Dysfunction of the temporomandibular joint treatment. Treatment of inflammation of the temporomandibular joint caused by rheumatic diseases. Diagnosis and treatment of TMJ dysfunction

This is a pathology of the facial muscles, lower jaw and the joint connecting it to the skull.

The danger of this disease is that patients do not immediately come to see to the right doctors, mistakenly believing that their problems relate to other areas of medicine.

The first definition of the disease was given by James Kosten, an otolaryngologist from the USA, who in the thirties of the twentieth century was the first to draw attention to the connection between middle ear pain and jaw pathologies in his patients.

In honor of him, the disease is called “Costen syndrome”.

Other names based on the main symptom are TMJ myoarthropathy.

The TMJ is one of the most complex joints in the human body. It consists of two mirror halves that work as one, providing the jaw with several degrees of freedom: the ability to open and close the mouth, longitudinal movement, and rotation of the jaw.

This is one of the most loaded joints of the body; it is involved in breathing, yawning, chewing, swallowing, facial expressions, and conversation.

The syndrome of painful dysfunction of the TMJ is caused by changes in the location of its various parts, muscle dysfunction, and the closure of teeth. The pathology is widespread; it is estimated that up to 75% of people visiting dentists experience it in one form or another.

The code according to ICD 10, the international classification of diseases, for TMJ disorders is K07.6.

For joint dysfunction in this classification the number K07.60 is provided.

Why does this disease occur?

Factors causing temporomandibular joint dysfunction syndrome are divided into three groups:

Myogenic, associated with muscle dysfunction. Increased tone, spasms, straining, using only one side of the mouth when chewing. This group includes bruxism - teeth grinding during sleep, excessive conversational load, as in lecturers, announcers, and actors.
Occlusal-articulatory, caused by pathologies of the dentofacial apparatus. These are bite defects and poor-quality prosthetics. The cause of problems may be the removal of a tooth or several, or a filling placed by the dentist that is too high.
Psychogenic, caused by disruption of the central nervous system. TMJ dysfunction can be triggered by mental stress that impairs muscle coordination.

Also, the reasons for the development of this disease can be congenital; this usually happens when the head of the jaw bone does not fit the socket on the temporal bone.

Such problems appear in childhood or adolescence. In case of juvenile dysfunction, to exclude possible complications- recommended surgical intervention.

The bilateral structure of the articulation leads to the fact that when joint dysfunction appears on the left, soon, due to a change in the functioning of the left node, it appears on the right, or vice versa.

How is it diagnosed?

Diagnosis of temporomandibular joint pain dysfunction syndrome is complicated by a wide range of external signs accompanying the disease.

Instead of the necessary dentist-orthodontist and neurologist, a person with TMJ dysfunction tries to be cured by an ENT specialist, a rheumatologist, a regular therapist, and others.

Primary diagnosis consists of taking anamnesis - listening to the patient’s complaints, finding out the medical history.

After that:

The jaw joint is palpated and auscultated. In addition to listening with a stethoscope, phonoarthrography is used to visualize intra-articular noise.
The doctor measures the width of the mouth opening and the limits of free movement of the joint.
Gnathodynamometry is performed to measure chewing force.
Mock-ups of the jaws are made to build a diagnostic model.
A wax occludogram is taken to locate the area where the teeth are closing too early.
To examine the joint with bones, X-rays, CT and ultrasonography.
The condition of nearby soft tissues is assessed using MRI results.
To identify problems with the blood supply, Dopplerography or rheoarthrography of the vessels supplying the joint is performed.
Electromyography is performed to assess muscle functionality.

When conducting differential diagnosis, Costen's syndrome is differentiated from a fracture of the bone process, arthritis, arthrosis, hemorrhage in the joint, inflammation of its contents, and other diseases.

Symptoms and signs

Signs that manifest TMJ dysfunction are divided into three groups:

Pain syndrome. Muscle pain appears not only in the masticatory and temporal muscles, it can occur in the cervical, thoracic, and even spinal muscles. Frequent ear and toothache. Painful sensations can disguise TMD as neuralgia, osteochondrosis, inflammation of the joint or ear, and other diseases.
Joint jamming. To open your mouth, you first have to look for the position of the jaw in which this will be possible, moving it back and forth and left and right. This movement causes the jaws to appear twitchy.
Extra sounds in the joint. Patients with TMJ dysfunction report clicking, squelching, and creaking sounds when moving the jaw. Sometimes they can be heard by the doctor even without a stethoscope. The sounds may be accompanied by unpleasant sensations or occur without signs of pain.

In addition to the symptoms included in these three groups, TMD can mimic nervous breakdown with symptoms such as migraine, insomnia, depression.

Dizziness and tinnitus can also be a consequence of joint dysfunction. Grinding of teeth during sleep, apnea and snoring are noted.

Sometimes the secretion of saliva is disrupted, causing a lack of saliva and an inflamed tongue.

Treatment method

Because of unclear picture diseases when it is disguised as other disorders, TMD is more often diagnosed in later stages development. This makes treatment very difficult.

Only a specialist can carry out the therapy necessary to treat temporomandibular joint pain dysfunction syndrome, but you can relieve unpleasant symptoms at home.

For this:

Use warm or cold compresses. The temperature should remain within reason and not cause injury. skin. The maximum time for applying a compress is fifteen minutes, but it can be repeated after a few hours.
At severe pain drink over-the-counter analgesics, nonsteroidal anti-inflammatory drugs, and herbal remedies. Before using them, you should refer to the instructions and take into account contraindications.
To put less strain on the affected joint, you should switch to a softer diet, eliminating foods that require effort to bite or chew.
Self-massage of the jaw is performed. Meditation and other relaxation techniques also help relieve muscle tone.

But folk painkillers and anti-inflammatory decoctions will only relieve pain and swelling, and will not restore the proper functioning of the joint; treatment of TMJ dysfunction occurs when you consult a doctor.

The procedures that make up the therapy are carried out by a dentist, chiropractor, physical therapist, oral surgeon and other doctors.

After examination and diagnostic testing, depending on the form and degree of the disease, the following are prescribed individually or as part of complex therapy:

Exercises for facial muscles, manual therapy, therapeutic massage.
Painkillers, anti-inflammatory drugs, muscle relaxants. Medicines are prescribed both in tablets for oral administration and in the form of ointments or balms.
If TMD is caused nervous symptoms a short course of tranquilizers may be prescribed.
If the disorder is of a nervous nature, consultation with a psychologist and the use of psychotherapy and biofeedback therapy are advisable. This will teach you ways to deal with the causes of muscle spasms without outside help take them off.
In addition to medications, bandages and bandages are used to relieve pain, taking on the excess load on the neck, jaw and joint.
An orthopedic splint, dental guard or jaw plate reduces the load on the TMJ and protects the teeth from abrasion during sleep.
Bite correction is used with braces, aligners, and orthodontic aligners.
It may be necessary to remove a wisdom tooth or other tooth that interferes with the normal closure of the jaws.
The opposite situation also occurs, in which prosthetics are indicated. In some cases they get around machining tooth or an incorrectly installed filling. In any case, without proper distribution of the load across the masticatory apparatus, recovery is impossible.
Electrophoresis or ultraphonophoresis is used to deliver drugs to a diseased joint; inductothermy or microwave therapy is used to relieve inflammation and reduce the severity of pain.
Also applicable laser therapy, acupuncture, as well as other methods of physiotherapy.

When conservative methods is not enough, surgical intervention is used. Myotomy is used to correct the function of the masticatory muscles.

Endoscopic arthroscopy and arthrocentesis are used to reshape the joint or head of the jawbone. Through an incision in the ear area, or a direct puncture, a miniature video camera with tools for correcting the shape and location of joint elements is inserted into the joint capsule. If necessary, excess liquid is removed from the cavity.

In case of tumors or injuries of the joint capsule, operations are performed on an open joint.

Recovery after endoscopic surgery several times faster than after the classic one.

Preventive measures and prognosis

It is easier to prevent any disease than to treat it; the basis for the prevention of muscle-joint dysfunction is regular preventive examinations by a dentist and neurologist.

You should also:

Avoid stress and unnecessary nervous tension.
Treat caries, pulpitis, periodontal inflammation, etc. in a timely manner infectious diseases oral cavity, nasopharynx, throat.
Replace lost teeth with dentures, remove problematic figure eights, correct bite.

If the disease does manifest itself, therapy is necessary.

Ignoring symptoms and refusing medical care lead to loss of mobility of the lower jaw, up to complete ankylosis, dysphagia - difficulty swallowing, deafness, constant headaches, wear of the dental apparatus and other unpleasant diseases.

TMJ dysfunction syndrome is usually detected in advanced stages and because of this, treatment is quite long, but usually ends in complete success, the return and preservation of all functions of the joint.

The most common reasons

Injuries, which are divided into microtraumas and macrotraumas.

Microtraumas are internal injuries and are provoked by diseases such as teeth grinding (bruxism) and jaw subsidence. Macrotrauma, such as a blow to the jaw or impact to the jaw due to an accident, can break the jaw, cause TAD, or damage the cartilage disc of the joint.

Long dental procedures. In these cases, it is advised to simply massage the area of pain and let the jaw rest;
Diseases such as osteoarthritis and rheumatic arthritis can cause VNS;
wear and tear due to aging;
bad habits, for example, bruxism (teeth grinding);
decreased bite height due to the loss of some teeth;
excessive loads while playing sports.

Causes of pathology

Head or neck injuries, e.g. severe bruises which lead to displacement of the intra-articular cartilaginous disc;
bruxism – spontaneous night rattle teeth;
malocclusion or missing teeth;
low-quality dentures or fillings that are too high;
one-sided type of chewing food;
a state of stress in which a person tenses his facial muscles and clenches his teeth;
rheumatoid arthritis, osteoarthritis and other diseases.

Uneven teeth (misocclusion), missing teeth, and errors in orthopedic or orthodontic treatment

Incorrect way of swallowing, in which the lower jaw moves backward

Myofunctional habits such as bruxism or teeth clenching, mouth breathing

Overload of joints as a result of stress or during athletic sports

JAWS

Incorrect jaw alignment

Injuries, such as from a car accident

Specific diseases, such as arthritis

There are currently several theories regarding what causes temporomandibular joint dysfunction. Most experts agree that some individual characteristics its structure in humans can act as prerequisites for dysfunction.

More often we're talking about about cases when the shape and size of the glenoid fossa do not correspond to the same parameters of the head.

It is believed that the basis of TMJ dysfunction is a complex of the following factors:

changes in the tone of the masticatory muscles;
spatial relationships of elements;
broken occlusion.

There are three main theories of the origin of pathology: occlusal-articulatory, myogenic, psychogenic.

According to the first dysfunction, TMJ can be caused by the following phenomena:

dental defects;
malocclusion;
pathological abrasion of teeth;
anomalies characterized by shortening of the alveolar process;
mechanical injuries;
violation of the technology for installing prostheses and dental structures.

As for the second group of factors, they include:

tonic muscle spasm;
overload of the masticatory muscles (which results from unilateral chewing, disruption of the structure of the teeth or their absence on one side);
Bruxomania - grinding of teeth during periods of wakefulness;
bruxism - night grinding of teeth;
professional activity associated with increased speech loads.

According to the psychogenic theory, neuropsychic tension and stress lead to disruption of muscle function and joint movement.

The main reasons predisposing to the formation of dysfunction are the following: any violation of occlusion, anatomical features joint structure, consisting in discrepancy in size articular head and pits.

Bruxism is not only a symptom, but also a cause of dysfunction of the temporomandibular joint. By constantly grinding our teeth and clenching them tightly, we injure the jaw cartilage.

Symptoms of TMJ dysfunction

With TMJ disease, you may feel your jaw clicking or crunching when chewing. Acute or aching pain in the joint also appears, which subsides over time or lasts for several years.

Other symptoms:

pain in the facial area, near the neck or ear, which intensifies when chewing;
discomfort and difficulty opening the mouth;
sudden blocking or clamping of the jaw in one position;
overstrain of facial muscles;
a feeling of “uncomfortable” bite when the teeth on the upper and lower rows do not fit together correctly;
swelling of one side of the face.

At later stages, headache and dizziness, tinnitus, and discomfort in the shoulder area appear. Associated symptoms such as snoring, sleep disturbance, depression, and difficulty swallowing are also possible.

There are a wide variety of symptoms of TMJ dysfunction, some of which can be easily confused with the clinical picture of other diseases. Most characteristic features joint dysfunctions are as follows:

Dysfunction of the temporomandibular cartilage can have a large and varied number of manifestations. Discomfort affects not only the joint itself.

It passes into the ear, occipital, and facial areas. The teeth begin to suffer.

There are no nerves in the cartilage layers themselves, so they do not hurt on their own. However, the pain extends far beyond this joint.

Diagnosis of TMJ dysfunction

During the initial examination, the dentist finds out the patient’s complaints and palpates the joint area. It is also important to assess the amplitude (degree) of mouth opening. Instruments are used to measure the nature of the work of the head muscles under different conditions.

Typically, diagnosis involves taking impressions to make plaster models of the jaw. This makes it possible to identify disturbances in the functioning of the jaw system, including improper occlusion (closing of teeth).

IN in some cases Computed tomography, MRI, and ultrasound of the jaw are prescribed.

It often happens that disorders of the jaw joint are associated with unsuccessful prosthetics or difficult removal teeth. Then pain dysfunction appears only 10-12 days after the procedure.

TMJ dysfunction is characterized by many various signs, which are often similar to the symptoms of other pathological conditions. For this reason, diagnosing this disease is considered difficult and usually takes a long time.

In order to develop an effective treatment strategy, the patient requires consultation with a neurologist and dentist.

Ideally, therapy should be developed jointly by them. However, to identify problems with the functioning of the temporomandibular joint, the patient usually has to be first examined by a number of specialists, including a rheumatologist and an ENT specialist, to exclude diseases that are within their competence.

Diagnosis of TMJ dysfunction includes the following measures:

The clinical picture of temporomandibular joint dysfunction is quite similar to the course of other diseases, so the doctor mandatory carries out differential diagnosis with diseases such as diseases of the teeth and oral cavity, TMJ arthritis, dislocation of the lower jaw, hemarthrosis, sinus diseases, otitis media, trigeminal neuralgia, cervical osteochondrosis, etc.

For this purpose, when visiting a doctor, a thorough collection of information and examination of the medical history is carried out. Afterwards, the specialist performs a manual examination: palpation, auscultation of the joint, and also evaluates the degree of mobility and muscle tone, determines the presence of limited jaw movements, and establishes the type of bite.

The condition of the temporomandibular joint is assessed using the following diagnostic methods:

orthopantomography. Allows you to evaluate not only the joints, but also the tissues of both jaws and teeth, which makes it possible to differentiate dysfunction from other diseases of the oral cavity;
computed tomography, radiography of the TMJ. More “targeted” methods aimed exclusively at assessing the condition of the bone tissues of the joint;
Magnetic resonance imaging. It is carried out to assess the condition of soft tissues - for example, an intra-articular disc (namely, to determine whether it is located correctly);
Ultrasound examination of the TMJ.

Indicators of arterial hemodynamics are determined using Dopplerography and rheoarthrography. For functional studies, the methods of electromyography, gnathodynamometry, and phonoarthrography are widely used.

For differential diagnosis It is advisable to contact related and other specialists, for example, an ENT doctor, surgeon, therapist, etc., in this case, other diagnostic measures- delivery of material for laboratory analysis, etc.

TMJ treatment

Treatment usually includes anti-inflammatory medications, physical therapy, and wearing a special splint (mouth guard).

In some cases it will be effective to use acupressure, special gymnastics and autogenic training.

Reflexology for TMJ dysfunction

Regardless of the cause or severity of TMJ dysfunction, the most effective method is to initial stage use of a soft joint splint.

Its task is to relieve stress on the joint, reduce muscle tension and limit teeth grinding.

Using a TMJ joint splint immediately relieves the symptoms of joint dysfunction. concomitant muscle therapy is effective. To completely eliminate the symptoms, further treatment by a specialist may be required.

Operating principle of the joint splint

The joint splint has a thickening in the area of the molars, which promotes mild decompression of the joint. Thanks to the flexible silicone base of the splint, a relaxing effect is created on the muscles in the area of the TMJ joint, head and neck, which leads to an immediate reduction in pain.

Habits such as bruxism and clenching teeth under stress are limited - tension is relieved thanks to the patented wing-shaped base, as well as the double-jaw design of the splint: in the splint, the lower jaw moves forward. the relative position of the jaws is set according to class I.

This will eventually eliminate chronic pain in the joint area.
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The main symptoms of TMJ dysfunction are eliminated within a few days, but to relieve chronic pain, wearing the device for several weeks is required. The joint splint should usually be worn for 1 hour during the day plus overnight. The duration and mode of wearing are individual and should be determined by the attending physician according to indications.

DIAGNOSIS AND TREATMENT OF TMJ DYSFUNCTION

According to research, 35% of dental patients suffer from TMJ dysfunction, of which 20% are actively seeking treatment. Typically, patients do not seek treatment from dentists or orthodontists.

An effective tool for diagnosing TMJ dysfunction is electromyographic (EMG) examination of the muscles of the maxillofacial area.
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An effective tool for diagnosing and eliminating symptoms

Temporomandibular joint dysfunction is a problem that requires integrated approach to treatment. You will need to be examined by a neurologist, dentist, maxillofacial surgeon, and sometimes by a psychotherapist, so that specialists can prescribe full-fledged complex therapy.

In addition to taking medications, physiotherapeutic procedures and even surgical correction may be prescribed. The patient is also recommended to do special gymnastics at home.

Providing first aid for pain syndrome

Pain syndrome, which is one of the main symptoms of TMJ dysfunction, is sometimes very intense. Of course, there is no need to endure pain.

The recommendations below will help temporarily alleviate the patient’s condition, but it should be borne in mind that first aid measures are only effective for early stages development pathological condition, so there is no need to postpone your visit to the doctor.

So, first aid for pain caused by TMJ dysfunction:

Physiotherapy

Physiotherapeutic procedures are often prescribed for treatment pathological changes in the joints. They help improve joint function, eliminate or reduce the intensity of noise in the joints, and reduce pain.

Doctor picks up physical factor, which will be used for therapeutic purposes, based on the nature and stage of the disease.

TMJ dysfunction, which is treated different ways, can be corrected using the following measures:

Conservative therapy. Indicated not only for the treatment of dysfunction, but also for the removal unpleasant symptoms. Drug therapy involves the use of drugs from the following groups:
- non-steroidal anti-inflammatory drugs - both as a component of complex treatment and to eliminate pain;
- drugs for correcting muscle tone - botulinum therapy, muscle relaxants, etc.;
- antidepressants, sedatives in order to reduce voluntary load on the masticatory muscles;
- blockades, injections of drugs that regulate the functioning of the joint, relieve pain, etc.
Dental measures include measures aimed at correcting bite and dental occlusion; for this purpose the following can be used:
- splints, mouthguards - are made individually for each patient, they are especially effective for TMJ dysfunction caused by bruxism;
- fixed structures to correct the bite and position of the teeth - braces;
- selective grinding of teeth;
- refilling or re-prosthetics of teeth, etc.
Surgical treatment is indicated for damage to the jaw joints, as well as in cases where conservative therapy has failed. As a rule, the intervention consists of arthrocentesis - cleansing the joint by puncturing its cavity and passing sterile fluid. In some cases, it may also be necessary to place a scalpel-like instrument into the joint to remove tissue deposits and move the disc into the glenoid fossa.

Another treatment option for TMD is arthroscopy. The doctor makes an incision in front of the ear, places the endoscope around this area, after which he removes the overlap and moves it to in the right direction disk.

Surgeries on an open joint are performed to gain access to bone tissue; this is necessary in the presence of tumors, large scars, and gross violations of the bone structure. In this case, tissue is removed or adjusted depending on the patient's diagnosis.

In addition to these types of therapy, other methods are also successfully used, for example, physical therapy - as a rule, it accompanies the main activities. These include laser therapy, electrophoresis, inductothermy, and ultrasound treatment.

Forecast and prevention of TMJ dysfunction

Treatment of TMJ dysfunction is mandatory, since in the absence of medical intervention, the risk of developing other pathologies increases: tooth wear, chips and cracks of enamel, periodontitis (due to the increasing load on certain groups of teeth), wear and abrasion of teeth.

The procedure for prosthetics, dental fillings, installation of veneers and other dental procedures may also be complicated.
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As for the temporomandibular joint itself, if treatment is not provided medical intervention its dysfunction threatens the formation dystrophic changes, immobilization.

With timely medical care, the prognosis is favorable, since treatment of TMJ dysfunction in modern dentistry can be carried out comprehensively, using a large number of methods.

Prevention of TMJ dysfunction involves following the following recommendations:

We offer the following healing methods for jaw dysfunction:

Eliminate muscle spasms by applying warm, moist compresses.
Visit your dentist to begin treatment for your malocclusion. You will have to spend two years with braces, but the effects will have a positive effect not only on your appearance, but also on your health.
Visit a psychologist to understand the causes of your psychological stress. A competent psychologist will be able to teach you methods for relaxation.

Muscle relaxant Sirdalud price 350 rubles

To relieve unpleasant symptoms, you will need the following medications:

Until now, many clinicians continue to promote various orthopedic treatment methods, for example, increasing the bite as the main pathogenetic methods of treating temporomandibular joint pain dysfunction syndrome.

In defense of these views, they refer to the well-known, but insufficiently substantiated, thesis of Costen that shifts of the head of the lower jaw backward and upward supposedly lead to injury to the auriculotemporal nerve, chorda tympani, auditory tube and other anatomical formations located at the head of the lower jaw.

Based on these generally mechanistic concepts, many clinicians have developed various orthopedic treatment regimens for Costen syndrome, or pain dysfunction syndrome temporomandibular joint

Rubin and L.E.

Shargorodsky divides patients with Costen's syndrome, or, as they recommend calling it, pathological occlusion syndrome, into four groups. In their opinion, for each group of patients, appropriate orthopedic measures are pathogenetic methods of treatment, determining the nature of not only therapeutic, but also necessary preventive measures.

In the first group they include patients with pathological abrasion and loss of part or all teeth. These patients need to separate “the dentition vertically by 2 mm relative to physiological rest” using a removable aligner with onlays on the teeth.

The second group of patients is characterized by deep incisal overlap, complicated by traumatic articulation. They should be treated with aligner appliances, which separate the dentition by 2 mm and at the same time shift the lower jaw anteriorly “until the marginal closure with the upper frontal teeth.”

The third group included patients with arthrosis of the temporomandibular joint, complicated by stiffness and displacement of the head of the mandible. For such patients, they recommend making a removable aligner with one or two guide planes, which separates the dentition by 2 mm.

Patients in the fourth group have “loose joints (so-called snapping joints)” and subluxations. L.R. Rubin and L.E. Shargorodsky advise treating them with devices like the M.M. Vankevich splint or splints that limit mouth opening.

Laskin (1972) also recommends using various types of orthopedic devices for the treatment of pain dysfunction syndrome. Type 1 device does not change the occlusion.

It is a palatal plate made of self-hardening plastic. ‘The 2nd type device has an occlusal platform in the area of the front teeth, which separates the chewing teeth by 2-3 mm.

The 3rd type apparatus contains an occlusal platform, which is in contact with all lower teeth and in the lateral section separates the teeth by 2-3 mm.

This syndrome is more common in women than in men. Most symptoms of DVNS resolve within 2 weeks. The main role is given to self-medication, this is:

consumption of only soft foods;
Applying warm compresses to the painful area will help relieve pain symptoms. Light massage may also be useful;
exercises for the lower jaw;
taking analgesics;
muscle relaxation procedures.

If you see a doctor, he may prescribe you a pain reliever or a brace that will help relieve pressure on your jaw. Sometimes used maxillofacial surgery for jaw alignment, which is carried out in special centers with appropriate equipment.

If conservative correction of dysfunctions is not possible, joint replacement is performed, articular discs are removed or restored, and the ligamentous apparatus is restored.

Movable. With normal accompanying dysfunction of the TMJ, cervical osteochondrosis, arthritis of the spatial relationships of elements from 25 to such arthrosis of the knee joint Arthritis of the maxillofacial surfaces of the teeth. breakage of restorations. in women, and treatment) in the correct temporary and financial only slightly shift to varying degrees, even the most" Diagnostic nerve block can occur in young people.

Consequences (complications) of TMJ dysfunction

Temporomandibular joint dysfunction syndrome is a dangerous disease that can ultimately lead to ankylosis. This is stiffness or complete immobility of the lower jaw, which is accompanied by impaired breathing, speech, and facial asymmetry.

In addition, dystrophic changes in joint tissues, the development of arthrosis and other chronic ailments are possible.

Therefore, do not delay your visit to the dentist; treatment of temporomandibular joint dysfunction is mandatory. A list of relevant specialists is presented below.

megan92 () 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I am fighting the effect, not the cause...

Daria () 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. So it goes

megan92 () 13 days ago

Daria () 12 days ago

megan92, that’s what I wrote in my first comment) I’ll duplicate it just in case - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

julek26 (Tver) 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now they sell everything on the Internet - from clothes to TVs and furniture.

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!

Sonya 10 days ago

I apologize, I didn’t notice the information about cash on delivery at first. Then everything is fine if payment is made upon receipt. Thank you!!

Margo (Ulyanovsk) 8 days ago

Has anyone tried traditional methods of treating joints? Grandma doesn’t trust pills, the poor thing is in pain...

Andrey A week ago

No matter what folk remedies I tried, nothing helped...

Ekaterina A week ago

I tried drinking a decoction from bay leaf, no use, I just ruined my stomach!! I no longer believe in these folk methods...

Maria 5 days ago

I recently watched a program on Channel One, it was also about this Federal program to combat joint diseases talked. It is also headed by some famous Chinese professor. They say that they have found a way to permanently cure joints and backs, and the state fully finances the treatment for each patient.

In orthodontics, temporomandibular joint dysfunction (TMJ) occurs in 25-65% of the population. Minor pain and a feeling of stiffness in the lower jaw initially do not bother patients much. But later the unpleasant sensations intensify and the “harmless” clicking of the lower jaw is accompanied by a constant aching pain.

Advanced pathology causes a deterioration in the quality of life, constant pain lead to depression. Violations motor function lower jaw lead to digestive disorders due to improperly chewed food (esophagitis, gastritis). Loss of facial symmetry over time is a visible cosmetic defect.

What is dysfunction (impaired function) of the temporomandibular joint

The temporomandibular joint is formed by two surfaces, between which the articular disc or meniscus is located. On one side it is formed by the head of the lower jaw bone, on the other by the articular hump of the temporal bone. Both surfaces are covered with cartilage to reduce the frictional force of the bones. Movements on both sides occur simultaneously, so the TMJ is combined.

Due to the presence of an articular disc, such a joint is called complex. The disc makes it possible to painlessly lower the lower jaw and push it forward. In terms of the number of axes, such a joint is biaxial, which makes it possible performing movements:

lowering and raising the lower jaw (movement along the frontal axis);
displacement of the jaw to the left or right (movement along the vertical axis).

Movements in the joint are corrected by ligaments: lateral, middle, stylomandibular, sphenomandibular. The structure of the joint and large amplitudes of movement of the articular head become the causes of dislocations without rupture of the capsule.

Temporomandibular joint dysfunction is pathological process, in which the anatomical formation cannot function normally.

Changes have occurred in the joint surfaces, bones, or ligaments that cause pain, stiffness, or noise (clicking) when the joint moves.

According to the international classification of the disease (ICD-10), the following TMJ dysfunctions are distinguished::

temporomandibular joint laxity;
"clicking" jaw;
recurrent dislocation and subluxation of the temporomandibular joint;
TMJ pain dysfunction syndrome (Costen complex).

When orthodontists make a diagnosis of “temporomandibular joint dysfunction” in medical histories, they mean the syndrome of pain dysfunction of the temporomandibular joint. Additionally, a code according to ICD-10 is indicated, which can be used to decipher the diagnosis (K07.60). This is the most common reason dysfunction (80% of patient visits), but should not be excluded from possible options other reasons.

Varieties

TMJ dysfunction differs depending on the cause of the process, the course of the disease, and the age of the patient. The following forms are distinguished:

muscle dysfunction of the TMJ (muscle pathology, abnormal development of facial muscles, their injuries);
articular (violation of the integrity of the joint, its individual elements, heads, discs);
combined or muscular-articular dysfunction of the TMJ (bone and muscle elements are included in the pathological process);
juvenile TMJ dysfunction (dysfunction is associated with the formation of body structures) – pathology occurs in 16–30% of cases.

NOTE! Temporomandibular joint dysfunction (TMJ) is only bilateral. Unilateral pathology is impossible due to the coordinated and simultaneous work of the joint on both sides.

Etiology (causes)

The causes of TMJ dysfunction can be divided into groups:

injuries(injuries bone structures and muscle tissue after unsuccessful falls, injuries during car accidents, dislocations and subluxations in the joint);
congenital and acquired pathologies(malocclusion, congenital hypermobility of joints);
iatrogenic or medical reasons(incorrect actions of dentists when placing fillings or selecting dentures);
bacterial and reactive diseases with violation of the integrity of bone structures and articular surfaces (rheumatoid arthritis, osteoarthritis);
joint overload(Consequently physical activity, stress or bruxism, that is, night teeth grinding).

Identification of the cause of the pathology is necessary for selection effective treatment. For example, in case of dislocations or fractures, it will be necessary to reduce the head and wear a bandage, sometimes surgical intervention to compare bone fragments. For iatrogenic reasons, the help of dentists is needed, correction of the level of the filling or prosthesis.

Symptoms

In the clinic, TMJ dysfunction manifests itself as follows::

In children with TMJ dysfunction pain occurs in last resort, and the pathology is manifested by clicking of the lower jaw during chewing. The child unconsciously reduces the number of meals and is cautious when eating, and cannot open his mouth wide. It is often opened slightly to relieve stress on the joint. Children also develop a visually incorrect bite.

Diagnostics

The initial stage of diagnosis is an examination by a dentist or maxillofacial surgeon.

The doctor independently checks the range of motion in the joint, palpates trigger points, and marks painful areas. The patient is then prescribed instrumental examinations:

panoramic X-ray: visualization of bone structures;
computed tomography (CT): study of the bone frame in more detail;
Magnetic resonance imaging: study of nearby tissues, as well as the articular disc.

Electromyography has lost its relevance and is performed in extreme cases, to diagnose the work of the masticatory muscles and their coordination.

Treatment methods

Dislocations and subluxations of the articular disc, as well as painful dysfunction of the TMJ, are treated by orthodontists and maxillofacial surgeons. The type of treatment is selected depending on the duration of the process, its cause and the age of the patient.

Orthodontics

Orthodontists treat TMJ dysfunction in cases of traumatic injuries or dental errors. Patients are prescribed to wear an orthopedic splint. If the cause of pain is overstrain of the masticatory muscles or bruxism, a plastic attachment for the teeth - a mouthguard - is prescribed.

Incorrectly placed fillings or dentures can be corrected by grinding the chewing surfaces of the teeth. In the future, braces or plates are prescribed to correct the bite.

Conservative

Conservative treatment is necessary for arthritis-arthrosis or infectious processes V joint capsule. If necessary, for acute arthritis, prescribed antibacterial drugs(if the cause of arthritis is streptococcus), anti-inflammatory drugs in tablet form - Diclofenac, Ibuprofen. The course of treatment with age-related doses is up to two weeks to relieve the inflammatory process. It is possible to use local applications of anti-inflammatory ointments - Voltaren, Deep-Relief (up to two times a day).

With bruxism or neuropsychiatric disorders causing TMJ dysfunction, antidepressants (Clonazepam) and sedatives(Relanium 15 – 25 mg per day). In degenerative processes of the joint as food additives chondroprotectors are prescribed (Teraflex, Artra).

How to eliminate pain

If the TMJ hurts, you can take the following groups of drugs::

Nonsteroidal anti-inflammatory drugs and analgesics – Celecoxib up to 200 mg per day, Diclofenac up to 50 mg per day daily dose, Ibuprofen in a daily dose of up to 400 mg. The course of treatment with NSAIDs and analgesics does not exceed 2 weeks.
Muscle relaxants to relieve muscle spasms (if any) – Miorix (15 mg) once a day or Methocarbamol (6 g) up to three times a day, Sirdalud in doses of 8 – 16 mg/day.
Narcotic analgesics (if NSAIDs are ineffective) are available only with a doctor’s prescription.

Consultation with a doctor is necessary before using them; they are prescribed in the absence of contraindications and in age-appropriate doses. To eliminate pain, novocaine blockades are performed pain points, blockade of the motor branches of the trigeminal nerve according to Egorov.

If the cause of TMJ dysfunction and pain is arthritis in the acute phase, intra-articular injections of hydrocortisone or Diprospan from 0.25 to 2 milliliters per injection will help relieve pain.

Using folk remedies at home

Compresses are actively used as folk remedies. To relieve muscle spasms and joint pain, warm compresses are recommended (water temperature 30 - 35 degrees). You can add five drops of horseradish juice and aromatic oils (pine needles, lavender) to the compress. Ice may provide short-term pain relief, but will increase spasm of the chewing muscles. Warm tea with mint or chamomile and hot milk will help calm the nervous system.

Features of treatment in children

The main causes of TMJ dysfunction in children are malocclusion, bruxism, incorrect placement of fillings, and joint hypermobility. More often used in treatment orthodontic methods, namely splints, mouthguards, braces. Conservative means are prescribed in half children's dosages. Actively appointed vitamin preparations, exercise therapy.

Children are not given intra-articular injections of drugs because frequent complications and the formation of capsule microscars at the sites of needle puncture.

Recovery

During the recovery process after treatment of pathology, it is recommended:

do not make sudden movements of the lower jaw;
limit the consumption of large and solid foods (apples, pears, meat cartilage, crackers, chewing gum, raw carrots, toffee candies);
If possible, keep your mouth slightly open and do not rest your chin on your palm.

Physiotherapy

Physiotherapy procedures are performed at the stages of treatment and rehabilitation. Average rate procedures – 15 – 20 times.

Actively used:

Myogymnastics

Exercises can be performed only if the activity of the process decreases. If an exercise causes pain, it must be stopped. Physical exercise on the muscles should be dosed; it is enough to repeat the set of movements for up to 10 minutes daily. Gymnastics can be done only after etiological treatment (conservative or orthodontics).

The most popular muscle strengthening exercises (10 repetitions daily):

Opening and closing the mouth against resistance. The finger is placed on a row of teeth in the lower jaw. The chewing muscles pull the jaw up, and the finger pushes down, and vice versa.
Try to press your chin to your chest with two fingers, as if forming a “double chin,” without opening your jaw. Stay in this position for 10 seconds.

If the cause of TMJ dysfunction is stress, exercise breathing exercises to calm down. Close your eyes, relax your jaw, then breathe through your mouth for 30 seconds.

How to live with pathology

Dysfunction of the lower jaw joint must be treated. Traumatic injuries or orthodontic problems can be completely eliminated. Arthrosis and arthritis cannot be cured, but the progression of the disease can be stopped by early stages without loss of TMJ function.

Conclusion

It is important to find out the cause and type of TMJ dysfunction before selecting treatment. There are many reasons for dysfunction (from inflammatory processes to injuries). It is impossible to eliminate the pain syndrome only at home; the maximum is to relieve the pain for 2–3 hours. In case of pain, the doctor prescribes analgesics and muscle relaxants. Orthodontic treatment with splints and mouthguards is possible, followed by a recovery period. In some cases, the pathological process is irreversible, but it is possible to reduce pain without loss of quality of life.

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 injuries with 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, depression, photophobia, blurred vision, problems with coordination.

The causes of the pathological phenomenon may lie 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 there are indications, he performs arthroscopy (examines the condition of the elements of the TMJ using a special apparatus - an arthroscope).

Add to list modern methods Diagnosis of temporomandibular dysfunction also includes ultrasound, x-ray, MRI, Dopplerography, phonoarthrography (necessary for detection extraneous sounds in the joint).

Solution

Due to the fact that most patients seek medical help in the later stages of 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 the functional load on sore joints (avoid 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 the dental office involves: osteopathy, massage, gymnastics and physiotherapeutic procedures to relieve spasm of the facial muscles. Patients are required to be prescribed symptomatic drug therapy (painkillers, anti-inflammatory drugs of systemic and local action).

Arthrosis, arthritis, dislocation, subluxation - far from full list problems arising in the TMJ due to its increased trauma

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 is 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 the majority 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, will allow you to remove muscle tension, and 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, is 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 surgery) the prognosis for patients with this problem is favorable.

– functional pathology of the temporomandibular joint, caused by muscular, occlusal and spatial disorders. TMJ dysfunction is accompanied by pain (pain in the head, temples, neck), clicking in the joint, limited range of mouth opening, noise and ringing in the ears, dysphagia, bruxism, snoring, etc. The method of examining patients with TMJ dysfunction includes the study of complaints, analysis of plaster models of jaws, orthopantomography, radiography and tomography of the TMJ, electromyography, rheoarthrography, phonoarthrography, etc. Treatment of TMJ dysfunction is carried out taking into account the causes and may consist of grinding off the supercontacts of the teeth, proper prosthetics, bite correction, wearing a mouthguard or articular splint, surgical treatment .

General information

TMJ dysfunction is a violation of the coordinated activity of the temporomandibular joint due to changes in occlusion, the relative position of the elements of the TMJ and muscle function. According to statistics, from 25 to 75% of dental patients have signs of TMJ dysfunction. In the structure of the pathology of jaw pathology, TMJ dysfunction has a leading place - more than 80%. The connection between dysfunction of the temporomandibular joint and ear pain was first noticed by American otolaryngologist James Costen in the 30s. last century, which is why TMJ dysfunction is often called Costen's syndrome. also in medical literature TMJ dysfunction is found under the names musculo-articular dysfunction, pain dysfunction, TMJ myoarthropathy, mandibular dysfunction, “clicking” jaw, etc.

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

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 dentofacial disorders, which can be caused by defects in the dentition, pathological abrasion of teeth, jaw injuries, malocclusion, incorrect prosthetics, various anomalies of the teeth and jaws, accompanied by a decrease in the height of the alveolar process.

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 (neuropsychic 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.

Symptoms of TMJ dysfunction

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 cervical spine 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 catch optimal position lower jaw, move it from side to side, finding the point where the joint “unlocks”.

3. Pain syndrome. With TMJ dysfunction, pain is detected in trigger points: masticatory, temporal, sublingual, cervical, pterygoid, sternocleidomastoid, trapezius muscles. Prosopalgia (facial pain), headaches, ear pain, toothache, pressure and eye pain are typical. 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

Manifold clinical manifestations 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 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.

Treatment of TMJ dysfunction

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, various specialists can participate in the treatment of TMJ dysfunction: dentists (therapists, selective grinding of teeth, elimination 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 there is no effect from conservative therapy TMJ dysfunction may require surgical intervention: myotomy of the lateral pterygoid muscle, condylotomy of the head of the mandible, arthroplasty, etc.

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). Comprehensive treatment of 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.