Osteoarthritis/Degenerative disorder of TMJ - 謝明吉、姜厚任 顎顏面 美學 重建 專科診所-風華整形聯合診所
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Physiology and pathology of the TMJ
Osteoarthritis/Degenerative disorder of TMJ


Osteoarthritis/Degenerative disorder of TMJ

"Dr. Jiang, I previously wore a bit plate for some time due to temporomandibular joint pain. The pain did subside after a few months, but why is it that I can't really chew now?"


"Dr. Jiang, I've occasionally had temporomandibular joint pain and times when I'm unable to open my mouth since I was young, but I've never bothered with it and it got better on its own. However, the pain this time has lasted for a very long time and still has not eased up. I've also found that my front teeth can't touch and I have to use my tongue to cut noodles and rice noodles when I eat…"


Brief introduction to temporomandibular joint osteoarthritis

Osteoarthritis/degenerative disorder of joints is one of the most common joint diseases. The main pathological changes occur on the two bone contact surfaces of stress-bearing joints, which is damage to the covering of the bone surface – the articular cartilage(Kalladka M,2014). X-rays or CT exams of patients suffering from osteoarthritis show damage and erosion to the cartilage, an uneven joint surface, decreased joint space and the production of osteophyte. The main symptom of osteoarthritis is pain, stiffness, trismus (but approximately 25% temporomandibular joint degeneration don't exhibit obvious symptoms), and you can often hear abnormal friction when working the joints.

Changes in osteoarthritis of TMJ is visible under CT:
A: Normal joint structure; B: Initial surface absorption of the joint surface and flattening;
C: Articular surface erosion; D: Formation of osteophyte


Osteoarthritis of TMJ is the ultimate symptom of many diseases of the temporomandibular joint(Zarb GA,1999), such as rheumatoid arthritis, trauma or articular disc displacement etc., eventually leading to articular cartilage and bone destruction. Statistics indicate that more than 20% of temporomandibular joint degeneration osteoarthritis symptoms are found in patients with temporomandibular joint disorder (Tanaka E, 2008). Many animal experiments also show disc displacement of TMJ lead to degenerative changes of condylar cartilage (Sharawy M,2000,2003). But similar to articular disc displacement, there may not necessarily have obvious symptoms (such as pain or trismus). About 35% of early temporomandibular joint osteoarthritis also exhibit no obvious signs (Brooks SL,1992)。


Occlusion and temporomandibular joint degeneration osteoarthritis

There are very different associations when compared with normal knee and hip osteoarthritis and aging. Numerous patients with osteoarthritis/degenerative disorders of the TMJ start developing symptoms from a young age. In addition to chewing pain and difficulties in opening their mouths, serious cases of long-term temporomandibular joint osteoarthritis cause bone resorption and dysfunctional remodeling resulting in decreased posterior ramus height, unstable dental occlusion and anterior open bite. These situations tend to occur after the patient starts wearing bite plates.




TMJ-OA treatment

The severity of TMJ-OA can be divided into three stages based on the extent of damage seen from bone and joint imaging(Kent JN, 1986). The later the stage, the more severe the damage to the articular bone and the more severely it affects chewing. The aim of TMJ-OA treatment is: Decrease joint pain, increase joint activity, prevent continued destruction to the joint structure.

  1. Early treatment
        Early TMJ-OA treatment are mostly non-invasive(Treatment guideline of AAOMS, 2015). For example with the use of nonsteroidal-anti-inflammatory drugs (NSAIDs) and muscle relaxation agents etc., to relieve pain and joint and muscle inflammation. Further, occlusal splints can also relieve muscle rigidity and prevent excessive joint stress and provide other benefits (Kuttila M, 2004).      
  3. Minimally invasive treatment
        For patients that are unresponsive to conservative treatments, the use of arthrocentesis/arthroscopy can effectively decrease symptoms of joint inflammation and pain(Nitzan DW, 2001). Furthermore, intra-articular injection of hyaluronic acid also relieves the symptoms of TMJ-OA in clinical studies(Lohmander LS, 1996). These cause less cartilage destruction and reduced fibrosis compared to traditional intra-articular injection of steroids(Shi ZD, 2002)。      
  5. Surgical treatment     Some TMJ-OA patients (20%) that undergo conservative or minimally invasive treatments still do not see an improvement in symptoms or functions, and some stage III OA patients (already with serous malocclusions, anterior open bit, mandibular retrusion, or asymmetry), must consider TMJ surgery(Mercuri LG,2007). Surgical options and decisions depend mainly on the responsiveness of patients on conservative treatments, mandibular shape and function, and the expected improvement on the patient's quality of life.       


Results of surgery vary among patients. Please consult your doctor.
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Results of surgery vary among patients. Please consult your doctor.