Temporomandibular arthritis: causes, symptoms and treatment of TMJ

The lower jaw connects to the skull through a joint called temporomandibular (TMJ). Its task is to ensure the movement of the jaw.

TMJ arthritis is an inflammation of the articular elements, accompanied by pain and decreased mobility of the lower part of the face.

Temporomandibular joint arthritis reasons

Arthritis is characterized by gradually progressive inflammation, which begins in the joint capsule and, if therapeutic measures are insufficient, passes to the remaining elements of the joint.

Pathology can start in the form of an acute one, with a long-term developing inflammation it degenerates into a chronic one. Traumatic injuries or infections can trigger the onset of arthritis. It often becomes a complication of certain pathologies.

The onset of inflammation of the joint of the lower jaw is provoked by:

1. Congenital malformations that contribute to inflammation.
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2. Infectious processes. Micro-pathogens enter the joint through the bloodstream, from neighboring organs (contact) or directly. General infection with scarlet fever, tonsillitis, syphilis, other pathologies leads to the lesion of the TMJ in a hematogenous manner. Contact infection is observed when infection is in the immediate vicinity salivary glands, abscesses of the face, purulent otitis media, parotitis. The infection penetrates directly into the joint during injuries, medical procedures, fractures.
3. With general joint damage caused by rheumatoid arthritis, inflammation can reach the TMJ.
4. The traumatic form is fixed in case of bruises and injuries of the facial bones. Injuries are received from blows to the face, with too much opening of the mouth. Arthritis can be associated with damage to the vessels that feed the joint.
5. Endocrine pathologies - hyperthyroidism, thyroid cancer.
6. Poisoning and intoxication caused by them.
7. Lack of micro- and macroelements, hypovitaminosis.

The reactive form occurs after infections - chlamydia, rubella and others. At the same time, there may not be micro-pathogens in the structures of the joint, inflammation is a consequence of the disease and its complication.

Classification of TMJ arthritis

The classification of jaw arthritis is carried out on the basis of the reasons leading to the inflammation of the joint:

1. Infectious nonspecific. It is caused by infections - flu, tonsillitis, ear or oral cavity diseases. Micro-pathogens pass into the joint tissue by contact, direct pathway or with blood.
2. Infectious specific. Inflammation of the TMJ becomes a consequence of a long-term infectious pathology - tuberculosis, syphilis.
3. Rheumatoid. It is a consequence of rheumatism, which has captured the entire articular apparatus.
4. Reactive. It proceeds without an infectious lesion of the articular structures, but is a consequence of the transferred infectious diseases - meningococcal, enteritis, ureaplasmosis and others.
5. Traumatic. Shocks, dislocations, unsuccessful opening of the mouth, medical manipulations can damage the integrity of the joint and cause inflammation.

Advanced arthritis of the lower jaw is accompanied by an accumulation of purulent or serous exudate and requires immediate treatment. The disease is more common in people not older than middle age.

Symptoms and Diagnosis

The disease proceeds with a constantly growing pain syndrome. With any movement of the jaw, including a simple attempt to open the mouth, the soreness increases sharply, radiates to the back of the head or tongue, often to the ear, temple. Because of pain in the upper face, arthritis is sometimes referred to as maxillary arthritis, although there is no such disease and no medical term.

Pronounced signs of arthritis:

• inability to open the jaw wider than a centimeter, deformation of the face towards the sore joint;
• redness of the skin, swelling;
• pain when touching;
• headache;
• noise in ears;
• crunching, clicking when moving the jaw.

The pain is mostly local in nature, but can radiate to any part of the face.

The photo shows changes in the joint capsule in arthritis, causing progressive inflammation of the jaw joint with pronounced symptoms, the condition requires immediate treatment:

With the accumulation of purulent exudate, additional symptoms appear:

• feverish state with a rise in temperature;
• severe persistent soreness;
• infiltration creates a feeling of bloating;
• increased sensitivity of the skin, inability to touch the face, reaction to cold and heat;
• ringing in the ears, hearing impairment, changes in the area of ​​the auditory canals, frequent formation of abscesses in the ear.

With purulent arthritis, the general condition worsens sharply, dizziness occurs.

The chronic form is accompanied by low mobility of the lower jaw, characteristic crunching, the mouth opens 2-2.5 centimeters, the pain is unexpressed.

Periodically there is noise in the ears, there is a deterioration in hearing acuity. With a long course, subluxation and dislocation of the jaw develop.

For other forms of TMJ inflammation:

1. Rheumatoid - accompanied by fever, various forms of arthralgia develop, symptoms of polyarthritis are observed. Heart defects may form.
2. Traumatic - significant limitation of mobility, severe and severe pain. With serious injuries, ankylosis often occurs - a lack of mobility due to tissue degeneration.
3. Reactive forms are accompanied by multiple specific symptoms and are chronic. In particular, in the tuberculous form, fistulas can form, bacterial infections of the articular structures with Koch's bacillus can join.

Dentists, otolaryngologists and traumatologists begin the diagnosis of TMJ disease. To determine the nature and exact nature of the disease, the participation of a rheumatologist, infectious disease specialist, neurologist, phthisiatrician, and in some cases a venereologist is required.

The following types of diagnostic procedures are used:

• radiography, CT, CBCT - the leading methods of detecting changes in the articular structure, are assigned selectively or together;
• Ultrasound of the maxillofacial area;
• blood and urine tests - general, biochemistry;
• ELISA and PCR studies help identify reactive forms.

When diagnosing, it is required to determine the form and cause of pathological changes in the TMJ. According to ICD 10, the disease is coded under headings M13 (other arthritis) or in section K07 (maxillofacial anomalies).

Treatment and prognosis for inflammation of the jaw joint

Providing immobility (immobilization) of the joint is an indispensable part of therapy. An individually made sling-shaped dressing is used, a special strip for separating the teeth. Fixation lasts 2-3 days. A liquid diet helps protect the TMJ from stress.

When a joint is injured, it is required to apply cold (2-3 days), analgesics are prescribed.

In the future, physiotherapy helps to speed up recovery:

• massage;
• UHF;
• diadynamic therapy;
• electrophoresis.

In acute inflammation, a whole range of medications is used:

• NSAIDs - Diclofenac, Dicloberl;
• anesthetics in tablets or injections - Baralgin, Analgin, Ketanov;
• antibiotics - tetracyclines, Lincomycin;
• chondroprotectors for the restoration of joint tissues with a long course - Chondroxide, Aflutop;
• injectable corticosteroids;
• antihistamines.

In case of severe joint damage, corticosteroids (Prednisolone, Dexamethasone) are used for injection into the joint (2-3 injections).

After improving the condition, physiotherapy is prescribed:

• paraffin and ozokerite applications;
• magnetotherapy;
• laser therapy.

With the accumulation of purulent contents or serous exudate, surgical treatment is performed. The joint is opened with an open incision, purification and removal of pus is carried out. If necessary, prosthetics with an implant made of titanium, ceramics is possible.

A more benign surgical option is the use of arthroscopes.

Treatment of the chronic form of inflammation is carried out with the help of physiotherapy, the use of chondroprotectors, and physical therapy.

With reactive forms, the patient is sent to specialized specialists - a rheumatologist, venereologist. It is possible to overcome arthritis only after eliminating the cause, that is, the underlying disease.

An obligatory part of the treatment is the relief of inflammation of the oral cavity, dental treatment, sanitation of the nasal passages and pharynx. Patients need to cure the pathology, since the inflammation passes to the joint by contact.

Suspecting the symptoms of maxillofacial arthritis, it is dangerous to delay diagnosis and treatment. The disease is serious and requires immediate treatment. Acute and traumatic forms are successfully treated with timely treatment, the prognosis is favorable.

With a sluggish inflammation, the articular elements undergo destruction, ankylosis may develop with loss of function and contracture. Long-term, including surgical treatment, which often ends in disability, will be required. A person loses the ability to eat and speak normally, the mobility of the lower jaw is limited, and headaches persist.

Prevention

To avoid inflammation of the TMJ, preventive measures help:

1. Elimination of infectious agents from the body.
2. Regular sanitation of the oral cavity - treatment of caries, stomatitis.
3. Protection of the face from injury, hypothermia. If you suspect damage to the facial bones, it is imperative to take an X-ray.
4. Selection of proven dental offices for dental treatment and prosthetics.
5. Health care - thorough treatment of endocrine and other pathologies, prevention of specific infections.

A balanced diet, a healthy lifestyle, hardening, and taking vitamin and mineral complexes help prevent arthritis of any localization.

Treatment of TMJ arthritis requires an integrated approach and an urgent visit to a specialist. You should not look for alternative methods to cure joint inflammation on your own. Taking advantage of medical help, you can avoid complications and maintain health.