Temporomandibular joint arthrosis (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
The cartilage of the jaw is not very 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 connection of bones, enclosed in an articular 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).
Under 50 years of age, arthrosis of the jaw occurs in almost 50% of the population, over 70 years - in 90%. At this age, the ability to regenerate bone tissue is sharply reduced. And that's just the registered ones.cases, because often the elderly try not to go to the doctors. The process is more typical for women.
A bit of anatomy
The maxillofacial or, as indicated in the atlas of anatomy, the temporomandibular joint - the connection is "two-story" and paired.
Between the bones there is a layer in the form of an interarticular disc. The construction is held by 2 loop-like ligaments, and during operation it is regulated by chewing muscles, which are considered the most trained in the body. Jaw movement options:
- horizontally left-right;
- forward-backward;
- vertical direction - up and down, as well as rotational movements when chewing.
The joint is also involved in the pronunciation of sounds.
Mechanism of development of pathology
The development of the process begins with the fact that gradually, for various reasons, begins to thin, and then completely disappears, first in some areas, then completely, the cartilage covering the head of the jawbone. Here, its fiber network of collagen is lost, it is replaced by fat. The cartilage dries, microcracks appear in it. An attempt by the body to compensate for the breakdown of 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 work fully.
Etiology of the phenomenon
The reasons can be local and general. Local changes include changes in the joint itself:
- presence of uneven load onjoint;
- deformation of the dentition;
- loss and decay of teeth;
- malocclusion;
- teeth gaps;
- disorder in the work of the jaws;
- anomalies in the structure of the jaw;
- jaw injuries and surgeries;
- wrong filling or prosthesis;
- inflammatory changes.
Common causes:
- old age;
- climax in women (disturbed bone metabolism);
- genetic predisposition;
- bad habits of biting and biting nails;
- bruxism;
- malnutrition;
- hypodynamia;
- arthritis of other joints;
- rheumatic processes;
- endocrinopathy (thyroid and diabetes);
- staying in the dentist's chair for a long time with your mouth open;
- infections (SARS, influenza);
- The habit of chewing solid foods.
Classification of pathology
Jaw arthrosis has 4 stages in its development:
- Pathological mobility of the ligaments, the joint space begins to narrow, inconsistently and unevenly. Cartilage degrades moderately. The best period for treatment.
- Progressive stage. The mobility of the joint decreases, pain appears. The condylar process of the mandible ossifies (ossification).
- Late stage. The cartilage is completely destroyed, there are osteophytes, destruction and reduction of the condylar process. The distance between the bones of the joint is increased, sclerosis of the surfaces of the joint.
- Launched stage. Ankylosis (fibrous fusion of the joint).
According to the changes on the x-ray, arthrosis of the jaw can be deforming and sclerosing. In the first case, the joint is expanded, the articular fossa is aligned, there are growths on the joint surfaces, the lower jaw is sharply deformed. In the second, the joint space is narrowed and there is bone sclerosis.
By origin arthrosis is divided into primary and secondary. Primary occurs in the elderly, it is polyarticular, without previous pathology, its cause is often unknown. Secondary occurs against the background of existing pathologies: injuries, inflammations, etc.
Symptomatic manifestations
Jaw arthrosis always develops gradually. Often the first degenerative signs are not noticed by the patient. Among them are morning stiffness of the joint, crunching and clicking. By day they disappear.
Further, pain joins when chewing, talking, and later at rest. Painful signs of arthrosis of the jaw joints make themselves felt in the evening or a change in weather. Pain reduces the amplitude of joint oscillations, its function is limited.
The following symptoms of osteoarthritis of the jaw appear:
- facial asymmetry;
- when opening the mouth, the position of the jaw changes noticeably - it moves to the side so that the mouth opens; the affected side becomes numb;
- pain appears in the tongue, ears and eyeballs, the back of the head.
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 appear on palpationcrepitus and crunch. The mouth does not open wide, there may be symptoms of parotitis and otitis media. Chewing muscles hurt when probing. X-ray shows typical changes in arthrosis of the lower jaw: the height of the mandible head is reduced, the shape is changed to club-shaped or pointed, there are osteophytes.
Diagnosis of arthrosis of the jaw joint
Doesn't cause much difficulty for a doctor. Complaints and the clinic become the basis. On examination, the face is asymmetrical and reduced in height, the mandible is displaced to one side.
The mouth does not open well, the distance between the incisors is less than normal, it can decrease to 5 mm. There is muscle spasm on the affected side.
Arthrosis of the upper jaw is often accompanied by a complete absence of teeth or partial. The main diagnostic criteria are accuracy and informativeness. Therefore, a CT or MRI is prescribed.
On x-rays, structural bone disorders are clearly visible, but it will not show concomitant pathologies. The main changes on the x-ray: the head is thickened and deformed, bone spikes, narrowing of the joint space. The degrees of change of the 4th stage are indicated above.
What is the danger of arthrosis of the jaw?
Difficult to diagnose early due to lack of symptoms. And consequently, early treatment, when it could easily cure the disease. Osteoarthritis is often discovered by chance during dental treatment.
Ultimately, arthrosis of the jaw not only worsens the quality of life due to immobilization of the jaw, but also leads to disability. Difficulty eating and talking. Headaches are inflammatory exhaustingcharacter.
Inflammation often passes to neighboring organs. Blood pressure rises, anesthetics do not help, vision and hearing deteriorate, migraines occur. Inflammation and swelling can lead to pinching of the trigeminal and facial nerve, inflammation of the periosteum.
Treatments
Jaw arthrosis treatment has goals:
- remove swelling and inflammation;
- regulate metabolism;
- restoration of cartilage tissue;
- general improvement of the body - for all these purposes non-steroidal anti-inflammatory drugs - NSAIDs are consistently used;
- blockades;
- vasodilating;
- muscle relaxants for better jaw opening;
- anxiolytics;
- antidepressants;
- opiates;
- GCS (glucocorticosteroids);
- adjuvants;
- vitamins and minerals.
In case of inflammation of the periosteum, antibiotics are prescribed.
Chondroprotectors are used to restore cartilage tissue. Among them are chondroitin, hyaluronic acid, glucosamine sulfate. The following drugs are most popular: "Teraflex", "Chondroxide", "Don", "Moveks", "Elbona", "Alflutop" and others.
Chondroprotectors are used for a long time at least 6 months. Of course, they will not restore cartilage, but they will nourish the remaining bone and cartilage tissue.
Better to use them out of aggravation. Any treatment is very successful in the initial stages of the disease. Later, the process becomes irreversible.
Jaw arthrosistreated with vasodilators. Treatment is carried out not only with pills, but also with general injections and inside the joint.
Intra-articular injection of drugs can be prescribed for severe inflammation, usually 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 iontophoresis. Also, a substance with the complex name polyvinylpyrrolidonepolymer is injected into the joint, which replaces the destroyed areas of cartilage.
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.
Treatment of arthrosis of the jaw should only be carried out by a doctor. The effect of therapy will be felt only with the complexity of treatment and course treatment.
Interrupting 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 arthrosis of the jaw really takes a long time, but justified by a good prognosis. As soon as there is a shift in the state of improvement,Wellness treatments begin.
Physiotherapy
Procedures are varied:
- ultrasound treatment;
- magnetotherapy;
- potassium iodide electrophoresis;
- UFO;
- galvanotherapy;
- paraffin and ozokeritotherapy;
- infrared irradiation;
- laser therapy;
- application of heated medical bile mixed with dimexide.
The combination of a course of medication and physiotherapy should be carried out every six months for the durability of the effect.
Exercise
They are often the only treatment needed. It is relaxation, twisting and stretching. When performed regularly, mandible exercises reduce jaw contraction.
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. Dental caps, braces, palatine plates, crowns and prostheses are used in the treatment. Sometimes the patient wears a sling bandage for 2-10 days, which reduces joint laxity.
Operation
It is carried out only when other methods are ineffective. Indication - permanent joint pain. The essence of the operation is the removal of a joint or cartilage, the removal or transplantation of the head of the mandible, the installation of a transplant. The latter method is the most effective because it completely replaces the damaged joint. The choice of treatment is made by the doctor.
Special Diet
It is necessary to use only sparing and frayed food, at least for the period of treatment. Solid and coarse food, tea, coffee, sorrel, spinach, smoked meats should be excluded. Recommended dishes containing collagen and elastin - jelly, hash, jelly.
Folk remedies
Treatment of arthrosis of the jaw with folk remedies should only be an addition to the main one. There are many recipes, both simple and complex. Apply often heating with s alt or sand. They are applied when heated to reduce pain at the site of injury for 1.5-2 hours until completely cooled.
Another recipe is to smear the entire jaw and behind the ear with egg white overnight.
Also used:
- celandine juice with honey - instilled in the nose;
- herbal compresses - horseradish, burdock, elecampane, St. John's wort, lemon balm, celandine, calendula, eucalyptus, plantain;
- recommended taking apple cider vinegar for a month 3 times a day before meals, it removes s alt from the body;
- useful mixture of cranberries, honey and garlic.
Prevention measures
The conditions must be simple, but quite effective:
- exclusion 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;
- clicking seeds;
- chewing gum for hours;
- long conversations on and off the phone;
- habit of yawning;
- frequent singing.
You need to visit the dentist regularlyand maintain oral hygiene.
