Temporomandibular syndrome. Prices for the treatment of pain dysfunction of the temporomandibular joint. Examination of patients with TMJ pain dysfunction syndrome

individual areas articular surfaces. Mechanical load in in this case- the cause of compensatory subchondral sclerosis of the end plates, which is the first sign of secondary osteoarthritis of the TMJ.

Temporomandibular joint dysfunction syndrome

Along with internal disorders in the joint, a pathology very often encountered in the practice of a dentist is called “temporomandibular joint dysfunction pain syndrome” (Costen syndrome, jaw arthropathy, pathological bite syndrome, musculofascial syndrome, masticatory myalgia, orofacial dyskinesia.).

First this term mentioned in the works of L. Schwartz (1959). Much attention This problem was addressed by P. M. Egorov and I. S. Karapetyan (1986), who in their monograph summarized 50 years of literary information and their many years of experience regarding the diagnosis and treatment of more than 500 patients with painful dysfunction of the masticatory muscles and TMJ. It becomes obvious that such great experience The work allowed the above-mentioned authors to consider the pain syndrome of TMJ dysfunction as an independent disease.

The pain syndrome of TMJ dysfunction must be understood as a number of extra-articular diseases that imitate the clinical picture of a diseased joint. This includes diseases of the masticatory muscles and extra-articular ligaments (myositis, myalgia, contracture, etc.). At the same time, there are no anatomical and morphological changes in the joint that are characteristic of internal disorders, arthritis or osteoarthritis. According to V. A. Khvatova (1998), this term can be used as preliminary diagnosis. Upon further examination, it should be changed to a specific disease of the TMJ or periarticular tissues (arthritis of the TMJ, arthrosis of the TMJ, various forms of internal disorders in the joint, acute or chronic injury to the masticatory muscles, diseases of the nerves of the face and jaws, diseases of the central nervous system etc.). Regardless of the functional and morphological disorders in the joint, in all of these cases, similar symptoms are observed: pain in the joint, masticatory muscles, ear, back of the head, facial pain, limited mouth opening, impaired lateral movements lower jaw, inability to chew food, noise in the ear, taste disturbances, dry mouth.

According to etiological factors, TMJ dysfunction can be:

1) myogenic;

2) occlusal;

3) articular;

4) neurogenic;

5) psychogenic;

6) mixed;

7) unknown etiology.

Myogenic dysfunction is associated with muscle diseases and manifests itself in the form of temporary or persistent contracture with varying degrees of myalgia. The cause of contracture or myositis can be a local injury to one of the masticatory muscles (including muscle injury during conduction anesthesia) or muscle groups for bruises or fractures of the lower jaw. The cause may also be overstrain of the patient’s masticatory muscles after forced long stay With open mouth during treatment or extraction of teeth, prolonged chewing of hard food, long-term immobilization of jaw fragments with bimaxillary splints.

Most common cause This pathology is a violation of occlusion, which occurs with changes in the dentition and TMJ (V. A. Khvatova, 1998). According to V.A. Khvatova, when drawing up a further treatment plan, it is necessary to keep in mind that, depending on the condition of the TMJ, 4 classes of occlusion can be distinguished.

1. Normal functional occlusion without disturbances in the TMJ. There are no complaints about the pathological condition of the organs

dentofacial system, despite the violation of closure

And the structure of the dentition and the position of individual teeth in the dental arch. This condition indicates the patient’s occlusal adaptation

And it can be considered adequate. To prevent muscle-joint dysfunction it is necessary timely recovery dental defects.

2. Eccentric violations of occlusion without or with violations of the topography of the elements of the TMJ.

The reason for the change in the topography of the articular heads in the articular cavities during central occlusion and their different mobility when opening the mouth are supercontacts. Their appearance is facilitated by violations of the occlusal surfaces due to tooth loss, dentoalveolar anomalies, an incorrectly formed shape of the chewing surface of fillings or artificial crowns of fixed and removable dentures.

In this situation, the displacement of the lower jaw when opening the mouth to one side is clinically determined. When unilateral chewing is formed (on any group of teeth), pain on the chewing side occurs due to compression of the articular tissues, and on the opposite side due to overextension. For elimination pain syndrome orthopedic or therapeutic correction of the dentition and occlusal surfaces with the elimination of muscle spasm is necessary.

3. Centric violations of occlusion with a violation of the topography of elements and morphological changes in the TMJ.

The reasons for this are end and included defects of the dentition, pathological wear of teeth, a decrease in the interalveolar distance in the manufacture of removable and fixed dentures, errors

V determining central occlusion. In the presence of pain syndrome of dysfunction, orthopedic treatment is necessary to restore central occlusion with radiological control of the topography of the elements of the TMJ. As a rule, at the first stage, temporary occlusal splints are made to help anatomical location articular head in the articular cavity. Subsequently, taking into account the correct topography, temporary prostheses are replaced with permanent ones. Before making occlusal splints, it is necessary to relieve painful muscle spasm using medications and FTL.

In the presence of centric occlusion and morphological changes

V joint (arthritis, arthrosis with synovitis, internal disorders in the joint accompanied by synovitis) at the first stage, the maxillofacial surgeon conducts an examination and medicinal treatment.

After eliminating the painful spasm of the masticatory muscles and inflammation in the joint, the topography in the TMJ is restored using orthopedic methods.

4. Unstable occlusion with progressive changes in the TMJ.

The most common cause is chronic systemic diseases joints. Clinically, this is manifested by a violation appearance, which is characteristic of microgenia. In the oral cavity, open bite, distal displacement of the lower jaw, asymmetry of occlusal contacts of the teeth on the right and left, decreased function of the lower jaw, and pain are determined. X-ray data confirm structural changes varying degrees. The above is typical rheumatoid arthritis and aseptic necrosis of the articular heads of unknown etiology. Treatment at the dentist, as a rule, does not give a positive result.

Articular causes of dysfunction of the masticatory muscles with varying severity of pain include inflammatory and dystrophic diseases of the TMJ. Degree functional disorders directly proportional to the degree of inflammation in the joint. Functional disorders of the TMJ and contracture of the masticatory muscles are more pronounced in acute arthritis or osteoarthritis with synovitis than in internal disorders of the joint.

When one of the TMJs is diseased, pain and contracture of the masticatory muscles manifest locally. Characteristic is a one-sided displacement of the lower

of the lower jaw towards the diseased joint when opening the mouth and limiting the lateral movements of the lower jaw in the opposite direction.

The influence of neurogenic and psychogenic factors on the development of pain dysfunction syndrome was mentioned back in 1948. H. G. Wolff experimentally proved that prolonged contraction of the masticatory muscles observed with emotional stress, can lead to pain not only in the TMJ area, but also in the facial area. Subsequently, more than once, the opinion about the influence of the nervous and mental systems on the state of facial and masticatory muscles was confirmed by clinical and experimental studies. Patients with the syndrome pain dysfunction TMJs are more susceptible to stress than healthy people. Chronic stress on the periphery it manifests itself in the form of parafunctions and bruxism, which in turn leads to a feeling of “fatigue” of the masticatory muscles, their spasm and pain syndrome. Row clinical observations clearly demonstrated the role mental factors in the development of the disease (P. Goodman, C. Greene, D. Laskin, 1979). After placebo treatment positive result was observed in 64% of patients with pain in the joint area.

TMJ pain dysfunction syndrome often occurs in people with normal occlusion and intact dentition. In these cases, obviously, the disease develops as a result of a violation of the complex neuromuscular mechanism that controls and carries out harmonious movements of the lower jaw. At the same time, for many people there is no pain even with a significant reduction in bite, complete loss teeth, severe deformation of the articular head. Consequently, pain in the TMJ area is the result not of one, but of a combination of the listed etiological factors.

Thus, occlusion, the supporting apparatus of the teeth, masticatory muscles and the temporomandibular joint form an interconnected functional unity; have stable self-regulation and are generally controlled by the central nervous system.

In case of discomfort in the joint area, the patient must rely on knowledge of the modern classification of TMJ diseases, the ability to conduct examinations and differential diagnostics. And only after confirmation of a certain disease should treatment begin; before this, treatment can be symptomatic, helping to reduce pain.

According to statistics, almost 20% of all visits to the dental clinic are associated with dysfunction of the temporomandibular joint (TMJ). The temporomandibular joint is the point of articulation between the temporal bones of the skull and the heads of the lower jaw. The TMJ is one of the most mobile joints in the human body. Approximately every 60 seconds, that is, when eating, talking, yawning or any other manipulation in which the jaws are involved, the joint begins to move.

TMJ dysfunction is pathological changes in jaw joint and facial muscles, which take part in all processes associated with jaw movement. In the structure of diseases associated with jaw pathologies, more than 80% is occupied by dysfunction of the temporomandibular joint (Costen syndrome, dysfunction of the lower jaw, TMJ myoarthropathy, etc.).

Treatment of TMJ dysfunction is always complex, since this disease is a multidisciplinary pathology and requires the participation of various specialists. Complex therapy usually includes:

• drug therapy;
• myogymnastics;
• physiotherapy;
• orthodontic, orthopedic and surgical treatment of dysfunction.

If you are looking for the best place in Moscow to get treatment for TMJ dysfunction, contact the Canadian Center for Innovative Dentistry and Neuromuscular Therapy. Experienced specialists will conduct comprehensive diagnostics, will determine the exact cause of the problem and help you quickly restore correct work muscles and joints of the jaw.

The combination of advanced technologies, deep scientific knowledge and many years of experience in the field of neuromuscular therapy allows our doctors to minimum term cope with even the most complex and difficult to diagnose cases.

Causes of TMJ dysfunction

The main reasons for the development of dysfunction of the lower jaw include articulatory-occlusal, myogenic and psychogenic disorders:

• malocclusion;
• jaw injuries (including birth injuries);
• dental defects;
• incorrectly performed prosthetics;
• pathological abrasion of teeth;
• various dental anomalies, which are accompanied by a decrease in the height of the alveolar process;
• bruxism;
• chronic microtraumas of the components of the TMJ;
• physical and neuropsychic stress, causing disruption of articular kinematics and function of the maxillofacial muscles.

Most researchers believe that the following negative factors underlie functional disorders of the temporomandibular joint:

• changes in the tone of the masticatory muscles;
• violation of occlusion;
• incorrect position of the jaws.

When the temporomandibular joint stops functioning normally, it affects all aspects of a person's daily life. TMJ dysfunction becomes the root cause constant pain and discomfort (first in the joint area, and then in the neck, shoulders and throughout the spine). If you do not start timely therapy, the condition will only get worse.

Therefore, at the first signs of dysfunction of the temporomandibular joint, you should immediately contact your dentist.

Symptoms of muscle-joint dysfunction

Temporomandibular joint dysfunction is quite difficult to diagnose because clinical symptoms similar to signs of many other diseases. Experts consider the following group of symptoms to be diagnostic criteria for muscular-articular dysfunction:

• sound phenomena in the TMJ area - crunching, clicking, popping in the joint that appears when chewing, opening the mouth, yawning and any movement of the jaw;
• blocking of the temporomandibular joint - restriction of joint movements when opening the mouth (to open the mouth wide, you first have to move the jaw from side to side);
• pain syndrome - pain of different nature in the area of ​​the jaw joint, face, shoulders and neck, in the ear area when chewing, opening the mouth wide, talking;
• difficulty chewing;
• swelling of the face on one side;
• dizziness, hearing loss, ringing in the ears, sleep disturbance, etc.

The symptom complex of TMJ dysfunction is very similar to clinical signs cervical osteochondrosis, trigeminal neuralgia, otitis media and many other diseases. Variety of symptoms and their similarity with others pathological conditions make it difficult to diagnose the disease. This is why many patients first turn to an otolaryngologist, therapist, neurologist or other specialized specialists and do not receive adequate treatment.

TMJ dysfunction requires a comprehensive examination and differential diagnosis. There is no need to steadfastly endure the pain caused by muscle-joint dysfunction, perceiving it as something inevitable. Come for a consultation with specialists at the Canadian Center for Innovative Dentistry and Neuromuscular Therapy, who will quickly provide comprehensive examination, establish the nature of the discomfort and prescribe adequate therapy.

Diagnostics

Symptoms of temporomandibular joint dysfunction may resemble the clinical manifestations of many other pathologies (diseases of the paranasal sinuses or teeth, arthritis, inflammatory diseases gums, etc.), so the dentist carefully studies the medical history and conducts a comprehensive clinical examination to accurately determine the cause of the patient’s symptoms.

Diagnosis of TMJ dysfunction includes:

• collecting a detailed medical history;
• palpation and auscultation of the temporomandibular joint for pain, the presence of sound phenomena (clicking, crunching when moving the jaw);
• assessment of the range of movements, the presence of “jamming” of the jaw when closing and opening the mouth;
• determining the type of bite and assessing the functionality of the facial muscles.

To assess the condition of the TMJ, an instrumental study is carried out:

• orthopantomography (full face overview shot, in which the specialist simultaneously sees the entire dental system, which makes it possible to diagnose various pathologies dentition, assess the condition of periodontal tissues, identify any abnormal changes in the temporomandibular joint, etc.);
• radiography, MRI or CT of the joint;
• rheoarthrography or Dopplerography - to determine arterial hemodynamics;
• electromyography;
• Gnathodynamometry.

Based on the results of the examination, the specialist decides to choose a treatment method that will most effectively cope with the problem. In some cases, conservative therapy is sufficient, but TMJ dysfunction may also require the intervention of maxillofacial surgery.

Treatment of TMJ dysfunction

Treatments for temporomandibular joint dysfunction range from simple recommendations on caring for the affected joint and prescribing conservative therapy before surgery. The treatment plan is drawn up individually in each clinical case and depends on the severity of symptoms and progression of the disease. But in all cases, therapy begins with sanitation oral cavity- treatment of periodontal disease, teeth, oral mucosa, correction of dentures.

During the entire period of the main treatment of TMJ dysfunction, patients are prescribed a gentle diet and limited speech load to reduce the load on the temporomandibular joint. Depending on the root cause of the development of the disease and the symptom complex, not only dentists of different specializations can take part in therapy, but also chiropractors, osteopaths, vertebrologists, psychotherapists, neurologists.

To relieve pain, drug therapy is prescribed - painkillers, sedatives, intra-articular injections and blockades. Special myogymnastics, physiotherapy, massage to relax the masticatory muscles are indicated.

Physiotherapy is an effective conservative method of treating muscle-joint dysfunction. The choice of technique depends on the clinical picture of the pathology, the results of electromyographic, radiological and other research methods, and patient tolerance medicines And physical methods impact.

For painful TMJ dysfunctions, it is quite effective to prescribe microcurrent therapy to the area of ​​the joint and masticatory muscles, as well as infrared magnetic laser therapy, electrophoresis, inductothermy, etc.

In addition, treatment of TMJ dysfunction includes (according to indications):

• selective grinding of teeth;
• correction of prosthetics or re-prosthetics;
• refilling;
• correction of malocclusion;
• wearing special orthopedic splints or mouth guards, as well as other methods aimed at restoring proper closure of teeth.

If the effect of conservative techniques There is no treatment for temporomandibular joint dysfunction; surgery is required. Operative therapy offers a number of effective treatment methods, including myotomy of the lateral pterygoid muscle, arthroplasty, condylotomy of the head of the mandible, etc.

Various orthodontic and orthopedic structures, for example, a simulated joint splint. This design relieves the temporomandibular joint, eliminates pain and creates conditions for the articular head to occupy correct position. These splints are designed for daytime wear; they cause virtually no discomfort and allow a person to communicate freely without experiencing pain or muscle tension.

Specialists at the Canadian Center for Innovative Dentistry and Neuromuscular Therapy use the most advanced techniques to treat temporomandibular joint dysfunction. latest developments in the field of conservative therapy and resort to surgical treatment only in as a last resort. An integrated approach allows our doctors even the most complex cases TMJ dysfunction is treated in short term while achieving the best results.

Treatment for TMJ dysfunction is, without a doubt, mandatory and necessary. This problem cannot be neglected because further development the disease is fraught with the occurrence severe complications- dystrophic changes in the temporomandibular joint and even its complete immobilization (ankylosis). An integrated approach and combination of treatment methods guarantee a positive result.

The Canadian Center for Innovative Dentistry and Neuromuscular Therapy is one of the most progressive dental clinics in Moscow. Competent approach, application latest technologies and developments in the field of neuromuscular dentistry make it possible to quickly eliminate all manifestations of TMJ dysfunction and restore normal, adequate functioning of the dental system.

If you are concerned about musculo-articular dysfunction of the TMJ, it is best to undergo treatment at the Canadian Center for Innovative Dentistry and Neuromuscular Therapy in Moscow.

Don't skimp on your health! Contact the professionals!

What does the diagnosis mean: TMJ dysfunction?

The TMJ is the temporomandibular joint, located in front of the ear, consisting of the temporal bone and the lower jaw. Muscles that perform the functions of chewing, swallowing and speech connect the lower jaw to the skull. It is this apparatus that allows our jaw to move left and right, open and close the mouth, and extend the lower jaw. It works correctly when the lower jaw moves synchronously in the joint on both the right and left - this is a symmetrical organ, therefore, if the work of one of them malfunctions, the work of the second also fails. TMJ diseases develop when the lower jaw moves during opening and closing of the mouth and other movements of the lower jaw.

TMJ dysfunction is a violation of the coordinated activity of the temporomandibular joint due to changes in the bite, the relative position of the elements of the TMJ and muscle function.

The varied clinical manifestations in patients with TMJ dysfunction and the lack of clear diagnostic criteria lead to the fact that for many years patients turn to various specialists: otorhinolaryngologists, neurologists, orthopedic dentists, therapists, and do not receive adequate treatment. Unfortunately, the lack of continuity between doctors of different specialties makes diagnosis difficult.

TMJ dysfunction is a multidisciplinary pathology, so its solution often requires the joint efforts of specialists in the field of dentistry, neurology, and psychology.

Typical symptoms of TMJ dysfunction are:

• Pain or tenderness in the face, jaw joints, neck and shoulders, in or near the ear when chewing, talking, or opening the mouth wide
• Limitation of mouth opening amplitude
• Locking (“jamming”) of the jaw in an open or closed position
• Clicking, cracking, or grinding sounds in the jaw joint when opening and closing the mouth (sometimes accompanied by pain).
• Facial muscle fatigue
• Difficulty chewing or a sudden “uncomfortable” bite (a feeling that the upper and lower teeth do not fit together correctly).
• Swelling on one side of the face

Causes of TMJ dysfunction

The main theories of the occurrence of TMJ dysfunction include occlusal-articulatory, myogenic and psychogenic.

According to the occlusal-articulatory theory, the causes of TMJ dysfunction lie in dentoalveolar disorders, which may be caused by defects in the dentition, pathological abrasion teeth, jaw injuries, malocclusion, incorrect prosthetics, various anomalies of the teeth and jaws, accompanied by a decrease in the height of the alveolar process.

Removal of one or more teeth, overestimation of fillings, irrational dental prosthetics and other reasons can provoke the appearance of pain, which sometimes occurs on the 10-12th day after treatment at the dentist. The intensity of pain in such patients usually increases when chewing and there is a pronounced limitation in the mobility of the lower jaw, often forcing them to switch to pureed and liquid food.

According to the myogenic theory, the development of TMJ dysfunction is facilitated by disturbances from the jaw muscles: tonic spasm, mechanical overload of the masticatory muscles, etc., caused by a unilateral type of chewing, bruxism, bruxomania, professions associated with heavy speech load, which ultimately leads to chronic microtrauma of the elements of the TMJ.

The psychogenic theory considers the etiopathogenesis of TMJ dysfunction, based on the fact that the factors initiating TMJ dysfunction are changes in the activity of the central nervous system (neuro-mental and physical stress), causing disturbances muscle functions and violation of joint kinematics.

According to most researchers, TMJ dysfunction is based on a triad of factors: violation of occlusion, spatial relationships of TMJ elements, changes in the tone of the masticatory muscles. Factors predisposing to the occurrence of TMJ dysfunction are the anatomical prerequisites for the structure of the joint, mainly the discrepancy between the shape and size of the articular head and the articular fossa.

The classic symptom complex of TMJ dysfunction, described by J. Costen, is characterized by dull pain in the area of ​​the temporomandibular joint; clicking in the joint while eating; dizziness and headache; pain in the cervical spine, back of the head and ears; tinnitus and hearing loss; burning in the nose and throat.

Currently diagnostic criteria The following groups of symptoms are considered to be TMJ dysfunction:

1. Sound phenomena in the temporomandibular joint. The most common complaint of patients with TMJ dysfunction is clicking in the joint that occurs when opening the mouth, chewing, or yawning. Sometimes the clicking noise can be so loud that people around you can hear it. However, pain in the joint is not always present. Other noise phenomena may include crunching, crepitation, popping sounds, etc.

2. Blocking (“locking”, “jamming”) of the temporomandibular joint. It is characterized by uneven movement in the joint when opening the mouth. That is, in order to open the mouth wide, the patient must first grasp the optimal position of the lower jaw, move it from side to side, finding the point where the joint “unlocks”.

3. Pain syndrome. With TMJ dysfunction, pain is determined in trigger points: masticatory, temporal, sublingual, cervical, pterygoid, sternocleidomastoid, trapezius muscles. Headaches, earaches, toothache, pressure and pain in the eyes. Pain syndrome due to TMJ dysfunction can mimic trigeminal neuralgia, cervical osteochondrosis, TMJ arthritis, otitis media and other diseases.

4. Other symptoms. With TMJ dysfunction, dizziness, sleep disturbance, depression, bruxism, dysphagia, noise or ringing in the ears, xerostomia, glossalgia, paresthesia, photophobia, snoring, sleep apnea, etc. may occur.

Diagnosis of TMJ dysfunction

The variety of clinical manifestations of TMJ dysfunction leads to diagnostic difficulties, so patients can be examined for a long time by a neurologist, otolaryngologist, therapist, rheumatologist and other specialists. Meanwhile, patients with TMJ dysfunction require joint cooperation between a dentist and a neurologist.

During the initial examination of the patient, complaints, life history and illness are clarified, palpation and auscultation of the joint area is performed, and the degree of mouth opening and mobility of the lower jaw is assessed. In all cases, impressions are taken for subsequent production of diagnostic models of the jaws, and occludograms are performed.

To diagnose muscular-articular dysfunction of the temporomandibular joint, it is necessary to carry out: clinical, anthropometric, electromyographic examination methods. It has been established that changes in the electrophysiological properties of the masticatory and lateral pterygoid muscles are the triggering point in the development of temporomandibular joint dysfunction. With muscular-articular dysfunction of the temporomandibular joint, functional change in the masticatory group of muscles of the occlusal and gnathic type.

The method of anthropometry of the facial skeleton makes it possible to identify among patients with muscular-articular dysfunction of the TMJ 42% of subjects with relatively symmetrical dimensions of the body and branches of the lower jaw (complaints of a “clicking” joint) and 58%) with unilateral shortening of the body of the lower jaw on the side of the complaints on average by 0.7 cm (complaints from the masticatory muscles).

To assess the condition of the temporomandibular joint, orthopantomography, ultrasound, radiography of the TMJ, and computed tomography of the TMJ are performed. In order to identify damage to the periarticular soft tissues, MRI of the TMJ is indicated. Arterial hemodynamic parameters are determined by Dopplerography or rheoarthrography. From functional studies in TMJ dysfunction highest value have electromyography, phonoarthrography, gnathodynamometry.

TMJ dysfunction should be distinguished from subluxations and dislocations of the lower jaw, arthritis and arthrosis of the TMJ, fracture of the articular process, synovitis, hemarthrosis, etc.

During the period of primary treatment, patients with TMJ dysfunction need to reduce the load on the temporomandibular joint (eating soft foods, limiting speech load). Depending on the reasons and associated violations, may be involved in the treatment of TMJ dysfunction various specialists: dentists (therapists, orthopedists, orthodontists), chiropractors, vertebrologists, osteopaths, neurologists, psychologists.

To eliminate the pain syndrome accompanying TMJ dysfunction, pharmacotherapy (NSAIDs, antidepressants, sedatives, botulinum therapy, blockades, intra-articular injections of glucocorticosteroids), dosed myogymnastics, massage, physiotherapy (laser therapy, inductothermy, electrophoresis, ultrasound, etc.) is indicated. Important elements complex therapy Psychotherapy and biofeedback therapy can be used to achieve functional relaxation of the masticatory muscles.

Dental treatment of TMJ dysfunction, according to indications, may include measures aimed at recreating the correct closure of teeth (selective grinding of teeth, removal of over-inflated fillings, competent prosthetics or re-prosthetics, etc.). To correct malocclusion, treatment is carried out using braces. In some cases, orthopedic and orthodontic treatment of TMJ dysfunction with non-removable devices is preceded by wearing orthopedic splints or mouthguards.

If conservative therapy for TMJ dysfunction fails, surgical intervention may be required: myotomy of the lateral pterygoid muscle, condylotomy of the head of the mandible, arthroplasty, etc.

To achieve success in the treatment of TMJ dysfunction, a set of measures is required: orthodontic treatment to correct the bite, surgery, dental retreatment, prosthetics, physiotherapeutic procedures, acupuncture.

According to indications, the doctor may prescribe nightly wearing of a trainer - a joint splint (TMJ, TMD), with the help of which myofascial pain syndrome is relieved. It can be used both for diagnosis and to prevent tooth wear due to bruxism.

Forecast and prevention of TMJ dysfunction

Treatment for TMJ dysfunction is mandatory. Neglecting this problem can be fraught with the development of degenerative changes (arthrosis) and immobilization of the temporomandibular joint (ankylosis). Complex treatment TMJ dysfunction, taking into account etiological factors, guarantees a positive result.

Prevention of TMJ dysfunction requires reducing the level of stress and excessive loads on the joint, timely and high-quality dental prosthetics, correcting the bite, correcting postural disorders, and treating bruxism.

VIDEO: TMJ dysfunction

Causes of TMJ dysfunction. Treatment of TMJ Dysfunction

What is temporomandibular joint dysfunction? This question interests many people. Problems with teeth are not uncommon for humans, problems with joints are also common, but there is a disease that combines these two types - temporomandibular joint dysfunction. This diagnosis is one of the most unstable, and treatment depends on the symptoms. More than half of all dental visitors complain about this disease, and this is not surprising, since latest research, approximately 58% of people suffer from some form of it.

Moreover, dysfunction is common in children, affecting approximately 23% of people under 18 years of age.

There are a lot of clinical manifestations of this disease, and treatment is complicated by the fact that the disease is polyetilogical, that is, it can be caused by either one or a number of factors.

Features of the disease

Diagnosis is quite complex, as is treatment, which can take several months. But the sooner treatment begins, the easier it is to stop pathological changes in the lower jaw joint and the easier it is to find the underlying causes, so you should never delay it.
Oddly enough, the most popular reason that can cause dysfunction of the TMJ joint is stress.
The second most popular reason for the development of TMJ dysfunction is the negligence or lack of experience of the dentist. The disease can be caused by unsuccessful dental treatment, but in most cases the dentist is not to blame; the blame goes to the patient who did not accurately follow the procedures and restrictions prescribed to him during the rehabilitation period after any intervention.
If we consider the doctor’s mistakes, then they include the incorrect installation of a chewing tooth filling, which causes asymmetry. Of course, it may be a couple of millimeters, but from that time on the joint is affected during chewing. increased load, due to which it is destroyed or displaced faster, and only after this does TMJ dysfunction begin.
In addition, there is a list of popular reasons:

1. Injury to the joint, such as a strong side impact that can dislodge a disc.
2. In cases where a session with a dentist lasts more than 3 hours without breaks. A constantly wide-open mouth compresses the discs.
3. If teeth have been lost and not replaced with implants. Thus, a person’s bite is reduced. To survive food, you have to do a lot of rotational movements, which is why the discs are rapidly developed.
4. Teeth grinding or clenching.
5. Clenching of teeth and cheekbones when lifting heavy weights.
6. Hormonal and contraception may negatively affect discs and joints, including the TMJ.

The list can be continued indefinitely, since there are also individual problems each person, but in any case they are interconnected with those given above.
Dentists, therapists, neurologists and other doctors try to avoid treating such patients, and if they provide care, it is not of high quality, and the patient has to go from one doctor to another, from one treatment room to another, but the problem does not go away.
In the USA, insurance companies pay the most money specifically for the treatment of jaw joint dysfunction, and the number of patient requests is simply colossal.

Symptoms that appear with temporomandibular joint dysfunction:

1. With a disease of the temporomandibular joint, sounds may be heard different sounds and clicks. This is the most common symptom, which with 100% accuracy indicates a violation of the TMJ. These sounds can be either insignificant or so loud that they can be heard nearby. standing people. Clicking occurs during wide opening of the jaw, excessive clenching of teeth, and while eating. This all means that the disc has shifted and during the click it returns to its place, but at the same time the muscles are overly tense, as a result of which headaches and toothaches appear.
2. Headache. Of course, they occur in everyone various reasons, but it can also be a symptom of TMJ. In this case headache will be localized in the temples, back of the head and, in rare cases, in the neck and shoulder blades. To test what a headache indicates, it will be enough to clench your jaw tightly, and if the pain intensifies at this moment, then the chance of TMJ increases significantly. But often, along with this symptom, teeth grinding appears, especially during sleep. The pain can be either mild or very severe, which doctors often confuse with migraine.
3. Pain dysfunction. This means that the disc flew out while the jaw was closed or wide open, and the muscles cannot put it back in place; in this position, the person cannot move the jaw due to severe pain.
4. TMJ locking. During the disease, jaw movements may cease to be smooth and there is a feeling that the movement is happening as if on rusty gears. That is, in jerks, and with each jerk there is a click.
5. A person's bite changes. This happens because, as the disc itself displaces, it also displaces the bone.
6. Infringement facial nerve, which can cause both severe pain, and paralysis of the facial area until the nerve can be released.
7. Symptoms can also radiate to the ears. Since the joint is located in close proximity to the ears, dysfunction in it can cause ear problems, ranging from ordinary pain, ending with hearing loss, but if you consult an ENT specialist in time, these symptoms can be quickly removed.
8. Inflammatory processes. Swelling may begin at the site of the lesion, body temperature rises and malaise is felt.

Treatment of the disease

There is no treatment as such, so first there is long period, during which the patient is checked for all possible factors that caused the disease.
If symptoms are detected, they should be removed immediately. This period may last a couple of months.
The joint itself is treated with a rather primitive method and only during the period of maximum inflammation, since at this time the disc has come out, the muscles are relaxed, as a result of which everything can quickly be put in its place.
After the doctor puts the jaw into place, it must be secured with a special bandage to prevent it from falling out again. In the coming days, eating any solid food is prohibited, you need to talk less, and these bandages will prevent you from yawning and the like.

Dysfunction of the temporomandibular joint in dentistry is called differently - Costen's syndrome, muscular-articular dysfunction, TMJ myoarthropathy, etc. In essence, this anomaly is a malfunction, impaired coordination of this joint and accompanying symptoms. Medical statistics are disappointing - according to research results, at least 80% of the world's population are faced with one or another manifestation of TMJ muscle-articular dysfunction.

This is due to the fact that the temporomandibular joint is one of the most actively involved joints in the entire body. The TMJ takes part in the act of swallowing, is involved in diction, and is “turned on” when yawning and chewing food. Moreover, this joint has a specific anatomy (the head does not match the size of the fossa), because of this the TMJ is especially susceptible to traumatic damage due to any careless movements of the head (jaw).

Why is there a problem?

TMJ dysfunction in modern dentistry is explained by 3 groups of factors:

• occlusal-articulatory ( increased abrasion tooth enamel, dentition defects, mechanical injuries, damage, malocclusion, medical errors during prosthetics, low position of the alveolar ridge, congenital anatomical abnormalities of the jaw or teeth);
• myogenic (hypertonicity, incorrect work muscles of the face and neck, bruxism, increased speech load, habit of chewing food only on the left or right side);
• psychogenic (malfunctions in the central nervous system, which lead to overstrain of individual muscles and organs).

The course of the disease is accompanied by a host of different manifestations - from pain in the affected joint (or both) to jamming of the jaw, deterioration of vision and hearing.

The syndrome of painful dysfunction of the TMJ is accompanied by a complex of problems - a violation of occlusion, muscle tone of the jaw and an incorrect relationship between the elements of the joint in space.

Signs

Symptoms of TMJ dysfunction vary from person to person and depend on the cause of the disorder. Classic manifestations of pathology are:

• pain in the joint (or both) of an aching, pulsating nature, which radiates to the back of the head, extends to the ear, neck, lower jaw;
• crunching, clicking in the TMJ when chewing, while talking, yawning or other jaw activity (sometimes these sounds are heard not only by the “victim” of dysfunction, but also noticeable to others);
• dizziness, migraine;
• TMJ pain dysfunction syndrome is characterized by stiffness, limited range of motion of the joint(s), the patient, as a rule, is not able to fully open his mouth;
• rapid fatigue of the facial muscles;
• lump in the throat;
• toothache of unknown localization;
• discomfort in the neck and shoulder area;
• noise, ringing in the ears, hearing loss;
• spasms of the facial muscles (suddenly the jaw tightens);
• swelling, facial asymmetry;
• “jamming” of the joint - in order to open the mouth, a person is forced to look for a suitable position of the head.

The following signs may indirectly indicate temporomandibular joint dysfunction syndrome: snoring, insomnia, depressive states, photophobia, blurred vision, problems with coordination.

The causes of the pathological phenomenon can lie both in dental diseases and lie in the neurological, psychological plane

Important! Pain in the temples and jaw with TMJ dysfunction is not always present. As a rule, it indicates the development of a local inflammatory process (arthritis) or indicates muscle spasms.

Diagnostics

The vagueness of signs of TMJ dysfunction complicates the diagnosis. Many patients with joint dysfunction are sent for consultation to the wrong specialist (for example, to a neurologist, because clinical picture malfunction of the TMJ is similar to trigeminal neuralgia). In order to get a complete picture of the causes, course, form, stage of the disease, the diagnosis should be carried out by a dentist who:

• examines and evaluates the condition of the lower jaw and dentition units;
• palpates the affected area, determines whether there are clicks or crunches during joint movements;
• compiles anamnesis;
• if indicated, performs arthroscopy (examines the condition of the elements of the TMJ using special apparatus– arthroscope).

The list of modern methods for diagnosing temporomandibular dysfunction also includes ultrasound, X-ray, MRI, Dopplerography, phonoarthrography (necessary for detecting extraneous sounds in the joint).

Solution

Due to the fact that most patients seek medical care for late stages pain dysfunction, treating this pathology can be quite problematic. Before going to the dentist for symptoms of TMJ problems, there are some therapeutic measures you can take at home:

• apply a warming or, conversely, cooling compress for 15 minutes;
• on the advice of a doctor, take a painkiller tablet (Ibuprofen, No-shpy);
• reduce functional load on sore joints (refuse to eat hard, difficult-to-chew foods, maintain a gentle speech regime);
• master the technique of relieving muscle spasms, meditation to eliminate psychogenic causes of problems of the temporomandibular joints.

Treatment of temporomandibular joint dysfunction in dental office involves: osteopathy, massage, gymnastics and physiotherapeutic procedures to relieve spasms of the facial muscles. IN mandatory patients are prescribed symptomatic drug therapy (painkillers, anti-inflammatory drugs of systemic and local action).

Arthrosis, arthritis, dislocation, subluxation - this is not a complete list of problems that arise in the TMJ due to its increased traumatic nature

Other medicines:

• antidepressants;
• sedatives;
• intra-articular injections of glucocorticosteroids (hormones);
• botulinum therapy.

If the “culprit” for problems with the jaw joints is an incorrect bite, the main method of treatment in this case is wearing braces or other orthodontic structures (especially in adolescence). Another effective way to combat jaw jamming - physiotherapeutic procedures. The most popular of them are: inductothermy, ultrasound, laser exposure and electrophoresis.

Treatment of TMJ dysfunction involves the fight against caries or extraction of affected dental units, acupuncture, and in severe cases, surgical intervention (condylotomy of the articular head, arthroplasty, myotomy of the lateral pterygoid muscle). In most clinical cases, even long-term wearing of a fixation splint allows you to get rid of discomfort in the joint and jaw area, relieve pain and eliminate other symptoms of TMJ dysfunction.

Important! This therapy also helps eliminate bruxism (teeth grinding) and prevent its dental consequences.

The first medical measure for patients with TMJ dysfunction is pain relief. Treatment includes not only taking medications, but also wearing special jaw plates and applying a neck brace. Do not forget about psychocorrection - this will lead to leveling out most of the symptoms of the pathological phenomenon and will allow you to relieve muscle clamps, increase the mobility of the “affected” joint.

Untimely treatment of the pathology (or lack thereof) is fraught with constant headaches, problems with vision and hearing, and complete immobilization of the lower jaw

Prevention and prognosis

With absence timely treatment Problems with the functioning of the TMJ can lead to serious consequences:

• complete immobilization of the lower jaw;
• hearing loss, vision impairment;
• constant migraines, muscle pain.

To prevent pathology, it is recommended to place adequate loads on the masticatory apparatus, place fillings and dentures in a timely manner, and, if indicated, wear orthodontic structures to correct the bite. If medical assistance was provided on time, the treatment of TMJ dysfunction, although long and difficult, was still successful.

Important! Correction of posture and elimination of stress factors play an important role in the fight against pathology.

So, malfunctions in the temporomandibular joint can be caused by both dental and neurological, psychogenic factors. TMJ dysfunction is difficult to diagnose, as it is often “masked” as other diseases. With timely medical care ( dental treatment, symptomatic drug therapy, physiotherapy and surgical intervention) the prognosis for patients with this problem is favorable.