Jaw arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

There are many types of arthritis that affect the jaw and cause pain. The jaw joint is called the temperomandibular joint.

The temporomandibular joint is the joint between the temporal bone of the skull and the lower jawbone (mandible). There are two temporomandibular joints, one on each side of the face just in front of the ears. Ligaments, tendons, and muscles support the joints and are responsible for jaw movement.

Within the temporomandibular joint (TMJ) there are cartilage cushions that allow the upper jaw to close on the lower jaw (i.e. biting and chewing, talking and yawning). It is one of the most frequently used of all the joints in the body.

Many TMJ-related symptoms are caused by stress on the structures around the joint. These structures include the muscles of the jaw, face, and neck; the teeth; and the cartilage discs in the joint.

All of these stresses can result in muscle spasm. This muscle spasm causes the formation of contracted muscles and pain amplification so that pain may be felt in areas distant to the jaw such as the head and neck.

Other possible causes of TMJ-related symptoms include arthritis, fractures, and dislocations.

Most often, the cause of a temporomandibular disorder is a combination of muscle tension and anatomic problems within the joints. Muscle pain and tightness around the jaw (myofascial pain syndrome) can arise from muscle overuse due to malalignment of the jaw, missing teeth, or injury to the head or neck. Pain can occur by trying to open the jaw too wide. Muscle pain and tightness can also result from grinding the teeth (bruxism).

Poor posture can also be an important factor. As an example, sitting at a computer all day strains the muscles of the face and neck.

In internal joint derangement, the cartilage disk inside the joint lies in front of its normal position. This eventually leads to disc damage.

Arthritis in a temporomandibular joint may result from osteoarthritis, rheumatoid arthritis, infectious (septic) arthritis, Lyme disease, or injury.

Jaw discomfort with chewing may be a symptom of giant cell arteritis, a potentially severe inflammatory condition that affects blood vessels.

Rheumatoid arthritis affects the temporomandibular joint in about 17% of people.

Hypermobility (looseness of the jaw) results when the ligaments that hold the joint together become stretched. In hypermobility, dislocation can result.

Symptoms of temporomandibular disorders include headaches, tenderness of the muscles, and clicking or locking of the joints. Temporomandibular disorders may be the reason for recurring headaches that do not respond to usual medical treatment. Other symptoms include pain or stiffness in the neck radiating to the arms, dizziness, earaches or stuffiness in the ears, and disrupted sleep.

People with temporomandibular disorders have difficulty opening their mouth wide.

People with muscle pain feel pain and tightness on the sides of the face upon awakening or after stressful periods during the day. Nighttime clenching and grinding of the teeth may cause a person to awaken with a headache. As the jaw opens, it may move deviate to one side. The chewing muscles are tender to the touch.

Internal joint derangement causes a clicking or popping sound in the joint when the mouth opens wide or the jaw shifts from side to side. In many people, these joint sounds are the only symptoms. In a small percentage of people who have missing teeth and who grind their teeth, there is progression to locking of the joints.

With osteoarthritis, the person feels a grating sensation in the temporomandibular joints when opening and closing the mouth.

When rheumatoid arthritis is severe, the top of the jawbone may erode and shorten. This damage can lead to sudden misalignment of many or all of the upper and lower teeth. If the damage is severe, the jawbone may eventually fuse to the skull (ankylosis).

A person with hypermobility can have their jaw dislocate causing pain and an inability to close the mouth.

When a doctor suspects internal jaw joint derangement, further tests can be done. Magnetic resonance imaging (MRI) is the diagnostic procedure of choice.

X-rays and a computed tomography (CT) scan or MRI can confirm the diagnosis of osteoarthritis. If hypermobility is the cause, the person generally can open the mouth wider than the breadth of three fingers; the jaw may be chronically dislocated. If ankylosis is the cause, the jaw's range of motion tends to be markedly reduced.

Treatment varies considerably according to the cause. Two common treatments are splint therapy and analgesics to relieve pain.

Splint therapy usually is the main treatment for jaw muscle pain and tightness. A plastic splint is made to fit over either the upper or the lower set of teeth and is adjusted to give the person an even bite. The splint, usually worn at night (a nightguard), reduces grinding, allowing the jaw muscles to rest and recover. For pain during the day, a splint allows the jaw muscles to remain relaxed and the bite to be stable. The splint can also prevent damage to teeth.

Physical therapy includes ultrasound, electromyographic biofeedback, spray and stretch exercises (in which the jaw is stretched open after the skin over the painful area has been sprayed with a refrigerant or numbed with ice), or friction massage. Transcutaneous electrical nerve stimulation (TENS) also may help. Stress management along with electromyographic biofeedback, often brings dramatic improvement.

Drug therapy may also be helpful. For instance, muscle-relaxing drugs, such as cyclobenzaprine, may be prescribed to ease tightness and pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) also relieve pain. Sleep aids (sedatives) may be used occasionally and for a short time to help people who have trouble sleeping because of the pain.

Injection of the jaw joint with lidocaine and glucocorticoid may be helpful.

If internal joint derangement cannot be treated by nonsurgical means, an oral surgeon may need to reshape the disk and sew it back into place. However, the need for traditional surgery is relatively rare since the introduction of procedures such as arthroscopy All surgical procedures are used in combination with splint therapy.

A person with osteoarthritis in a temporomandibular joint needs to rest the jaw as much as possible, use a splint or other device to control muscle tightness, and take an analgesic or another non-steroidal anti-inflammatory drug for pain.

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