Pain syndrome due to dysfunction of the temporomandibular joint - symptoms and treatment of TMJ. Temporomandibular joint pain dysfunction syndrome

Syndrome pain dysfunction Temporomandibular joint (TMJ) is a mild but very painful pathology. This joint is used by a person almost every minute: when talking, chewing, yawning, swallowing. The vast majority of TMJ disorders involve problems with the jaw muscle, which causes pain and tension.

Bilateral chewing of food protects the masticatory muscles from overload and fatigue.

It is important to pay attention to therapeutic exercises. Smooth movements of the lower jaw down-up, right-left and back-and-forth are prescribed before each meal, if pain occurs during eating, after sleep. When performing exercises, you should not allow overload and pain in the muscles or joints.

At each subsequent visit, the dentist monitors the results of treatment and emphasizes the importance for the patient of following the instructions given to him. All this, in combination with the prescription of muscle relaxants, sedatives and the exclusion of unfavorable emotional factors in everyday life and at work, leads to an improvement in the condition of almost 50% of patients.

Autogenic training for painful TMJ dysfunction

Despite their small mass, the muscles of the face send significantly more impulses to the brain than the muscles of the limbs or torso. Facial and masticatory muscles constantly contract under various psycho-emotional and physical stress. A person’s state of mind is expressed by his facial expressions.

In a state of emotional arousal, a person's facial and chewing muscles increase in tension. Consequently, muscle tone and activity are closely related to the functional state of the central nervous system. This connection was proven by the works of I.M. Sechenov and I.P. Pavlov.

In addition, the masticatory muscles experience significant stress during eating, talking, and singing. The state of the chewing and facial muscles is influenced by the main sense organs located on the face: vision, hearing, smell and taste. They take basic information from environment and constantly send a large number of impulses to the brain, enhancing its activity.

Many people experience spontaneous contraction of the masticatory muscles during emotional or physical stress. More than a quarter of the world's population suffers from bruxism - a spontaneous contraction of the chewing muscles during sleep. A prolonged tense state of the masticatory muscles often leads to the development of temporomandibular joint pain dysfunction syndrome. Therefore, it is very important to teach the patient to actively control and regulate the tone of the facial muscles. This is an important prerequisite for normalizing the flow of impulses to the brain and improving the general condition.

Autogenic training (controlled self-relaxation) as a method of psychotherapy was proposed by J. G. Schultz in 1932. It creates conditions for general calming of the nervous system and for more complete rest, helps eliminate painful spasms of the masticatory muscles and dysfunction of the lower jaw. Under the influence of autogenic training, the mood improves and the patient’s faith in recovery is strengthened. In this way the patient provides active influence on the course and outcome of your illness.

In the complex treatment of temporomandibular joint pain dysfunction syndrome, elements of autogenic training are used for psychotherapeutic and psychoprophylactic purposes.

Autogenic training has broad, but not unlimited, indications. It is important to take into account not only the stage of the disease, but also the personality, the intellectual minimum of the patient, whether he can master and apply autogenic training, and whether he has the desire to cooperate with the doctor. You need a special “psychological suitability” for autogenic training. Successful implementation of auto-training depends on understanding its meaning and trust in the doctor.

Autogenic training should be carried out regularly. It cannot claim an independent role, but is only one link in complex treatment. It should not be recommended for acute pain, since with them it is impossible to achieve concentration on performing the exercise.

Before starting training, the patient should be explained the essence of the disease and the importance of coordinated harmonious contractions of the masticatory muscles in the treatment and prevention of temporomandibular joint pain dysfunction syndrome.

An explanation of the essence of painful disorders and the mechanisms for overcoming them is necessary to establish appropriate contact with the patient. Treatment by persuasion and explanation is an integral part of autogenic training. An authoritative explanation from a doctor that the pathological symptoms of the disease are based on mental stress, stressful situations, not organic disorders, helps to mitigate the anxiety reaction during treatment and during relapses of the disease.

During the first conversation, pay attention to the tension of the masticatory and facial muscles, to eliminate their possible excessive activity. Explain to the patient the physiological connection between muscle tone and emotional state. These data help the patient to correctly imagine the therapeutic role of relaxation of the masticatory muscles. The active position of the patient will help him carry out independent psychological self-influence.

Combining autogenic training with other treatment methods significantly increases the effectiveness of treatment. Before starting the exercises, the patient needs to calm down, disconnect from all extraneous worries and thoughts and fully tune in to carefully performing the exercises. Then they begin to practice techniques that promote muscle relaxation.

The exercises are best performed while sitting in the “coachman’s position.” The patient tilts his head forward so that the lower jaw is perpendicular to the floor. The hands and forearms rest on the thighs. The muscles of the face, torso and limbs are relaxed, the eyes are closed. To facilitate the implementation of the main task of autogenic training, several preparatory exercises are performed. To do this, the patient is asked to gradually close the teeth and thus tense the muscles of mastication. Tension of the chewing muscles is accompanied by a slow, deep breath. When exhaling, the patient completely relaxes the masticatory muscles. Exercises for preliminary tension of the masticatory muscles are necessary for the patient so that he can, by contrast, better feel, realize and reproduce from memory the feeling of complete relaxation of these muscles.

As soon as the patient assimilates this sensation, there is no need to tense the masticatory muscles. Om switches to sensory reproduction of relaxation, that is, it reproduces the desired sensation from memory.

The patient mentally imagines his face slightly smiling, kind and mentally says: “I am completely calm, my masticatory muscles are relaxed, my teeth are unclenched.

• A feeling of heaviness increases in the masticatory muscles, the eyelids become heavy and closed;
• the lower jaw droops;
• eyebrows droop;
• the forehead is smoothed;
• lips are relaxed;
• the mouth is half open, the cheek muscles are relaxed;
• all facial muscles are relaxed and calm;
• breathing is even, calm;
• my whole body is relaxed"

These exercises are carried out at least three times a day for 10 minutes until the painful spasm of the masticatory muscles stops. This usually takes from 2 to 6 weeks.

When the patient has mastered the technique of deep relaxation of the masticatory muscles and has a good idea of ​​the sensations associated with their relaxation, his lower jaw makes a pendulum-like movement when shaking his head from side to side.

Autogenic training is recommended to be carried out when the first signs of temporomandibular joint pain dysfunction syndrome appear. It allows you to prevent or relieve muscle spasm in the early period and avoid the appearance of pain and jaw contraction.

Muscle relaxation gives good results in combination with other treatment methods. Autogenic training distracts the patient’s attention from a stressful situation, causing spasm muscles. To independently conduct autogenic training, it is advisable to provide the patient with a special instruction manual or methodological development.

It is important to emphasize once again that ignorance or misunderstanding of the etiology of temporomandibular joint pain dysfunction syndrome can lead to the wrong choice of treatment methods. However, with this disease there is always tension, fatigue, and spasm of the masticatory muscles. The doctor must constantly keep this in mind and take appropriate measures. Relaxation of the masticatory muscles helps relieve increased tone, fatigue, tension and spasm of the masticatory muscles. How independent method treatment, autogenic training is prescribed simultaneously or after eliminating all unfavorable general and local factors and, above all, sanitation of the oral cavity, elimination of dentition defects, etc.

Therapeutic exercises for painful dysfunction of the TMJ.

In the complex treatment of pain dysfunction syndrome of the temporomandibular joint, therapeutic exercises are used to prevent or eliminate functional disorders that have arisen: increased tone or spasm of the masticatory muscles, limited mobility of the lower jaw, discoordination of contractions of the masticatory muscles, excessive mobility of the head of the lower jaw. jaws, clicking in the temporomandibular joints. Various gymnastic exercises affect separate groups muscles performing complex movements and the temporomandibular joint.

In cases of dysfunction of the masticatory muscles, when there is clicking in the temporomandibular fuss, displacement of the lower jaw forward or to the side, limited or excessive mobility of the lower jaw, therapeutic exercises are one of the main types of complex treatment of temporomandibular pain dysfunction syndrome. laryngeal joint. Before therapeutic exercises, it is advisable to carry out thermal procedures. They help improve blood circulation and the functional state of the masticatory muscles.

At the beginning of treatment, until all exercises are mastered, therapeutic exercises are carried out under the supervision of an instructor or doctor 3-4 times a day. Then the patient performs the exercises independently, and the number of sessions is increased to 5-8 times a day. Each exercise is repeated 8-10 times.

The patient performs the exercises while sitting, sitting comfortably on a regular chair or in a dental chair. So that patients can control their movements, therapeutic exercises should be performed in front of a mirror [Sokolov A. A., Zausaev V. I., 1970].

It is recommended to take 2-3 minute breaks between exercises, since spasmed masticatory muscles quickly tire. Exercises should not be accompanied by pain or cause a feeling of fatigue in the muscles. Failure to comply with these requirements can lead to negative results: an increase in painful spasm of the masticatory muscles and even greater contraction of the jaws.

Exercises for active stretching of the masticatory muscles are carried out with limited mobility of the lower jaw caused by spasm, reflex and cicatricial contracture or injury to the muscles that lift the mandible. These exercises are designed to stretch the masticatory muscles. The patient performs them independently with the teeth positioned in centric relation and in incisal closure of the teeth.

The patient makes maximum hinge movements of the lower jaw up and down (up to 10 times from each position); then, from the central relationship of the teeth, shifts the lower jaw to the right, left and forward (10 times in each direction).

Exercises for reflex relaxation of the masticatory muscles are based on the use of the physiological principle of intercombination of reflexes, i.e. if a group of synergistic muscles is in the contraction phase, then the group of antagonist muscles is in the corresponding relaxation phase. So, when lowering the lower jaw, the muscles of the floor of the mouth contract and the muscles that raise the lower jaw relax. The stronger the muscles that lower the mandible contract, the more the muscles that raise the mandible relax. Consequently, the use of special exercises with counteraction carried out by a doctor, instructor or the patient himself on the chin, angle or branch of the lower jaw allows for deeper relaxation of spasming muscles. It occurs due to the reflex component of relaxation.

Reflexive relaxation of the muscles that lift the lower jaw and shift it forward and to the sides is used. To reflexively relax the muscles that lift the lower jaw, the doctor or physical therapy instructor, or the patient himself, places one hand on the chin and holds the lower jaw in place. At the same time, the patient is asked to perform rhythmic movements of the lower jaw up and down, overcoming the resistance of the hand.

Reflex relaxation of the lateral pterygoid muscles is achieved by placing the hand of the instructor or the patient on the angle or branch of the lower jaw of the side in which lateral movements will be performed (Fig. 21). After appropriate instruction, the patient performs the exercises independently.

Anterior advancement of the lower jaw is performed with the help of an instructor, a doctor, or independently. The doctor places his right hand on the chin and his left hand on the patient's head. While moving the lower jaw forward, the doctor applies resistance with his right hand. At independent execution exercises, the patient places the palm of his left or right hand on the chin and resists the movement of the lower jaw anteriorly and posteriorly. First, a doctor or instructor demonstrates how to perform these movements, then the patient performs the exercises independently.

In addition, the patient is warned that for 3-4 weeks he should limit the movements of the lower jaw, not open his mouth wide, and smoothly chew soft food on both sides of the jaw. With combined types of pathology, for example, when a low bite height is combined with dysfunction of the masticatory muscles or with deformation of joint elements, etc., treatment measures become more complex. They include restriction of movements of the lower jaw, various types of orthopedic interventions, therapeutic exercises, etc. It should be borne in mind that if the patient is undisciplined and does not have enough willpower to regularly follow the doctor’s orders, then he, as a rule, , other methods of treatment, including various orthopedic devices, do not help.

It is not possible to predict in all cases what the clicking in the temporomandibular joint will result in in the future. To eliminate clicking, the main focus most often has to be on normalizing muscle function. If a doctor accidentally discovers a clicking sound in a joint in patients who do not pay attention to it and do not make any complaints about it, then they should limit themselves to only the corresponding entry in the history of the disease. It’s not worth talking about this to a restless person who is easily suggestible. For many people, clicking continues for a long time without any consequences.

In cases where clicking is one of the symptoms of pain dysfunction syndrome of the temporomandibular joint, complex treatment of the latter disease is carried out, including treatment of incoordination of contraction of the masticatory muscles.

Drug treatment of painful TMJ dysfunction.

The syndrome of painful dysfunction of the temporomandibular joint is often accompanied by a violation of the patient’s psycho-emotional balance. The resulting emotional tension, anxiety or fear, as a rule, increases the tone of the masticatory muscles, intensifies their spasm and reduces the mobility of the lower jaw. The current stressful situation has an adverse effect on the course of the disease. This dictates the need for systematic regulation of the patient’s mental state and tone of the masticatory muscles using various pharmacological agents and, above all, tranquilizers, analgesics, muscle relaxants and other medications.

Tranquilizers relieve anxiety, fear, and reduce emotional stress. At the same time, many of them have muscle relaxant and anticonvulsant effects.

For symptoms of bruxism, severe spasm of the masticatory muscles and limited mobility of the lower jaw, it is advisable to prescribe Elenium (chlordiazepam) 0.005-0.01 g or Seduxen (diazepam) 0.0025-0.005 2-3 times a day. The use of these drugs is contraindicated in acute diseases of the liver, kidneys, pregnancy, severe myasthenia gravis. They should not be prescribed to patients whose work activities require increased reaction and attention.

People with poor tolerance to tranquilizers, as well as weakened or elderly patients are prescribed tazepam (oxazepam) 0.01 g per dose 2-4 times a day. It differs from Elenium and Seduxen in its mildness of action, relatively low level of toxicity, better tolerability and less pronounced muscle relaxant effect. Tazepam has the same contraindications for use as Elenium.

With increased muscle tone or with damage to the temporomandibular joint, with concomitant spasm of the masticatory muscles, with neuroses and psychoneurotic conditions accompanied by excitement, irritability, anxiety, fear, sleep disturbance, prescribe meprotan (meprobamate) 0. 2-0.4 g per dose 2-3 times a day or cutamil (isoprotan) 0.25-0.5 g per dose 2-4 times a day. Meprotan and scuta-mil are not recommended to be prescribed during or before work to leads whose profession requires quick mental and physical reactions.

Trioxazine (trimethacin) does not have a depressing effect on human behavior. It is prescribed for adults orally at 0.3 g per dose 2-3 times a day. Trioxazine relieves fear, reduces tension, emotional arousal, but does not relax muscles.

To eliminate pain in the area of ​​masticatory muscles and the temporomandibular joint, various non-narcotic painkillers are prescribed orally 2-3 times a day: acetylsalicylic acid(aspirin) 0.5-1 g, amidopyrine (pyramidon) 0.25 g, analges 0.25-0.5 g, indomethacin (methindol) 0.025 g, brufen (ibuprofen) 2 tablets and other medicines. These drugs simultaneously have an antipyretic and anti-inflammatory effect, therefore they are also used to treat rheumatoid arthritis, nonspecific infectious polyarthritis, osteoarthritis, bursitis and other diseases of the joints.

Long-term use of these drugs may be accompanied by dizziness, drowsiness, dyspeptic symptoms, suppression of hematopoiesis, allergic reactions and other complications.

Local use of anesthetics for painful TMJ dysfunction.

It is advisable to use local anesthesia for severe pain and severe limitation of the mobility of the lower jaw.

Blockade of trigger zones or motor branches trigeminal nerve eliminates pain and spasm of the masticatory muscles, as it breaks the vicious circle in which spasm of the masticatory muscles increases pain, and pain increases muscle spasm.

Pain and spasm of the masticatory muscles can be relieved by superficial anesthesia by spraying the skin above the trigger area with a stream of chlorethyl or infiltrating the painful areas of the masticatory muscles with a weak solution (0.25-0.5%) of anesthetic.

We usually use and get good results from blocking the motor branches of the trigeminal nerve at the infratemporal crest [Egorov P. M., 1967].

Local anesthesia of trigger zones leads to a blockade of spontaneous pathological impulses from these areas and often causes prolonged or complete cessation of some forms of musculofascial pain.

These pains can also be eliminated for several days, weeks, and sometimes forever, using short-term intense stimulation of trigger points with a dry needle injection, intense cold, administration of an isotonic sodium chloride solution, or subcutaneous electrical stimulation.

In order to diagnose and treat the syndrome of painful dysfunction of the temporomandibular joint, it is possible to perform superficial anesthesia of the skin over the painful area of ​​the muscle with a stream of chloroethyl.

If it comes into contact with the skin, chloroethyl quickly evaporates and causes cooling, ischemia and decreased skin sensitivity. However, it must be borne in mind that strong cooling with chlorethyl can cause tissue damage. When exposed to chlorethyl, the patient lies on his back or side. Protect the auricle, nose and eyes with a towel or napkin. Before frost appears, the skin above the trigger area is treated with a jet of chlorethyl directed at an acute angle at a distance of 50-60 cm from the face.

Reduced pain and improved mouth opening indicate a positive result of treatment. Chlorethyl is highly flammable. Therefore, it should not be used near lit gas, cigarettes, etc. The room should be well ventilated. The use of chlorethyl is contraindicated for heart disease.

Pain and jaw constriction can be eliminated by injecting a weak (0.25-0.5%) anesthetic solution into each painful area of ​​the muscle.

Pain in neighboring muscles sometimes stops after infiltration of only one, the most painful, trigger zone with a weak anesthetic solution.

Let's consider the technique of introducing anesthetic solutions into each muscle that lifts the mandible.

In the masticatory muscle itself, the painful area is often located in the upper part of the anterior edge at the site of attachment of the muscle to zygomatic bone. In these cases, it is more advantageous to insert the needle from the anterior edge and advance it from behind to the painful area. To determine the site of injection of the anesthetic, you can use the following method: the index finger of the free hand is placed on the zygomatic bone, the thumb is placed at the lower edge of the lower jaw, where the facial artery crosses it. The line connecting these two points corresponds to the location of the anterior edge of the masseter muscle. The middle finger is placed over the painful area of ​​the muscle, which must be hit with a needle. The needle is inserted from the front edge of the masticatory muscle to the depth indicated by the middle finger.

The location of the trigger zone at the posterior edge or in the area of ​​the lower part of the masticatory muscle is determined and fixed with the index finger of the left hand, and 1-2 ml of a 0.25-0.5% anesthetic solution that does not contain vasoconstrictors is injected into this zone.

An anesthetic solution is injected into the medial pterygoid muscle, depending on the location of the trigger zone, intra- and extraorally. If the painful area is located in the upper half of the medial pterygoid muscle, then an intraoral approach is used. To do this, place the index finger in the retromolar fossa, and the middle finger on the hook of the pterygoid process of the main bone and retract the cheek. The line drawn between these points corresponds to the location of the anterior edge of the upper half of the medial pterygoid muscle. The needle is injected into the anterior edge and advanced across the internal pterygoid muscle posteriorly to its painful area. This blockade differs from the mandibular anesthesia technique in that an anesthetic solution is not injected along the needle, since with the end of the needle it is necessary to determine the location of the painful area in the muscle (by the appearance of sharp pain while inserting the needle).

The extraoral approach is used to block the trigger zone, located in the lower half of the medial pterygoid muscle. To do this, from the side of the oral cavity, use the index finger of the left hand to identify and fix the painful area of ​​the medial pterygoid muscle. The nail phalanx of the thumb of the same hand is placed behind the angle of the lower jaw, opposite the index finger. Treat the skin with tincture of iodine or alcohol, insert a needle at the nail phalanx thumb. The needle is advanced along the inner surface of the angle of the lower jaw under the index finger. A weak anesthetic solution that does not contain vasoconstrictors is injected into the painful area of ​​the medial pterygoid muscle.

In the temporalis muscle, trigger zone blockade can be performed using extraoral and intraoral methods. The painful area of ​​the upper edge of the zygomatic bone, at the anterior edge of the lower part of the temporal muscle, is easily accessible for extraoral blockade.

This area is fixed with the index finger of the left hand, the skin is treated with tincture of iodine or alcohol. The needle is injected and advanced under the index finger, into the temporal muscle, where a weak anesthetic solution, without vasoconstrictors, is injected.

With limited mouth opening, it is much more difficult to reach the trigger zone in the area of ​​attachment of the temporal muscle to the inner surface of the ramus of the lower jaw. To do this, the patient is asked to open his mouth as wide as possible. Using the terminal phalanx of the index finger of the left hand, the painful area is identified and an anesthetic solution is injected into it intraorally.

In the lateral pterygoid muscle, the painful area is often located in the area of ​​the outer plate of the pterygoid process of the main bone. It can be turned off from the oral cavity.

To do this, a curved needle is inserted into the transitional fold behind upper tooth wisdom and advance the needle along its curvature inward and backward to the outer plate of the pterygoid process of the main bone, where the anesthetic is injected.

We administer intramuscular anesthetic solutions in cases where there is an easily accessible painful area in one, usually the masseter or temporal muscle.

Often there is a painful spasm of all or a number of muscles that lift the lower jaw, with simultaneous irradiation of pain in the neck or upper limb. The clinical picture of temporomandibular joint dysfunction syndrome in these cases is not always typical, so sometimes it is not possible to determine the location of the main areas of painful muscle spasm.

To eliminate multiple injections of an anesthetic solution into each painful area of ​​the masticatory muscles, and in some cases for the purpose of differential diagnosis of temporomandibular joint pain dysfunction syndrome, we have proposed and have been successfully using since 1965 our own method of blocking the motor branches of the trigeminal nerve in infratemporal crest [Egorov P.M., 1967] with a weak solution (0.5-0.25%) of anesthetic without adrenaline.

Blockade of the motor branches of the trigeminal nerve according to Egorov.

Among the numerous methods of blocking the branches of the mandibular nerve wide use received subzygomatic methods. This approach is relatively short and more accessible for advancing the needle to the branches of the trigeminal nerve.

When studying anatomical preparations and histotopographic sections, the author found that under the lower edge of the zygomatic arch, skin, subcutaneous fatty tissue, and sometimes parotid tissue are located in layers. salivary gland, masticatory and temporal muscles.

Corresponding to the posterior half of the lower jaw notch between inner surface temporal muscle and outer surface In the lower part of the bone of the same name there is a narrow layer of fiber, which gradually expands downward and, at the level of the mandibular notch, separates the medial surface of the masticatory and temporal muscles from the lateral pterygoid muscle. The width of the layer of fiber in the pterygotemporal space in adult specimens ranges from 2 to 8 mm. On preparations of newborns it is presented in the form of a narrow layer 1-2 mm wide. The strip of this fiber below merges with the fiber of the pterygomaxillary space, the latter reaching the lower edge of the mandibular foramen. On top, a thin layer of fiber is sometimes located between the base of the skull and the lateral pterygoid muscle, as well as between the upper and lower heads of this muscle. The motor branches of the mandibular nerve are located in the described layers of fiber.

It should be noted that the distance from the outer surface of the lower edge of the zygomatic arch to the tissue upper section The pterygotemporal space in adults is subject to very significant individual fluctuations (15-35 mm) (P. M. Egorov).

Existing subzygomatic methods of blocking the branches of the mandibular nerve (Versche et al.) do not take into account the wide range of variability in spatial relationships between organs and tissues located along the path of needle advancement. The research conducted by the author makes it possible to introduce a certain precision into the technique of blocking the motor branches of the mandibular nerve from the lower edge of the zygomatic arch and for each patient to individualize the depth of needle insertion and deposit the anesthetic solution only in the tissue of the pterygotemporal space.

The author found that as a guideline for switching off the motor branches of the mandibular nerve from the lower edge of the zygomatic arch, it is advisable to use the lateral surface of the squama of the temporal bone, located almost in the same vertical plane with the tissue of the pterygotemporal space. The essence of this method is as follows: the patient is in the dental chair. His head is turned in the opposite direction. Thumb of the left hand, the doctor determines the location of the head of the lower jaw and the anterior slope of the articular tubercle. To do this, he asks the patient to open and close his mouth, move his lower jaw from side to side. Having determined the location of the articular tubercle, the doctor asks the patient to close his mouth, then, without removing his finger from the articular tubercle, treats the skin with alcohol or tincture of iodine. Under the lower edge of the zygomatic arch, he inserts a needle directly anterior to the base of the articular tubercle and moves it slightly upward (at an angle to the skin of 65-75°) until it contacts the outer surface of the scales of the temporal bone, notes the depth of immersion of the needle into the soft tissue and pulls it up to the zygomatic arch towards himself. Then sets the needle perpendicular to the skin or slightly downward and again immerses it in soft fabrics to the marked distance.

The end of the needle is at the top of the infratemporal crest, in the pterygotemporal cellular space. The nerves pass here, in the pterygotemporal cellular space. The nerves innervating the temporalis and masticatory muscles pass through here. Along the slit-like gap separating the upper head of the lateral pterygoid muscle from the base of the skull, there is a direct connection with the tissue of the infratemporal fossa, in which other motor and sensory branches of the mandibular nerve are located.

To turn off the motor branches of the mandibular nerve in order to relieve spasm and pain in the masticatory muscles, it is enough to inject 1-1.5 ml of a 0.5% anesthetic solution without vasoconstrictors. The anesthetic is administered slowly over 2-3 minutes.

By the end of the anesthetic administration, patients often note a significant improvement in mouth opening, a decrease or cessation of pain at rest and during movements of the lower jaw. Favorable results that occurred after blockade of the motor branches of the trigeminal nerve confirm the diagnosis of temporomandibular joint pain dysfunction syndrome.

At the same time, this blockade is a good therapeutic procedure that relieves pain for 2 hours, sometimes for a longer period of time. However, more often less intense dull pain 4-6 blockades with an interval of 2-3 days along with other methods of treatment (therapeutic exercises, autogenic training etc.) leads to the cessation of pain and restoration of the full range of movements of the lower jaw. An anesthetic depot is created in the area where the neurovascular bundles of the masticatory, temporal, and lateral pterygoid muscles are located. This circumstance is of no small importance, since in the area of ​​injection of the anesthetic solution there is a local increase in temperature by 1-2°C within 48-72 hours.

The simplicity of the technique and the absence of complications when carrying out more than 5 thousand blockades convinced us of high efficiency this diagnostic and therapeutic method. After a course of treatment with blockades in 32% of patients with severe pain, we observed the cessation of pain and normalization of the functions of the temporomandibular joint for a long period of time. In patients with mild symptoms of temporomandibular joint pain dysfunction syndrome (slight pain or clicking in the joint, etc.), we noted favorable results from drug therapy, therapeutic physical culture and other treatment methods without blocking the motor branches of the trigeminal nerve with weak anesthetic solutions.

Principles of orthopedic treatment of temporomandibular joint pain dysfunction syndrome.

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

In defense of these views, they refer to the well-known but insufficiently substantiated provisions of Kosten that shifts of the head of the lower jaw backwards and upwards 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 schemes for orthopedic treatment of Costen syndrome, or the syndrome of painful dysfunction of the temporomandibular joint. Thus, L. R. Rubin and L. E. Shar- urban divide 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, the corresponding orthopedic measures are pathogenetic methods of treatment, determining the nature of not only the therapeutic ny, 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 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 experience “loose joints (so-called snapping joints)” and subluxations. L.R. Rubin and L.E. Shargorodsky advise treating them with devices such as the M.M. Vankevich splint or splints that limit mouth opening.

S. S. Greene, D. M. Laskin (1972) also recommend the use of various types of orthopedic devices for the treatment of pain dysfunction syndrome. Type 1 device does not change 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 device contains an occlusal platform that is in contact with all - with the lower teeth and in the lateral section, separates the teeth by 2-3 mm.

According to a number of authors, orthopedic treatment should be reduced to repositioning the head of the mandible to the “optimal position”, for example, in the center of the articular fossa, in the center of the articular disc. Most orthopedic dentists note the high effectiveness of orthopedic treatment methods. However, in the fair opinion of R. Goodman, S. S. Greene, D. M. Laskin, none of them gave a real assessment of the true effectiveness of orthopedic treatment in comparison with placebo treatment or with the patient’s self-recovery occurring without treatment.

A number of authors believe that patients with temporomandibular joint pain dysfunction syndrome respond well to treatment various types placebo. This is convincingly evidenced by clinical and experimental observations.

R. Goodman, S. S. Greene, D. M. Laskin (1976), who carried out a false model of orthopedic treatment, i.e. limited themselves to only simulating the alignment of the occlusal surface, obtained positive results in 64% of patients. Obviously, a significant part positive results orthopedic treatment is associated with the placebo effect. It follows that in many patients, a change in occlusion is not the main cause of the disease and a specific method of treating temporomandibular joint pain dysfunction syndrome. Particularly convincing in this regard are the observations of S. S. Greene and D. M. Laskin (1974). In 94% of patients, they noted positive results of treatment without any orthopedic interventions. It is likely that psychological and other factors play a more important role than various changes in occlusion.

Thus, orthopedic treatment of temporomandibular joint pain dysfunction syndrome, if indicated, should be carried out along with other methods (drugs, physiotherapy, autogenic training, therapeutic exercises, etc.) aimed at eliminating various etiological factors -Torov.

Therefore, before planning orthopedic treatment, it is necessary to establish a complete diagnosis, that is, to find out and take into account all local and general unfavorable factors. In the simplest cases, pain and discomfort are first eliminated by grinding the leading contacts of the teeth under the control of carbon paper directly in the patient’s mouth. This helps the patient achieve muscle relaxation and reduce or eliminate muscle pain. The most complex articulatory relationships must first be studied on plaster models of the jaws enclosed in an articulator, and only after that an individual plan must be drawn up indicating the sequence of various orthopedic or orthodontic measures. Typically, defects in the dentition are eliminated, supercontact points are ground with small cylindrical stones, the bite is increased or the occlusal surface is leveled with various occlusal overlays, and the position of the dentition and individual teeth is corrected using orthodontic methods.

Details of planning and carrying out these types of orthopedic interventions are set out in a number of manuals [Gavrilov E. I., Oksman I. M., 1978; Kurlyandsky V. Yu., 1977, etc.], to which we refer the reader. Here we will touch only on the general principles of orthopedic interventions for temporomandibular joint pain dysfunction syndrome.

With defects in the dentition, overload of some groups of teeth and masticatory muscles occurs. Adequate prosthetics according to generally accepted indications creates a uniform load on the teeth and masticatory muscles. By grinding some surfaces of the cusps, we eliminate interference with the movements of the lower jaw and create permanent irreversible changes in the occlusal surface. When leveling the occlusal surface, it is better to remove the very minimum amount of tooth tissue than to remove too much (N. A. Sho-re). During work, it is necessary to constantly monitor the preservation of the anatomical shape of the teeth. This will help
achieve correct simultaneous multiple contacts of teeth. Adequate occlusal stabilization reduces the load on the muscles and creates the necessary conditions for stabilizing the mandible. Grinding eliminates occlusal interference and, thus, reduces tooth mobility, changes the magnitude of tactile afferent nerve impulses, which affect the tone and harmonious function of the masticatory muscles. Single or multiple occlusal interferences can appear as a result of weak natural abrasion of the occlusal surface of the teeth. It should be emphasized that the occlusal surface cannot be leveled until all the causes of the temporomandibular joint pain dysfunction syndrome have been established. In some patients, changes in occlusion appear secondary to bruxism, spasm, or hyperfunction of the masticatory muscles. Therefore, the doctor must first eliminate the causes of muscle dysfunction. If all factors are considered and the doctor comes to the conclusion that it is necessary to change the occlusion, then possible adverse reactions of the patient to grinding of individual cusps should also be taken into account. The patient should be told what to expect from the intended treatment and warned that there may be increased sensitivity to temperature stimuli in the area of ​​the ground surfaces. After some time, dental hyperesthesia usually disappears.

After leveling the occlusal surface, it is important to teach the patient to chew food on both sides.

Occlusal linings (splints) are used to temporarily change the proprioceptive sensitivity of periodontal teeth, creating discomfort in the oral cavity. All splints must be stable on the teeth and create comfort in the oral cavity. Occlusal pads activate a large number of peristontal receptors that change afferent nerve impulses, which in turn affects the function of the masticatory muscles. Therefore, they help stabilize the mandible. Therefore, occlusal splints must create simultaneous multiple contacts. intertubercular position. Without adequate occlusal stabilization is impossible. harmonious function of the masticatory muscles. It is known that single-point contact increases the tone of the masticatory muscles and often contributes to the development of their dysfunction.

There are stabilizing splints that create uniform multiple contacts of teeth, bite blocks or relaxation splints that help relax the masticatory muscles, soft or elastic splints to eliminate clenching and change periodontal efferent nerve impulses, splints with peloto, which allow only articulated movements.

Splints that regulate the occlusal level are used in deep bites to determine the individual bite height. With the help of these splints, the vertical relationship of the jaws is changed until pain and other symptoms of dysfunction of the temporomandibular joint cease.

Stabilizing splints are made for a jaw with fewer teeth. This type of temporary splint is indicated for defects in the dentition, low or crossbite, and large discrepancies in the dental arches. However, it must be borne in mind that all removable splints are not worn for long, since prolonged use of them leads to tooth displacement.

Relaxation splints are made of transparent plastic for 1-2 weeks. They consist of a shortened palatal plate and a well-formed occlusal lining only on the upper frontal teeth. The lateral teeth are separated so much that free movements in all directions are possible and afferent nerve impulses from their periodontium are almost completely excluded. Tactile nerve impulses come only from the front teeth. They relax the muscles that lift the mandible and activate their antagonists. This normalizes muscle function. Relaxation splints are used for limited mobility of the lower jaw, for painful spasms of the masticatory muscles and for repositioning the head of the lower jaw when it is displaced, for example, up and back.

Soft or elastic splints are used only when clenching teeth. They should be manufactured individually in the articulator and the occlusal plane should be carefully formed. Splints with peloto look the same as stabilizing splints, only in the area of ​​the chewing teeth they have relots. They are used for clicking in the joint, lateral displacement of the lower jaw and pain in the temporomandibular joint.

Orthopedic treatment of temporomandibular joint pain dysfunction syndrome should help create satisfactory occlusal stabilization of the mandible and coordinate the function of the masticatory muscles. Elimination of incorrect tooth contacts helps restore the normal level of neuromuscular activity of the temporomandibular complex. Indeed, in some cases, orthopedic methods are effective, but the group of such patients is small. And although for some patients this method turns out to be almost miraculous, in most cases, patients who underwent such treatment and those who did not recover almost simultaneously.

Currently, many clinicians believe that pain dysfunction syndrome occurs due to occlusal disharmony, which disrupts the normal neuromuscular function of the temporomandibular complex. To eliminate the cause of pain dysfunction syndrome, they recommend correcting occlusal disharmony. The scope of occlusion correction varies from leveling the occlusal plane to complete reconstruction of the dentition. Proponents of the psychophysiological theory of the occurrence of pain dysfunction syndrome of the temporomandibular joint report successful treatment of it with medications and psychotherapy, without making any changes to the occlusion.

Proponents of the theory of occlusal disharmony, while recognizing the usefulness of this treatment, believe that without appropriate correction of occlusion, the success of treatment is temporary. We believe that malocclusion is one of the many etiological factors of pain dysfunction syndrome. Many modern authors consider occlusion not in a narrow mechanical plan, relating only to the relationship of teeth, but in a broad aspect, taking into account directly or indirectly various neuromuscular mechanisms that are activated when the upper and lower teeth during movement or rest of the lower jaw. Violations of this complex system play a certain role in the occurrence of facial pain. Any position of the lower jaw is the result of the complex activity of a large number of muscles.

The temporomandibular joint is located in front of the ear and includes the lower jaw and temporal bone. It is this that makes it possible to talk, swallow, chew, and move the jaw in different directions. TMJ dysfunction is a pathology of the coordination of this joint as a result of improper placement of its components, malocclusion, or problems with muscle function.

Diagnosing the disease is difficult. This is due to the multiplicity of symptoms and the large number of changes that occur during the disease. All this complicates the diagnosis and treatment process.

TMJ dysfunction: signs

TMJ dysfunction syndrome is characterized by symptoms:

• Pain in the jaw, face, shoulders and neck.
• Discomfort when opening the mouth, talking, eating.
• Inability to open mouth wide.
• Problems with the jaw returning to its place when opening.
• Clicking and other sounds when the mouth moves in different directions.
• Difficulty chewing.
• Fatigue of facial muscles.
• The appearance of swelling on one side of the face.

TMJ dysfunction - causes of the disease

A common cause of TMJ dysfunction is stress. TO possible factors that led to the development of the disease include:

1. Illiterate placement of the filling. As a result, the symmetry in the functioning of this joint is disrupted, one side of the jaw experiences overload, the discs are displaced, and this syndrome occurs.
2. Long-term dental treatment at the dentist.
3. Joint injury.
4. Increased stress during sports.
5. Grinding of teeth.
6. Loss of teeth and changes in bite due to this reason.
7. Taking certain oral contraceptives.

A common symptom is headache. The patient feels discomfort in the temples, back of the head and even shoulder blades. Headache It can be so severe that doctors suspect migraines and brain diseases.

The proximity of the joint to the ears leads to the appearance painful sensations in the ear, congestion and even hearing loss. Ringing is also an alarming symptom.

Diagnosis of TMJ dysfunction

Given the variety of symptoms, diagnostic difficulties arise. Therefore, patients go from office to office to find out accurate diagnosis and are examined for a long time by several specialists: a therapist, a neurologist, an ENT doctor, a rheumatologist. In fact, the identification of the disease and its further effective treatment depends on the coordinated work of two doctors: a dentist and a neurologist.

The symptoms of this anomaly are similar to other diseases. In this regard, the doctor needs to study the anamnesis and conduct a series of studies. The doctor will check the joint for pain, listen to the sounds made when the jaw moves, note how much restriction of movement and blocking the jaw has as it moves up and down, and check the bite.

A panoramic image is taken to rule out other diseases. To assess the condition of soft tissues, computed tomography or magnetic resonance imaging is performed. After the examination, the doctor decides on treatment or refers the patient to a maxillofacial surgeon.

Treatment of TMJ dysfunction

The treatment strategy for TMJ dysfunction is to reduce the load on the affected area. It is necessary to limit conversations, eat soft foods and perform other gentle actions. To get rid of pathology, specialists are involved: dentists, osteopaths, neurologists, psychologists.

Considering that TMJ dysfunction syndrome forces the patient to experience pain, pain therapy is carried out.

1. Taking sedatives and antidepressants.
2. Massage, myogymnastics, and various physiotherapeutic methods (electrophoresis, laser, ultrasound) are indicated.
3. Psychosomatics and visiting a psychologist.

At a dentist's appointment, treatment of this pathology is carried out primarily with the aim of returning the bite to the place of the bite for proper closure of the teeth, correcting fillings that rise above the surface of the crown, and high-quality prosthetics. To correct the bite, braces are used. Recovery is facilitated by the use of orthopedic mouth guards and splints.

If therapeutic treatment did not bring the desired results, conservative therapy is carried out. In this case, it is carried out surgical intervention. It includes following procedures: myotomy of the lateral pterygoid muscle, arthroplasty, condylotomy of the head of the jaw located below.

For successful treatment, a complex of medical actions is indicated. This includes treatment by an orthodontist, replacement of fillings, surgery, proper prosthetics, physiotherapy and acupuncture.

Treatment of such an anomaly is extremely important. If you neglect this problem, complications will arise: arthrosis, joint immobilization. Only combined treatment will give a positive result.

It is possible to prevent the disease, it is necessary to avoid stress, excess pressure on the joint, carry out high-quality dental prosthetics, correct the bite, if necessary, and solve problems with posture.

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 explained by 3 groups of factors:

• occlusal-articulatory (increased abrasion of tooth enamel, dentition defects, mechanical injuries, damage, malocclusion, medical errors during prosthetics, low position of the alveolar ridge, congenital anatomical anomalies of the jaw or teeth);
• myogenic (hypertonicity, improper functioning of the muscles of the face and neck, bruxism, increased speech load, the 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 mass various manifestations– from pain in the affected joint (or both) to jamming of the jaw, deterioration of vision and hearing

The syndrome of TMJ pain dysfunction is accompanied by a complex of problems - violation of occlusion, muscle tone jaw and incorrect relationship of joint elements 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 unclear 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 can lie both in dental diseases and lie in the neurological, psychological plane

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

Diagnostics

The vagueness of signs of TMJ dysfunction complicates the diagnosis. Many patients with joint dysfunction are sent for consultation to the wrong specialist (for example, to a neurologist, since the clinical picture of a 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 detecting extraneous sounds in the joint).

Solution

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

• apply a warming or, conversely, cooling compress for 15 minutes;
• on the advice of a doctor, take a painkiller tablet (Ibuprofen, No-shpy);
• reduce the functional load on sore joints (avoid hard, difficult-to-chew foods, maintain a gentle speech regime);
• master the removal technique muscle spasms, meditation for elimination psychogenic causes 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 - this is not a complete list of problems that arise in the TMJ due to its increased traumatic nature

Other medicines:

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

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

Treatment of TMJ dysfunction involves the fight against caries or extraction of affected dental units, acupuncture, and in severe cases, surgical intervention (condylotomy of the articular head, arthroplasty, myotomy of the lateral pterygoid muscle). In 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

In the absence of 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 of the temporomandibular joint can be caused by both dental, neurological, and 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 occurs 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.

In accordance with the myogenic theory, the development of TMJ dysfunction is facilitated by disorders of the jaw muscles: tonic spasm, mechanical overload of the masticatory muscles, etc., caused by a one-sided type of chewing, bruxism, bruxomania, professions associated with a large speech load, which ultimately leads to chronic microtrauma of the TMJ elements.

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

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 the cervical spine, back of the head and ears; tinnitus and hearing loss; burning in the nose and throat. Currently diagnostic criteria The following groups of symptoms are considered to be TMJ dysfunction:

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

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

3. Pain syndrome. With TMJ dysfunction, pain is determined at 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

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

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

To 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 causes and associated disorders, various specialists can be involved 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 TMJ dysfunction with non-removable devices is preceded by wearing orthopedic splints or mouthguards.

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

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.

Dysfunction of the temporomandibular joint manifests itself as a pain syndrome that spreads to the head area, temporal part and neck. With the disease, there is impaired functioning of the TMJ, accompanied by muscular, occlusal and spatial deviations. In the patient, the pathology is accompanied by a clicking of the movable joint, impaired range of mouth movements, and pathological sounds in the ear cavity. It is necessary to consult a doctor promptly and carry out comprehensive treatment to avoid complications.

Etiology and pathogenesis

Pain dysfunction syndrome manifests itself due to the influence of various pathological factors:

• broken bite;
• the presence of a number of teeth with defects;
• improper installation of dentures;
• pathological abrasion of teeth;
• dental deviations different types, in which the size of the alveolar process decreases;
• constant grinding of teeth;
• microtrauma of chronic TMJ structures;
• stress of a physical and neuropsychic type, due to which joint kinematics are disrupted and the functions of the muscles of the facial and jaw area are affected.

When the articular disc and other jaw structures become dysfunctional, the joint begins to malfunction, which affects the patient’s daily life. The pathology provokes severe pain and discomfort in the temporomandibular joint. If treatment measures are not taken in time, the condition quickly worsens and dangerous complications arise.

Symptoms of temporomandibular joint dysfunction

As the pathology worsens, the patient may hear a clicking sound in the joint when opening the mouth.

In the early stages, it is quite difficult to independently identify temporomandibular syndrome, because clinical manifestations practically absent or less pronounced. Over time, muscle-joint dysfunction manifests itself as pain, which intensifies when moving the jaw, chewing, or while talking. The patient also experiences other symptoms:

• crunching, clicking, popping in a moving joint that occurs when active movement jaw;
• limited mobility when opening the mouth;
• irradiation of pain in the ear, head;
• difficulty chewing food;
• swelling of the face on one side;
• impaired hearing function;
• dizziness;
• loss of normal sleep.

With TMJ dysfunction, in order to open the mouth wide, the patient must first move the jaw in different directions.

The pathogenesis of temporomandibular joint dysfunction is quite complex and occurs with a symptom complex that resembles signs of neck osteochondrosis, inflammation of the auricle and other abnormalities. Thus, it is sometimes difficult for doctors to find out the etiology of the disease and select suitable treatment. For this purpose, differential diagnosis is required, in which it is possible to distinguish dysfunction of the maxillary joint from other pathologies.

How is diagnosis carried out?

If you suspect a problem with the joint, you should see a doctor.

In case of pathology, you should seek help from medical institution. The doctor will examine the damaged area and collect a history of the disease. Temporomandibular joint dysfunction syndrome is confirmed through laboratory and instrumental examinations. During diagnosis, the doctor palpates and examines the joint for pain, discomfort and sound disturbances. It is also important to assess the range of motion and whether the moving joint is jammed. The following methods are used for diagnosis:

• orthopantomography, which takes a full-face photograph;
• ultrasound examination;
• radiography, which determines the presence of displacement and other pathologies;
• CT and MRI;
• rheoarthrography or Dopplerography with determination of hemodynamics in the arteries;
• electromyography;
• gnathodynamometry to determine the strength of the masticatory muscles.

How is the treatment carried out?

Modern treatment methods make it possible to eliminate dystrophic deviations of the TMJ even in the later stages. Painful dysfunction of the temporomandibular joint is eliminated different ways depending on the stage at which the disorder is diagnosed. First of all, it is important to reduce the load on the damaged area. For this purpose, they switch to a gentle diet and limit their speech load. It is possible to eliminate pain manifestations that arise against the background of painful TMJ dysfunction by the following means:

If necessary, the doctor may resort to injections of corticosteroids into the joint itself.

• non-steroidal anti-inflammatory drugs;
• medications with sedative effects;
• glucocorticosteroids, which are injected into the temporomandibular joint.

Myogymnastics, massage treatments and physiotherapy are also effective. The latter is prescribed only after a doctor’s prescription and includes the following manipulations:

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

Diseases of the temporomandibular joint often require the use of measures to recreate the correct bite. The dentist can remove high fillings, install dentures, or perform selective teeth grinding. A mouthguard is also often used in treatment, or the doctor prescribes wearing a joint splint. When using this product, the load on the moving joint is reduced, thereby eliminating pain.

If conservative treatment diseases of the temporomandibular joint turned out to be ineffective, then surgery is indicated. Depending on the disorder, the surgeon performs myotomy, condylotomy, arthroplasty or other surgical procedure.

Unconventional therapeutic methods

To prepare the medicine, you need to chop the radish tediously.

It is possible to treat the disease at home using remedies traditional medicine. Before using them, consult a doctor, but it is important to understand that they provide only symptomatic treatment. The following recipes are effective:

• Egg yolk + turpentine + Apple vinegar. The components are mixed in equal quantities, after which the finished medicine is rubbed into the affected area.
• Black radish + honey. A tincture is prepared from the main products, and the vegetable must be chopped. Add half a glass of vodka and 1 tbsp to the mixture. l. salt. Mix and rub into the affected area, then wrap it in a warm scarf.

Possible complications

If dysfunction is not treated for a long time and pathological symptoms are not eliminated, then irreparable consequences arise. In especially severe cases, joint immobility develops - ankylosis. With this deviation, the patient’s speech is impaired, it is impossible to breathe normally, and the face becomes asymmetrical. Dystrophic disorders in the tissues of the mobile joint, progression of arthrosis or other chronic diseases are also possible.

Prognosis and prevention

With early diagnosis and treatment, TMJ dysfunction is successfully eliminated and a person can fully restore joint mobility. Otherwise, arthrosis, ankylosis and other complications develop. Pathology can be prevented by reducing the level of anxiety and stress. It is also important to reduce the load on the joint and promptly treat dental diseases. It is equally important to control your posture, since it is also a predisposing factor to the development of dysfunction.