Treatment of temporomandibular joint dysfunction

Symptoms

When patients experience pain in the temporomandibular joint, clicking sounds are heard and the mobility of the joint system is limited. The discomfort seems to be in nearby areas rather than internally. In this case, headaches are observed, they are difficult to eliminate with medication. The clinical picture is complemented by:

1. Stiffness in the cervical vertebrae, pain in the arms, ears, dizziness, sleep disturbances.
2. Tension on the sides of the face, compression of the masticatory organs, impaired night breathing, apnea.
3. Patients feel pain in the jaw joint when opening the mouth. The jaw may deviate, making it difficult to open the mouth completely.
4. Disc misalignment, causing a popping sound. There is no click if the patient has internal joint disorders that are associated with disc dislocations without reposition.
5. Sensation of friction in arthritis, hardening of bone tissue in osteoarthritis, swelling in rheumatism, inflammation in infectious arthritis.
6. Limitation of movements with ankylosis.
7. High degree of mobility during dislocations.

It happens that the jaw jams, pain appears in the temples, crowns, and eye sockets, vision is impaired, there is ringing in the ears, and anxiety appears.

Causes and prevention of arthrosis of the facial jaw

Based on the reasons for their occurrence, it is customary to distinguish between primary and secondary arthrosis of the jaw. The first are typical for older people (50-60 years and older) and are not associated with pathologies of the joints or dentofacial apparatus. The latter occur against the background of other disorders - for example, injury, infection, metabolic disease.

Let us consider the causes of arthrosis of the jaw joint in more detail:

• infectious disease (acute or chronic, for example, tonsillitis);
• sports or household injury (dislocation or subluxation of the jaw joint, bruise, jaw fracture);
• systematic overload (for example, when crunching nuts or intense exercise in the gym);
• dental diseases (absence of a tooth or part of it, “gentle” chewing on one side due to a dental problem);
• bruxism (unconscious grinding of teeth, usually during sleep), stress, high mental stress, mental disorders and nervous tics;
• diseases of the cardiovascular system;
• endocrine and metabolic diseases (gout, diabetes, hormonal imbalance);
• congenital anomalies of the dentofacial apparatus (including malocclusion), in which the load is distributed incorrectly;
• genetic diseases of muscle and cartilage tissue (scapulohumeral-facial muscular dystrophy, collagenopathies, as well as systemic lupus erythematosus and other autoimmune diseases);
• age-related changes (both senile and hormonal - for example, with menopause).

Often, arthrosis of the facial jaw (or temporomandibular joint - TMJ) begins due to a violation of occlusion - i.e., contact of teeth and functions of the masticatory muscles (with loss of a tooth, tumor or inflammation of the muscle muscles, lesions of the facial and trigeminal nerves). Therefore, in order to prevent arthrosis of the jaw joint, it is important to promptly replace chewing teeth with prosthetics, eliminate inflammation of the gums and dental pulp, and also treat under-erupted wisdom teeth. Do not ignore innervation disorders and muscle injuries due to stroke, surgery or incorrectly selected dentures.

Regardless of the causes, arthrosis of the jaw joint remains a chronic disease that requires lifelong monitoring and inevitably progresses.

Possible causes of pain

Most often, the joints of the jaw hurt because the muscle fibers are strained and anatomical changes occur in the joint unit. The situation is aggravated by psychological reasons, sleep disorders, and emotional stress. In addition, provoking factors include:

• Bruxism, that is, grinding of crowns;
• Osteopenic disorders of the body;
• Genetic bone pathologies;
• The jaw joint near the ear hurts when an infection develops, the patient has suffered a neck or head injury;
• Muscle pain, internal disorders, tension;
• Ankylosis, arthritis, excessive mobility;
• Lack of chewing organs, unprofessional orthodontic treatment;
• Active conversation load;
• Pain in the jaw joint and radiates to the ear in patients with the habit of biting nails or placing the smartphone close to the hearing organ;
• Problems of the central nervous system, scoliosis and osteochondrosis of the spine;
• Pathologies of the endocrine system;

In addition, dysfunction occurs with asynchronous movements of the joints on both sides.

Basic information about gnathology

Gnathology is a branch of dentistry devoted to the work of the dentofacial apparatus and all its components - nerves, bones, chewing and facial muscles, periodontal tissues, joints, teeth. It is gnathology that is responsible for the correct structure of the jaw, normal chewing of food, and a beautiful smile.

Every dentist can have minimal knowledge and skills in this area, but when solving more complex and specific problems, you will definitely have to turn to a specialist - a professional gnathologist.

Diagnostics

Diagnosing TMJ disorders first involves taking a medical history, followed by a physical examination. The doctor applies light pressure on the side of the face where there is discomfort, on the masticatory muscle fibers. At the same time, the patient closes and opens his mouth. Popping or clicking sounds and jaw thrusting are analyzed. If indicated, an MRI may be prescribed. The procedure will show whether there are internal problems with the joint. If osteoarthritis is suspected, x-rays and CT scans can confirm the diagnosis.

Pain in the jaw joint when chewing and opening the mouth often occurs with infectious arthritis. Diagnosis is made by inserting a needle into the joint itself to collect fluid. This research method is called aspiration. The liquid is analyzed for the presence of pathogenic bacteria. Hypermobility and ankylosis are determined by the width of the mouth opening. Sometimes the patient is referred for polysomnography to determine sleep disorders. An orthopantomogram of the jaw plays an important role in the research process.

How is diagnosis and treatment done by a gnathologist?

Treatment with a gnathologist begins with a personal conversation with the patient, during which the doctor identifies all the nuances and causes of concern. Even minor complaints can be the result of serious problems.

For a more accurate diagnosis, modern diagnostic methods are used, including hardware ones:

• computed tomography (CT) – allows you to identify pathologies of the jaw structure, assess the position of the teeth, and quickly and effectively identify any deviations from the norm;
• myography - the study of facial muscles - allows you to identify the causes of problems and discomfort when chewing;
• assessment of the condition of the muscular system and spine;
• radiography in different projections;
• visual examination of the oral cavity.
• occlusion therapy

Treatment methods are individual in each case and depend on the results of the examination and the final diagnosis. Most often, the patient is given mouth guards to relax muscles or stabilizer splints. In some cases, myogymnastics are prescribed to stimulate the formation of a correct bite and to prevent the development of complications after orthodontic treatment.

In any case, you should not refuse to visit a gnathologist, since even the slightest deviations in the functioning of the TMJ can subsequently provoke more serious diseases or the development of new ones, lead to disruption of the chewing load and, as a result, accelerate tooth wear, nullify orthodontic treatment or results prosthetics.

Which doctor should I go to?

In order to properly treat pain in the jaw joint when opening the mouth, it is necessary to develop an optimal treatment regimen. This can be done by a professional orthodontist.

• If the patient needs to have braces, plates, dentures, or implants installed, impressions of the teeth are taken. Complex therapy for TMJ gives good results.
• In serious cases, surgical technologies are used - bone and muscle grafting. The pathology cannot be neglected so that it does not develop into arthrosis with the proliferation of connective tissue and subsequent immobilization of the joint. It is important to eliminate the root cause of the disease.
• Severe spasms and discomfort are relieved with compresses.
• For stress that leads to tension, the patient is prescribed sedatives.
• Sometimes splinting is required.
• The patient may be recommended physical therapy.
• Patients may be prescribed nonsteroidal drugs, muscle relaxants, and sedatives.

Therapy also includes eliminating defects in the masticatory organs, grinding fillings, correcting prosthetic errors, replacing structures, and correcting bites. The load on the joint must be reduced. To do this, you should include soft foods in your diet, perform relaxation exercises and massage complexes. Ultrasound and laser therapy may be required. It is easier to eliminate the disease at the initial stage so that it does not become chronic. Timely visits to the doctor, correction of posture, elimination of stressful situations, replacement of lost units are effective preventive measures.

Definition of temporomandibular joint

The temporomandibular joint is a fairly mobile joint that connects the lower jaw and the temporal bone, located on either side of the skull, in front of the ears.

This hinge joint provides the following functions:

• sedate jaw movements characteristic of conversation;
• maximum opening of the mouth, for example, when yawning;
• movement of the jaw during chewing.

The main assistants to the joints of the maxillofacial apparatus are the masticatory muscles, which help keep the lower jaw in the correct anatomical position, while easing the load on it.

Causes of dysfunction of the temporomandibular joint

Modern dentistry has facts that have not been fully studied about the causes of pathologies of the temporomandibular joint. However, based on the available data, experts suggest that the main problem lies in the destructive processes of the muscles and altered components of the joint itself.

Orthodontists identify the following pathologies and situations as the main causes and provoking factors for impaired mobility of the joint connecting the lower jaw (mandible) and the temporal bone:

• trauma to the lower jaw, which can provoke a violation of static and dynamic occlusion;
• damage to the facial muscles, which is accompanied by an increase in the load on the joint;
• pinching of the facial nerve causes excessive muscle tension, which, in turn, disrupts the functioning of the joint and mandible as a whole;
• involuntary contraction of the chewing muscles, which is usually accompanied by damage to the dentition, periodontal disease and inflammation of the TMJ;
• damage to the temporomandibular joint due to the progression of osteoarthritis or rheumatoid arthritis;
• inadequate prosthetics;
• congenital anomalies of the structure of the lower jaw;
• malocclusion, which in 95% is caused by destructive manifestations;
• pathologically low alveolar processes;
• inflammatory processes of the articular surface of infectious etiology;
• incorrect position of the disc at the junction of the head of the joint and the corresponding notch;
• prolonged tension of the facial muscles, clenching of teeth due to strong emotional stress.

The information provided about the probable causes of TMJ dysfunction is confirmed by clinical studies and the results of collected anamnesis about the disease.

Therapeutic measures for diseases of the temporomandibular joint

When an accurate diagnosis of TMJ dysfunction is established, the doctor prescribes a course of therapeutic measures, the features of which are determined by the degree of the pathological process and the etiological factor. The disease requires complex treatment. The most lasting effect in restoring the functions of the maxillofacial apparatus is provided by the following recommendations, methods and means:

• complete exclusion of solid food, which will make it possible to maintain conditional rest for the mandible joint;
• maximum restriction of mobility (no yawning, no talking);
• alternating warm and cold compresses in combination with certain exercises to warm up the joints, which is performed under the supervision of a physiotherapist;
• for pain relief, the doctor prescribes non-steroidal anti-inflammatory drugs in a certain dose and at the recommended dosage interval;
• in case of extremely severe pain, it is possible to take narcotic analgesics;
• muscle relaxants are used to eliminate tension in the muscles of the face, neck and shoulder girdle, if any;
• to restore harmony in the patient’s psycho-emotional background, it is possible to take antidepressants in small dosages;
• physiotherapeutic procedures (laser, electrophoresis with novocaine, ultrasound, radio wave therapy, neurostimulation);
• installation of a special design on the teeth (mouthguard, orthopedic splint), which allows you to prevent the closure of the dentition as much as possible, correct the bite and restore the movement of the TMJ joint in the physiologically correct position;
• orthopedic treatment involves the installation of crowns and bridges to align the dentition and ensure comfortable static and dynamic occlusion;
• avoidance of foods that irritate tooth enamel to prevent relapse of exacerbation;
• a slightly open position of the mouth, which is carried out using the tongue located between the front teeth, will ensure relaxation of the masticatory muscles and jaws;
• in some cases, doctors use the injection of analgesic drugs into the muscle tissue of the projection of the pathological joint.

Complex treatment using the listed methods and means, in most cases, gives a positive effect and long-term remission.

Who treats TMJ dysfunction?

Degenerative processes in the lower jaw joint are a disease that is treated by dentists and specialists in treating problems of the maxillofacial apparatus, for example, orthodontists and orthopedists. However, the etiological factor may necessitate intervention in the treatment process by specialists from other areas of clinical medicine. Thus, to ensure maximum effectiveness of therapeutic measures, the direct participation of such doctors may be necessary:

• a traumatologist is needed when the temporomandibular joint is displaced due to injury;
• consultations with a neurologist will be needed, first of all, if the facial nerve is pinched, as well as when exposed to many other factors, since the disease often involves nerve endings in nearby tissues and organs;
• a psychologist will be needed to stabilize the patient’s psycho-emotional state if destruction in the lower jaw joint has occurred due to prolonged tension in the facial muscles caused by psychological trauma or stress.

Of course, dental specialists play a leading role in the treatment of temporomandibular joint dysfunction, and representatives of related areas act as consultants.

If you have pathological symptoms, you should immediately contact any specialist, for example, even a therapist. The doctor will definitely conduct an examination and coordinate the patient’s further actions if he detects signs of dental pathology. The variety of manifestations of the disease of the maxillofacial apparatus, in most cases, causes difficulties in diagnosis even for an experienced specialist. An accurate diagnosis is established after additional examinations.

Characteristic symptoms

Symptoms characteristic of the manifestation of a destructive process in the joint, which ensures the mobility of the lower jaw, can be pronounced or blurred, which is typical for a protracted chronic process. Periods of remission followed by exacerbations are also likely, that is, symptoms can suddenly appear against the background of imaginary well-being.

Specialists in the treatment of TMJ destruction identify the following characteristic symptoms of this pathology:

• severe soreness of the muscles of the face, neck, shoulder girdle and parotid region with irradiation into the ear cavity;
• toothache;
• pain tends to intensify during speech, eating or yawning, that is, when the amplitude of movement of the lower jaw increases;
• there is pronounced stiffness and limitation in the movement of the jaws;
• partial ankylosis (immobility) may occur as a result of jamming or blocking of the joint;
• there is a pronounced sound when opening the mouth, for example, clattering, clicking or creaking, which, in most cases, is accompanied by sharp pain;
• tension and fatigue of the facial muscles;
• sometimes swelling of the affected joint increases;
• difficulty chewing, accompanied by a feeling that the jaws are not touching each other.

The patient's general condition also shows deterioration, characterized by headache, dizziness, noise and aching pain in the ears, and decreased performance. Acute pathological processes in the temporomandibular joint sharply reduce a person’s quality of life with debilitating manifestations, disrupting many vital functions.