Arthrosis of the temporomandibular joint (TMJ)

The temporomandibular joint is a complex paired anatomical formation that provides horizontal and vertical movement of the lower jaw relative to the lower jaw. The load on the joint is determined not only by the quality of the food that needs to be chewed, but also by the condition of the dental system. The condition of the temporomandibular joint (TMJ) in turn affects our well-being and overall health.

According to data provided in the reports of the World Health Organization for 2021, musculo-articular dysfunction of the TMJ is detected in approximately every second person aged 20 to 50 years. And these are only those cases that are recorded in medical documentation. A fairly large number of people do not associate persistent headaches, clicking in the joints when chewing, difficulty opening the mouth with a painful condition of TMJ and are in no hurry to seek medical help.

Often, the pathology of the temporomandibular joint is detected during an examination performed for another reason, for example, in preparation for prosthetics. At the same time, the variants of joint diseases can be very different from dysfunctional syndrome to habitual joint dislocation.

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)

Differentiation of diagnosis

The symptoms of pathological processes in the joint, which provides movement of the lower jaw, are similar to the manifestations of other diseases. Doctors, using special examinations, must accurately differentiate the diagnosis so as not to miss the development of the following serious pathologies:

myocardial infarction, which is also characterized by pain radiating to the neck, lower jaw and shoulders;
otitis media of unknown etiology can be suspected when there is severe pain and hearing loss;
cerebrovascular accident may occur with dizziness, flashing of flies and nausea;
cervical and thoracic osteochondrosis are similar in localization of pain;
pinching of the facial nerve is also caused by unilateral tension of the facial muscles and swelling;
complicated diseases of the gums and teeth, which are accompanied by inflammation and immobility of the lower jaw.

To avoid making an incorrect diagnosis, the doctor carefully studies the patient’s life history and illness, conducts a visual and palpation examination, and also prescribes the necessary tests.

[slide-anything id=”3470"]

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).

Dissatisfaction with facial aesthetics, limitations in mouth opening

Before

Frontal photograph of the bite. Cross occlusion is noted on the right side. Absence of contacts of the premolar group on the left side. Tilt of the occlusal plane of the lower jaw to the left

Lateral photograph of the bite (right). Incorrect inclination of the frontal group of teeth in the upper jaw is noted. The lower jaw occupies a posterior (retracted) position

Lateral photograph of the bite (left). The incorrect inclination of the anterior group of teeth in the lower jaw is clearly expressed. Lack of closure of teeth in the lateral region

MRI slice of the right TMJ in the closed mouth position. The normal position of the articular disc is noted. Articular head of regular shape

MRI slice of the Left TMJ in the closed mouth position. There is a pronounced structural deformation of the articular head

MRI slice of the right TMJ in the open mouth position at 34mm. The normal position of the articular disc is noted

MRI slice of the left TMJ in the open mouth position 34mm. There is a limitation in the movement of this deformed joint. The articular disc is not in the correct position

After

Frontal photograph of the bite. Patient with a splint in the postoperative period

Lateral photograph of the bite (right). Ensures uniform contacts in the lateral sections

Lateral photograph of the bite (left). Ensures uniform contacts in the lateral sections

Specialists:

Nazaryan David Nazaretovich

Description:

The main complaints of the patient in this clinical case were dissatisfaction with facial aesthetics (the lower jaw is shifted to the right side) and limitations in mouth opening with pain in the area of the left TMJ. The entry MRI of the TMJ shows a pronounced deformation of the head of the left condyle with unreducible displacement of the articular disc.

The patient was recommended to undergo surgical treatment of the TMJ with preliminary production of Splint in preparation for the operation and subsequent use of this mouth guard in the postoperative period to support the joint structures during the healing period. The second stage of treatment for this patient will be orthodontic treatment in preparation for orthognathic surgery aimed at changing the position of the jaw bones and eliminating asymmetry.

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.

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.

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.

Center for the treatment of TMJ dysfunction in Moscow

Today, clinics and treatment centers for TMJ dysfunction in Moscow, various forums and patient reviews make it possible to determine the gold standard of effective treatment methods and related equipment that most effectively treats this disease.

The list of necessary diagnostic and treatment equipment used by leading specialized institutions, including the Partner Med clinic, includes:

Articulators and facebows "Girbach"
Axiograph "Gamma"
"Mist Tens" device
Computer electromyograph "Synapsis"
Fox osteopathic apparatus
Computer occlusion analyzers “T-scan”

and some other devices.

The course for the treatment of TMJ dysfunction at the Partner Med dental clinic lasts from 3 to 12 months, depending on the complexity and number of necessary diagnostic and treatment procedures in each specific clinical case.

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.

Constant clicking in the TMJ area when chewing

Before

Frontal photograph of the bite. There is an inclination of the occlusal plane of the upper jaw to the right side

Lateral photograph of the bite (right). Incorrect inclination of the maxillary incisors is noted. (Lower jaw lock). Stamped crown on tooth 4.6

Lateral photograph of the bite (left). Missing tooth 2.6

Photograph of the teeth of the upper jaw. Crowded position of the anterior group of teeth. Rotations of the molar and premolar groups. Erupted teeth 1.8, 2.8 (as one of the causes of traumatic nodes in occlusion). Asymmetrical dentition

Photograph of the teeth of the lower jaw. Secondary caries under old restorations on the molar group of teeth. lack of correct anatomy of the stamped crown of tooth 4.6. erupted teeth 3.8, 4.8

MRI slice of the left TMJ in the mouth opening position of 54 mm. The head of the joint extends beyond the articular tubercle, but to a lesser extent on the right side. (joint hypermobility)

MRI slice of the left TMJ in the open mouth position 43mm. Reposition of the disc is noted (the disc is in the correct position)

MRI slice of the Left TMJ in the closed mouth position. Anterior displacement of the articular disc is noted

MRI slice of the right TMJ in the open mouth position 54 mm. The head of the joint extends beyond the articular tubercle (hypermobility of the joint)

MRI slice of the right TMJ in the open mouth position at 43mm. The normal position of the articular disc is noted

MRI slice of the right TMJ in the closed mouth position. The normal position of the articular disc is noted

Stages

Frontal photograph of the bite. Beginning of correction of the inclination of the occlusal plane of the upper jaw

Lateral photograph of the bite (right). There is a rise in the bite due to orthodontic onlays

Lateral photograph of the bite (left). There is a rise in the bite due to orthodontic onlays

Photograph of the teeth of the upper jaw

Photograph of lower jaw teeth

After

Frontal photograph of the bite. There is no inclination of the occlusal planes of the upper and lower jaw

Lateral bite photograph (right)

Lateral photograph of the bite (left). The contact density in the molar area will be restored by replacing the temporary crown on the 2.6 implant

Photograph of the teeth of the upper jaw

Photograph of the teeth of the lower jaw. The temporary crown of tooth 4.6 needs to be replaced

Specialists:

Nazaryan David Nazaretovich

Description:

The patient complained of constant ringing clicks in the TMJ area when chewing, opening the mouth and moving the lower jaw. Entry MRI revealed joint hypermobility and disc dislocation with recovery.

After wearing Splint, positive dynamics, and analysis of the results of the control MRI, no indications for joint surgery were identified. The task was to rebuild the patient's bite to support the joint. Treatment with braces lasted 17 months. At this stage, implantation was carried out in the area of 2.6 teeth, removal of all 8 teeth, temporary prosthetics on an implant, as well as restoration of the erased cutting edges of the central incisors. After removing the braces, local orthopedic work will be performed to stabilize the bite.

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.

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

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).

Pain syndrome and restrictions in movements of the lower jaw

Before

Frontal photograph of the bite

Lateral photograph of the bite (right). Absence of tooth 4.5, absence of tooth 1.4 are noted with replacement of the defect with a removable partial apparatus

Lateral bite photograph (left)

MRI slice of the left TMJ. There is a structural change in the shape of the joint head. Anterior disc dislocation without reduction (without restoration)

After

Frontal photograph of occlusion after joint surgery

Lateral bite photograph (right)

Lateral photograph of the bite (left). There is a rise in the height of the bite on the operated side

MRI section of the left TMJ after surgical reduction of the articular disc. The correct position of the disc is noted

Frontal photograph of the bite in the mouthguard (Splint)

Lateral photograph of the bite in the mouth guard (Splint) (right view)

Lateral photograph of the bite in the mouthguard (Splint) (left view)

Specialists:

Nazaryan David Nazaretovich

Description:

A typical complaint for patients with TMJ problems is pain and restrictions in the movements of the lower jaw. Such complaints were also present in this clinical case. The entry MRI of the TMJ shows a pronounced structural change in the shape of the head of the left joint and an articular disc displaced forward without the ability to restore its position.

We carried out preliminary Splint therapy in preparation for joint surgery (we made a transparent rigid mouthguard for the lower dentition) and assessed the result over time with a series of control MRIs of the TMJ. Using the example of a section from one of these studies, one can clearly compare the picture before and after surgery. The patient also noted positive dynamics regarding pain symptoms already at the stage of wearing a mouth guard. In the postoperative period, pain was no longer observed. The range of movements of the lower jaw was restored. Of course, the closure of the teeth changed after placing the disc in the correct position. We will require orthodontic and orthopedic treatment to support the stability of the TMJ.

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

Reader rating

Rating: 4.5 / 5 (2)

Advantages of the TMJ Treatment Center Partner-Med

Experience at least 5 years

Only doctors with 8-30 years of experience practice at the Partner-Med clinic

15 year labor guarantee

Only a qualified dentist gives an extended guarantee of up to 15 years on his work.

Study abroad

Our doctors annually improve their qualifications in specialized clinics in Europe.
Chief Physician, Dmitry Nikolaevich Salatsky