Arthrosis of the temporomandibular joint (TMJ) is a disease characterized by a chronic course and dystrophic changes in cartilage, bone and connective tissue structures.
The cartilage covering the joint surfaces, gradually becomes thinner and disappears, and degenerative changes can cause perforation of the disk. Bone changes are observed (in some cases, excess bone formation). Head of the joint changes shape – it takes a club-shaped or hook-shaped form. Regenerative processes in the cartilage tissue very poorly expressed.
The causes of osteoarthritis of the temporomandibular joint
The disease is characterized by gradual development. In the history of the disease can be inflammation of the joint, long-term use of incorrectly made dentures and pathological dental abrasion.
Some patients attribute the exacerbation of the process have recently had flu and SARS etc., as well as rheumatism.
All the causes that contribute to the development of the pathology and can be divided into local and General.
Common causes of osteoarthritis:
- metabolic disorders;
- hormonal imbalance;
- neurodystrophic disorders;
- diseases of infectious origin.
Dystrophic processes develop on the background of trophic disorders on the cellular and extracellular level.
Local causes of pathology:
- long-term ongoing inflammatory process in the joint;
- regular and excessive head TMJ.
The reasons for the excessive load are partial adentia (especially posterior teeth), bruxism, pathological attrition of hard tissue of teeth and anomalies of occlusion. Local factors are often combined: for example, abnormal abrasion can be combined with bruxism (pathological grinding of the teeth), and lead to a reduction of vertical dimension.
Special attention give to the occlusive articulation factors as they exacerbate and accelerate the degeneration of the structures of the joint as in the normal closing of dentition, and in the pathology of occlusion. The changes lead to a change in stress on the temporomandibular joint. It develops compensatory-adaptive processes, resulting in metabolic changes at the cellular and tissue level. Progression of this process leads to the rebuilding of tissues, supporting its work in the conditions of changed load. Over time, compensatory mechanisms are exhausted, and growing degenerative processes. Movement of the lower jaw become asynchronous.
The factors contributing to the development of pathology include:
- an unbalanced diet;
- the lack of nutrition;
- exposure to adverse exogenous factors;
- inattentive attitude to own health and rare preventive doctor visits (check-up).
Patients may present various complaints:
- pain, the intensity of which increases with the load on the joint;
- the constant pain of a dull aching character;
- pathological noise in the joint (crepitation, clicking);
- limitation of mouth opening (sometimes it does not exceed 0.5 cm);
problems with the mobility of a joint (especially in the morning);
- the displacement of the jaw to one side.
The patient may complain that he is able to chew only on one side, and to chew food on the opposite causes him pain and inconvenience. The combination of symptoms may be different. Not all signs of arthrosis of the temporomandibular joint are observed simultaneously in one patient.
In the course of inspection may be determined by maceration in the corners of the mouth, retraction of the lips, reducing the lower third of the face (manifested pronounced nosogubnye folds), the shift of the jaw towards the affected osteoarthritis of the TMJ.
In the early stages of the development of arthrosis of the temporomandibular joint changes are only detected during computed tomography; there is a marked narrowing of the joint space, sclerotic changes of bone structures and erosion (defects) in the cortical surface of the joint head.
During palpation revealed crepitus in the diseased joint and the crunch less pain.
Typical signs of osteoarthritis of the TMJ is the displacement of the mandible in the affected side. The dentist can easily identify this by tracking the displacement of the cutting points when opening and closing the mouth.
An objective assessment of the closure of dentition doctor gives, getting individual casts, diagnostic models, and fixing them in the articulator, as well as after x-ray examination of the affected tissues, electromyography and recording movements of the lower jaw.
During the review of the x-ray revealed gross changes at the tissue level – flattened form of the head joint, exophytic growths, and pointed or clavate form.
Dentist always conducts a differential diagnosis of TMJ arthrosis, arthritis and neuromuscular dysfunctions. Arthritis is more typical for young and middle-aged; it is characterized by acute and rapidly progressive course, and is accompanied by severe pain syndrome. Arthrosis of the temporomandibular joint is more frequently diagnosed in the elderly, and develops relatively slowly. According to medical statistics, about 55% of individuals older than 50 years and more than 92% of patients aged 70 years and older are prone to osteoarthritis of the TMJ.
Problems can arise in the differential diagnosis of arthritis and chronic TMJ arthritis, because these diseases have many common symptoms – tingling in the joints and limitation in opening the mouth.
Dysfunction of the neuromuscular nature manifested clicks in the joint and pain in the masticatory muscles. These patients are often fixed headaches caused by muscle tension in the buccal-occipital area. Symptoms usually is temporary. Arthrosis of the temporomandibular joint and neuromuscular disorders helping radiography (changes pattern is not detected), and palpation (palpation of the lateral pterygoid muscle is sharply painful).
Effective methods of differential diagnosis is a diagnostic anesthesia; with arthrosis of TMJ mobility of the lower jaw is not improving.
Upon detection of the exostosis should take biological material for histological and cytological analysis to exclude osteochondroma and candeleros dysplasia.
Treatment of osteoarthritis of the temporomandibular joint
Diagnosis of osteoarthritis requires a comprehensive TMJ treatment. Depending on the nature of the changes used physiotherapy, medical, orthopedic and surgical methods.
The main goal of orthopedic treatment is to eradicate factors contributing to overload of the joint. For this to normalize the shape of the teeth and the relationship of the dentition.
Orthopaedic intervention may include:
- normalization of jaw movements:
- restoring physiological occlusion;
- normalization of the ratio of dentition;
- restoration of the anatomical integrity of the dentition and their individual units.
In violation of occlusal contacts shown a selective grinding of teeth.
In parallel with orthopedic techniques is carried out and the drug effects.
According to testimony in case of arthrosis of the temporomandibular joints are manufactured dentures.
The most effective physiotherapy in arthritis of the temporomandibular joints are considered galvanization, fluctuorization, physiotherapy and local massage. Also widely used electrophoresis with novocaine or solutions of potassium iodide (10%).