In about 5 percent of all cases, which number 35 million in the United States alone, TMJ (temporomandibular joint) Dysfunction or TMD (temporomandibular joint disorders) may be the result of one of many different arthritic conditions. The most common of these, referred to as osteoarthritis, causes degeneration of cartilage and bone in the TM joint, just as it does in many other joints (ie the hands and knees) in the body. Although it can be taken on by severe trauma to the joint, it is most often caused by repeated use, such as regularly chewing hard foods or opening the mouth too broadly, or simple age-related deterioration. It generally occurs bilaterally – that is, equally on both sides of the mouth. Rheumatoid arthritis, on the other hand, is a chronic inflammation of the joint; as with osteoarthritis, it can affect the TMJ in the same manner it affects other joints, but it does not need to be present bilaterally. Ankylosis (fusion of the jaw joint) can occur in advanced cases. When infectious arthritis is the cause, the damage to the joint tends to increase as the disease progresses.
The symptoms of arthritic TMJ Dysfunction depends very much on the type of arthritis involved, but some of these include painful swapping in the joint, a limited range of movement of the jaw or a shift in its position when moved, and a number of troublesome sounds, including popping, clicking, scraping or grinding, when the mouth is opened or closed.
Diagnosis of most types of arthritic TMD involves examining the jaw's range of motion and determining the bones' integrity through the use of X-rays, CT or MRI scans, or minimally invasive arthroscopy. In the latter, a fiber optic scope is inserted directly into the joint to view the damage directly. Arthrocentesis, can also be a useful technique, especially when an infection is the cause. It involves the insertion of a syringe into the space within the joint, along with the removal and analysis of the fluid that cushions it.
Often, the pain and discomfort that comes with an arthritic TM joint can be relieved with self-care treatments similar to those used for other arthritic conditions. For example, resting the joint can help eliminate the strain on the injured muscles. This may involve eating a soft diet, taking small bites, and applying moist heat packs to the painful area. It may also involve managing your stress level so you do not clench or grind your teeth. Mouth splints, those worn over the teeth, can also help prevent you from clinging and managing your symptoms. Other options include non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy that uses gentle jaw exercises.
If the joint is particularly painful, or if the damage is extensive, the dentist or other healthcare professional may choose to inject steroids directly into the joint space to provide pain relief. There is a drawback however – you can only inject the area a limited number of times, as the steroid drugs can have unwelcome side effects.
Surgery is usually the option of last resort, but it may be appropriate if the symptoms of the arthritic degeneration of bone and cartilage do not respond to more conventional, and less invasive, treatments. Surgery will not cure the disease, but it may repair some of the joint damage and ease the resulting symptoms. Today, most surgery that is performed on the TM joint is arthroscopic – that is, it uses tiny instruments and fiber optics to allow the doctor to view and repair the joint. It is less invasive than open surgery, and, as a result, there is less scarring and a survivor recovery time.
In the case of infectious arthritis, treatment may include antibiotics (primarily penicillin G), a flushing of the affected area, pain control using a variety of medications, and restriction of the jaw's motion until healing takes place. Jaw-opening exercises may be used once the infection is cleared up to increase the range of motion.
The facial joint can be affected by arthritis just like any joint in the body, so it is not surprising to find it is one of the causes of TMJ Dysfunction. If you experience pain, tightness, or a limited range of motion in your jaw, talk to your dentist or other healthcare professional, who can diagnose the exact cause of the problem and ensure that you receive the proper treatment to correct it.