Arthrosis of the temporomandibular joint (TMJ) is a chronic disease of the musculoskeletal system, which is progressive in nature and is accompanied by degeneration of synovial tissues and destruction of articular cartilage.
General concepts
Cartilage of the jaw is not particularly strong, the joint itself is articulated, located at the junction of the lower jaw (mandible) and the skull (its temporal bone). The upper jaw does not have a movable joint, being part of the bones of the facial part of the skull.
A joint is always a movable joint of bones, enclosed in a joint bag, inside which there is a lubricating fluid for the surfaces of the joint (synovial). Therefore, talking about arthrosis of the upper jaw is not entirely true.
Due to the developing discrepancy in the load on the joint, the surrounding tissues are involved in the process with the development of dystrophic changes in them (bones, meniscus, cartilage, muscles and ligaments).
Up to 50 years, jaw arthrosis occurs in almost 50% of the population, older than 70 years - in 90%. At this age, the ability to regenerate in bone tissue is sharply reduced. And these are only registered cases, because often the elderly try to not contact the doctors. The process is more characteristic of women.
A bit of anatomy
Maxillofacial or, as indicated in the atlas of anatomy, temporomandibular joint - the connection is "two-story" and paired.
Between the bones there is a layer in the form of an interarticular disk. The design is held in place by 2 loop-shaped ligaments, and during operation it is regulated by the masticatory muscles, which are considered the most trained in the body. Options for the movement of the jaw joint:
- in the horizontal direction left-right;
- back and forth;
- vertical direction - up and down, as well as rotational movements when chewing.
The joint also participates in the pronunciation of sounds.
The mechanism of development of pathology
The development of the process begins with the fact that gradually, for various reasons, it begins to thin out, and then completely disappears first in some areas, then completely, the cartilage covering the head of the jawbone. Here his collagen fiber network is lost, it is replaced by fat. The cartilage dries, microcracks appear in it. The body’s attempt to compensate for the decay of the cartilage is manifested by the growth of osteophytes - elements of bone tissue, since the cartilage itself is not capable of regeneration. The shape of the joint is broken, and it cannot fully work.
Etiology of the phenomenon
The reasons may be local and general. Local include changes in the joint itself:
- the presence of uneven load on the joint;
- deformation of the dentition;
- tooth loss and decay;
- malocclusion;
- tooth crevices;
- disorder in the work of the jaws;
- anomalies in the structure of the jaw;
- injuries and operations on the jaw ;
- improper filling or prosthesis;
- inflammatory changes.
Common reasons:
- elderly age;
- menopause in women (bone metabolism is impaired);
- genetic predisposition;
- bad habits in the form of biting and biting nails;
- bruxism;
- malnutrition;
- physical inactivity;
- arthrosis of other joints;
- rheumatic processes;
- endocrinopathies (thyroid and diabetes);
- Stay in the dentist's chair for a long time with an open mouth;
- infections (SARS, flu);
- the habit of chewing solid foods.
Pathology classification
Osteoarthritis of the jaw has 4 stages in its development:
- The pathological mobility of the ligaments, the joint space begins to narrow, intermittently and unevenly. Cartilage degrades moderately. The best period for treatment.
- Progressive stage. Joint mobility decreases, pain appears. The condylar process of the lower jaw ossifies (ossification).
- Late stage. Cartilage is completely destroyed, there are osteophytes, destruction and reduction of the condylar process. Between the bones of the joint the distance is increased, sclerosis of the surfaces of the joint.
- Neglected stage. Ankylosis (fibrous joint fusion).
According to changes on x-ray, arthrosis of the jaw can be deforming and sclerosing. In the first case, the joint is enlarged, the articular fossa is aligned, on the surfaces of the joint are tubercles of growths, the lower jaw is sharply deformed. In the second, the joint gap is narrowed and there is sclerosis of bones.
By origin, arthrosis is divided into primary and secondary. Primary happens in the elderly, it is polyarticular, without a previous pathology, its cause is often unknown. Secondary occurs against the background of existing pathologies: injuries, inflammations, etc.
Symptomatic manifestations
Osteoarthritis of the jaw always develops gradually. Often the first degenerative symptoms are not seen by patients. Among them are morning stiffness of the joint, crunching and clicking. In the afternoon they disappear.
Then the pain when chewing, talking, and later at rest, joins. Pain symptoms of arthrosis of the joints of the jaw make themselves felt in the evening or change of weather. Pain reduces the amplitude of joint oscillations, its function is limited.
The following symptoms of jaw arthrosis appear:
- asymmetry of the face;
- when opening the mouth, the position of the jaw changes markedly - it goes to the side so that the mouth opens; the sick side goes numb;
- pain appears in the tongue, ears and eyeballs, nape.
With complaints of pain in these places, patients turn to different doctors, but the reason is only in arthrosis. The pain is constant and aching. The patient chews on one side.
Symptoms of arthrosis of the lower jaw are manifested by palpation of crepitus and crunch. The mouth does not open wide, there may be symptoms of mumps and otitis media. Chewing muscles hurt when palpated. On the x-ray typical changes in the arthrosis of the lower jaw: the height of the mandible head is reduced, the shape is changed to club-shaped or spiky, there are osteophytes.
Diagnosis of jaw arthrosis
For the doctor does not cause much difficulty. The basis is complaints and the clinic. On examination, the face is asymmetric and reduced in height, the mandible is shifted to 1 side.
The mouth does not open well, the distance between the incisors is less than normal, can be reduced to 5 mm. On the affected side - muscle spasm.
Arthrosis of the upper jaw is often accompanied by a complete lack of teeth or partial. The main diagnostic criteria are accuracy and informational content. Therefore, CT or MRI is prescribed.
On an X-ray, structural disorders of the bone are clearly visible, but he will not show any associated pathologies. The main changes on x-ray: the head is thickened and deformed, bone spikes, narrowing of the joint space. The degrees of change of the 4 stages are indicated above.
What is dangerous arthrosis of the jaw?
Difficult early diagnosis due to lack of symptoms. And therefore, early treatment, when it could easily cure the disease. Often arthrosis is detected accidentally during dental treatment.
Ultimately, jaw arthrosis not only worsens the quality of life due to immobilization of the jaw, but also leads to disability. Difficulty eating, talking. Headaches are inflammatory and debilitating.
Inflammation often passes to neighboring organs. Blood pressure rises, anesthetics do not help, vision and hearing worsen, migraines occur. Inflammation and swelling can lead to pinching of the trigeminal and facial nerve, inflammation of the periosteum.
Treatment methods
The treatment of jaw arthrosis has the following objectives:
- remove swelling and inflammation;
- establish metabolism;
- restoration of cartilage tissue;
- general recovery of the body - for all these purposes, non-steroidal anti-inflammatory drugs - NSAIDs are consistently used;
- blockades;
- vasodilator;
- muscle relaxants for better opening of the jaw;
- anxiolytics;
- antidepressants;
- opiates;
- GCS (glucocorticosteroids);
- adjuvants;
- vitamins and minerals.
With inflammation of the periosteum, antibiotics are prescribed.
Chondroprotectors are used to restore cartilage. Among them are chondroitin, hyaluronic acid, glucosamine sulfate. The following drugs are most popular: "Teraflex", "Chondroxide", "Don", "Movex", "Elbon", "Alflutop" and others.
Chondroprotectors are used for a long time for at least 6 months. Of course, they will not restore the cartilage, but they will nourish the remaining bone and cartilage tissue.
It is better to use them without exacerbation. Any treatment is very successful in the initial stages of the disease. Later, the process becomes irreversible.
Arthrosis of the jaw is also treated with vasodilator drugs. Treatment is carried out not only with tablets, but also with general injections and into the joint.
Intra-articular administration of drugs can be prescribed for severe inflammation, usually it is corticosteroids. With local exposure, there is no side effect on the stomach, but repeated administration of GCS can cause cell death and accelerate cartilage degeneration. Then they can be replaced with hyaluronic acid - it will also relieve inflammation, but does not cause degenerative changes in the bones.
With oral administration of GCS, the doctor prescribes additional drugs to reduce acidity - Omeprazole, etc. GCS is also used in physiotherapy for ionophoresis. Also, a compound with the complex name polyvinylpyrrolidone polymer, which replaces the destroyed parts of the cartilage, is injected into the joint.
Treatment of arthrosis of the lower jaw can use not only general, but also local treatment with ointments and gels. Opioid therapy is used to reduce pain - Fentanyl, Promedol, Tramadol, Codeine, etc. Conventional analgesics will not help here.
Only a doctor should treat jaw arthrosis. The effect of therapy will be felt only with the complexity of treatment and course treatment.
Interruption of the course will cause all symptoms to return. In addition to medicines, treatment is supplemented by physiotherapy, massage, exercise therapy, diet, orthopedics and, if necessary, surgery.
Treatment of symptoms of jaw arthrosis really takes a lot of time, but is justified by a good prognosis. As soon as there is a shift in the state of improvement, wellness procedures begin.
Physiotherapy
The procedures are varied:
- ultrasound treatment;
- magnetotherapy;
- electrophoresis with potassium iodide;
- Ural federal district;
- galvanotherapy;
- paraffin and ozokerite therapy;
- infrared radiation;
- laser therapy;
- the application of heated medical bile mixed with dimexide.
The combination of a course of medicines and physiotherapy should be carried out every six months for the persistence of the effect.
Exercises
They are often the only treatment needed. This is relaxation, twisting and stretching. With the regularity of performing exercises with the mandible, the compression of the jaw is reduced.
Orthopedic treatment
It is indicated for those patients who have malocclusion, teeth and jaw. The essence of the method is to create a uniform load on all jaw joints. In the treatment, dental burls, braces, palatine plates, crowns and prostheses are used. Sometimes the patient wears a sling-like bandage for 2-10 days, which reduces the looseness of the joint.
Operation
It is carried out only with the ineffectiveness of other methods. Indication - permanent joint pain. The essence of the operation is to remove the joint or cartilage, eliminate or transplant the mandible head, and install the graft. The latter method is most effective because it replaces the damaged joint completely. The choice of treatment is made by a doctor.
Special diet
It is necessary to use only gentle and grated food at least for the period of treatment. Solid and rough foods, tea, coffee, sorrel, spinach, and smoked foods should be excluded. Recommended dishes containing collagen and elastin - jelly, khash, jelly.
Folk remedies
Treatment of jaw arthrosis with folk remedies should be only an addition to the main one. There are many recipes, both simple and complex. Often used warming with salt or sand. They are applied in a heated form to reduce pain to the lesion site for 1.5-2 hours until completely cooled.
Another recipe is lubrication of the entire jaw and behind the ear with egg white at night.
Also used:
- celandine juice with honey - bury in the nose;
- compresses from herbs - horseradish, burdock, elecampane, St. John's wort, lemon balm, celandine, calendula, eucalyptus, plantain;
- it is recommended to take apple cider vinegar for a month 3 times a day before meals, it removes salts from the body;
- useful mixture of cranberries, honey and garlic.
Preventive actions
The conditions must be fulfilled simple but effective enough:
- elimination of physical inactivity and stress;
- getting rid of bad habits is not only alcohol and smoking, but also the habit of biting nails, pencils and pens;
- snapping seeds;
- chewing for hours on chewing gum;
- long conversations on the phone and out;
- habit of yawning widely;
- frequent singing.
The dentist should be visited regularly and observe oral hygiene.