Temporomandibular joint dysfunction syndrome (TMJD) is one of the most difficult and controversial diagnoses that dental practitioners have to deal with. According to V.A. Khvatova (1997), from 27% to 76% of patients seeking help from a dentist have complaints of dysfunction of the TMJ, from 14% to 29% of children and adolescents suffer from this disease. Diversity clinical manifestations dysfunction of the temporomandibular joint is determined by the polyetiology of the pathological changes developing in it, which complicates its diagnosis and treatment.

Most common reason development of TMJ dysfunction is - stress. No less common causes of TMJ dysfunction are mistakes made by dentists - orthopedists, orthodontists, therapists, and surgeons. Even an incorrect placement of a filling on a chewing tooth can disrupt the symmetry in the work of the TMJ joints, lead to unilateral loads, then displacement of the discs, and finally, to pain dysfunction of the TMJ joints.

To others possible reasons diseases include:

joint injury

a decrease in the height of the bite due to the loss of teeth, especially chewing;

bruxism, wear and tear as a result of stress;

excessive loads when practicing athletic sports;

malocclusion;

Since TMJ dysfunction is difficult to diagnose, dentists are not very familiar with its symptoms and treatment methods (and other doctors even more so), patients do not receive the required timely assistance and go from one doctor to another, getting to chiropractors, otolaryngologists, therapists, neuropathologists, psychoneurologists, and finally come to a psychotherapist, where they are prescribed means "to calm the nerves." Many dental clinics prefer to avoid these patients, since many of them already have a complicated somatic system.

In the United States, the cost of treating temporomandibular joint dysfunction is second only to therapy malignant tumors... A similar situation is observed in Germany. According to the American Dental Association, TMJ dysfunction affects about 75 million people in the United States.

Since there are many different symptoms TMJ lesions, it is difficult to make a proper diagnosis. However, there are several classic symptoms - those that affect the TMJ joints themselves, ears, head, face and teeth.

Clicks and other noises in the temporomandibular joint

Most frequent symptom TMJ lesions - clicking in the joint lower jaw... These sounds can be so loud that others can hear them when you chew. Joint pain directly at the sound of the click may or may not be. But one thing is for sure: if the disc is misaligned (which is usually the case) when the click occurs, then the muscles that move the lower jaw when chewing are tense more than normal. This tension leads to pain in the muscles, face, head and neck.

Blocking (capturing, locking) the TMJ

Blocking (gripping, locking) the TMJ - this term is used to denote the uneven movement in the joint due to disorders in it. The blockage of the temporomandibular joint can be seen simply as an uneven movement when opening the lower jaw (as if it is catching something). Sometimes a person with a blocked joint must move the lower jaw to one side or the other in order to open the mouth wide. It also happens that a person has to open his mouth until he hears and / or feels a loud sound at the point at which the lower jaw is actually "unlocked".

Change in bite

Disturbances in the temporomandibular joint can also be manifested by a change in dental occlusion, or bite. If the temporomandibular joint disc is misaligned, then the bones and disc do not fit together properly and therefore the bite of the teeth changes.

Ear symptoms

Due to the proximity of the TMJ to auricles, the lesion of the TMJ often causes various ear symptoms... Some symptoms include ear pain, congestion or dullness, or even hearing loss. That is why many patients with TMJ lesions first turn to their family doctor and an ENT specialist before the dentist suspects TMJ pathology.

Headache

Headache is one of the most common symptoms of TMJ pathology. Usually headache with pathology, the TMJ is located in the temples, the back of the head and even the shoulders (shoulder blades). Jaw clenching and teeth grinding can be symptoms of TMJ pathology; these symptoms cause muscle pain, which can lead to headaches. A displaced TMJ disc can also cause joint pain that often radiates to the temples, forehead, or neck. These headaches are often so severe that doctors accept and treat them (without special success) as migraines or brain pathology.

Increased tooth sensitivity

If the temporomandibular joint disc is misaligned, the teeth can become very tender, in part due to movements such as clenching the jaws and grinding teeth. Patients often go to their dentist for dental pain, but the doctor usually cannot find any cause for the pain. Unfortunately, unnecessary pulp extractions and even tooth extractions are often performed when trying to help a suffering person. And this is the worst, because after these invasive and irreversible procedures, the pain not only remains, but intensifies!

Other symptoms

Many other symptoms can be associated with TMJ pathology... Often there is pain in the shoulders (shoulder blades) and back due to increased muscle tension (spasm) - a condition called myofascial pain syndrome. Some people with TMJ pathology also experience dizziness, disorientation, and even confusion.

Depression is often seen in TMJ pathology. It may be due to the patient's experience of the fact that no one can understand the problem that is causing such pain and suffering. In addition, a lot of scientific evidence shows that patients with chronic pain (and almost all patients with TMJ pathology) have changes in the chemical structures of the brain (called neurotransmitters) due to this pain. These neurotransmitters can cause depression. Along with depression comes the inability to get good night sleep. Bad dream may be directly due to TMJ pain or due to changes in neurotransmitters in the brain that send impulses even when the patient is asleep. Such sufferers usually awaken with the feeling that they have not slept at all, or at least have not slept well. Not only does the lack of sleep make these unfortunate people feel more painful, it also increases their depression.

A patient with TMJ pathology may also suffer from photophobia (increased sensitivity to light). TMJ disorders can cause pain in and behind the eye, which can cause hypersensitivity to the light. Blurred vision and twitching of the eye muscles are also common symptoms in these patients.

And finally, another common symptom is ringing in the ears. This sound can be caused by many different problems (working under loud sounds or taking too much aspirin or ibuprofen).

Questions you should answer if you are suspected of having TMJ pathology:

Do you have frequent headaches?

Do you hear joint clicking or popping sounds when you chew?

Do you hear a rubbing sound (like crumpled newspaper) when you chew?

Do you have a feeling of stuffiness, pressure, or blockage in your ears?

Do you hear ringing or buzzing in one or both ears?

Do you feel dizzy often?

Do you feel like your lower jaws are catching something?

Do your lower jaws feel tight, difficult to open your mouth?

Don't you feel like you can't open your mouth as wide as you did before?

Are you trying to separate your teeth with your tongue? Are you biting your tongue while doing this?




Unpleasant sensations in the temporomandibular joint most often occur with arthritis. It can span two sides or be one-sided. Arthritis is characterized by discomfort when chewing food and opening the mouth.

The chronic form can cause significant harm not only to the physical, but also to the emotional well-being of a person.

It is for this reason that treatment should be started immediately after the definition of the disease. This ailment can occur at any age, but older people are more likely to suffer. Also, quite often pain is observed in children. This is due to the constant growth in the growing body.

Causes

Pain and discomfort in the temporomandibular joint may appear on different reasons... It is extremely important to correctly determine the cause, because the effectiveness of future treatment will depend on this. Each of them has its own characteristics. The main reasons for the development of the disease:

1. Infection and viruses;
2. received injuries of a mechanical nature;
3. all kinds of inflammatory ailments.

The infection can cause joint pain. The harmful microorganisms begin to form a positive environment for the formation of inflammation. It can enter the mouth by contact, direct contact, and blood. The most common is the straight path. So infection occurs when the joint capsule is injured and damaged. All kinds of microorganisms enter the oral cavity, which provoke the appearance of the disease.

The contact route is characterized by the multiplication and spread of bacteria from infected tissues. The main causes of contact infection: boil, purulent mumps, phlegmon, abscess, otitis media, osteomyelitis and all kinds of infectious diseases oral cavity... Measles, sepsis, diphtheria, tonsillitis, gonorrhea and syphilis can cause bloodborne infection.

Symptoms

To determine arthritis of the temporomandibular joint, you need to know the main symptoms, among which:

1. Pain... With the formation of inflammatory processes, the pain is always very sharp, cutting or stabbing. It tends to intensify during movement. It is very difficult for a person to open his mouth even for a few minutes. It is worth noting that temporomandibular arthritis can have transient pain. This is because different parts of the face are connected by the trigeminal nerve.
2. Fever. Heat the human body is observed when advanced stages diseases. Also, arthritis of the temporomandibular joint can be accompanied by muscle aches, increased fatigue, headaches and general weakness.
3. Redness and inflammation... In the hearth accumulates large amount microbes, as a result, the joint may swell.
4. Hearing impairment... When inflammation occurs, a decrease in the external auditory canal is observed. As a result, hearing can be impaired on the side of the joint injury.

Treatment


The first step is to note that the pain will not go away on its own, it is extremely important to provide the right treatment. In any form of this whitening, it is necessary to ensure the immobility of the jaw. For this, a special bandage is applied, which reliably fixes the jaw. If we are talking about an injury, then the bandage is worn for 7-9 days, but in the case of an infectious type, it is enough to fix the jaw for 1-3 days.

During treatment, it is better to refuse solid food, it is better to eat exclusively liquid food... If you are substitutes for at least some symptoms of arthritis of the temporomandibular joint and feel pain, then you should definitely consult a doctor for detailed advice. He will help to correctly determine the cause and prescribe treatment.

For any form of inflammation and deviation of the temporomandibular joint, anabolic drugs are prescribed. For traumatic types, medications are also prescribed that stimulate blood circulation in damaged tissues. If your ailment is of infectious origin, then you simply cannot do without strengthening the immune system. For this, doctors prescribe all kinds of vitamin complexes.

Each individual case has its own specifics, but in most cases after 3 days effective treatment positive changes are observed. After the relief of the main symptoms of the disease, they are prescribed additional procedures, these include: magnetotherapy, mud therapy, electrophoresis, hot paraffin applications, laser therapy, massage and all kinds of exercises that are necessary for muscle recovery.

If you have, then you can eliminate some of the symptoms at home. Bee venom ointments can be effective. But remember that it is forbidden to make them for people with allergic reactions... It is also recommended to make compresses from coltsfoot, chamomile, oak bark and thyme.

This procedure is best done at least 2 times a day. Before going to bed, it is recommended to apply iodine grid on the jaw. This product widely used in medicine. Its properties allow you to get rid of many negative factors... Will help relieve joint pain warm rinses from chamomile.

If the appearance of arthritis is associated with the presence of dental diseases, then after the elimination of the main symptoms, the oral cavity must be sanitized. This measure is mandatory. Otherwise, in just a couple of months, arthritis and joint pain will return again. With a rheumatoid variety, doctors prescribe a general strengthening course. These are all kinds of trace elements, dietary supplements and vitamins.

In practice, there are often cases of purulent and rather complex arthritis of the temporomandibular joint. In this case, you cannot do without a full surgical intervention... So the articular cavity is opened and a special drainage is installed. People suffering from purulent arthritis should undergo inpatient treatment, which can last from 2 to 4 weeks, it all depends on the complexity of the situation.

As mentioned earlier, only after determining the type and characteristics of the disease, treatment can be prescribed. Various methods are used to find out the cause. The most common are general analysis blood test and evaluation of clinical data.

In any case, every health problem leaves its mark on the body. Doctors advise you to improve your nutrition and put more emphasis on all kinds of fruits and vegetables. So the immune system will recover much faster and be less susceptible to disease.

DO YOU STILL SEE IT HARD TO GET RID OF JOINT PAIN?

Judging by the fact that you are now reading these lines, victory in the fight against joint pain is not yet on your side ...

Constant or intermittent pain, crunching and palpable pain during movement, discomfort, irritability ... All these symptoms are familiar to you firsthand.

But perhaps it is more correct to treat not the effect, but the cause? Is it possible to get rid of joint pain without serious consequences for the body? We recommend reading the article by DOCTOR OF MEDICAL SCIENCES, PROFESSOR BUBNOVSKY SERGEY MIKHAILOVICH about modern methods getting rid of joint pain ...

Temporomandibular joint dysfunctions

Immediate diagnosis and relief of symptoms


with the joint splint for temporomandibular joint

What is TMJ?

The temporomandibular joint (TMJ) forms a flexible joint between temporal bone skull and lower jaw. It is one of the most active joints in the entire body. It is used practically all the time - when talking, chewing food and swallowing (1-2 times per minute).




You can feel the movement of the joint if you open and close your mouth by placing your little finger in the ear canal. If there is a TMJ disorder, this procedure can be painful.

Causes of TMJ dysfunction

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TMJ dysfunction syndrome was first discovered in 1934 by otolaryngologist Dr. B. Kosten, it occurs when the joint is under increased stress, the reasons for this may be teeth, muscles or jaws.

Kosten was the first to demonstrate that pain in the ears, head and neck area can be eliminated by correcting the bite, relieving excessive pressure on the joint using an intraoral splint.
According to the American Dental Association, about 75 million people in the United States suffer from TMJ dysfunction. However, most people with chronic head and neck pain do not have this syndrome.

TMJ dysfunction symptoms

Pain dysfunction of the TMJ manifests itself in various pains, both aching and acute, pronounced. Headaches, pain in the ears, lower jaw, neck, difficulty or accompanied by clicking, opening and closing the mouth are common symptoms. More often, pains are manifested not in the joint itself, but in the muscles surrounding it. It's like a pebble in a shoe - not only the sole suffers, but also the knee and back, as the body tries to maintain balance.

Patients often do not receive the treatment they require

Many dentists find this treatment difficult and not guaranteed. Other doctors begin treating symptoms without identifying the underlying cause. As a result, patients go from one specialist to another without receiving the correct diagnosis and treatment.

Causes of TMJ dysfunction

TEETH

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

MUSCLES

Wrong way swallowing, in which the lower jaw moves back
Myofunctional habits such as bruising or clenching of teeth mouth breathing
Joint overload due to stress or athletic sports

JAWS

Incorrect jaw alignment
Injury, such as from a car accident
Specific medical conditions such as arthritis

Treatment of TMJ dysfunction

Regardless of the causes or severity of TMJ dysfunction, the most effective method- at the initial stage, the use of a soft joint splint.
Its task is to relieve stress on the joint, reduce muscle tension and limit teeth grinding.
The use of a joint splint for the TMJ immediately relieves the symptoms of joint dysfunction. concomitant muscle therapy is effective. For complete elimination of symptoms, further treatment by a specialist doctor may be required.

The principle of the joint splint

Joint splint has a thickening in the molar area, which promotes gentle decompression of the joint. Thanks to the flexible silicone base of the splint, a relaxing effect is created on the muscles in the TMJ joint, head and neck, which leads to an immediate reduction in pain.
Habits such as bruxism, clenching the teeth under stress are limited - stress is relieved thanks to the patented wing-shaped base, as well as the two-jaw splint design: in the splint, the lower jaw is pushed forward thus. the position of the jaws is set according to the 1st class. Over time, this allows you to eliminate chronic pain in the joint area.
The main symptoms of TMJ dysfunction are eliminated within a few days, but to relieve chronic pain requires wearing the device for several weeks. The 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.

DIAGNOSTICS AND TREATMENT OF TMJ DYSFUNCTION

According to research data, 35% of dental patients suffer from TMJ dysfunction, of which 20% are actively seeking treatment. Usually, patients do not seek treatment from dentists or orthodontists. An effective tool for the diagnosis of temporomandibular joint dysfunction is an electromyographic (EMG) study of the muscles of the maxillofacial region.

An effective tool for diagnosing and eliminating symptoms

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

As a rule, more than half of these patients suffer from bruxism during sleep or grit their teeth strongly during moments of even minor emotional stress during the day. Asymmetries of the shoulders, shoulder blades, shortening of one leg can also cause TMJ dysfunction syndrome. In this case, the side short leg usually correlates with the pain side. The pain syndrome can be effectively relieved by correcting the bite and relieving excess pressure in the joint area using a soft TMJ splint.

Palpation of the TMJ muscles and joints - these areas are examined for muscle tension

Scheme of palpation examination of the musculature of the maxillary region in patients with TMJ dysfunction:


Soft TMJ splint does not require special fitting, manufacturing and correction. Its unique design combined with low cost makes the treatment of joint disorders faster and more affordable.

The joint splint is developed by MRC for diagnosis and immediate elimination of symptoms of TMJ dysfunction - initial stage treatment. It is made made of medical grade silicone, shaped like a perfect dental arch. The splint has a thickening in the molar area, which causes gentle decompression of the joint. The device also fixes the mutual arrangement of the jaws according to the I class (edge ​​to edge). This creates a relaxing effect on the muscles in the joint, head and neck area, resulting in immediate relief of pain, both acute and chronic. Due to its flexibility, the device is suitable for all types and sizes of jaws (trimming is possible in the case of a very narrow arch).

Treatment of TMJ dysfunction of any degree of complexity is most effective to start with the use of soft splints, which cause TMJ decompression, reduce muscle tension and nocturnal bruxism (teeth grinding), and prevents ceramic chipping. For further treatment orthodontic or orthopedic treatment, aimed at changing the height of the bite (prosthetics).

Additional methods treatment

V individual cases may need additional treatment: making an individual hard tooth splint, physiotherapy, massage, relaxing exercises, cold compresses. Some patients need to consult an orthopedist for posture correction.
An articular splint is also indicated for the prevention of TMJ dysfunction in all types of orthopedic or orthodontic treatment that change the height of the bite or the ratio of the jaws.

Simulated tire TMD ™

The TMD articular splint, developed by MRC specifically for patients with dysfunction of the temporomandibular joint (TMJ), in which the use of a rigid structure is indicated - snapping in the joint, displacement of the articular disc, difficulty opening the mouth. The TMD splint allows you to relieve the lower jaw joint, remove pain syndrome and position the articular head correctly.

If, as a result of bruxism, the chewing surfaces of the upper molars are significantly worn out, then outer surface after fitting, the splints will remain smooth, which will allow the lower jaw to take its most natural position. After using the splint for a while, there is a feeling of displacement of the dental contacts, which is positive sign... The slight discomfort felt when using the splint during the first days is normal and disappears after a few days.

The temporomandibular joint allows a person to talk, chew food, and yawn. This joint in the skeleton is the busiest.

On average, according to a medical atlas, the TMJ is used 2 times per minute.

Dysfunction of the temporomandibular joint was first discovered by B. Kosten, a well-known otolaryngologist in the mid-30s of the last century. The specialist noted that this condition occurs due to high physical loads.

Kosten was able to prove that this syndrome provokes pain in patients in the area:

• heads;
• ears;

At the same time, he also proposed to eliminate the mentioned problem by correcting bite defects, as well as using an intraoral splint.

In turn, doctors point out that usually patients complain that they have a certain pain point in the area of ​​the left or right joint. In this case, the movement of the jaw is often accompanied by a fairly clearly audible crunch or click. As a result, a person cannot eat and speak normally. In addition, sometimes patients indicate that their ears are blocked.

There are two considered joints on the human face. If they work symmetrically, then there are no problems or pains.

But if one of them is damaged at least a little, and very soon the second will start working incorrectly.

Dysfunction always develops in situations where the lower jaw is displaced when the mouth is closed or opened. Therefore, they lead to it:

• change in bite;
• violation muscle tone or soft tissue injury;
• change in the position of individual components of the temporomandibular joint.

The vagueness of symptoms in most cases forces patients to visit doctors who are not involved in the treatment of this joint. Meanwhile, to determine the diagnosis, often the interaction of several specialists in related fields is required, which, according to objective reasons difficult.

Symptoms

Most characteristic features TMJ dysfunction should be called pain. It occurs when a person eats, speaks or, for example, yawns, in the area:

• faces;
• jaws;
• shoulders;
• in or near the ear.

She is usually blunt and quite strong.

At the same time, there is a limitation of the jaw's mobility, accompanied by its jamming.

Often, the work of the joint is accompanied by a crunch or crackle. When eating, the muscles of the face get tired very quickly. In addition, in some severe cases, one of the cheekbones noticeably swells.

Causes

Specialists now cannot bend to consensus, discussing the nature of the disease. Therefore, there are three leading theories of the appearance of TMJ dysfunction. This is about:

• myogenic;
• psychogenic;
• occlusal and articulatory.

In the latter case, the pathology develops due to:

• teeth defects;
• fast erasability of their surfaces;
• jaw injury;
• illiterately made prosthesis;
• wrong bite;
• other diseases, leading to the fact that the alveolar ridge becomes shorter.

In this situation, the pain syndrome usually appears about 10 or 12 days after the patient:

• pulled out one or more teeth;
• set too high a seal;
• incorrect prosthesis.

Moreover, in all cases, patients complain that the pain increases markedly with food and is accompanied by a decrease in the mobility of the jaw, which sometimes forces them to switch to soft food.

The myogenic hypothesis suggests that dysfunction is due to abnormalities in the muscles that move the jaw. This is due to both tonic spasm and mechanical overload of the muscles. Moreover, the habit of chewing on one side leads to the named problems. In addition, it develops due to:

• bruxism;
• professional factors.

As a result, there is a chronic injury to the TMJ.

The psychogenic version suggests that the disorder is provoked different kinds pathological changes in the structure of the central nervous system.

Diagnostics

If you suspect TMJ dysfunction should promptly apply for medical help... Such problems are studied by such a medical discipline as neurology. However, in order to make the correct diagnosis, ideally, a consultation with a dentist is also required.

During the examination, the physician interviews the patient and examines him. It will be necessary to make impressions of the jaws in order to then make a diagnostic model.

In addition, sometimes it is required (in order to assess the condition of the joint) to undergo such examinations:

• orthopantomography;
• fluoroscopy;

MRI is needed in situations where there is suspicion of soft tissue damage. The quality of blood circulation is determined by Doppler sonography or rheoarthrography.

The main studies of the functional nature of doctors are called:

• gnathodynamometry;
• electromyography;
• phonoarthrography.

It is extremely important to exclude the following pathologies in the diagnosis:

• dislocation or subluxation of the jaw;
• arthritis;
• fracture of the articular process;
• synovitis;
• hemoarthrosis.

How to treat

First of all, it is necessary to reduce the stress on the joints. For this, the patient is transferred to soft food and it is recommended to talk less. For treatment, depending on what causes led to dysfunction, are attracted different specialists... It can be:

• orthodontist;
• terpaevt;
• dentist;
• vertebrologist;
• neurologist;
• psychologist;
• osteopath;
• chiropractor.

Pain is relieved with medication. In some cases, they are also prescribed:

• glucocorticosteroids (injections);
• antidepressants;
• various blockades;
• sedatives, etc.

Shown and myogymnastics. The main thing here is not to overload sore joints.

From physiotherapeutic agents, the following are suitable:

• laser treatment;
• electrophoresis;
• inductothermy;
• ultrasound.

The massage will help relax the chewing muscles. Psychotherapy also achieves a similar effect.

If the problem is due to dental factors, then the patient will need:

• restore the correct bite with braces;
• fix too protruding filling or prosthesis;
• polish teeth to restore their occlusion, etc.

If none of the above fixes the problem, then surgery is considered.

Treatment with folk remedies

It makes sense to use such options only in situations where the severity of dysfunction symptoms is not very pronounced. Ointments or compresses are most effective.

This composition is quite suitable for external use:

• 5 grams of turpentine and 10 vinegar are added to one yolk;
• everything is thoroughly mixed until smooth;
• cool slightly.

Ointment rubbed into sore spot until completely absorbed.

Here's another recipe:

• black radish is chopped on a frequent grater;
• juice is squeezed out;
• mixed with 150 milliliters of honey and a spoonful of table salt.

This drug is applied to the joint and wrapped in a scarf.

It should be noted that folk remedies full treatment cannot be replaced. Therefore, it is extremely important:

• follow all the doctor's orders;
• avoid eating solid foods;
• perform assigned exercises.