the head and fossa);
reactive-inflammatory (from the word “response”) changes in the synovial membrane;
fibrosis (overgrowth of connective tissue) with hardening of the joint capsule, which affects nearby muscles, tendons and ligaments.

With the destruction of cartilage, its shock-absorbing functions are reduced, and impacts are transmitted directly to the bone. Patients involuntarily increase the destruction by reacting emotionally to events - they clench their teeth, not daring to say too much, with a “stony” face and tense muscles, compressed blood vessels and stress hormones, they face the blows of fate. The amount of nutrients decreases, the TMJ would be happy to recover - but there is no building material. Instead, the epiphyseal sections of the bone are flattened under pressure, and bone growths appear on them.

Then the joint enlarges, compressing the nerve endings located nearby. The pain radiates to the ear, back of the head, and teeth. When the jaw moves, a specific clicking sound appears (occlusion-articulation syndrome).

ICD codes M.19. 0 (1, 2, 8 – last digit changes)

Type of pathology

The clinical picture of arthritis depends on the form in which the disease occurs:

Acute form.

It is expressed by swelling of the soft tissues and severe pain in the affected area. As a rule, the acute form is the result of some kind of injury.

Chronic form.

This form is manifested by aching pain and difficulty opening the jaw, especially in the morning.

Infectious form.

Most often it is a consequence of a previous illness (flu, ARVI). Infectious arthritis is characterized by severe pain that makes it difficult to open the mouth. The pain radiates to the ears, temples and back of the head.

Traumatic appearance.

The most common form of the disease that occurs against the background of trauma.

Specific arthritis.

Rare disease. As a rule, it occurs as a consequence of syphilis, tuberculosis or gonorrhea.

Purulent form.

It is a consequence of acute arthritis in an advanced form. A compaction forms in the area of the mandibular joint, and body temperature may increase.

Rheumatoid form.

Constant pain in the maxillary joint area. With this form, the clinical picture may be supplemented by pain in the knee, hip or elbow joint.

Depending on what caused the inflammation, the following routes of infection are distinguished:

Hematogenous. Bacteria enter the joint along with the blood (syphilis, tuberculosis, measles, etc.).
Contact path. The disease develops due to damage to areas located near the maxillary joint (otitis, phlegmon, abscess).
Straight way. Develops due to direct penetration (wound, jaw fracture).

The form of pathology can be identified only after examination and diagnostic testing.

Causes of arthrosis of the temporomandibular joint

Arthrosis can be triggered by a one-time injury (compression, blow, bruise), as a result of which cracks and erosions appear on the articular surfaces. The disease is caused by a fracture of the condyle and condylar process if the fusion is incorrect.

Other reasons:

prolonged stress;
consequence of acute traumatic arthritis;
birth trauma (arthrosis develops due to improper application of forceps);
underdevelopment of the jaw (microgenia);
sudden removal of molars (accident, fight);
errors during dental prosthetics;
impaired coordination of muscle contractions during dislocation and subsequent sharp (jerky, zigzag, circular) movements of the jaw;
complete absence of teeth;
deep bite;
introduction of drugs into the joint cavity (for example, hydrocortisone, glucose solutions, novocaine).

Structure of the TMJ

Etiological factors of arthrosis (without which the disease does not develop):

infections;
metabolic disease;
injuries;
atherosclerosis of the terminal branches of blood vessels;
prolonged spastic contraction of the lateral pterygoid muscle (responsible for moving the jaw forward and to the side).

Even children are diagnosed with TMJ arthrosis. In newborns, the disease develops as a result of birth trauma. Dysfunction in the joint due to various malocclusions is observed in 40% of children from 4 to 14 years old, but in only 1% x-rays reveal coracoid (myogenic) arthrosis.

During menopause, the likelihood of developing arthrosis due to endocrine disorders increases. With age, it is possible to develop senile, i.e. invaluable arthrosis, when cartilage tissue cannot recover, dries out and collapses.

At risk are people whose professional activities involve inadequate load on the joint (violinists), or those suffering from spasms of the masticatory muscles (bruxism).

There are two main types of TMJ dysfunction:

Myogenic (source: muscle pain);
Arthrogenic (associated with TMJ condition).

Myogenic TMJ dysfunction usually occurs due to fatigue or tension in the masseter or accessory muscles. Leads to facial pain, headaches, and sometimes neck pain.

Arthrogenic dysfunction of the TMJ, as a rule, is the result of inflammation, degenerative changes in hard and soft tissues in the joint. It most often occurs due to capsulitis or synoviitis (inflammation), slipped discs, and degenerative arthritis.

Symptoms of TMJ arthrosis

Information about arthrosis of the temporomandibular joint on the Internet is 50% far-fetched descriptions of arthrosis of large joints, 30% is outdated data and obvious nonsense. And only 20% is true. Alas, texts are written by people without medical education, copying not from special educational literature or monographs, but from each other. Therefore, trust only trusted sources, and treat your health where there are no such ignorant things on the clinic websites.

First signs

A person may assume that he has arthrosis of the jaw when, after visiting doctors and following their recommendations, pain in the back of the head, ear, when chewing, hearing loss on one side, clicking, etc. does not go away.

Due to the structural features of the joint, the body manages to turn on the compensatory mechanism, so there is no long-term aching pain; due to the medications taken, it successfully disappears for a while.

Obvious symptoms

There are only 2 obvious symptoms (but it is also impossible to say 100% that this is arthrosis):

displacement of the jaw to the side;
pain when chewing.

You need to see a doctor immediately.

TMJ diseases

Diseases of the TMJ (temporomandibular joint) are characterized by a common symptom - dysfunction of the masticatory apparatus - and are the competence of orthopedic dentistry.

Arthrosis of the TMJ

Arthrosis of the TMJ is a disease that occurs as a result of uneven load on the joint: on the one hand, compression, and on the other, stretching. Increased loads can occur due to malocclusion, occlusion and articulation, as well as if incorrect prosthetics were performed (insufficient examination, poorly fixed fixed prosthesis, incorrectly sized bridge, excessive grinding of the tooth for a crown).

Symptoms of TMJ arthrosis:

Pain in the joint in a calm state, inactivity;
Clicking and crunching in the joint;
Stiffness in the lower jaw after a night's sleep or after prolonged exercise (long conversation, chewing food);
Limited mouth opening;
Moving the jaw to the side when opening the mouth.

Treatment

The treatment of arthrosis of the TMJ requires an integrated approach from a group of doctors:

Orthopedic treatment – corrects malocclusion – straightens the shape of the teeth, corrects the relationship of the dentition, installs or replaces previous dentures;
Therapeutic treatment – partial grinding of teeth that interfere with the normal closure of the jaws;
Physiotherapeutic methods – galvanization, massage, electrophoresis.

Arthritis of the TMJ

TMJ arthritis is inflammation of the temporomandibular joint of infectious or non-infectious origin. Initially, it spreads only to the joint capsule, then it can reach areas of the bone, accompanied by the melting of cartilage and the appearance of connective tissue in the joint cavity.

There are two stages of the disease: acute and chronic. When acute pain becomes severe, visible deformation of the face and swelling are observed. The joint is constantly stiff. In the chronic stage, painful sensations increase with movement, and in an immobilized state they are moderate or weakly noticeable. The joint is stiff in the morning.

Symptoms of the disease:

Acute throbbing pain when moving the joint (talking, chewing), radiating to the temple, back of the head;
Pain on palpation of the lower jaw;
Redness of soft tissues and their swelling;
Feeling of fullness in the jaw.

Treatment

Immobilization of the diseased joint by applying a sling-shaped bandage to the lower jaw or other methods;
A diet that excludes chewing food for 3 days;
Using analgesics and cold compresses for pain relief;
Taking antibiotics, injections of chondroprotectors and corticosteroids into the joint;
Physiotherapeutic measures – mud therapy, ultraphonophoresis.

Ankylosis of the TMJ

Ankylosis of the TMJ is a partial or complete loss of mobility of the lower jaw, which is caused by fibrous or bony fusion of the joint surfaces. The danger of this disease is that it can occur for many years without symptoms until the cartilage completely dies. Bone ankylosis develops in childhood, while fibrous ankylosis occurs in adults.

Symptoms of the disease:

Limitation in opening the mouth;
Impaired breathing (night apnea and snoring), speech, chewing;
Distortion of the face to the side;
Shortened and underdeveloped lower jaw;
Increased formation of plaque and tartar.

Treatment

The treatment has two goals: restoring joint mobility and facial aesthetics.

In the first stages, treatment may be limited to physiotherapeutic measures in the form of ultraphonoresis, hyaluronodase, as well as hydrocortisone injections into the joint. Sometimes they resort to mechanical expansion of the jaws under anesthesia or surgical dissection of the adhesions.

Persistent deformities and adhesions in late stages of development can only be eliminated surgically. The complexity of the operation should be taken into account due to difficulty breathing in patients with this disease. In some cases, a tracheotomy is required.

Ankylosis can be prevented by timely treatment of diseases of the facial joints and birth injuries in children.

Musculo-articular dysfunction of the TMJ

Impaired coordination of the muscles of the lower jaw and the joint, as well as the placement of the head and disc of the joint relative to the tubercle. Factors that contribute to the development of this disease may be incorrect orthodontic treatment, unprofessional implantation, bone grafting of teeth, sinus lifting, as well as endocrine, articular and other diseases.

Symptoms:

Painful sensations in the jaw, increasing at night and with movement (in another form, painful sensations may be absent);
Clicking sounds when moving the jaw;
Temporary stiffness in jaw movement;
Tension of the facial muscles, most often one-sided;
Sleep disturbance.

Treatment

The main task is to create the correct bite for the patient and restore normal jaw closure. These tasks are carried out by grinding protruding contacts on the surface of the teeth, which interfere with the normal closure of the jaws. Advanced stages can only be treated surgically - dissection of adhesions, straightening and installation of the disc in place.

TMJ dislocation

TMJ dislocation is a displacement of the head of the joint beyond its normal location, in which the function of the lower jaw is completely disrupted. There are 2 types:

traumatic - received as a result of a blow to the jaw, yawning or screaming;
habitual - which develop as a result of stretching of the joint capsule and ligaments.

Symptoms:

The lower jaw is displaced downwards, the mouth does not close on its own;
Excessive salivation;
The appearance of depressions in the area of the tragus of the ear and protruding heads of the joint in the area of the cheekbones;
Strong pain.

Treatment

Reduction of the joint;
Immobilization of the TMJ.

How dangerous is the disease?

TMJ arthrosis is silent and unnoticeable; people live with the disease for years without even knowing about the problem. But in vain.

Degrees of TMJ arthrosis

In the Russian Federation, the Kosinskaya classification of arthrosis has been adopted, which takes into account both symptoms and radiographic data. However, the TMJ is an exception to the rule: the joint “hangs”, held by muscles and ligaments, and does not experience weight loads comparable to other joints.

When at stage 1 according to Kosinskaya the joint space narrows, the pressure on the jaw simultaneously increases, which leads to problems with the teeth, but maintains the distance. The process is gradual, so this moment can be recorded on an MRI, but since there are no symptoms characteristic of the disease in the initial stage, it cannot be said unequivocally that this is stage 1 arthrosis. Only at stage 2, when symptoms appear (pain, facial asymmetry, etc.), and the patient finally consults a doctor, is a diagnosis made.

Stage 3 according to Kosinskaya: absence of joint space, sclerosis, necrosis, inability to open the mouth, chew and speak.

Damage to the TMJ by arthrosis

Possible complications

Arthrosis is not only a problem of the joint. Compensatory, in an effort to maintain chewing function, the body redistributes the load, which leads to tooth loss and rapid wear.

The previous diseases will be reflected in TMJ synovitis, and then the inflammatory process will affect the ear and nose (with decreased hearing, nasal congestion on one side), a headache will appear, which can radiate to the neck, back of the head and not stop.

The face will lose symmetry and become pasty (the skin appears loose, finely swollen, and grayish in color). Feeding is possible only through a tube; already at the second stage the ability to fully open the mouth is lost

Any localization and form of arthrosis has serious complications, so you should not delay treatment.
See how easily the disease can be cured in 10-12 sessions.

Exacerbations

Osteoarthritis is not arthritis; a chronic disease does not have periods of exacerbation. But this does not mean that the pain will be equally aching. The inflammatory process (cold, infection, virus) spreads to the joint with the development of synovitis. Swelling and pain appear, which can appear at any radial point (from the teeth to the back of the head). The source of inflammation expands, the oral cavity, ears, and breathing through the nose are at risk.

You need to understand that the brain is located nearby. And you shouldn’t wait for necrotic tissue to give rise to oncology.

TMJ dysfunction - causes and consequences.

Orthodontist-dentist Nikolaeva Nadezhda Nikolaevna

The temporomandibular joint ( TMJ ) is a paired joint formed by the head of the mandible, the mandibular fossa and the articular tubercle of the temporal bone. The heads of the mandible meet at an obtuse angle at the anterior edge of the foramen magnum. The TMJ ensures the movement of the lower jaw and represents a complex activity of the body in the form of chewing, swallowing, talking, yawning. The muscles of mastication ensure precise movement of the joint in an error-free manner, unless there is dysfunction ( TMJ )
. According to WHO, about 40% of the population aged 20-50 years suffer from TMJ . But not every person seeks help from a gnathologist or osteopath with complaints about the joint, preferring to visit other doctors with headaches, fatigue, attacks of fear, pressure... Dysfunction manifests itself in the form of a neurological clinic: headache, dizziness, clicking and crunching joint, muscle tension, spasms in the head, neck, throat. Otology clinic: noise, ringing, ear congestion, hearing loss. But there are other, hidden and long-term consequences of TMJ dysfunction:

Cervical lordosis. Poor posture, when the neck is excessively straightened or, on the contrary, the head protrudes noticeably relative to the person’s body.
Curvature in the sacroiliac joint (pelvic bones) as a result, a change in the length of the limbs.

With pain and dizziness, it would seem clear: head, ear, joint. Everything is close, everything interacts. But what effect does TMJ on the entire musculoskeletal system, especially on the length of the limbs?

The TMJ is the structure of one complex - the DENTAL GNOSTIC system. The dental system is a complex of interactions between the structures and functions of the head and neck. Includes components of the bones of the skull, lower jaw, hyoid bone, clavicle and sternum, muscles and ligaments, joints, vascular, lymphatic and nervous systems, as well as soft tissues of the head and teeth. In addition, it has a connection with the sacrum and coccyx through the dura mater. Everything in the system is interconnected and depends on the normal functioning of all its parts.*

Main functions of the dental system:

Providing basic body functions: chewing, swallowing, biting, speaking, breathing.
Participation in maintaining statics: gait mechanism, cervical, vertebral and muscle balance, pelvic balance, equilibrium.
Effect on cranial (cranial) function - especially the temporal bone.
Influence on the functions of the nervous, endocrine, lymphatic systems.

Let's look at the basic functions of the body: chewing, swallowing, speaking, breathing. These basic body functions are performed through the movement of the lower jaw. The movement of the lower jaw is ensured by the movement of the head of the lower jaw in the articular fossa of the TMJ , with the help of the temporal, masticatory, pterygoid, hypoglossal and other muscles. The line of closure of the teeth - the occlusal plane, or simply the bite, should normally be parallel to the planes of the entire musculoskeletal system. The main planes of which pass through the pupils, the line of closure of the teeth, the second and third cervical vertebrae, shoulder blades, iliac crests, knees and ankles. The parallelism of the lines indicates the health of the musculoskeletal system and the dental system. A change in any of the planes leads to changes in the other planes. Therefore, a violation of the occlusal plane relative to others can cause pain and negative changes in completely unexpected parts of the body.

Violations of occlusion as a result of tooth wear, congenital malocclusion, and more often, inadequate dental treatment or prosthetics, inept use of braces, illegal removal of healthy teeth, lead to response disorders in the cervical spine and spasm of the muscles of the back of the neck. Prolonged spasm causes structural changes in the muscle, shortening it and causing it to lose its ability to contract and relax. Muscle spasm leads to spasm of the chewing and facial muscles. Thus, for the body, muscle spasm on one side is a pathological process that leads to spasm in another area. For example, the temporal muscle is involved in supporting statics; the masticatory muscles are its synergist. These muscles contain a large number of proprioceptors (sensory fibers). A constant flow of nerve impulses from proprioceptors is involved in the regulation of the vertical position of the body. Violation of occlusion (bite) leads to unbalanced movement of the lower jaw and maxillofacial muscles, incl. masticatory and temporal muscles. A change in the flow of nerve impulses, due to dysfunction of the TMJ , causes curvature of the spine in the cervical region and sacroiliac joint, which leads to twisting of the pelvis and changes in the length of the limbs.

An imbalance in the TMJ sends a negative stimulus to the nervous system 24 hours a day, 7 days a week. Any malocclusion changes the direction of force in the skull. For example, premature contact on the lateral teeth causes uncoordinated muscle movement and distortion of nerve impulse transmission to the brain. Uncoordinated muscle movements often cause tension in the fascia of the neck. The nodes of the sympathetic trunk of the autonomic nervous system lie anterior to the prevertebral fascia of the neck. Thus, dysfunction of the TMJ , causing tension in the fascia of the neck, can irritate cervical sympathetic communications, provoking a reflex spasm of the vessels of the head. Spasm of the blood vessels in the head causes a disturbance in the blood supply to the cerebellum, which is manifested by a lack of coordination, dizziness - as a result of anxiety. TMJ dysfunction causes torsion (torsio; Latin “rotation, twisting”) of the temporal bone, in which the labyrinth with the vestibular apparatus is located. Changes in the vestibular system lead to imbalance and dizziness. Nasal congestion may also be associated with TMJ . Due to the shortening of the fascia of the neck muscles, there is a violation of lymphatic drainage and the outflow of venous blood from the head. This may manifest itself in the form of tissue edema in the area of the nasal passages, since this area is rich in blood vessels. Diseases of the temporomandibular joint have the following causes :

Malocclusion (occlusion) is a closure of the teeth, which disrupts the shape and function of the dental system. This manifests itself in the form of deformation of the occlusal surface of the teeth with blockade of the movement of the lower jaw. Which can lead to pathological wear of teeth, functional overload of the TMJ and chewing muscles. The most common TMJ problem is a decrease in bite height. This is due to several factors: impaired teething, bruxism, premature loss of milk or permanent teeth, congenital absence of a group of teeth, microdontia (small teeth), pathological abrasion of enamel, violation of the vertical size of teeth due to the work of the dentist. Changes in the position of the TMJ due to illiterate orthodontic treatment, illegal or forced removal, tooth decay.
Stress (overexertion, strong clenching of teeth).
Jaw trauma (fractures of facial bones and jaw).
Endocrine, metabolic disorders, infectious diseases.
Excessive physical activity.
Bad habits (biting nails, holding the phone incorrectly, etc.)

Symptoms of temporomandibular joint diseases:

Headache, spasms in the facial muscles and jaw area.
Clicking, crunching, grinding when the jaw moves.
Pain, congestion and ringing in the ears.
Enlarged submandibular lymph nodes.
Dizziness.

TMJ diseases on human health is far from being studied, in contrast to the methods of diagnosis, treatment and restoration of TMJ by a doctor. In most cases, a transparent corrective aligner is enough to save yourself from many present and future health problems.

Types of arthrosis of the temporomandibular joint

For treatment to be effective, it is important to understand that there are several types of arthrosis of the lower jaw.

Deforming arthrosis

Osteoarthritis of the TMJ usually develops after injury. The clinical course depends on the nature of growth and the location of osteophyte proliferation (towards soft tissues or the articular cavity). If bone growth is directed to soft tissues, the disease is asymptomatic for a long time. If the osteophyte grows into the cavity of the glenoid cavity, local acute pain appears, which occurs with limited jaw movement. Clicking and crunching are dull, and sometimes popping sounds appear.

The joint becomes deformed with the growth of the condyle, changes occur in the synovial membrane and are accompanied by hemorrhagic synovitis. The reason for this is irritation of the TMJ, caused by the multiple presence of dead and rejected cartilage cells (intra-articular detritus). The synovial villi on the inner lining of the joint enlarge and fat is deposited in them. Occasionally, they degenerate, forming islands of bone and cartilage tissue (metaplasia), which are separated from the articular surface and form intra-articular free bodies.

Please note: this is not salt, it is osteochondral tissue. Therefore, folk remedies for arthrosis, which can still help with gout, do not work.

Viral and infectious diseases during this period inflame the joint membrane, accelerating the destruction of cartilage and bone.

Facial asymmetry does not appear in all patients diagnosed with arthrosis deformans. This depends on the compensatory capabilities of the neuromuscular complex and on the functional grinding of the articular surfaces.

Sclerosing arthrosis

Not only vessels can be sclerotic. With arthrosis, the 2 upper layers of bone become sclerotic (bone tissue is replaced by dense connective tissue). In this case, some compaction of the head occurs, followed by expansion. Since replacement is a slow process, the body manages to compensate for the changes. Therefore, the disease goes unnoticed in the initial stages.

Neoarthrosis (post-infectious arthrosis of the TMJ)

The disease is a consequence of an acute inflammatory process in the TMJ, with repeated acute respiratory viral infections and with the presence of dysfunctional jaw syndrome (luxation, neuromuscular, occlusal-articulatory). It is asymptomatic. With exacerbation of chronic inflammation, the following is noted:

dull, aching pain that intensifies when moving the jaw;
crunch;
clicking in the HFNS.

X-rays show usuria (disappearance of osteochondral tissue), defects in the articulating surfaces of bones, and sometimes the complete absence of condyles.

Myogenic arthrosis of the TMJ

In orthopedics, there is a separate type of deforming arthrosis of the TMJ, myogenic. Its difference: a beak-shaped bone growth on the anterior surface of the condyle.

X-ray shows myogenic arthrosis, the contours of the articular surface due to osteophyte resemble a bird

Myogenic arthrosis occurs due to prolonged spastic tension of the lateral (lateral) pterygoid muscle. Its middle bundles are attached to the anterior-inner surface of the condyle and its process. Prolonged muscle spasm leads to a lack of coordination of muscle contractions, the bone beams change direction, stretch, positioned along the direction of the tendon traction. If the spastic contraction of the muscle continues, the bones that form the joint will begin to break down.

Differences from other forms:

the condyle always has a beak-like shape;
bone growth (osteophyte) is always localized in a specific place;
no restrictions on jaw movement;
the disease occurs without facial asymmetry.

The initial stages of the disease are asymptomatic. The osteophyte grows gradually on the anterior surface of the condyle, does not rub against hard tissues, and forms a bed in soft tissues. In the joint area, nutrition is disrupted, there may be a slight swelling on the face, spider veins - but very often this is explained by fatigue, overload, without paying attention to the TMJ. Painful symptoms occur at the moment of dislocation, subluxation of the lower jaw. Since the movement of the jaw in such cases is atypical, the osteophyte injures the soft tissues, irritating the nerve endings - severe pain appears (it hurts to chew hard food), severe swelling, clicking, mild swelling and paleness of the skin flap (pastyness). At the moment the mouth opens, the jaw begins to shift to the side.

Metabolic arthrosis

This is a rare type of disease that occurs when salt metabolism in the body is disrupted. The reason is needle-shaped crystals of uric acid settling in the TMJ. In patients, large joints are first affected; they suffer for a long time from metabolic polyarthritis, the visual manifestation of which is “gouty bumps” on the joints.

Symptoms:

significant deformation of the head of the lower jaw, detected by palpation;
asynchronous movement of the condyles when opening and closing the mouth;
hinge movements on the side of the diseased temporomandibular joint;
crunch;
local dull pain;
when opening the mouth, the jaw moves to the side;
Lateral position of the head leads to facial asymmetry.

On radiographs with metabolic arthrosis, the condyle is covered with whitish needle-shaped curls of various shapes that are not permeable to x-rays.

Crunching in joints - when to worry

Intra-articular injections of hyaluronic acid

Senile arthrosis of the TMJ

Senile, or invaliable, arthrosis occurs with age. “Aging” of cartilage tissue occurs in 3 stages:

cartilage tissue becomes soft and loose;
loses some of the water, dries out, becomes denser;
The smooth surface disappears, the cartilage becomes fragile and becomes covered with cracks.

After 60 years, bone exposure begins. Patients feel uncomfortable chewing and clicks are noted in the TMJ. The x-ray shows subtle changes.

Features of diagnostic measures for TMJ dysfunction

For the most accurate diagnosis of damage to the articular surface of the lower jaw at the junction with the temporal bone of the skull, specialists use the following methods and the following examination plan:

clarification of the patient’s vital functions (work specifics, presence of chronic diseases, psycho-emotional background);
questioning the patient about the probable cause of pathological changes in the jaw (trauma, inflammatory processes in the oral cavity, past dental history, the presence of neurological pathologies);
visual inspection of the outer surface of the projection of the joint and the oral cavity, if possible;
palpation examination of the joints of the mandible, which helps to identify muscle tension, swelling and displacement;
listening to sounds when opening the mouth, which can be in the form of clicks or crackling sounds;
determination of the amplitude of jaw mobility;
identifying the scope of possible movements;
assessment of the functionality of the masticatory muscles;
determining the correct bite;
X-ray examination of the dentofacial apparatus, which will be the most informative for excluding other pathologies of teeth and gums;
the magnetic resonance imaging method allows you to examine the soft structures of the jaw, for example, intra-articular cartilage and its physiological position, the correctness of which determines the condition of the TMJ;
CT scan results will provide a layer-by-layer image of the bone structure of the jaws.

The results of these examinations may require consultation and treatment with a dental surgeon, traumatologist or orthodontist.

Diagnostics

In the initial stages, arthrosis of the jaw is asymptomatic (more precisely, if there is pain, discomfort - they are attributed to a cold, problems with teeth, inflammation of the facial nerve, etc.). When constant pain appears, the face loses symmetry, it is impossible to chew - the patient begins to visit doctors.

Remember: at the slightest suspicion of TMJ arthrosis, you should consult a doctor; it is impossible to make a diagnosis yourself (if you are not an orthopedist or a healer).

In the clinic to confirm the diagnosis you will need:

take blood tests (clinical - to identify an infectious-inflammatory process, biochemistry - for arthrosis, biochemical parameters should be normal);
take an x-ray in 2 projections (the image clearly shows the deformation of the osteophyte, the narrowing of the joint space, but the articular cartilage is not displayed in the image, and it is impossible to assess the degree of destruction of the TMJ in the early stages);
undergo an MRI or computed tomography (MRI uses magnetic waves, and computer tomography uses X-rays, so in the early stages, MRI is an advantage).

Occasionally, an ultrasound of the joint is prescribed. In addition, a personal examination is required, because often it is necessary to treat not only arthrosis, but also to remove defects in the dentition, and to treat the accompanying inflammation of nearby tissues.

Which doctor should I contact?

The first signs of the disease are often discovered by a dentist when visiting a patient for dental treatment or complaining of pain in the jaw. When palpating the jaw muscle, its compaction is noted, and the mobility of the joint is limited. To clarify the clinical picture, the doctor may prescribe conventional or contrast radiography, as well as a computed tomography examination. Depending on the results, treatment may require the participation of several specialists.

Treatment of arthrosis that has developed against the background of anatomical pathologies of the joint (bad bite, abrasion of teeth, absence of several adjacent lateral teeth) is carried out by dental doctors. A dental therapist, an orthodontist and a prosthetist can take part in the treatment.

If there is a history of diseases that provoke the development of arthrosis of the TMJ, the dentist may refer the patient to specialists of a different profile:

If the cause is a disease associated with metabolic disorders, an endocrinologist is involved in the treatment.
If nerve conduction disorders are detected, the help of a neurologist will be required.
An infectious lesion of the maxillofacial joint or the presence of an inflammatory process localized in other joints (arthritis, rheumatism) is a reason to consult a rheumatologist.
In some cases, with arthrosis of the TMJ, partial hearing loss is observed, then an otolaryngologist joins the complex treatment.

Treatment of TMJ arthrosis

Treatment of TMJ arthrosis is complex, regardless of the stage of development of the disease. The disease cannot be overcome with one method or remedy.

Medicines for the treatment of TMJ arthrosis

In the early stages, arthrosis of the TMJ is asymptomatic, but dysfunctional syndromes may appear. Therefore, treatment should be aimed at normalizing the functioning of the lower jaw. To do this, use myogymnastic exercises (only after consultation with a doctor) and physiotherapy.

Then the position of the articular heads is normalized, the integrity of the dentition and bite are restored. For pain, clicking, crunching, and asynchronous contraction of the masticatory muscles, permanent splints, braces, and bandages are used.

At the same time, the doctor prescribes medications to restore cartilage tissue, relieve inflammation and improve metabolism around the joint.

For arthrosis of the jaw joint, consultation with a psychotherapist is indicated, because Chronic muscle spasms are always associated with problems in relationship with the world.

Medication

To restore cartilage tissue, chondroprotectors are prescribed:

glucosamine, stimulates the production of key elements in cartilage tissue, restores the articular surface, protects from destruction;
chondroitin sulfate, increases the ability of cartilage molecules to retain water (especially important for senile arthrosis of the temporomandibular joint), neutralizes the influence of enzymes that destroy cartilage, and stimulates the formation of collagen.

But if the cartilage is completely destroyed, chondroprotectors are not effective.

To relieve muscle spasms, the doctor prescribes mydocalm and sirdalud.

Remember: you cannot use medications on your own without a doctor. Muscle spasm is a protective reaction; without it, the TMJ will begin to deteriorate at an accelerated pace.

Drugs of this group, muscle relaxants, are used only with the simultaneous use of chondroprotectors and orthopedic treatment (splints).

Corticosteroids quickly relieve pain during synovitis, intra-articular injection only relieves inflammation, BUT the next dose is less effective (3-4 injections is the maximum), and the hormone destroys and does not heal articular cartilage. Therefore, for arthrosis of the temporomandibular joint without inflammation, drugs are not used with proper treatment.

The hyaluronic acid preparation “Ostenil mini”, a 1% solution of sodium hyaluronate (10 mg of active substance in 1 ml syringe), is also called “liquid prosthesis”. It restores the joint more effectively than chondroprotectors. 1-2 injections per year (3-4 years) are enough. There are only 2 drawbacks:

there should be no inflammation in the joint, drugs with HA are instantly destroyed in such an environment, and the treatment will not be effective;
this is an expensive drug (however, it is better to use it than to go under a scalpel).

For post-infectious arthrosis of the TMJ, Movalis (selective anti-inflammatory) is prescribed to suppress inflammation, as well as:

Brufen;
indomethacin;
methindol;
butadione;
rheopirin;
sodium salicylic acid;
antibiotics (in the presence of low-grade fever).

Please note: long-term use of non-steroidal anti-inflammatory drugs has a negative effect on articular cartilage.

Electrophoresis with medical bile, bischofite, dimexide (compresses are also made from them), as well as with salicylic sodium (10%), lidase is indicated. Mud therapy helps a lot.

For post-infectious arthrosis, treatment is physiotherapeutic (electrotherapy with potassium iodide solution (5%) and novocaine solution (2%)). Recommended ointments are apisatron, vipratox, and an analgesic mixture.

For myogenic arthrosis, they practice novocaine blockade with vitamins B1, B12, massage using anesthetic ointments, UHF.

Metabolic arthrosis of the jaw joint is myogymnastics and the use of a splint. At the same time, salt-removing therapy (delogil, collection of salt-removing herbs) is prescribed.

Chondroprotectors: what are they, how to choose, how effective are they?

Joint pain at rest

If the condyle in the temporomandibular joint is excessively enlarged, surgical and orthopedic treatment is performed.

In addition, at any stage and for almost any type of arthrosis, vasodilators xanthinol nicotinate and pentoxifylline are prescribed, which relieve spasm of small vessels and improve blood circulation in the joint. At the same time, slight redness of the face and a feeling of heat are the norm.

Therapeutic ointments and creams do not cure advanced arthrosis of the jaw joint, but their use relieves pain, relieves swelling, and improves tissue nutrition. Finalgon and Nicoflex increase blood circulation, relieve pain and partially relax the spasmed muscle. Creams based on bee venom additionally improve the elasticity of ligaments, but due to the large number of allergic reactions, they must be used with caution. Ointments containing non-steroidal anti-inflammatory drugs (Voltaren-gel, Fastum, ibuprofen, indomethacin, etc.) are less effective than medications, but do not have as many contraindications.

Orthopedic treatment

Orthopedic devices help redistribute the load in the joint and straighten the jaw. Using splints and a sling bandage:

functional rest is created in the joint;
traumatic factors are eliminated;
the activity of the chewing muscles and joints is restored.

When treating arthrosis, the dentition must be restored. Wearing mouth guards, braces, and teeth grinding are practiced.

How to treat TMJ arthrosis with exercise therapy

Physical therapy for arthrosis of the jaw joint is useful only after permission and under the supervision of a doctor.

The joint is destroyed from the inside, and the destruction of it and nearby tissues, as well as compensatory muscle spasm, intensifies with movement. Stupid exercises can cause harm, because... unknown until images are received:

how arthrosis develops;
what type is it;
where are the osteophytes directed?

The joint is already receiving load - we talk, eat, opening and closing our mouths. And moving the jaw from side to side will add subluxation and swelling.

At home you can do:

soft massage with a sponge using rotational movements around the joint to stimulate lymph outflow and blood circulation;
gently tap a bag of raw peas or beans around the joint;
stroke the cheek from the nose to the bridge of the nose, applying slight pressure with the palm of your hand.

Nutrition, diet

The development of arthrosis of the temporomandibular joint is not associated with dietary habits (you just don’t need to crack hard nuts so as not to break your teeth). However, it is important to pay attention to the amount of water entering the body. The individual need for clean water is calculated using the formula: 1500 ml + 20 ml per kg (over 20 kg). For example, with a weight of 60 kg, the amount of liquid is 1500 ml + 40 * 20 ml = 2300 ml

When edema occurs, diuretic herbs and herbs (birch, linden, clover inflorescences, mistletoe branches, etc.) are used.

Traditionally, for problems with joints, it is recommended to eat more vegetables and fruits (vitamins and minerals), as well as jellied meats, jelly (some patients have a special craving for soft cartilage, pig ears, etc.).

Eat a varied dietC

When pain occurs (stage 2), it is painful to eat. Food should be soft and pureed. These are juices, pureed soups, ready-made baby food in jars. Sometimes you have to feed through a tube - do not bring yourself to this state, at the first unpleasant sensations, consult a doctor.

If an operation has been performed on the joint, the food for the first time should be dietary. Food should be pureed, spicy, spicy and salty foods should be excluded.

Folk remedies

Among the folk remedies for arthrosis of the jaw, a compress with bischofite or medical bile helps a lot. But due to the fact that it is necessary to align the joint, this is a temporary measure to alleviate the condition. You still have to go to the doctor.

A compress is made only when there is no inflammation, swelling on the face or viral infectious diseases. First, place a warm (not hot!) heating pad on the sore side of the face for 3-5 minutes to warm the joint and slightly relax the spasming muscles. Then put gauze on it (attention: no colorful synthetic rags), soaked in a bischofite solution, cover first with parchment paper (cling film), then with a flannel cloth (terry towel). The compress should be kept for 1-1.5 hours, for people with sensitive skin no more than 20 minutes. If there are no negative reactions, the procedure time is increased. Course of home treatment: 10-15 compresses every other day.

A compress with medical bile cannot be used if you have pustular rashes, acne, rosacea, or rosacea. 6 layers of gauze are soaked in bile and a “sandwich” is made in the same way as with bischofite. However, they keep it for 30 minutes maximum. Course of treatment: daily for 2-3 weeks.

In case of cardiovascular insufficiency or hypertension, such procedures without medical supervision are prohibited.

When diagnosed with “metabolic arthrosis of the jaw joint,” herbal preparations that remove salts are taken. For example, collection (all herbs 100 g, grind in a meat grinder into powder):

mint;
buckthorn;
dandelion;
immortelle;
juniper fruits;
celandine;
buckthorn;
chicory (herb);
yarrow;
sage (leaves);
burdock.

1.5 tbsp. collection, brew 1.5 tbsp of boiling water and infuse. Drink 0.5 tbsp. 3 times a day before meals.

This is the only type of arthritis where herbal treatment is effective. However, you can drink herbs to strengthen the immune system and for prevention during epidemics of viral infections.

Surgical operations

Surgical intervention is indicated:

during ossification;
with further destruction if conservative treatment does not produce results.

The joint or part of it is removed, replaced with an artificial implant or your own graft (usually part of the fibula).

Causes of pain in the jaw joint.

Like any other, the mandibular joint is a connection of bones. The lower jaw bone, the head of which is covered with cartilage tissue, is attached to the temporal bone. The articular disc serves as a kind of layer between them. Mouth movements are regulated by the work of the chewing muscles, which are already recognized as the most trained in the body. Together with ligaments, the muscles provide strength to the mandibular joint, while allowing the jaw to move in different directions. The mobility of the jaw is individual for each person and largely depends on the anatomical features of its structure.

Pain in the jaw when chewing or speaking causes significant inconvenience. There are many reasons why it can arise. To prevent complications, it is important to receive timely treatment.

The main causes of pain in the jaw joint:

Fracture

A fracture is diagnosed when complete or partial damage to the jaw bone is detected. A fracture is often the result of a strong mechanical impact on the mandibular joint. Fractures can be open or closed, single or comminuted. The consequences of a fracture can be deformation of the dentition, loosening or loss of teeth at the site of injury, displacement of teeth, numbness of the lower jaw, headache, and dizziness.

Treatment:

the mandibular joint must be fixed with a tight bandage, and if necessary, the tongue is also fixed;
ensuring peace;
urgently seek qualified medical help.

Treatment is aimed at creating conditions for proper bone fusion and restoration of bite.

Osteomyelitis of the jaws

Osteomyelitis is an acute inflammation of the lower jaw bone caused by an infection, usually through a diseased tooth. Symptoms - not only the tooth hurts, but the entire jaw, fever - 38 and above, swollen lymph nodes in the neck, the inflammatory process is confirmed by a blood test.

Treatment:

removal of infected teeth;
complete sanitation of the oral cavity with antibacterial drugs;
in case of complications, an incision is made in the area of the purulent focus and the purulent formations are removed.
Delayed seeking medical help can lead to an abscess or sepsis.

Temporomandibular joint dysfunction syndrome

In addition to pain when chewing, dysfunction of the mandibular joint is accompanied by the presence of obvious sounds when moving the jaw, these can be clicks, a “clicking” sound or grinding. Noises of this kind indicate a displacement of the jaw bone in relation to the articular disc. Dysfunction in most cases occurs due to overstrain of the mandibular joint. It can occur as a result of periodic involuntary clenching of the jaw, for example, in sleep. In addition, dysfunction can develop due to stress.

Treatment:

removal of muscle tone;
eliminating muscle spasms (taking painkillers, applying cold compresses and ensuring complete rest is often quite enough to eliminate joint dysfunction).

Neuralgia

Various types of neuralgia can also lead to pain. For example, cranial neuralgia, which is a consequence of inflamed nerves of the skull, is often a source of jerking pain. With neuralgia of the glossopharyngeal nerve, the pain is localized in the area of the mandibular joint, and the area of its spread is extensive; the right or left side of the head can hurt completely, starting from the chin up to the temporal part. The pain will increase with palpation.

Treatment:

prescription of medications;
local anesthesia.

Arthritis

The most common disease of the jaw joint is arthritis. Depending on the cause, purulent, rheumatoid or traumatic arthritis can be diagnosed. Purulent arthritis. It develops if the maxillofacial joint becomes infected, resulting in purulent formations. The infection can result from diseases such as tonsillitis, influenza, or be the result of hypothermia. Infection in the mandibular joint can also penetrate through the blood, for example, with otitis media. In addition to pain, there is general weakness and increased body temperature.

Treatment:

taking antibacterial drugs;
in complicated cases, the purulent focus is opened, and the mandibular joint is treated from the inside with antiseptics;
ensuring rest of the jaw joint during the treatment period.

Rheumatoid arthritis

It is also a very common disease that is infectious and allergic in nature. The most common culprits for this type of arthritis are streptococcal and staphylococcal infections. The consequences of rheumatoid arthritis are muscle fiber atrophy and tendon damage.

Treatment:

electrophoresis session;
physiotherapy;
restriction of motor activity of the jaw joint during rehabilitation.

Traumatic arthritis.

It is a consequence of hemorrhage in the maxillofacial joint, resulting from strong mechanical impact. It is possible to develop this type of arthritis after dislocation of the lower jaw. The consequence may also be

subsequent deformation of the mandibular joint.

Treatment is similar to that used for other types of arthritis.

Osteoarthritis.

The main factor of occurrence is time. The disease appears due to wear and tear of the mandibular joint. People over 50 years of age are more susceptible. However, it can develop earlier and the cause may be previous diseases of the jaw joint, such as joint dysfunction, arthritis, or even unprofessional dentures. Symptoms in the form of pain appear in the later stages of the disease.

Treatment:

relieving excess stress and load;
use of special tires;
conservative physiotherapy.

Approach to treating the disease in our clinic

Our clinic is an example of integrative medicine: a synthesis of Eastern and Western approaches to treatment. In addition to neutralizing the causes of the disease and restoring the functionality of the HFNS, we restore the disturbed energy balance of the body and the integrity of its structure. Therefore, patients have the strength to cope with the disease and recover much faster than using only the usual medical protocol. All patients are different, so the appointment after the examination is individual.

We combine proven techniques of the East and innovative methods of Western medicine.
Read more about our unique method of treating arthrosis

General clinical recommendations and prevention

With arthrosis of the temporomandibular joint, it is necessary to reduce the load on the joint. To do this, you need to restore the integrity of the dentition and periodically wear braces. If you are involved in (and cannot quit) contact sports (boxing, martial arts), be sure to wear sports mouthguards.

To restore blood circulation in the joint, it is recommended to slowly (!) open and close your mouth (without sudden or lateral movements).

You will also have to get rid of habits that create additional stress on the joint:

chew gum vigorously;
support your cheek with your palm;
chew seeds, nuts, hard cartilage.

Osteoarthritis of the jaw joint is called a disease of suppressed emotions. The illness can be a consequence of divorce, dismissal, or critical life situations. The most severe forms develop in nice and non-conflict people who keep their own emotions to themselves. You need to learn to enjoy life and stop seeing the world in gray colors.

Frequently asked questions about the disease

Who treats arthrosis of the temporomandibular joint?

The treatment is complex. If there is no gnathologist in the medical institution, treatment is carried out by a surgeon or orthopedic traumatologist. In this case, a dentist, a neurologist, an otolaryngologist and, if necessary, a rheumatologist and an infectious disease specialist must be involved.

Is it possible to cure TMJ arthrosis?

If bone growths have begun, the process can be stopped, but it will not be possible to defeat the disease when the joint is young and healthy. But if you start treatment at least at stage 2 of the disease, you will be able to get rid of the symptoms, stop the destruction and even restore cartilage tissue.

Why is arthrosis of the TMJ dangerous?

Deformation in the joint leads to facial asymmetry, secondary inflammation spreads to the nasopharynx and ear. Due to spasmed muscles, teeth wear out and fall out. The skin on the face becomes pasty and ages quickly.

What is the difference between arthrosis and TMJ arthritis?

Arthritis is an inflammatory process in the temporomandibular joint of infectious-allergic, traumatic, autoimmune, etc. origin, which in advanced cases can lead to arthrosis. For example, a purulent infection (purulent otitis, boil in the ear canal, flu, sore throat, mumps, etc.) infects the joint fluid. The inflammatory process spreads to the joint capsule (the local temperature rises, the blood vessels of the heads of the bones grow and dilate). The purulent process then dissolves the cartilaginous surface and meniscus, and then destroys the bone tissue, leading to arthrosis. Arthrosis destroys the joint asymptomatically at the first stage and without an acute inflammatory process. The cartilage loses moisture, dries out, and cracks. The bone then grows, changing the structure of the joint.

Literature

Evdokimenko P.V. Arthrosis
Petrosov Yu. A., Kalpakyants O. Yu., Seferyan N. Yu. Diseases of the temporomandibular joint

Themes

Arthrosis, Joints, Pain, Treatment without surgery Date of publication: 10/08/2021 Date of update: 11/01/2021

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Classification of TMJ arthritis

The nature of the course of arthritis implies the presence of acute and chronic forms. The acute form of this disease is characterized by a serous and purulent course. There is also a classification of TMJ arthritis, depending on the etiological origin:

traumatic arthritis;
infectious arthritis (nonspecific and specific);
rheumatoid arthritis;
other rare forms (reactive arthritis and others).

Specific infectious inflammations of the TMJ include: syphilitic, tuberculous, actinomycotic, gonorrheal, etc.