TMJ arthritis

TMJ arthritis is an inflammatory (infectious or non-infectious) disease of the joint connecting the lower jaw with the temporal bone of the skull. In the acute stage, TMJ arthritis occurs with sharp pain in the area of the affected joint, giving into the ear and temple; swelling and hyperemia of the skin over the joint; the inability to completely close the dentition and restriction of mouth opening; a general temperature reaction. Diagnosis of arthritis includes analysis of anamnestic information, palpation of the joint area, radiography and CT of the TMJ. In the treatment of TMJ arthritis, jaw immobilization, antibiotics, NSAIDs, chondroprotectors, intra-articular corticosteroid injections, physiotherapy, myohymnastics are used.

TMJ arthritis is an acute or chronic inflammation of the structural elements of the temporomandibular joint, accompanied by a violation of its function. In the general structure of TMJ diseases, arthritis accounts for 6-18% and is statistically more common in young and middle-aged people. Taking into account the etiology and course of TMJ arthritis, its treatment may fall within the competence of clinical dentistry, traumatology, rheumatology.

In infectious arthritis, pathogens can enter the TMJ cavity by hematogenic, contact or direct route.

Hematogenic infection in the joint tissue is possible with scarlet fever, measles, sore throat, diphtheria, typhus, salmonellosis, brucellosis, gonorrhea, tuberculosis, syphilis, actinomycosis, etc.

Contact infection of the TMJ can be observed with purulent mumps, otitis media, mastoiditis, osteomyelitis of the lower jaw or temporal bone, furuncle of the external auditory canal, abscess and phlegmon of the parotid-masticatory region.

Direct infection is most often associated with a puncture of the TMJ, a fracture of the lower jaw, a gunshot wound, etc.

Reactive arthritis of the TMJ is aseptic in nature (there are no pathogens in the affected joint), but having a direct pathogenetic connection with the infection. Reactive arthritis of the TMJ can develop on the background of:

  • chlamydia;
  • ureaplasmosis;
  • rubella;
  • viral hepatitis;
  • enteritis;
  • meningococcal infection, etc.

In rheumatoid arthritis, TMJ damage occurs simultaneously with other joints (knee, hip, shoulder, small joints of the hands and feet, etc.) or shortly after them. Acute traumatic arthritis of the TMJ can be associated with mechanical damage to the joint with a bruise, a blow to the jaw, excessive opening of the mouth; it is often combined with hemarthrosis. In infectious and traumatic lesions, as a rule, TMJ inflammation is unilateral; in rheumatism, it is bilateral.

The TMJ is a paired joint formed by the temporal and mandibular bones and provides movement of the lower jaw. The main elements of the temporomandibular joint include the articular head of the mandible, the mandibular fossa of the temporal bone, the articular disc, the articular tubercle, the articular capsule and the ligamentous apparatus. In the initial stage, inflammation engulfs the joint capsule and periarticular tissues.

In the future, the inflammatory process spreads to the synovial membrane, articular surfaces and areas of bone tissue, accompanied by the loosening and melting of cartilage, the formation of connective tissue in the joint cavity. The outcome of arthritis of the temporomandibular joint may be muscle contractures, deforming arthrosis, fibrotic or bone ankylosis of the TMJ.

Taking into account the underlying causes of the inflammatory process, infectious and non-infectious TMJ arthritis are distinguished:

  • Infectious TMJ arthritis is divided into nonspecific and specific (tuberculosis, syphilitic, gonorrhea, actinomycotic, etc.).
  • TMJ arthritis of non-infectious genesis can be traumatic, rheumatoid, reactive in origin.
  • TMJ arthritis may have an acute or chronic course; the acute stage may be accompanied by serous or purulent inflammation.

Acute arthritis

The leading symptom in the clinic of acute TMJ arthritis is a sharp pain in the joint area, which increases when you try to open your mouth or perform a jaw movement. As a rule, the pain is local, pulsating, but it can often radiate into the tongue, ear, occiput, temple. With arthritis of the TMJ, the patient can open his mouth no more than 5-10 mm; when trying to open his mouth, the lower jaw shifts to the sick side.

In the projection of the affected temporomandibular joint, hyperemia of the skin, swelling of soft tissues, soreness during palpation is determined. With the accumulation of serous exudate in the joint cavity, patients complain of a feeling of bursting in the jaw, the inability to close their teeth tightly.

Purulent arthritis

Purulent arthritis of the TMJ occurs with the phenomena of fever, the formation of a dense infiltrate in the joint area, hyperesthesia and hyperemia of the skin. Patients complain of acute local soreness, hearing loss, dizziness attacks. Upon examination, a narrowing of the external auditory canal is revealed. It is possible to form abscesses that open into the parotid region or the external auditory canal.

Chronic arthritis

In chronic arthritis of the TMJ, pain is manifested to a lesser extent; the leading complaints are joint stiffness of varying degrees of severity, a feeling of stiffness in the joint, glossalgia, tinnitus. The amplitude of the mouth opening is 2-2.5 cm; when the jaw moves, there is a crunch and clicking in the joint. Deformation of the articular head and the cortical plate of the cavity with chronic inflammation can lead to subluxation and dislocation of the lower jaw.

Rheumatic arthritis

Rheumatic arthritis of the TMJ occurs with multiple arthralgias, polyarthritis, fever; at the same time, acquired heart defects may be detected in patients. Laboratory examination reveals positive rheumatic tests (CRP, sialic, diphenylamine, etc.).

Traumatic arthritis

In traumatic arthritis of the TMJ, the moment of injury is accompanied by sharp pain in the joint, followed by a trism and restriction of passive and active movements of the lower jaw. Often, with traumatic injuries, there is a rupture of the ligamentous apparatus, hemorrhage into the joint, which further leads to ankylosing of the temporomandibular joint.

Tuberculosis arthritis

TMJ arthritis of a specific etiology has a chronic course. So, with tuberculous arthritis of the TMJ, fistulous passages often develop, a secondary bacterial infection joins. Diagnosis is facilitated by the presence of contact with a tuberculosis patient in the anamnesis, positive tuberculin tests, characteristic changes in the lungs.

Gonorrheal arthritis

The course of gonorrheal arthritis of the TMJ is acute, with pain and infiltration in the joint area, subfebrility, intoxication. Syphilitic arthritis of the TMJ is characterized by the formation of gum in the periarticular tissues, the formation of contracture of the lower jaw. With actinomycotic arthritis of the TMJ, periodic exacerbations of the chronic process also lead to the development of pronounced contractures of the masticatory muscles.

Taking into account the leading etiological factor, dentists, traumatologists, rheumatologists, otolaryngologists, phthisiologists, dermatovenerologists, infectious diseases specialists can be involved in the diagnosis of TMJ arthritis. The main method of verifying the diagnosis is radiography, computed tomography of the TMJ or CBCT of the temporomandibular joint. The defining radiological sign of acute TMJ arthritis is the expansion of the articular gap; chronic arthritis is the narrowing of the articular gap, the appearance of marginal usures of the articular head and articular tubercle.

In determining the etiology of specific TMJ arthritis, the decisive role belongs to the methods of PCR and ELISA diagnostics. Acute TMJ arthritis requires differentiation with:

  • trigeminal neuralgia;
  • acute otitis media;
  • pericoronitis;
  • other diseases occurring with arthropathies (gout, dermatomyositis, Behcet's disease, Bekhterev's disease, etc.).

Treatment of all types of TMJ arthritis begins with immobilization of the jaw and providing rest to the affected joint for 2-3 days. This is achieved by applying a sling-like bandage to the lower jaw or splints and an interdental plate to separate the bite, prescribing a semi-liquid diet. Further tactics depend on the form of arthritis:

  • In case of traumatic arthritis of the TMJ, cold compresses, analgesics, blockades are indicated in the first 2-3 days; in the future, physiotherapeutic treatment (UHF, electrophoresis, mud therapy, diadynamic currents), myohymnastics and massage of the masticatory muscles are performed.
  • Therapy of acute arthritis of the TMJ is carried out with the use of NSAIDs, antibiotics, intra-articular injections of corticosteroids, chondroprotectors, physiotherapy (laser therapy, magnetotherapy, ultraphonophoresis, mud therapy, paraffin therapy, ozokeritotherapy), acupuncture. With purulent arthritis of the TMJ, an emergency autopsy and drainage of the joint cavity is performed through an external incision.
  • In chronic arthritis of the TMJ, it is important to conduct courses of massage, physical therapy, physiotherapy, rehabilitation of the nasopharynx and oral cavity, rational prosthetics of teeth.

Treatment of specific and rheumatic arthritis of the TMJ is carried out by appropriate specialists taking into account the underlying disease.

TMJ arthritis is a serious disease that requires immediate medical attention. The outcome of acute infectious and traumatic arthritis is usually favorable; chronic inflammation of the TMJ often ends with the formation of bone ankylosis, requiring complex surgical treatment. Prevention of TMJ arthritis involves timely rehabilitation of chronic purulent foci and treatment of acute infectious diseases, prevention of joint injury, prevention and elimination of specific infections.

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