Inflammation of the jaw muscles. Inflammation of the jaw joint, symptoms and treatment. Complications and prevention

Acute pain in the temporomandibular joint (TMJ) usually appears when it is inflamed ( arthritis). Pain may be unilateral or bilateral, acute or chronic ( long-term). Quite often, this disease is accompanied by increased pain when opening the mouth, difficulty eating and other symptoms. When chronic pain Such disorders can cause serious harm to both the physical and emotional state of a person, so treatment should be delayed of this disease Not recommended.

This disease is most often observed in children and the elderly. In the first case, this is explained by the constant processes of growth of bones and teeth in the child’s body, as well as the increased risk of injury to the joint during games. Elderly people are more likely to experience various infectious and systemic inflammatory diseases. Men and women get sick with the same frequency.

Interesting Facts

• The temporomandibular joint moves whenever a person chews, swallows or speaks ( that is, on average every 30 - 40 seconds).
• Every second person has experienced pain or discomfort in the jaw joint at least once during their life.
• Movements in the mandibular joint can be carried out in three planes, which is due to the peculiarities of its structure.

Anatomy of the temporomandibular joint

The structural elements of the temporomandibular joint are:

• Articular surfaces. The joint itself is formed by the articular surfaces of the lower jaw ( articular head) and mandibular ( articular) fossa of the temporal bone.
• Joint capsule. The TMJ capsule is composed of dense connective tissue. It surrounds the joint from the outside and limits the articular cavity.
• Synovial fluid. The inner layer of the joint capsule is lined with endothelial cells, which produce the so-called synovial fluid. It fills the joint cavity, providing gliding articular surfaces relative to each other, as well as performing protective ( antibacterial) function. The amount of synovial fluid in the joint cavity directly depends on the functional activity of the joint - with increasing loads, the rate of its formation increases, while with prolonged inactivity of the joint ( for example, when immobilized after a jaw fracture) its quantity decreases.
• Intra-articular disc ( cartilage). An important structural feature of the temporomandibular joint is the presence of special fibrous cartilage between the articular surfaces. With its edges, this cartilage fuses with the articular capsule, dividing the joint cavity into 2 sections ( top and bottom).
• Ligamentous apparatus. In the area of ​​the temporomandibular joint there are three ligaments - 1 large ( collateral ligament) and two small ones. Their main function is to limit the movements of the articular head - collateral ligament prevents its excessive posterior displacement, while the minor ligaments support the lower jaw. This joint is also connected by two ligaments to the malleus of the middle ear ( bone formation involved in the perception of sounds).

There are 3 types of movements possible in the temporomandibular joint:

• Opening and closing the mouth. These movements are carried out due to the displacement of the articular head of the lower jaw, while the articular disc remains in place. This occurs during speech and when chewing food.
• Moving the lower jaw forward. In this case, the head of the lower jaw is displaced along with the articular cartilage, that is, the movement occurs in the upper part of the articular cavity.
• Lateral displacement of the jaw. During this movement, the head of the lower jaw from the side of rotation ( that is, in the joint towards which the jaw moves) rotates around its axis, while in the opposite joint the articular head is displaced downward and sideways. This movement is especially important when chewing hard, rough foods.

Arterial blood enters the joint through branches of the external carotid artery ( along the superficial temporal and other smaller arteries). Venous blood flows into the venous network of the lower jaw and further into the jugular vein of the neck. Lymphatic drainage occurs in the cervical lymph nodes, which is important for the spread of infection during purulent inflammation of the joint.

Causes of inflammation of the temporomandibular joint

The cause of inflammation of the temporomandibular joint can be:

• mechanical injury;
• infection;
• systemic inflammatory diseases.

Mechanical injury

Joint injury can cause:

• rupture of the joint capsule;
• rupture of periarticular ligaments;
• crack/fracture of the articular surfaces of bones;
• hemorrhage into the joint cavity.

Infection

Infection can enter the joint cavity in three ways:

• straight;
• contact;
• hematogenous ( through blood).

Contact route of infection
Contact infection of the temporomandibular joint involves the spread of bacterial agents from infected nearby tissues ( muscles, bones, ligaments and so on).

The cause of hematogenous infection of the TMJ can be:

• tuberculosis of the lungs or intestines;
• purulent foci of any location;
• sepsis ( penetration and spread of pyogenic microorganisms in the blood).

Systemic inflammatory diseases

TMJ inflammation can be caused by:
Rheumatoid arthritis
This disease is characterized by damage connective tissue throughout the body. The most obvious clinical sign this causes damage to various joints. Damage to the temporomandibular joint in rheumatoid arthritis occurs in approximately 15% of patients.

The exact causes of the disease have not been established. A certain role in its occurrence is played by genetic predisposition and viral infections ( herpes virus, hepatitis B virus and others). The essence of this disease is that cell activation occurs in the joint cavities immune system (T and B lymphocytes), which accumulate in the tissues of the articular cavity. A chronic inflammatory process develops, the outcome of which is damage and destruction of intra-articular components ( cartilage, articular surfaces of bones and other).

Systemic lupus erythematosus
Joint damage in systemic lupus erythematosus occurs in more than 90% of patients. The essence of this disease is also a disruption of the immune system, but in this case B lymphocytes produce autoantibodies ( that is, immune complexes that attack the intracellular structures of the body’s own cells), which leads to damage to various tissues. A distinctive feature is the fact that deformation of the components of the articular cavity does not occur, and clinical manifestations can completely disappear after the underlying disease is cured.

Reactive arthritis
This disease is characterized by non-purulent inflammation of the joints that occurs soon after an intestinal or genitourinary infection ( after infection with mycoplasmas, chlamydia and other microorganisms). The reason for joint damage is that the structural components of some microorganisms and their toxins are similar to some tissues of the human body.

Once entering the body, infectious agents come into contact with the immune system, as a result of which a number of defensive reactions are launched aimed at identifying and destroying “foreign” agents ( antigens). However, since “foreign” antigens are similar to “our own”, cells of the immune system also damage the tissues of their own body, including various components of the joints ( cartilage, ligaments, articular surfaces).

Gout
This disease is characterized by a metabolic disorder, as a result of which uric acid crystals begin to be deposited in the tissues of the body. There are many causes of the disease, but their essence boils down to either increased formation of uric acid ( when eating large amounts of meat, when carrying out antitumor treatment ), or to a violation of its excretion by the kidneys. As a result of an increase in the concentration of uric acid in the blood, its salts ( urates) accumulate in various tissues, including joints, causing the development of an acute inflammatory process.

Symptoms of inflammation of the temporomandibular joint

As mentioned earlier, the inflammatory process in the joint can be acute or chronic.

Symptoms of acute inflammation

Acute inflammation of the temporomandibular joint can manifest itself:

• Pain. When a joint is inflamed, the pain is always sharp, sharp, stabbing or cutting. Pain always increases with movement ( during speech, when chewing food, etc.), which can significantly affect a person’s quality of life ( usually patients cannot open their mouth more than 1 - 1.5 cm). The pain may also radiate ( spread, "give") V nearby organs and tissues of the face and head. The irradiation of pain is due to the fact that different parts of the soft tissues of the face are innervated by the same nerve ( trigeminal nerve). As a result, pain impulses emanating from the temporomandibular joint area may be perceived by the patient as pain in other areas.
• Swelling and redness of the soft tissues in the joint area. This symptom is characteristic of purulent arthritis, accompanied by the proliferation of pathogenic microorganisms in the joint cavity. At the site of inflammation, a large number of inflammatory mediators are released. They cause the dilation of blood vessels, the flow of blood into the affected area increases, resulting in its redness. At the same time, there is an increase in the permeability of the vascular walls, as a result of which blood plasma leaves the vascular bed and permeates the surrounding tissues, causing the development of edema.
• Local increase in temperature. Increase in temperature by 1 - 2 degrees compared to surrounding tissues ( or with a symmetrical area of ​​another joint, if only one of them is inflamed) is also due to the expansion of blood vessels and inflow to the site of inflammation more warmer blood.
• Feeling of fullness in the joint area. This sensation can be caused by both tissue swelling and the accumulation of a large amount of exudate in the joint cavity.
• Hearing impairment. As a result of the spread of the inflammatory process to the tissue of the external auditory canal, its narrowing may occur, as a result of which the patient may experience ear congestion and decreased hearing on the side of the injury. If the inflammation is infectious, the infection can spread to the structures of the middle and inner ear, which can lead to more serious hearing impairment, including complete deafness.
• Fever. Symptoms such as increased body temperature above 38ºC, pain and aching muscles, headaches, general weakness and increased fatigue may indicate the presence of a systemic infection in the body, as well as purulent inflammation of the TMJ.

Symptoms of chronic inflammation

Chronic inflammation of the temporomandibular joint can manifest itself:

• Pain. The pain in this case is less pronounced and is described by patients as “aching”, “pulling”. The pain may be constant or appear only when the joint is loaded ( while talking or eating). The function of the joint is also limited ( the patient can open his mouth no more than 2–3 cm).
• Stiffness of movements in the joint. Stiffness is especially pronounced in the morning or after a long period of time ( few hours) inactivity of the joint. The development of this symptom is due to compression of the articular components by proliferating cells. After several active movements, the joint “warms up”, as a result of which the feeling of stiffness may disappear.
• Crunching when moving the joint. The occurrence of a crunch or “click” when moving in a joint is caused by a narrowing of the joint space and the bringing together of the articular surfaces of the bones. Quite often, the crunching may be accompanied by increased pain.
• Moderate systemic manifestations of inflammation. Body temperature may be normal or slightly elevated ( up to 37 – 37.5ºС). The patient may complain of feeling weak, increased fatigue.
• Hearing impairment. During the transition acute process In chronic cases, damage to ear components can disappear on their own, but quite often various types of hearing impairment persist.

Diagnosis of the causes of inflammation of the temporomandibular joint

Which doctor should you consult if you have inflammation of the jaw joint?

After a thorough interview and clinical examination, the doctor may suspect one or another cause of inflammation and, based on this, refer the patient to the appropriate specialist.

Depending on the causes of arthritis, the process of diagnosis and treatment may involve:

• Orthopedist and traumatologist – in case of damage to the bone, cartilaginous or ligamentous components of the joint.
• Dentist - for diseases of the teeth and oral cavity.
• Otorhinolaryngologist ( ENT doctor) – for diseases of the ear, throat, nose, and paranasal sinuses.
• Infectious disease specialist – when identifying infectious and inflammatory processes in the body.
• Rheumatologist – if the cause of arthritis is systemic inflammatory ( rheumatic) disease.
• Dermatovenerologist – if there are foci of infection in the head, neck, face or other parts of the body.
• Phthisiatrician – if you suspect a tuberculosis infection.
• Neurologist – if there is suspected damage/disease of the trigeminal nerve.

To identify the cause of inflammation of the temporomandibular joint, the following is used:

• assessment of clinical data;
• general blood analysis ( UAC);
• determination of proteins of the acute phase of inflammation;
• determination of autoantibodies in the blood;
• determination of the level of uric acid in the blood;
• radiography of the mandibular joint;
• examination of synovial fluid.

Evaluation of clinical data

Possible changes in the OAC due to inflammation of the mandibular joint

Determination of proteins in the acute phase of inflammation

Proteins of acute phase of inflammation

If a systemic inflammatory disease is suspected, it is recommended to investigate:

• Rheumatoid factor. Formed in most patients with rheumatoid arthritis, as well as in some patients with systemic lupus erythematosus. Represents immune complexes formed by abnormal ( structurally changed) and normal antibodies.
• Antinuclear antibodies. This term refers to a complex of autoantibodies that bind to the nucleic acids of cell nuclei, causing their destruction and cell death. This type of antibody is characteristic of patients with systemic lupus erythematosus, and also occurs in approximately 10% of patients with rheumatoid arthritis.
• Antiplatelet and antileukocyte antibodies. Characteristic of systemic lupus erythematosus.

X-ray of the mandibular joint

A radiological sign of an acute inflammatory process is widening of the joint space ( space between two surfaces of articular bones), caused by tissue swelling and accumulation of exudate in the joint cavity. When the acute process transitions to chronic, the exudate gradually resolves, and thinning of the articular cartilage is often observed, as a result of which the joint space decreases.

The disadvantages of the method include relatively low accuracy ( simple radiography does not reveal microcracks, as well as minor deformations of the articular surfaces of bones), which is why the main indication for its use is the suspicion of a fracture or dislocation of the articular head of the lower jaw after injury.

CT scan

This method allows you to identify microcracks, dislocations and subluxations of the articular head of the lower jaw, determine the presence of a fracture and the degree of displacement of bone fragments. The disadvantages of the method include radiation exposure and higher cost ( compared to conventional radiography).

Magnetic resonance imaging

MRI can detect injuries such as rupture of the capsule and ligaments of the joint. Also, using this study, it is possible to identify minor damage to the articular surfaces of the temporal bone and lower jaw, observed in rheumatoid arthritis and other rheumatological diseases. There is no radiation exposure, so the only drawback is the high cost of the method, which significantly limits its use in everyday practice.

Synovial fluid examination
This study involves puncture ( piercing) joint cavity with a needle and taking a small amount of intra-articular fluid for further study in the laboratory. This procedure carries a risk of joint infection, so it should be performed by an experienced specialist and only with sterile instruments.

Examination of synovial fluid may reveal:

• Changes in color and transparency. Normally, synovial fluid is clear, colorless or slightly yellowish. Its turbidity, the appearance of foreign suspensions and impurities, the detection of leukocytes, as well as staining in a different color usually indicate the addition of an infection.
• Presence of rheumatoid factor. Evidence in favor of rheumatoid arthritis or systemic lupus erythematosus.
• Uric acid crystals. Their presence allows us to confirm the diagnosis of gout.
• Blood cells. This indicates damage to the blood vessels and hemorrhage into the joint cavity.

First aid for acute pain in the temporomandibular joint

First aid for pain in the mandibular joint includes:

• immobilization ( immobilization) affected joint;
• use of cold;
• taking anti-inflammatory drugs.

Immobilization of the affected joint

In addition, if inflammation develops after an injury, there is a high probability of a fracture. If the joint remains mobile, the bones or their fragments can damage nearby tissues, which will further increase the pain and aggravate the patient’s condition. That is why the first thing to do in case of acute pain in a joint is to immobilize it, that is, stop eating and keep conversations with others to a minimum until the exact cause of the inflammation is determined.

Using cold

To cool the inflamed joint, you can use an ice bag, a bottle of cold water or simply cold compress (which should be changed every 2 – 3 minutes). It is important to remember that contact of ice directly with the skin is extremely undesirable, as this can cause hypothermia of surrounding tissues. It is best to wrap an ice bag with a handkerchief or thin towel and then apply it to the inflamed joint for 5 to 15 minutes ( no more).

Taking anti-inflammatory drugs

NSAIDs used for pain in the temporomandibular joint

Is surgery necessary for inflammation of the temporomandibular joint?

The main indication for surgical treatment is purulent arthritis of the mandibular joint. In this case we are talking about infectious inflammation of the joint caused by pyogenic microorganisms ( staphylococci, streptococci and others). The resulting pus fills the joint cavity, significantly disrupting its function. In addition, suppurative arthritis can cause melting and necrosis ( death) intra-articular components ( cartilage, articular surfaces of bones, etc.), which will lead to complete loss of joint function. There is also a high risk of infection spreading to neighboring organs and tissues ( in the ear, in the neck area, in the cranial cavity) or penetration into the blood and spread throughout the body, which can lead to the death of the patient.

Preoperative preparation includes performing the necessary tests ( general blood test and general urine test, determining the state of the blood coagulation system). The operation itself is performed under general anesthesia in a sterile operating room. After making a skin incision and gaining access to the joint, the joint capsule is opened, and the joint cavity is cleared of purulent masses and necrotic ( dead) fabrics. The integrity of intra-articular structures and the degree of spread of pus to adjacent tissues are also assessed. After the operation is completed, the joint cavity is drained ( that is, a thin rubber band or tube is installed in it, thanks to which blood or inflammatory fluid accumulating in the joint will be released out), after which the joint capsule and skin are sutured.

In the postoperative period, the patient is prescribed:

• Antibiotics wide range actions ( for example, ceftriaxone 1 gram 1 time per day intramuscularly).
• Narcotic painkillers ( for example, 1 ml of 1% morphine solution intramuscularly).
• Nonsteroidal anti-inflammatory drugs ( ketorolac, indomethacin)
• Physiotherapy may be prescribed from 2–3 days after surgery ( UHF therapy, dry heat, electrophoresis and others).
• Strict diet, including exclusively liquid foods.

It is also worth noting that surgical treatment may be necessary for traumatic inflammation of the joint, if the injury resulted in a fracture of the articular surfaces of the bones, rupture of the joint capsule or ligaments, and other serious damage. In the postoperative period, such patients are prescribed long-term immobilization of the joint ( for a period of 1 – 2 to 4 – 5 weeks).

Treatment of post-traumatic inflamed temporomandibular joint

In the treatment of post-traumatic inflammation of the temporomandibular joint, the following is used:

• immobilization;
• drug treatment;
• physiotherapy.

Immobilization

Methods of immobilization of the mandibular joint

Method name	Description	Photo
Soft chin sling	It is one of the simplest and easiest ways to immobilize the mandibular joint. Consists of a soft part ( slings), which is applied to the chin area, and two wide rubber bands, which are placed behind the back of the patient’s head and fixed there to one another.
Sling bandage for the lower jaw	You can make a sling-shaped bandage yourself using improvised materials ( from an elastic or regular bandage folded into several words). There should be 2 strands extending from the corners of the sling on each side. The sling is placed at the level of the chin, after which its upper ends are brought behind the neck ( below the ears) and fix ( tie). The lower ends of the bandage are passed in front of the ears and fixed on the parietal region.
Parietal-chin bandage	To apply a bandage, use a wide bandage, rounds ( rpm) which are carried out alternately around the circumference of the head ( from frontal to occipital region ), then around the chin and occipital bone ( bypassing ears behind) and around the chin and parietal bones ( bypassing the ears in front). This bandage is quite fragile and usually moves 1 to 2 hours after application. To prevent this you can use elastic bandage instead of the usual one.

For the purpose of long-term immobilization, the following are used:

• Various methods of intermaxillary ligature fastening ( that is, the teeth of the upper and lower jaws are fastened together using wire). The procedure itself is performed under local anesthesia.
• Application of dental splints, which can be fixed to the teeth and other parts oral cavity (the procedure is also performed under local anesthesia).

Drug treatment

Drug treatment of post-traumatic inflammation of the mandibular joint

Physiotherapy

Physiotherapeutic methods for treating post-traumatic inflammation of the mandibular joint

Treatment of inflammation of the temporomandibular joint caused by rheumatic diseases.

For arthritis caused by rheumatic diseases, the following is used:

• drug treatment;
• developmental exercises.

Drug treatment

Drug treatment of rheumatoid arthritis

Developmental exercises

A complex will help prevent ankylosis of the temporomandibular joint simple exercises which must be performed daily 3-4 times a day throughout the course of treatment. It is worth noting that it is recommended to start performing these exercises only after the acute inflammatory process has subsided and the pain has relieved.

To prevent ankylosis of the mandibular joint, it is recommended to perform the following exercises:

• Lightly pressing your chin from below with your hand, you must slowly open your mouth, lowering the lower jaw as low as possible. After this, without stopping the pressure on the chin, you need to slowly close your mouth.
• Grasping the protruding part of the chin with your fingers, you need to slowly lower and raise the lower jaw, trying to push it down and back.
• Lightly pressing your fingers on the side of your chin, you need to move your jaw to the right and left. After this, you need to press on the chin on the other side and repeat the exercise.
• Pressing on the front edge of the chin ( pushing him back) you need to push the lower jaw forward as much as possible.

Treatment of inflammation of the temporomandibular joint caused by infection

Drug treatment for arthritis caused by infection

What can be the complications and consequences of inflammation of the jaw joint?

To treat inflammation of the mandibular joint, the following is used:

• Anti-inflammatory herbal tea. To prepare the collection, take 20 grams of black elderberry flowers, 80 grams of birch leaves and 100 grams of willow bark. All ingredients are crushed and mixed thoroughly, after which 4 - 5 tablespoons of the collection are poured with 1 liter of boiling water and infused for 2 - 3 hours. Should be taken 3-4 times a day, 100 ml ( half a glass) before eating. In addition to anti-inflammatory, it also has an analgesic and antibacterial effect.
• Burdock root infusion. To prepare the infusion, add 400 milliliters of boiling water to 1 tablespoon of crushed root and leave for 2 to 3 hours. Strain thoroughly and take 1 - 2 tablespoons 3 - 4 times a day. Has anti-inflammatory and analgesic effects.
• Infusion of yarrow. Yarrow also has a pronounced anti-inflammatory effect. To prepare the infusion, pour 2 tablespoons of dry crushed herbs into 200 milliliters ( 1 glass) boiling water. After cooling, filter and take 50–100 ml 3–4 times a day.
• Infusion of hernia fragrant. The fresh herb of this plant has a pronounced antibacterial and anti-inflammatory effect. To prepare the infusion, pour 1 tablespoon of chopped herbs into 500 ml of boiling water and infuse for an hour. After cooling, the infusion must be filtered and taken 50–100 ml 3 times a day. This recipe is especially effective for inflammation caused by infection or rheumatic diseases.
• Propolis tincture. It has a pronounced analgesic and anti-inflammatory effect. 100 grams of propolis should be poured with 500 ml of vodka and infused in a dark place at room temperature. After 2–3 weeks, the tincture must be carefully strained and taken orally, 10–20 drops 2 times a day.

Is there an effective prevention of inflammation of the temporomandibular joint?

Inflammation of the temporomandibular joint can be caused by:

• Trauma. In case of injury to joint components ( fracture of articular bones, soft tissue bruises, etc.) an inflammatory process develops, characterized by tissue swelling, severe pain and dysfunction of the joint. As a result of the release of certain biologically active substances at the site of inflammation ( serotonin, histamine, bradykinin and others) there is an expansion of blood vessels and the release of liquid plasma from the vascular bed. Inflammatory fluid ( exudate) can accumulate in the joint cavity, increasing pressure on the swollen tissues and further damaging them.
• Infection. Infection can enter the joint cavity in various ways (when a joint is injured, when bacteria spread from nearby or distant foci). Infection of the joint is also accompanied by the development of an inflammatory process with all the adverse effects described earlier. In addition, when infected with pyogenic microorganisms ( for example, staphylococci) the progression of the purulent-inflammatory process can lead to the destruction of intra-articular structures, which will lead to irreversible dysfunction of the joint.
• Rheumatic diseases. Rheumatic diseases are characterized by excessive activity of the human immune system, resulting in the development of systemic inflammatory reactions that damage various tissues of the body ( first of all the joints). Also, in some diseases of this group, malfunctions in the functioning of the immune system occur, resulting in damage to the body’s tissues by the body’s own immune cells.

• Treat traumatic injuries promptly. Immediately after an injury, apply a cold compress or ice to the joint area. If necessary, you can take anti-inflammatory drugs ( for example, nimesil at a dose of 100 mg). If the pain does not go away after 1–2 days, it is recommended to consult a traumatologist or orthopedist.
• Treat infectious diseases in a timely manner. Even if the source of infection is far from the joint, infectious agents can enter the blood and spread throughout the body. That is why, if a bacterial infection is detected, it is necessary to start taking antibacterial drugs as early as possible. You should also follow the duration of treatment prescribed by your doctor. If you stop taking antibiotics immediately after the clinical manifestations of the disease disappear, there is a high probability that some of the pathogenic bacteria will not die, but will remain in various tissues of the body, which can lead to relapse ( re-exacerbation) infections.
• Timely and adequate treatment of rheumatic diseases. Treatment of systemic inflammatory diseases should be prescribed by a rheumatologist after a thorough examination of the patient, taking into account the individual characteristics of the patient and the course of the disease. Self-medication is often ineffective and can also lead to the development of a number of dangerous complications.

Is it possible to cure inflammation of the mandibular joint at home?

The cause of inflammation of the temporomandibular joint can be:

• injury;
• infection;
• rheumatic diseases ( rheumatoid arthritis, systemic lupus erythematosus, gout and some others).

To treat arthritis of the jaw joint after injury it is necessary:

• Immobilize the joint. It is recommended to talk as little as possible, and also to avoid eating rough and hard foods that require thorough chewing.
• Apply a cold compress. Exposure to cold reduces the severity of inflammation in the joint, reduces tissue swelling, reduces the risk of complications and speeds up the healing process.
• Eliminate pain. For this purpose, non-steroidal anti-inflammatory drugs can be prescribed ( for example, nimesulide at a dose of 100 mg every 6 – 8 hours), which can be bought without a prescription at any pharmacy.

Treatment of infectious inflammation of the mandibular joint is carried out with antibiotics. The patient can take them independently at home, but these drugs should be prescribed by a doctor after a comprehensive examination. Anti-inflammatory drugs may also be used to relieve pain.

Treatment of rheumatological diseases involves the use of various medications ( hormonal anti-inflammatory drugs, immunosuppressants and others), which themselves can cause a number of adverse reactions. That is why treatment must be carried out under the supervision of a specialist; the patient must strictly follow the rheumatologist’s instructions and regularly undergo all tests prescribed by the doctor.

Pain in the jaw joint area may indicate the development of inflammation and dangerous diseases. Let's take a closer look at the symptoms of inflammation of the jaw joint and the most effective treatment methods.

Inflammation of the jaw joint: the main causes of the disease

Most often, the jaw joint becomes inflamed for the following reasons:

1. Mechanical injury. This could be a fall or a blunt blow to the jaw, which severely injures soft and bone tissue. Also, with a jaw injury, the following may occur:

Hematoma formation;

Rupture of the internal joint capsule;

Crack or fracture.

As a result of injury, inflammation occurs in the joint cavity. This leads to fluid accumulation and a sharp deterioration in jaw mobility.

2. Infection also threatens the development of an inflammatory process. The infection itself can enter the joint in the following ways:

Direct (with a fracture, bullet wound, knife cuts, etc.);

Contact (for diseases such as abscess, phlegmon, boil, purulent mumps and otitis media);

Hematogenous (develops with acute fungal, bacterial or viral diseases).

Typically, hematogenous infection occurs in the following diseases:

Gonorrhea;

Syphilis;

Diphtheria;

Tuberculosis;

3. Rheumatoid arthritis quite often cause inflammation of the jaw joint. With this disease, the soft tissue of the joints is severely affected in humans. Inflammation of the jaw occurs in almost 20% of patients.

To date, there is no exact information about the causes of the development of rheumatoid arthritis. Scientists have identified the provoking factors of the disease. They are hereditary predisposition and various viral infections (hepatitis, herpes, etc.).

4. Lupus erythematosus is a disease in which a person’s immune system is disrupted and joints are damaged. It is also important to know that the joints themselves are not deformed, so after healing the discomfort may disappear altogether.

5. Reactive arthritis accompanied by severe inflammation of the joints (including the jaw joint). It occurs after a previous infection in genitourinary system or intestines. The deterioration of the condition of the joints itself occurs due to damage to the patient’s tissues by certain microorganisms.

6. Gout is accompanied by metabolic disorders, due to which uric acid begins to be deposited in the patient’s body tissues.

This disease usually develops due to poor nutrition, lack of nutrients or sedentary human life.

Due to the large accumulation of this substance in the blood, salt begins to accumulate in the joints, which leads to the development of inflammation, acute pain and burning.

Inflammation of the jaw joint: symptoms and manifestations

Acute inflammation of the jaw joint is accompanied by the following symptoms:

1. Pain. This is the most common symptom inflammation. The nature of the pain can be different: sharp, aching, stabbing and cutting. The intensity is strong and often repeated (especially after chewing food).

Also, sometimes the pain can radiate to other parts of the face (upper jaw, ears, etc.). This is due to the fact that different parts of the soft tissues on the face are innervated by the same nerve, which passes through the jaw joint.

2. Redness and severe swelling are most characteristic of acute arthritis (purulent form), in which pathogenic microbes collect in the joint.

3. An increase in body temperature is primarily associated with the dilation of blood vessels and the flow of warm blood to the area of ​​the inflammatory process. This provokes the development of such a symptom.

4. A feeling of bursting and squeezing in the joint is observed due to tissue swelling.

5. Hearing loss can occur due to the spread of inflammation. It is also important to know that with infectious inflammation, the disease can spread to the inner ear, causing complete deafness.

6. Fatigue.

7. Fever.

8. Body aches.

9. Weakness.

10. Loss of appetite.

11. Apathy.

12. Pain when eating.

13. Frequent pain in my head.

14. A sharp increase in blood pressure and exacerbation of hypertension.

Symptoms of chronic inflammation in the jaw joint are:

1. Aching pain. Its intensity will not be as pronounced, however, it will give a person no less unpleasant sensations than in the acute form. Also, the pain can be paroxysmal and occur at any time.

2. Impaired joint mobility. This will be especially obvious in the morning.

3. The appearance of a crunching sound in the sore joint, which may be accompanied by pain.

4. Slight increase in temperature.

5. Chronic weakness.

6. Slight hearing loss (may be in one ear).

Inflammation of the jaw joint: diagnosis and treatment

Due to the fact that inflammation in the jaw joint can be caused by a variety of diseases, before starting treatment it is important to identify the source of the disease. To do this you should go through the following diagnostic procedures:

1. General analysis blood.

2. General urine analysis.

3. Detection of uric acid levels.

4. Analysis for the amount of protein.

6. X-ray of the jaw joint.

It is also advisable to visit the following doctors:

1. Traumatologist.

2. Neurologist.

3. Therapist.

4. Rheumatologist.

5. Dentist.

6. Otorhinolaryngologist.

Inflammation of the jaw joint: treatment methods

Traditional treatment inflammation of the jaw joint includes the following techniques:

Immobilization;

Drug treatment;

Physiotherapeutic treatment.

1. Immobilization. It is indicated for dislocations, stretch marks, bruises and joint injuries that have led to the development of inflammation. The main goal of immobilization is to immobilize the affected joint. To do this, a soft chin bandage, sling-shaped or parietal-mental bandage can be applied to the patient’s face.

Depending on the severity of the patient’s condition, he must wear such a bandage from several hours to several weeks.

2. Drug treatment. It is aimed at relieving pain, swelling and improving blood circulation. Most often, the patient is prescribed the following groups of drugs:

Anti-inflammatory drugs (Nimesil);

Non-narcotic analgesics (Paracetamol);

For severe pain, narcotic painkillers (Tramadol, Morphine) may be prescribed;

Cytostatics for inflammation (Cyclophosphamide, Azathioprine).

It's important to seem that these drugs can be taken either orally in the form of tablets or administered by injection.

3. Physiotherapy usually carried out after drug treatment as a restorative procedure. The duration of such treatment is determined by the attending physician depending on the severity of the disease and the patient’s condition.

Traditional physiotherapeutic treatment includes the following set of procedures:

1. UHF therapy. It is aimed at influencing the affected tissues by an electric field. In this case, the energy emitted by this field will be absorbed by diseased cells, which will lead to improved blood circulation and normalization of endocrine systems.

UHF therapy also has the following therapeutic effects:

Relieves pain;

Nourishes tissue;

Relieves inflammation;

Improves metabolism in the patient's tissues.

To achieve the maximum therapeutic effect, this procedure must be performed twice a day with intervals of fifteen minutes. The general course of treatment should not exceed two weeks. You can repeat it after two months.

2. Electrophoresis- This is one of the types of physiotherapeutic procedures, which involves treatment with electric current and various medications. When the current hits the diseased area, it has such healing effect:

Pain reliever;

Relieves inflammation in the joint;

Relaxes;

Improves blood circulation.

Most often, for joint diseases, doctors use electrophoresis with novocaine. It effectively helps relieve pain.

In this case, a solution with this drug is applied to electrophoresis, after which it is applied to the patient’s body. After applying an electric current, the medicine will act on the diseased area.

The duration of this procedure is 20 minutes. The course of treatment must include at least 14 sessions.

Pain in the temporomandibular joint is a characteristic sign of arthritis. Pain can manifest itself unilaterally or bilaterally and have varying intensity, observed regularly or periodically. Inflammation of the jaw joint leads to a decrease in quality of life due to the inability to fully open the mouth, communicate and eat. Chronic forms of the disease affect the physical, but also the psycho-emotional state of a person, so treatment of the disease should not be delayed.

Causes

The pathology is more often diagnosed in elderly patients and children. In the first case, the condition is caused by degenerative processes of bone tissue and impaired absorption of calcium, in the latter – by the constant growth and development of bone structures.

The development of inflammation of the jaw joint is provoked by several factors. The disease occurs after a fall or blow to the jaw, as a result of which inflammatory processes develop in hard and soft tissues. Jaw injury is also dangerous due to fractures, cracks and rupture of the internal capsule of the joint.

Infection in the body is another common cause of the problem. Pathogenic particles can penetrate into the jaw structure in several ways: direct (in case of injury), contact (in case of complications of abscess, otitis media, purulent parotitis), hematogenous (in case of acute viral and fungal diseases). IN the latter case infection is observed with syphilis, diphtheria, tuberculosis, tonsillitis, gonorrhea, measles.

The photo shows otitis in acute form

With rheumatoid arthritis, 20% of patients experience pain in the jaw joint. Scientists have not yet identified the exact causes of the development of rheumatoid arthritis. Predisposing factors include hereditary predisposition, hepatitis B chronic form and severe viral infections.

The jaw joint also hurts against the background of lupus erythematosus. The disease is associated with decreased immunity and joint damage. Bone structures are not deformed in pathology. After recovery, the symptoms of lupus erythematosus disappear on their own.

Reactive arthritis is an acute inflammation of the jaw and other types of joints. Develops after infection of the digestive and genitourinary systems.

Due to metabolic disorders, another dangerous disease develops - gout. Lactic acid accumulates in the patient’s tissues, which leads to the accumulation of salts in the joints. The condition is accompanied by acute burning pain in the jaw bones.

Types and symptoms of pathology

Arthritis of the jaw joint is classified depending on the cause. The most commonly diagnosed infectious type of disease. The pathology is dangerous because, if not treated in a timely manner, it leads to mumps and mastoiditis. Infectious arthritis of the mandibular joint is accompanied by headaches radiating to the back of the head; swelling of the affected area.

Specific infectious arthritis develops as a result of damage to bone structures due to syphilis or gonorrhea.

The traumatic form of the disease is more often diagnosed in young people due to participation in traumatic sports. Characteristic signs of damage: swelling and severe pain on the side of the injury.

Doctors rarely diagnose dystrophic arthritis. The problem occurs due to uneven load on the jaw when chewing. A characteristic sign of arthritis is a change in facial proportions and malocclusion.

Common symptoms of inflammation include:

• Throbbing pain. The intensity of the sensation increases when you move the joint or press on the chin area.
• Swelling of the damaged area. The pathological process spreads to the soft tissues, causing redness and swelling of the skin over the jaw joint.
• Amplitude limitation. If there is a problem, the patient cannot open his mouth more than 0.5 cm.

TO additional symptoms inflammation of the temporomandibular joint includes:

• deterioration in hearing quality due to gradual narrowing ear canal;
• feeling of stuffiness and extraneous noise in the ears;
• dizziness and chills.

In advanced stages, the pathology is accompanied by clicking and crunching of the jaw. Pain and limited range of motion are especially noticeable in the morning. After warming up, the severity of the symptom weakens.

Adolescents and the elderly should be attentive to the first signs of arthritis. This category of people has a particularly high risk of developing temporomandibular joint diseases.

Treatment

What to do if you get sick? You should not self-medicate, since it is impossible to select a competent treatment regimen without identifying the cause of the pathology. To diagnose the disease, it is enough for an experienced specialist to study the symptomatic picture of the pathology and visually examine the patient. Special attention during a visual examination, the doctor pays attention to the symmetry of the jaw; pain of the area during palpation and range of motion when chewing.

X-rays are considered the most common and accessible way to diagnose diseases of the teeth and jaw structures.

If necessary, the procedure is carried out with contrast enhancement, due to which pathological neoplasms in the jaw structure are revealed.

To diagnose arthrosis of the maxillary and mandibular joint, highly specialized examination methods are used:

• Electromyography.

Diagnosis of TMJ arthritis is complicated due to the fact that the disease symptomatic picture similar to neuralgia.

Treatment of the disease in the acute stage

An important role in the treatment of inflammation of the jaw joint is to ensure rest of the affected area. A fixing bandage is applied to the jaw, under which a gasket is placed.

To relieve the symptoms of pain in the temporomandibular joint, patients need to wear a fixation bandage for several days.

Another goal of therapy is to accelerate the resorption of blood contents poured into the affected area. Drug therapy for the jaw joint includes:

• Take painkillers 2 times a day.
• UHF 1 time per day for 3-5 days.
• Electrophoresis with alternating drugs (Novocaine and potassium iodide).

If the unpleasant symptoms do not subside, then patients are prescribed the Bernard procedure (2-3 sessions). Inflamed areas are exposed to dynamic currents

In addition to analgesics, anti-inflammatory drugs and antibiotics can be prescribed to eliminate signs of pathology. If the doctor recommends injections into the affected joint, then therapy is carried out in a hospital setting. Improper administration of the drug at home can lead to stretching of the joint capsule.

Which doctor treats purulent inflammation of the joint? If there is a problem, you need to contact a surgeon who will perform surgery. The essence of the operation is to open and drain the purulent focus. After surgery in a hospital setting, the patient is offered conservative treatment, which includes: UHF, dry heat, electrophoresis.

Treatment of chronic arthritis

A rheumatologist deals with the treatment of chronic forms of pathology. The same applies to traumatic injury jaws. Treatment measures are based on several principles:

• Carrying out physiotherapeutic procedures: electrophoresis, ultrasound therapy.
• Performing special gymnastic exercises to strengthen the jaw muscles (myogymnastics).
• Massage the chewing muscles to speed up blood circulation in the problem area.

Complex treatment is carried out after consultation with an otolaryngologist, who identifies chronic diseases nasopharynx. With adequate treatment, even irreversible processes in the jaw structures can be eliminated and the joints can return to their previous functionality.

Medicines for treatment

Pharmaceutical agents for the treatment of inflammation of the temporomandibular joint are selected by a specialist. When the disease occurs, patients are usually prescribed the following groups of drugs:

• Non-steroidal drugs – Ketorol. Diclofenac, Ibuprofen. Before prescribing anti-inflammatory drugs, the doctor pays attention to the presence of gastrointestinal diseases in the patient. In case of exacerbation of ulcers or gastritis, taking medications of this group is prohibited. In this case, the drugs are prescribed in the form of ointments and gels to treat damaged areas. If you cannot do without painkillers in tablet form, then Omez or Omeprozole are prescribed in combination with them.
• Vitamin complexes. For inflammation of the temporomandibular joint, patients are prescribed vitamins C and D 3 (Vigantol, Aquadetrim), as well as calcium supplements (Kalcemin).
• Medicines that prevent further damage to cartilage tissue based on hyaluronic acid, chondroitin sulfate.
• Means for intra-articular injections – Diprospan.

The effect of drug treatment for inflammation of the mandibular joint will be greater if it is combined with physiotherapeutic procedures: magnetotherapy, infrared irradiation, ozokerite therapy, electrophoresis.

Ozokerite therapy involves the application of paraffin with ozokerite to the affected area of ​​the body.

Folk remedies

Traditional medicine can speed up recovery and reduce signs of swelling. For this purpose, a variety of creams and ointments made from natural products are used.

Mustard cream is suitable for local treatment of the joint. In the process of preparing it, salt (200g) is used, mustard powder(100 g) and paraffin. The mixture is heated in a water bath and left for 10 hours. The product is applied to the skin until it is completely absorbed into the skin. It is recommended to carry out the procedure at night. In the morning, wash off the remaining ointment.

Creams based on:

• propolis and other bee products;
• medicinal herbs (coltsfoot, thyme, chamomile);
• iodine, which has a resolving effect.

Complications and prevention

Dangerous complications of TMJ inflammation include abscess, cellulitis, meningitis and blood poisoning. First, necrotic masses accumulate in soft tissues, and then spread throughout the body through the bloodstream. Pathogenic microorganisms enter the membranes of the brain and infect them. Complications especially often develop against the background of reduced immunity.

A terrible consequence of acute arthritis of the jaw is the transition of the disease to a chronic form with the formation of adhesions inside the joint cavity. As calcium salts are deposited, another problem develops - ankylosis, in which a person completely loses jaw mobility. Ankylosis leads not only to functional, but also aesthetic problems - facial deformation, jaw asymmetry.

To prevent the disease, it is necessary to promptly treat ENT infections and dental problems, since TMJ arthritis often develops against their background. Don't forget to take it regularly vitamin complexes. Microelements contribute to the normal development of joint cartilage tissue.

Defeat cartilage tissue jaw joint is quite rare. In fact, there are literally several dozen specialists who are able to recognize the disease and prescribe a qualified course of therapy. Symptoms and treatment of arthritis of the maxillofacial area facial joint depend on the causes of the onset of the inflammatory process.

What is arthritis of the jaw joint

• Infection - the catalyst is past illnesses. Gonorrhea, flu, acute respiratory viral infections and even colds can lead to inflammation.
• Injuries - fractures, bruises, and even sudden opening of the mouth can cause inflammation over time.
• Rheumatic processes. Changes and disturbances in metabolism can cause mandibular or maxillary arthritis to develop. The most common diseases are gout, rheumatoid arthritis and systemic lupus erythematosus.

Effective conservative treatment of temporomandibular joint arthritis is aimed at combating the symptoms and cause of the disease.

Signs of jaw arthritis

1. Acute form - treatment of arthritis of the mandibular joint is usually required after receiving a mechanical injury. The cause of the acute form can be a sharp opening of the mouth during a yawn or a strong blow. Acute arthritis of the jaw joint of an infectious nature appears due to otitis media, mumps, etc.
2. Chronic form - if treatment for arthritis is not prescribed in a timely manner maxillary joint medications, then the disease goes into advanced stage. Curing chronic arthritis is quite problematic and often takes a lot of time.

Regardless of the form of the disease, the following symptoms characteristic of the pathology are observed:

• Stiffness - depending on the form of the disease and its progression, can be expressed by characteristic slight restrictions or a complete inability to perform even simple movements. Drug treatment helps relieve swelling and gradually restore the functionality of the joint.
• Pain syndrome - although deforming arthritis of the jaw develops late stages diseases, small changes in the structure are observed at the very beginning. This causes severe muscle spasm. Pain occurs due to degenerative processes. Pain is one of the main reasons for visiting a rheumatologist. If a patient has severe jaw pain, and the discomfort usually appears in the morning, this is a clear symptom characterizing inflammation of the temporomandibular joint or adjacent tissues due to arthritis.
• Sensations during palpation. The maxillofacial joint affected by arthritis can be easily identified during an external examination of the patient. During palpation of the damaged area, unpleasant sensations arise, sometimes manifested in shooting pains.
• Swelling of the buccal mucosa can also indicate related diseases and suppuration that appear due to ordinary flux.
• Redness of the skin - the inflammatory process is always characterized by a change in the color of the skin. When making a differential diagnosis, shade may be important. Yes, for gouty arthritis characterized by a color change to a dark plum shade, the infection necessarily manifests itself in the formation of ulcers.
• Jaw deformation - X-ray signs help identify the disease even at an early stage. The photographs show changes in the interarticular space and slight deformation of the cartilage tissue. X-ray diagnostics in later stages is carried out to determine the extent of the lesion. Upon visual examination, there is a noticeable displacement of the jaw towards the affected joint.
• Formation of compactions - occurs due to infectious arthritis. X-rays can show a strong accumulation of synovial fluid, and also make it possible to determine the etiology of the disease by characteristic changes.

Treating chronic arthritis of the temporomandibular joint is quite problematic. At the development stage, all prescribed drugs are aimed exclusively at combating the symptoms of the disease.

Some symptoms of jaw arthritis are similar to those of other pathologies. Inflammation of the trigeminal nerve and neuritis, dental problems - these diseases have similar symptoms. Therefore, differential diagnosis is mandatory.

How to treat jaw arthritis

Dislocations and subluxations of the joint are adjusted by a specialist and later fixed with a cape-like bandage. Further therapy depends on the etiology of the disease and may include the following:

• Drug blockade. You can relieve joint pain with drugs that are part of the NSAID group (anti-inflammatory drugs), as well as with stronger drugs. How last resort Novocaine injections are prescribed. In later stages, characterized by persistent pain of inflammatory origin, a short course of corticosteroids is prescribed. Treatment lasts no more than 2-3 days.
• Antibiotics. Treatment folk remedies for infectious and rheumatoid arthritis cannot replace a course of antibacterial therapy. First, the inflammatory reagent is determined. Later, narrow-spectrum antibiotics are prescribed. Narrowly targeted drugs allow you to avoid the harmful effects of side effects of therapy; you should be especially careful when prescribing them for arthritis in pregnant women or children.
• Treatment with ointments and compresses. If your joint is aching, you can relieve the pain with the help of special warming compounds. An ointment for maxillofacial arthritis, which contains bee or snake venom, can quickly relieve swelling and reduce pain. Thanks to its warming effect, the ointment relieves muscle spasms and restores mobility.
• Rheumatoid arthritis of the jaw joint requires the use of anti-inflammatory drugs, and at the same time, sanitation of the oral cavity may be required. In difficult cases, you may need to consult a dentist specializing in the elimination of bite defects.
• Exercises to restore mobility. You can restore the mobility of the oral cavity with upper jaw arthritis with the help of special gymnastics. The exercise involves using a fist to block the movement of the lower jaw. You can only open your mouth using the upper part. The exercise should be performed for only 2 minutes 2-3 times a day. To perform it painlessly, gymnastics is combined with the use of medicinal ointments (or camphor oil).
• Physiotherapeutic procedures, hypothermia, electrophoresis, UHF sessions, magnetic therapy, massage, all these methods serve as a good prevention of arthritis and are used during the rehabilitation period.

Surgical treatment for arthritis of the jaw is mainly prescribed to eliminate the consequences of purulent inflammation and dental problems.

What are the risks of arthritis in the maxillofacial joint?

Depending on the etiology of the disease, the following consequences occur:

• Rheumatoid arthritis - the lesion progresses, becomes chronic, and spreads to adjacent joints and tissues. Over time, ankylosis is observed - complete immobility of the jaw.
• Infectious arthritis - sepsis is observed. Since the jaw is located next to the brain, untreated disease is fatal.