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)

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).

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.

Symptoms and prevention of TMJ dysfunction

Pain in the masticatory joint is an extremely rare occurrence. In this regard, patients rarely associate the existing pathological manifestations with the condition of the TMJ. Let's see what symptoms you need to make an appointment with a gnathologist:

• Headache. There are a great many causes of headaches, but the “contribution” of the temporomandibular joint is most often “forgotten” by specialists. Elimination of TMJ pathology often relieves a person of headaches.
• Clicking in the joint. The characteristic sound when opening the mouth is a consequence of dislocation or subluxation of the masticatory joint, which usually resets on its own.
• Limitation of mouth opening. This may be a consequence of swelling of the joint tissue as a result of the development of an inflammatory process or dislocation of the joint.
• Pathological abrasion of tooth enamel.

Measures to prevent the development of TMJ dysfunction include regular visits to the dentist, rational prosthetics, timely treatment and restoration of damaged teeth, and orthodontic treatment as indicated.

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.

Treatment of articular disc displacement without accompanying reduction

Internal disorders of the temporomandibular joint (TMJ) are quite common even among asymptomatic patients, not to mention patients with clinical signs of dysfunction. In many cases, in patients with displacement of the articular disc without concomitant reduction, the primary pathology first develops in conditions of normal relations between the disc and the condyle, after which the stage of disc displacement with reduction (“clicking jaw”) begins, and then without reduction (according to the “clicking jaw” mechanism). capture and block").

This article will describe a simple treatment algorithm that allowed a patient with articular disc displacement without accompanying reduction to return to the stage of disc displacement with reduction.

Clinical case

A 69-year-old patient with the main complaints of pain in the projection of the jaw, limited opening of the oral cavity and the inability to move the jaw forward sought dental help. According to the patient, her symptoms began to develop about 6 months ago: it was then that she noticed that it was difficult for her to move her jaw forward to whistle to her dog. According to the anamnesis, for about 50 years the patient had been experiencing “clicking” of the jaw on the left side, and these symptoms stopped approximately at the time when it became difficult for her to move the lower jaw forward. During the clinical examination, it was discovered that the maximum interincisal distance was 35 mm, while during the maximum opening of the oral cavity the jaw shifted slightly to the left. After massage and stretching of the left masseter muscle and joint, the intensity of pain decreased, but the range of motion did not increase. Thus, a diagnosis of left-sided displacement of the articular disc without accompanying reduction of the TMJ was made. The patient was sent for magnetic resonance imaging (MRI) to study the location and condition of the disc with the mouth open and closed. MRI data revealed that on the left side there was anterior displacement of the articular disc in both positions, which also confirms the diagnosis of displacement without reduction (photos 1-4).

Photo 1. MRI scan of the right TMJ with the mouth closed: visualization of the position of the disc.

Photo 2. MRI scan of the right TMJ with the mouth open: visualization of the position of the disc.

Photo 3. MRI scan of the left TMJ with the mouth closed: visualization of anterior disc displacement without reduction.

Photo 4. MRI scan of the left TMJ with the mouth closed: visualization of anterior disc displacement without reduction.

This diagnosis was discussed with the patient, suggesting possible treatment options, after which she signed an informed consent form. During the follow-up visit, a solution of mepivacaine without epinephrine (Carbocaine 3%, Septodont) was injected into the left TMJ capsule, after which the patient immediately reported a “popping” sensation in the left joint. The maximum opening of the oral cavity increased to 46 mm. No deviations of the jaw to the side during mouth opening were noted, nor were there any accompanying pain symptoms. To support disc reduction, a temporary splint was made for the lower jaw and positioned in a slightly more anterior position. The patient was recommended to use this splint for 3 days all the time, and then come for a follow-up visit in a week. During the re-examination, the patient reported a decrease in pain and “unlocking” of the joint. The maximum level of opening of the oral cavity was 45 mm. Based on the impressions obtained, she had a customized mouth guard made for her upper jaw, similar to a Farrar splint. 1 year after using the mouth guard, the patient confirmed that there were no episodes of joint movement blocking, pain, or any other signs of dysfunction. In this case, the maximum opening of the oral cavity was about 46 mm without any deviation of the jaw to the side during the opening process.

Disk Lock Treatment

The above description is not intended to be a comprehensive guideline or definitive protocol for the treatment of articular disc displacement without concomitant reduction. The clinician is expected to have at least a working knowledge of the diagnosis and treatment of major intra-articular disorders and some experience in performing intra-articular injections. Clinicians who do not have this basic knowledge regarding the diagnosis and treatment of TMJ disorders should acquire it through appropriate courses.

Diagnostics

The diagnosis of articular disc displacement without reduction is made based on the patient’s medical history, examination results and, if possible, also based on information obtained during MRI. Relevant signs and symptoms of articular disc displacement without reduction include the following:

• a history of disc displacement with accompanying reduction (with the presence of a click), often for many years;
• a history of episodes of joint locking, after which the patient had to move his jaw so as to cause the development of a click/pop to restore the possibility of full range of motion;
• a history of episodes of waking up in the morning with an existing “joint blockage”;
• limited range of motion, in which the mouth opening is about 26 mm, but can also be 30 mm or slightly more, depending on how long the signs of joint locking have progressed;
• the presence of deviation of the lower jaw to the side during the opening of the oral cavity.

During palpation in cases of displacement from reduction, the doctor can almost always diagnose the presence of a click/pop, while similar symptoms are not observed in cases of displacement without reduction. To definitively confirm the diagnosis, it is advisable to conduct an MRI examination without contrast with the mouth open and closed. It is recommended that the dentist first analyze the obtained MRI scans himself, and then discuss the recorded changes with the radiologist.

Once the diagnosis has been made and if there are indications for joint release, the patient's informed consent must be obtained before starting treatment. Patients should be informed of the potential for potential side effects, including bruising, pain at the injection site, reactions to anesthetic components, and partial temporary facial nerve palsy. Alternative treatment options include arthrocentesis, arthroscopy with surgical correction, open joint surgery, mouth guards, and physical therapy, the effectiveness of which varies depending on the situation.

Injection

The area of ​​future injection should be treated with alcohol or iodine solution. If necessary, the injection site can first be numbed with a local anesthetic in the form of a spray or gel. The active drug is a local short-acting anesthetic without adrenaline, such as mepivacaine (for example, Carbocaine 3%, Septodont), or 2 ml of lidocaine (for example, Xylocaine-MPF, Fresenius USA), which is administered with a Luer syringe with a 30-gauge needle, length 1 inch or 27 gauge 1 and 1/4 inches long depending on the anthropometric parameters of the patient. Before injection, the joint space is palpated directly in front of the tragus with the mouth as open as possible. Under ideal conditions, the injection is made into the posterosuperior joint space. The needle should move forward, inward, and upward until it reaches a depth of approximately 1 inch. Contact with the posterior aspect of the condyle is not necessary but can occur, in which case the clinician is able to accurately confirm the location of the needle (Figures 5-6).

Photo 5. Projection of the injection area into the joint capsule.

Photo 6. Projection of the injection area into the joint capsule.

Premature injection during needle insertion may result in inadvertent anesthesia of the temporal and/or zygomatic branches of the facial nerve, making eye closure difficult. After the injection, ask the patient if his/her bite has changed. They should answer positively and indicate the impossibility of closure of the distal teeth. If the bite has not changed, this means possible anesthesia of the auriculotemporal nerve, which provides only partial anesthesia of the joint. The temporoauricular nerve provides approximately 75% of the innervation of the joint capsule, while additional innervation comes through the system of deep temporal and masseteric nerves. If necessary, the injection can be repeated, carefully checking the final location of the needle. The purpose of depositing an anesthetic solution inside the joint capsule is not so much an anesthetic effect, but rather a hydraulic effect, which is more responsible for the mechanism of “unlocking” the joint.

Unlocking and training

After a successful injection of anesthetic, ask the patient to move the jaw from side to side and then open the mouth wide. This set of movements must be performed for several minutes. Typically, 30% to 50% of patients are able to unlock the joint on their own simply by using gentle movements and opening and closing the jaw. In this case, the doctor must ensure careful monitoring of the patient for several minutes after the injection in order to be sure that no adverse reactions develop. While the patient performs a series of jaw movements, heat-sensitive plastic is prepared to make a temporary mouthguard. If the patient cannot unlock the jaw on his own, then you can help him manually by moving the jaw in the direction opposite to the existing block, and then guide the jaw when opening the mouth wide (photo 7-8).

Photo 7. Manual release of the joint.

Photo 8. Making a temporary stabilizing splint from thermoplastic.

After unblocking, it is extremely important to instruct the patient about further actions and effects. If, after performing a set of movements of the lower jaw, the patient does not feel the difference between the blocked and unlocked state, it is likely that a repeated block of the joint will form over the next 24 hours. In order for the patient to feel the difference between the unlocked and locked state, it is necessary to ask him to bite on the back teeth and try to move the disc again. This is also done so that the patient realizes that he himself can unlock the joint if necessary. To test for an unlocked state, the patient must be able to place at least three fingers between the maxillary and mandibular incisors while opening the mouth to maximum. The patient can check the fact of unlocking 5 minutes before bedtime and immediately after waking up in the morning. If in the morning the patient is diagnosed with a block, he is recommended to take a hot shower, which helps relax the muscles and, accordingly, unblock the joints. After instructions, the patient is fitted with a temporary thermoplastic mouth guard on the lower jaw. These mouthguards are designed with an edge-to-edge incisor ratio for class 1 ratios, or for class 2, subclass 2. In this case, it is extremely important that the mouth guard ensures disc displacement with reduction. Patients are advised to use this splint at all times, even while eating and sleeping for the next 3-4 days, and at least while sleeping for another 7 days (photo 9-13).

Photo 9-12. Manufacturing of a temporary stabilizing splint from thermoplastic.

Photo 13. Finished temporary stabilizing splint made of thermoplastic: view with the mouth closed.

Control and alternatives

After a week of using the primary aligner, patients return for follow-up. If the patient again experiences a block, the procedure can be repeated. If there is no block, then the patient should be instructed about the need to take preventive measures to minimize the risk of developing it. The essence of preventive measures depends on each individual clinical situation, but very often involves the use of specific mouth guards (orthotics) at night. If the above-described treatment approach does not demonstrate any effectiveness after several attempts, then the patient can be offered arthrocentesis or arthroscopy with surgical correction. Recommendations for any intervention depend on the medical history, characteristics of the diagnosis, the presence of pain, dysfunction, and the extent to which the existing pathology affects the quality of life. If a conservative treatment method is ineffective, then before performing surgical procedures it is highly recommended to conduct an MRI examination of the joint area to confirm the diagnosis. Unfortunately, the procedures of arthrocentesis and arthroscopy are characterized by only short-term clinical effect, but at the same time they provide almost complete relief of pain and significantly increase the available range of motion. The long-term ineffectiveness of surgical approaches to the treatment of disc displacement without accompanying reduction may be due to the inability to use a stabilizing splint immediately after the procedure, especially in cases where joint interventions are performed while the patient is sedated.

conclusions

Patients with articular disc displacement and accompanying reduction very often progress to a state of disc displacement without reduction. Analysis of typical symptoms of this form of intra-articular pathology, as well as performing the necessary diagnostic procedures, including MRI examination, allows you to make the correct diagnosis and choose the most appropriate treatment method. The time criterion in cases of treatment of articular disc displacement without concomitant reduction is extremely important: the longer the patient has a joint block, the less chance of complete relief of this condition.

Posted by Jamison R. Spencer, DMD, MS

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:

1. cartilage tissue becomes soft and loose;
2. loses some of the water, dries out, becomes denser;
3. 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.

Structure and functions of the temporomandibular joint

The joint is formed by the head of the horn of the lower jaw and the articular surface (fossa) of the temporal bone. Between these bone formations there is a fibrous intra-articular disc, which is fused on all sides with the joint capsule. Ligaments and muscles help keep the joint in the correct position. They limit the range of motion in the joint. Attempting to exceed this functional limitation causes pain and prevents damage to the TMJ.

The main function of the joint is to ensure movement of the lower jaw in three directions:

• vertical: opening and closing the mouth;
• horizontal: lateral displacements of the lower jaw relative to the upper;
• sagittal: movement of the lower jaw back and forth relative to the upper.

The combination of movements of one jaw relative to the other allows us to chew, speak, and express emotions through facial expressions.

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.

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:

1. glucosamine, stimulates the production of key elements in cartilage tissue, restores the articular surface, protects from destruction;
2. 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).

TMJ dysfunction - symptoms and treatment

There is no single, universal method for treating TMJ dysfunctions. Full treatment may be hindered by pain that does not allow the necessary therapeutic measures to be carried out.

Conservative therapy allows you to relieve acute manifestations of pathology, ensures the weakening or complete disappearance of symptoms and restores the function of the lower jaw in full.

Physiotherapy is effective in reducing pain. To reduce pain, fluctuarization is used in the TMJ area. The essence of the procedure is the use of alternating, partially or fully rectified low-voltage electric current with a chaotically varying oscillation frequency. Fluctuarization helps reduce pain after 2-3 sessions. If the myogenic nature of the pain is caused by myositis (inflammatory damage to the skeletal muscles) due to contact involvement of the muscle in the inflammatory process, then treatment should first of all be aimed at eliminating the cause of the inflammation.

Amplipulse therapy (sinusoidal modulated current therapy) has shown effectiveness in the treatment of myofascial syndrome (a chronic condition in which pain points form in muscle tissue), reducing the tone of spastically contracted muscles.

Pain of joint origin is treated by prescribing phonophoresis with hydrocortisone, which allows to relieve pain in the acute period and reduce inflammation.

All types of treatment must be carried out under the control of electromyography to assess the effectiveness, equalize and normalize the electrical potentials of the muscles.

During complex treatment, the patient himself must perform myogymnastics after proper training in the technique. It includes passive and active exercises for the moving muscles of the lower jaw and neck muscles. Passive exercises are carried out without load; the patient needs to perform various movements of the lower jaw. Active exercises also include various movements of the lower jaw, but with a load (the patient’s arms counteract the movement being performed) [3]. Exercises should be done 3 times a day for 10-15 minutes.

To normalize bite and occlusal disorders, special orthopedic treatment methods are used - correction of occlusion and the use of orthopedic structures (splints, mouth guards, bite blocks, myostimulation, etc.).

Surgical treatment methods are used for serious morphological pathological changes in the joint. The main indication for surgical treatment is anterior displacement of the intraarticular disc.

Surgical treatment consists of focal chondroplasty of the disc or head of the lower jaw using autologous cartilage (usually nasal cartilage). It is also possible to reduce the disc and suturing the stretched intra-articular ligaments and joint capsule. These methods are aggressive for a complex articular system and they do not always give good results [11].

In the complex issue of treating TMJ dysfunction, over time, the most effective scheme has proven to be the use of medication, manual therapy, physiotherapy and orthopedic treatment aimed at restoring the dentition and normalizing the bite.

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.

Causes of dysfunction of the masticatory joints

A gnathologist specializes in the diagnosis and treatment of TMJ diseases. In fact, this is a dentist with a narrow specialization. Factors that can lead to temporomandibular joint disease include:

• vascular pathology, which leads to impaired blood supply to the joint;
• increased tone of the muscles of the face and neck (increased tone, spasms);
• violation of occlusion;
• manifestations of psychosomatics.

Occlusion disorders underlie the largest number of cases of TMJ disease. Normally, the antagonist teeth of the upper and lower jaws contact their chewing surfaces in a certain way. The cusps and depressions on the upper surface of the antagonist teeth should contact according to the “pestle and mortar” principle. If the teeth on the jaw are positioned incorrectly and their correct contact is impaired, compensatory mechanisms are activated. In particular, the tone of the chewing muscles changes and the lower jaw shifts in such a way as to achieve full contact of all chewing surfaces of the teeth.

This displacement eliminates the occlusal obstacle, but creates additional stress on the temporomandibular joint. Habitual displacement of the jaw over time leads to damage to the anatomical structures of the joint. Increased tone of the masticatory muscles provokes hemodynamic disturbances in the TMJ area, which does not contribute to rapid regeneration.

If the cause of unpleasant symptoms in the TMJ area is a violation of occlusion, a gnathologist may recommend orthodontic treatment. This is the only way to get rid of the problem, since if the teeth are incorrectly positioned on the jaw, only symptomatic treatment of TMJ problems can be carried out, which will only lead to a temporary improvement in the condition.

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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Treatment

A gnathologist can carry out treatment either independently or with the involvement of specialists from other fields. This is especially true when the cause of the development of TMJ pathology has been identified and can be eliminated. The help of an orthodontist is necessary for patients with malocclusion. Wearing a brace system or aligners to correct occlusion has a beneficial effect on the condition of the entire dental system.

Detection of arthrosis or ankylosis of the temporomandibular joint also requires the involvement of specialized specialists. The doctor's specialty will be determined by the cause of the development of degenerative-dystrophic processes in the tissues of the TMJ. Metabolic disorders, injuries, infections will require additional examination and the development of an individual treatment plan.