TMJ arthritis

Acute and chronic traumatic arthritis

TMJ inflammation of traumatic origin is divided into two forms depending on the nature of the damage.

Acute traumatic arthritis occurs due to direct jaw trauma or excessive mouth opening (e.g., during dental procedures). The pathogenesis is based on hemorrhage into the joint cavity and surrounding tissues. Subsequently, serous exudation develops, which without treatment leads to the formation of fibrous adhesions and persistent restriction of mobility. Patients complain of swelling, acute pain when chewing, and the inability to fully open the mouth.

Chronic traumatic arthritis is a consequence of prolonged increased load on the joint. Risk factors include tooth loss, pathological tooth wear, and errors in prosthetics (overestimated or underestimated bite). Because of this, the condylar processes shift within the fossae. The disease may debut with nonspecific symptoms: tinnitus, hearing loss, dizziness, dry mouth, and a burning sensation of the tongue. In the advanced stage, morning stiffness, crepitus, and deviation of the jaw toward the affected side appear.

General clinical presentation and diagnostics

In the first days of acute arthritis development, its clinical manifestations are similar regardless of the etiology of the disease. The classic symptom complex includes:

• Pain syndrome: constant spontaneous pain in the projection of the joint.
• Dysfunction: marked limitation of the range of jaw movements.
• Local inflammatory reactions: skin redness (hyperemia), swelling, a feeling of pressure and fullness.
• Systemic signs: fever, general malaise (depend on the severity of inflammation).

Diagnosis is based on anamnesis, objective status, and instrumental studies. Radiography is a mandatory step: in an acute process, it shows widening of the joint space (due to effusion), and in chronic — its narrowing. In late stages, foci of bone destruction and deformation are visualized. For the most accurate and early diagnosis of soft tissue structures, MRI is used.

Comprehensive approach to treatment

The choice of treatment tactics is determined by the cause that caused the arthritis. The primary measure for any form of the disease is the creation of complete rest in the joint (strict limitation of jaw function).

Conservative therapy: Suppression of inflammation plays a central role using nonsteroidal anti-inflammatory drugs (NSAIDs), such as meloxicam or nimesulide. By blocking the cyclooxygenase enzyme, they reduce the synthesis of prostaglandins, relieving pain and edema. For bacterial arthritis, broad-spectrum antibiotics are prescribed. It is also necessary to correct the bite, perform dental sanitation, and treat chronic foci of infection with an ENT specialist. Systemic support includes immunotherapy, desensitizing, and antioxidant drugs.

Surgical and local treatment: Indicated for purulent foci or bone structure trauma. Arthrocentesis, osteosynthesis, condylectomy, or TMJ arthroplasty are performed. Locally, intra-articular administration of antibiotics and applications of dimeoxide solution with anti-inflammatory ointments are used.

Physiotherapy stages

Physiotherapeutic intervention changes depending on the phase of the inflammatory process:

1. Acute stage: UV therapy and UHF therapy are indicated strictly in non-thermal dosages.
2. Relief of acute symptoms: diadynamic therapy (DDT), shortwave therapy (SWT), and electrophoresis with NSAIDs are used.
3. Residual effects: ultrasound and hydrocortisone phonophoresis are effective.
4. Remission: thermal procedures (ozokerite, paraffin therapy, mud therapy) and electrophoresis with enzymes (trypsin, lidase) are prescribed.

Internal (non-inflammatory) TMJ disorders

About 89% of patients with TMJ pathology suffer from internal disorders — conditions in which the anatomical relationships of soft tissue structures (disc, capsule, ligaments) are altered. The main triggering factor is forced occlusion, leading to overstretching of the ligamentous apparatus. Patients with connective tissue dysplasia have a high predisposition to such disorders.

One of the mildest forms is chronic dislocation of the mandibular head. The pathology is asymptomatic and is diagnosed incidentally by a dentist. In this form, the articular heads freely move beyond the fossae when opening the mouth wide (the interincisive distance exceeds 40 mm). According to MRI, the articular disc is in the correct position, and upon auscultation, specific noises or clicks are absent.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Clinical forms and syndromes of articular disc displacement
• Pathogenesis of fibrous adhesion formation during joint hemarthrosis
• The impact of connective tissue dysplasia on TMJ biomechanics
• Indications and methods of surgical intervention: from arthrocentesis to joint replacement

Other topics in "Chapter 13. Temporomandibular Joint Disorders (V.V. Bekreev)"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.