Treatment of TMJ (joint dysfunction)

Publication date: March 13, 2021.

Date the information on this page was updated: December 08, 2021.

TMJ dysfunction is a fairly common pathology these days, as it is largely caused by stress factors. Here it can be difficult to understand what is primary and what is secondary, because people with joint dysfunction usually come with bite pathology, pathology of the musculoskeletal system (curvature of the spine, neck). Therefore, joint treatment is a complex story. It happens that the primary pathology is a pathology of the joint, and sometimes it is the musculoskeletal system.

Comprehensive treatment of TMJ

When the doctor has determined the cause of the joint pathology, or causes, he determines the patient's readiness for a comprehensive treatment plan. In addition to the orthodontist, an osteopath or chiropractor may be involved, or even an orthopedist if more complex correction of the musculoskeletal system is required.

Causes

Risk factors for developing osteoarthritis:

people aged 40-60 years;
injuries;
bite defects;
partial or complete loss of teeth;
genetic predisposition;
infectious processes of the ears.

It is difficult to determine the exact cause of the development of the disease, since the cause may be minor injuries that are left unattended.

Pathology can occur in adolescents with rapid growth, which is associated with anatomical features and accelerated growth of bone tissue against the background of underdevelopment of cartilage and muscles. Joint deformity can be diagnosed due to a lack of vitamins and an improper diet. If the body does not receive sufficient trace elements, this leads to deterioration of the cartilage.

Intense load on weakened temporomandibular muscles entails various microtraumas, the consequences of which are difficult to predict.

What may be the symptoms of TMJ dysfunction?

Tenderness or pain in the area of one or both TMJs at rest or when opening the mouth.
Crunching, clicking, crepitation and other noises in the area of one or both TMJs when opening the mouth.
History of TMJ injuries (previous), incl. dislocation, subluxation, chronic subluxation.
Restrictions in the mobility of the TMJ, restrictions in opening the mouth.
Excessive tone of the masticatory muscles, bruxism (“grinding” of teeth in sleep, at rest).
Asymmetry of the chin, lips, lip frenulum, asymmetry of mouth opening, S-shaped opening.
Suspicion of a forced position of the lower jaw.

Structure of the TMJ

The presence of one or more of the above symptoms may indicate TMJ dysfunction.

Traditional orthodontic treatment does not address TMJ dysfunction. During orthodontic treatment, the severity of dysfunction may not change, decrease or increase. At the moment, in the world scientific orthodontic literature there is no convincing data on the connection between orthodontic treatment and the condition of TMJ. Deterioration of the joint after treatment may have nothing to do with this treatment.

Note! Even in the absence of visible clinical manifestations of joint dysfunction, hidden disorders may occur that require special diagnostics to identify them.

If there is a forced incorrect position of the lower jaw, its position may change during the treatment process with changes and complication of the treatment plan (the need to remove individual teeth, increasing the duration of treatment). A reliably forced position cannot be diagnosed by traditional orthodontic methods; to verify its presence, as a rule, a special analysis is required (manual functional analysis, determination of the central relationship of the jaws), the use of a special articular splint for a period of several months, which, however, does not give 100 % guarantees.

To conduct a detailed articular diagnosis, explain the specifics of your case, and further manufacture an articular splint, you can make an appointment with an orthodontist who deals with the issue of TMJ dysfunction.

TMJ dysfunction is a chronic condition that can be compensated, but not cured (i.e., it is possible to eliminate symptoms, however, pathological changes in the joints, if they have already occurred, will most likely persist).

Non-surgical treatment of TMD

Nonsurgical treatments for painful and dysfunctional TMD include patient education, joint stress reduction, medications, and physical therapy. Of course, the patient cannot control nighttime chewing activity, which is precisely the main source of excess load on the TMJ. To control this activity and reduce the load on the joint, various occlusal devices (for example, mouthguards) are used. According to research, they can reduce the load on the TMJ when clenching teeth in 82% of patients. During the daytime, the load on the joint is reduced by increasing the patient’s attention to his condition, switching to soft foods, and taking anti-inflammatory painkillers. A physical therapist can teach the patient specific exercises to increase mobility in the TMJ and relieve pain and stress on the joint.

What happens if TMJ dysfunction is not treated?

If the dysfunction is not treated, the compensatory capabilities of the body may sooner or later be exhausted, the symptoms will worsen, the pathology will begin to progress, causing greater discomfort (sometimes for several years), thereby affecting the deterioration of the function of the dental system.

In order to try to prevent this and carry out treatment taking into account the individual characteristics of the structure and functioning of the temporomandibular joints, patients are usually offered the following approach.

Prevention

It is better to prevent arthrosis of the jaw than to treat it. Preventive measures are based on regular sanitation of the oral cavity, purulent chronic foci, and treatment of acute infectious diseases. It is important to prevent injury to the node. For a favorable prognosis of the disease, rational prosthetics, timely normalization of bite defects, and treatment of concomitant pathologies are used.

Patients diagnosed with arthrosis of the TMJ are registered at the dispensary. Dentists provide the necessary therapeutic courses. The doctor may prescribe oral irrigation with antiseptic solutions. It is necessary to adjust the splints daily and change the intermaxillary traction. It is necessary to cure endocrine and somatic diseases that become provoking factors of pathology. Patients should lead a healthy lifestyle, protect themselves from stress, and eat a balanced and healthy diet.

Treatment method for TMJ dysfunction

1. Diagnosis of TMJ dysfunction.

When diagnosing a joint in the clinic, a series of measurements and tests are carried out, all sensations in the joint area are recorded (discomfort, clicks, pain, deviation of the jaw when opening and closing), the difference in sensations in the right and left joint.
The orthodontist also takes impressions of the jaws and takes photographs of the face and intraoral photographs, and also performs three-dimensional computed tomography of the face (3D CT); if necessary, the doctor can give a referral for an additional study - magnetic resonance imaging of the TMJ (MRI).
Often, the orthodontist, in addition to manual functional analysis, conducts a visual assessment of: posture, symmetry of the shoulder girdle, shoulder blades, hip bone structures, etc., performs the necessary tests and photographs. Based on the results, it is possible to schedule a consultation with an osteopath or chiropractor to jointly manage the patient. Related specialists (orthopedist, surgeon, periodontist) can also be involved in drawing up a treatment plan.

What exercises are prescribed to patients to normalize the work and relax the masticatory muscles?

Exercise No. 1

Draw a vertical line on the mirror with a marker, stand opposite so that the line divides your face into the right and left halves, place your fingers on the area of the articular heads, lift your tongue up and back, open and close your mouth along the line (it may not work right away), 2-3 times /day 30 repetitions. There is no need to open your mouth wide (a comfortable width), the main thing is symmetrically (so that the jaw does not “move” in any direction). If there is a click, open until it clicks.

Exercise No. 2 (cycle)

Do it whenever possible, for example, in front of the TV, at the computer, or in a traffic jam while driving. Open and close your mouth without closing your teeth for 30 seconds, then alternately reach your right and left cheeks with your tongue for 30 seconds. Open - close your mouth again, then for 30 seconds move your tongue in a circle inside the vestibule (behind the lips), first in one direction, then in the other direction (clockwise - counterclockwise), open again - close your mouth, etc.. For this a half-hour cycle, the teeth should not touch, the lips should be closed. If you want to close your mouth or swallow, place your tongue between your teeth. Repeat the cycle for 20-30 minutes 2-3 times/day

Surgical treatment of TMD

Surgical intervention in the treatment of TMD does not play a major, but very important role. Surgery is indicated for approximately 5% of patients suffering from TMD. Moreover, the range of surgical interventions is very wide. Despite the many supporters of each individual surgical method, there are currently no strict clinical data substantiating the indications for a specific operation in a specific clinical case. Therefore, when deciding on any surgical intervention, the doctor uses criteria to assess the stability of the patient's condition.

Occlusive therapy for TMJ dysfunction

After diagnosis, the patient is scheduled for an appointment with the orthodontist to determine the central relationship of the jaws (“true” position of the lower jaw, the position in which your joint and chewing muscles will be most comfortable).

In order to more accurately establish and fix this position, an occlusal splint (splint) will be individually made for the patient from a special plastic, which is erased as it is worn. The splint must be worn constantly (sleeping, talking, eating in it if possible) - this is the meaning of occlusion therapy, which will help the joint and masticatory muscles rebuild into the most comfortable functional state.

Cleaning and caring for the splint is very simple - after eating (as well as while brushing your teeth), brush with a soft brush with toothpaste or soap.

Clinical picture

Symptoms primarily depend on the stage of development of arthrosis. The main symptom is a constant dull aching pain. When the jaw moves, the joint begins to crunch and click.

In addition, the patient may feel stiffness in the movement of the joint (most often manifests itself after sleep). The pain occurs when eating, so you have to chew on only one side.

In advanced cases, the patient has great difficulty opening his mouth at all. The jaw moves to the side, the asymmetry of the face is disrupted. To avoid irreversible consequences, it is necessary to treat the disease at an early stage.

Installation of a brace system for a patient with TMJ dysfunction

Installation of a brace system on the upper jaw is carried out on average after 3 months of occlusion therapy. The splint is adjusted once every 1-2 weeks, or at the discretion of the doctor, until the main complaints from the TMJ are eliminated (in parallel with the alignment of the teeth in the upper jaw), then a brace system is installed on the lower jaw with partial reduction (grinding) of the interfering parts of the occlusal tires, or complete removal. Here the patient needs to be patient - the process may take several months.

At the same time, the new position of the lower jaw is monitored: repeated manual functional analysis, photometry, bite registration is possible, computed tomography of the face during treatment, continuation of orthodontic treatment with a brace system.

Upon completion of orthodontic treatment, final monitoring of the position of the lower jaw follows (manual functional analysis, photometry, bite registration, 3D CT scan of the face upon completion (after) treatment).

Joint splint

Joint splint with braces

Diagnostics

To cure the disease, a number of studies are necessary. Only an integrated approach to diagnosis will help make the correct diagnosis.

First, the patient’s oral cavity is examined, an anamnesis is collected, complaints are identified, and the node is palpated.
The muscles of the head and neck are examined.
X-ray examinations are being carried out. Most often, TRH is prescribed in the lateral projection.
A full neurological evaluation may be required.
Artography, computed tomography, and MRI have a high degree of information content.

An x-ray shows defects in the affected area and degenerative bone pathologies. Areas of osteoporosis may appear. If the doctor is in doubt, it is recommended to undergo a morphological zonal analysis. According to indications, cartilage cells are studied, fatty degeneration is detected, EMG and orthopantomography are performed. The amplitude of movement must be assessed.

Indications for surgery for osteoarthritis

The most common indication is severe pain and/or dysfunction of the TMJ of articular origin, which is aggravated by activity of the lower jaw. The more severe the pain and dysfunction, the better the prognosis for surgical intervention. The lack of effectiveness of arthrocentesis (sampling fluid from the joint) also became an indication for further surgical treatment. This low effectiveness of the procedure is explained by adhesions, which, in the absence of bone deformation, are not visible on an x-ray.