Treatment of diseases of the temporomandibular joint

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.

What happens if TMJ dysfunction is not treated?

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

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

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.

How does TMJ arthrosis manifest?

Osteoarthritis of the maxillofacial joint can be caused by trauma, inflammation, the absence of a large number of teeth, or the use of dentures with poorly formed dentition. The causes of the development of pathology can also be metabolic disorders, connective tissue diseases or nerve conduction disorders.

Symptoms of arthrosis appear gradually as dystrophic changes develop. Most often patients complain of:

• aching pain that can radiate to the upper part of the skull - the area of ​​​​the eyes or ears;
• characteristic crunching or clicking sounds that occur when the joint moves;
• decreased mobility of the bone joint, especially noticeable in the morning;
• displacement of the lower jaw to the right or left side from the center.

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.

Examination of patients with TMJ pain dysfunction syndrome

When examining patients with temporomandibular joint pain dysfunction syndrome, the doctor clarifies the patient’s complaints and finds out whether he has had acute and chronic psychogenic injuries. He finds out the presence of local provoking factors. After this, he conducts an external examination, palpation and auscultation of the temporomandibular joint, palpates the masticatory muscles, muscles of the shoulder girdle and neck, and identifies trigger points in them.

The dentist evaluates the degree of mouth opening and the pattern of movement of the lower jaw, bite and alignment of teeth. In order to find out the cause of pain dysfunction syndrome, doctors at the Yusupov Hospital use the following diagnostic methods:

• functional research methods (axiography, electromyography of masticatory muscles);
• computed tomography;
• magnetic resonance imaging;
• panoramic survey radiography;
• orthopantomography.

Patients are consulted by a dental surgeon or maxillofacial surgeon, orthodontist, orthopedist, psychotherapist, neurologist, gastroenterologist, and otorhinolaryngologist. Doctors carry out differential diagnosis of TMJ pain dysfunction syndrome with the following diseases:

• pathology of the temporomandibular joint - infectious, traumatic, rheumatoid, psoriatic arthritis, deforming arthrosis;
• muscle diseases - bacterial and viral myalgia;
• facial pain due to neuralgia of the branches of the trigeminal nerve, glossopharyngeal and tympanic nerve, pterygopalatine ganglion;
• migraine, temporal arteritis.

Doctors at the Yusupov Hospital take an individual approach to treating patients with temporomandibular joint pain dysfunction syndrome. Complex cases of the disease are discussed at a meeting of the Expert Council with the participation of candidates and doctors of medical sciences. If necessary, patients are advised by leading specialists from specialized partner clinics.

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).

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.

Functions of the TMJ

TMJ

or
temporomandibular joint
is a joint located above the ear that connects the temporal bone to the lower jaw and the lower jaw to the skull. The muscles that are attached to this joint are actively involved in speaking, facial expressions, chewing, and swallowing. Together, muscles, ligaments, cartilage and joints make up the apparatus, thanks to which we can generally open and close our mouth, move our jaw back and forth and left and right, and the load on this apparatus is significant - comparable to the load, for example, on the knee joint.

The temporomandibular joint is the only paired and symmetrically moving joint in the human body, and problems with its functioning lead to numerous unpleasant diseases. TMJ dysfunction—limited work and mobility of the jaw joint—occurs when the joint on the right and left sides of the skull does not move synchronously or evenly. For example, to open the mouth, the patient must first move the lower jaw from side to side, “until it clicks.” Or when you open your mouth, you feel pain in your jaw or temples.

This disease has many names: arthritis (arthrosis) of the TMJ, myofacial syndrome, myoarthropathy of the TMJ, chronic dislocation of the lower jaw, Costen's syndrome (named after the American doctor who first identified this disease). This pathology is difficult to diagnose and treat, and at the same time it can cause a wide variety of pain - from headaches to neck pain.

Statistical fact: from 30% to 70% of dental patients suffer from functional pathology of the temporomandibular joint. And these are not always older people, as one might expect. On the contrary, people of all ages, including children, suffer from TMJ pain and related pain.

TMJ dysfunction was first described by otolaryngologist (ENT doctor) Kosten in 1934. Kosten studied pain and noise in the ears and burning in the nose, which intensified during or after eating, and was the first to think of linking them with malfunction of the temporomandibular joint. Subsequently, his colleagues and other doctors who examined this problem expanded and supplemented the list of symptoms. Now this list is quite extensive, and often not all symptoms can be associated specifically with TMJ problems.

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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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.