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

Chronic in nature, myofascial syndrome and so on. The first person to study this pathology was the American otolaryngologist Kosten. It was he who discovered the connection between ear pain and dysfunction of the temporomandibular joint. As a result, the disease acquired another name: Costen syndrome. It is worth noting that this pathology is considered the most painful and complex, since it is difficult not only to diagnose, but also to treat.

Features of the joint

Located in front of the ear. He plays an important role. A joint is made up of bones and temporal bone. At the same time, his muscles perform many functions: speech, swallowing, chewing, and so on. In addition, they connect the skull with the muscles and joints that allow a person to open and close the mouth. The device is also responsible for movement lower jaw right, left, forward, down and up.

What is TMJ dysfunction

Dysfunction of the temporomandibular joint, the treatment of which has its own characteristics, manifests itself when symmetry is disturbed. The device works correctly as long as everything moves the same way on both the right and left. If a malfunction occurs in one joint, then a violation of symmetry occurs, which leads to dysfunction of the second joint. Pathology begins to develop in cases where the lower jaw moves when closing and opening the mouth, and then when moving in other directions.

Main causes of pathology

Temporomandibular joint dysfunction syndrome occurs in patients of various age groups. Statistics show that approximately 70% of the population suffers from such disorders. There are plenty of reasons for the development of pathology. Among them are:

• stress;
• malocclusion;
• sudden muscle strain when grinding rough and hard food;
• increased abrasion of dental tissues;
• physical activity and training during which a certain muscle group is tense;
• mistakes made by dentists, surgeons, therapists, orthodontists, orthopedists: fillings, dental prosthetics;
• injuries of the joints of the lower jaw.

When filling or prosthetic teeth, a specialist can install an oversized crown or filling. As a result, symmetry is broken. And this, as is known, leads to the development of dysfunction of the temporomandibular joints. Moreover, with such improper treatment the load falls on only one side of the teeth when chewing food, which leads not only to disc displacement, but also to pain.

Noise and clicking

How does temporomandibular joint dysfunction manifest? The symptoms of this pathology are very diverse. The most common sign of this pathology is clicking sounds that are heard in the joints of the lower jaw. Such sounds can be quite loud. They can be heard by people who are close to the patient when he simply opens his mouth, yawns or chews food. Wherein painful sensations may not occur.

As a rule, when the discs are displaced, muscle strain occurs when the patient hears a click. This usually happens when chewing food. At such moments, the patient may feel pain in the neck, head, and face due to tension.

Headache

Syndrome pain dysfunction temporomandibular joint often manifests itself as pain in different areas heads. This is another common sign of pathology. Usually headache with the development of dysfunction, the TMJ is localized in the area of ​​the back of the head and temples. But often discomfort the patient may also experience it in the area of ​​the shoulder blades.

The cause of the headache in this case may be muscle pain that occurs when grinding teeth and clenching the jaw. Also, discomfort may bother the patient due to displacement of the discs of the joint itself. In this case, pain radiates to the neck, forehead or temples. It is worth noting that such unpleasant phenomena can be quite strong. In some cases, the doctor mistakenly diagnoses brain pathology or migraine.

Locking, gripping a joint: locking

Painful dysfunction of the temporomandibular joint often causes uneven movement of the lower jaw due to certain disorders. Blockage may be noticed when opening the mouth. There is a feeling that the patient is trying to “catch” something with the lower jaw.

In some cases, people with a blocked joint need to move the device left and right to open their mouth wider. But there are other situations. Sometimes the patient is forced to open his mouth until a peculiar click is heard in the area of ​​the joint with impaired functions.

Ear symptoms

Since the TMJ is located very close to ears, certain ear symptoms. Some of them are quite unpleasant. Signs of dysfunction in this case include:

• pain;
• feeling of ear fullness;
• dullness in the ears causing hearing loss.

It is because of these signs that many patients who have temporomandibular joint dysfunction seek help from a local physician or ENT doctor.

Dental problems

Joint dysfunction can lead to changes in bite or dental occlusion. This often happens due to disk displacement. The bones and their connections do not correspond to the norm, which leads to a change in the bite.

In addition to this problem, the patient may become very sensitive teeth. This most often occurs due to teeth grinding and jaw clenching. Often people with this pathology turn to dentists with complaints of pain in their teeth. It is not always possible for specialists to determine the main cause of unpleasant sensations. Because of this, the patient may have the tooth removed or have it depulped. But this does not save you from TMJ dysfunction.

Other signs

Dysfunction of the temporomandibular joint in certain situations is accompanied by inflammatory processes resulting from synovitis or arthritis in the joint itself. In this case, a person may complain of tissue swelling and pain. This often leads to general malaise, weakness and fever.

In addition to the above symptoms, the patient may be concerned about:

Initial diagnostic stage

Temporomandibular joint dysfunction has many symptoms. However, the diagnosis of such a pathology is multi-stage, lengthy, complex and difficult process. It is not always possible to deliver correct diagnosis, only based on patient complaints. First of all, functional diagnostics are performed, which allows us to determine the causes of the development of pathology.

In this case, a set of procedures is carried out:

• collection of medical data;
• identification of all complaints;
• examination of the muscle tissue of the neck and head;
• X-ray diagnostics: magnetic resonance and cone beam tomography;
• neurological examination, lateral teleradiography;
• cephalometric analysis;
• identification of parafunctions;
• occlusion.

Dental examination

In some clinics, a small functional dental analysis is often performed to determine the diagnosis. This is also considered primary diagnosis. In this case, an impression is taken from the patient, and then a model is made. Also, special drops are used for diagnosis, which help identify bruxism. During the examination, the dentist must evaluate the bite, as well as the quality of interdental contacts, etc.

Large functional analysis is considered the most difficult, not only in implementation, but also in data interpretation. In this case, the specialist must have special skills and knowledge. For similar diagnostics Additional equipment required.

All of the above tests are necessary to make a diagnosis and identify the causes of TMJ dysfunction. The accuracy of the studies performed depends on the experience of specialists and equipment. After diagnosis, the patient is prescribed adequate therapy. It, in turn, can be surgical, reconstructive or conservative.

Who to contact

This pathology is quite difficult to diagnose. Even experienced dentists rarely make a diagnosis such as painful dysfunction of the temporomandibular joint. Treatment in many cases is prescribed incorrectly and does not produce results. In most cases, patients do not receive qualified assistance from dentists and begin to visit other specialists: psychotherapist, neurologist, therapist, otolaryngologist, chiropractor, osteopath, and so on. In reality, it is dentists who should treat dysfunction.

Temporomandibular joint dysfunction: how to treat

To get a positive result, you must complex therapy. It includes orthopedic treatment of dysfunctions of the temporomandibular joint, which is aimed at correcting the bite. In certain situations, surgical intervention, acupuncture, physiotherapeutic procedures, dental prosthetics, or removal and installation of a new filling are performed.

In addition to the above, your doctor may prescribe wearing a trainer at night. This is a kind of joint splint that allows you to relieve myofascial pain syndrome. It is also used for diagnostics and to prevent abrasion of dental tissues during bruxism.

Can temporomandibular joint dysfunction cause complications? Treatment of such a pathology must be carried out without fail. In some cases, the dysfunction leads to disc displacement. As a result, the surfaces of the joints are susceptible to restructuring - arthrosis. It begins to grow in the cavity connective tissue, which itself is rude. As a result, the joint stops moving. This pathology is called ankylosis.

How to give first aid

If the patient is completely sure that he has dysfunction of the temporomandibular joint, then, if necessary, you can help the patient by reducing pain and also improving chewing function. To do this you need heat, but only moist. In this case, you can apply a compress to the sore spot: a bottle pre-filled with hot water. To avoid burns, it is recommended to wrap the container in a slightly damp, but not wet, towel.

To reduce the intensity of pain and also reduce inflammation, it is recommended to use ice. In this case, you can use a bag or bottle. However, you should not apply such a compress directly to skin. The package or bottle should be wrapped in a towel. It is not recommended to use it for longer than 15 minutes. In this case, the break between procedures should be at least 60 minutes. Analgesics can temporarily relieve pain.

How to relax a joint

To prevent the joint from straining frequently, you should follow several rules. Food should be pureed or soft, as well as mixed. It is worth avoiding chewy, rough, hard and hard foods. You should bite off in small pieces. With this disorder, it is not recommended to open your mouth wide.

Relaxing your body completely also helps reduce pain. Any relaxation technique will work for this.

Painful dysfunction of the temporomandibular joint: ICD-10

According to international classification diseases, dysfunctions of the temporomandibular joint are indicated by code K07.6. In this case, violations can manifest themselves in different ways. This includes: complex or loose TMJ, “clicking jaw”, lobar TMJ dysfunction syndrome.

Exceptions include jaw sprains and dislocations.

Pathological changes in the structure of the joints, including pathologies of the maxillary and mandibular joints, are accompanied by severe pain, limited mobility and greatly reduce the patient’s quality of life. With the development of dysfunction of the temporomandibular joint, the patient cannot eat or speak normally. How does the TMJ work, what symptoms indicate the development of its dysfunction, why does pathology occur and how to identify it? What are the treatment methods for temporomandibular joint pain syndrome? Is it possible to do without surgery? Let's figure it out together.

Structure of the temporomandibular joint

The temporomandibular structure is distinguished by its complex and unique structure. It is formed by the articulation of the socket of the temporal bone and the head of the lower jaw bone, which acts on the principle of a hinge.

The main feature is that the head of the bone is elliptical in shape, and not spherical, as in the structure of other joints. It fits most tightly in the back of the fossa. The posterior maxillary shock-absorbing “cushion” is also localized here, consisting of elastic and loose fibers of connective tissue.

A flexible and movable interarticular disc divides the cavity into two separate chambers. The function of limiting the movements of the lower jaw is performed by a number of structural elements, including the articular tubercle and processes - zygomatic and condylar. Each person’s TMJ is individual, and its parameters depend on a whole range of internal and external factors.

Symptoms of TMJ dysfunction

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TMJ dysfunction is characterized by a number of symptoms, the main one of which is pain. The patient complains about dull pain in area temporomandibular joint, he often has a headache and cervical region spine (we recommend reading: ). Sometimes the pain syndrome spreads to the ears, eyes and teeth. In such cases, it is important to differentiate the pathology from otitis media, arthritis of the joint in question, cervical osteochondrosis and neuralgia trigeminal nerve.

In addition to pain, the following signs indicate the development of TMJ dysfunction:

Causes of pathology

There are currently several theories regarding what causes temporomandibular joint dysfunction. Most experts agree that some individual characteristics its structure in humans can act as prerequisites for dysfunction. More often we're talking about about cases when the shape and size of the glenoid fossa do not correspond to the same parameters of the head.

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

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

Diagnostic methods

TMJ dysfunction is characterized by many different symptoms, which are often similar to the symptoms of other pathological conditions. For this reason, diagnosing this disease is considered difficult and usually takes a long time. In order to develop an effective treatment strategy, the patient requires consultation with a neurologist and dentist.

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

Diagnosis of TMJ dysfunction includes the following measures:

TMJ treatment

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

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

Providing first aid for pain syndrome

Pain syndrome, which is one of the main symptoms of TMJ dysfunction, is sometimes very intense. Of course, there is no need to endure pain. The recommendations below will help temporarily alleviate the patient’s condition, but it should be borne in mind that first aid measures are only effective for early stages development pathological condition, so there is no need to postpone your visit to the doctor.

So, first aid for pain caused by TMJ dysfunction:

Physiotherapy

Physiotherapeutic procedures are often prescribed to treat pathological changes in the joints. They help improve joint function, eliminate or reduce the intensity of noise in the joints, and reduce pain. The doctor selects a physical factor to be used for therapeutic purposes, based on the nature and stage of the disease.

Name of procedure	Short description	Note
Ultraphonophoresis	The procedure is based on the complex effect of ultrasound and the drug administered with its help (for dysfunction, potassium iodide, propolis, hydrocortisone, analgin are indicated).	Physical factors can be reapplied no earlier than 4-12 weeks after ultraphonophoresis treatment.
Microwave therapy	Ultrahigh-frequency electromagnetic vibrations affect the skin receptors of the vessels and tissues located underneath. This promotes the formation of biologically active substances that have a general physiological effect.	Domestic clinics usually use the Luch-2 device (emitter diameter 35 mm).

Medicines

When treating TMJ dysfunction, the doctor prescribes a complex of medications. First of all, we are talking about analgesics, which are intended to relieve pain and improve the patient’s well-being. You will also need to take muscle relaxants and vitamins. Sometimes tranquilizers and/or chondroprotectors are also recommended.

Group of drugs	Drug names	Note
Nonsteroidal anti-inflammatory drugs	Nimesulide, Ibuprofen, Diclofenac	Used to reduce and eliminate pain
Muscle relaxants	Sirdalud, Mydocalm, Compresses based on Lidocaine (2%) and Dimexide (25%)	Decrease muscle spasm, decreased tone, easier movement of the lower jaw (see also:)
B vitamins	Milgamma, Neuromultivit	Improving nerve conduction, reducing pain intensity
Tranquilizers	Diazepam, Grandaxin	Short course according to indications
Antidepressants	Fevarin, Ladisan, Amitriptyline
Chondroprotectors	Chondroitin sulfate	Prescribed if symptoms of TMJ arthrosis are present

Joint correction surgically

If conservative treatment does not bring relief to the patient, there is no positive dynamics against the background of persistent pain and “blockade” of the joint, then surgical correction of the TMJ is prescribed.

It should be borne in mind that even surgery does not always solve the problem of temporomandibular joint dysfunction. IN modern medicine Three main varieties are actively practiced surgical intervention. All of them are performed under general anesthesia:

• Open joint surgery. It is used in the presence of tumor formations or severe joint injuries. The surgeon opens the area of ​​the temporomandibular joint. Depending on the condition of the affected area, the doctor corrects it or removes it.
• Arthroscopy. A small endoscope is inserted into the joint cavity through an incision near the patient's ear. The doctor examines the tissues, the image of which is displayed on the monitor screen. This operation makes it possible to remove the affected tissues (if their volume is insignificant) and correct the location of the condyle or disc.
• Arthrocentesis. The joint cavity is pierced with special needles, after which a sterile liquid is passed through it. If necessary, the surgeon removes the tissue overlays and moves the disc into the hole.

To restore and maintain mobility of the lower jaw, the patient will also need to correct malocclusions (if any). After the operation, the doctor will recommend limiting the consumption of solid foods (for example, nuts, crackers), muscle exercises, and regular auto-training classes. To reduce stress on the affected area, it is recommended to keep your mouth slightly open.

This is a pathology of the joint (temporomandibular), which is caused by spatial and occlusal muscle changes. Most often it is accompanied by serious pain in the neck, radiating to the temples, and a migraine is formed. When moving the jaw, clicks appear, mouth opening (amplitude) noticeably worsens. Ringing and noise in the ears are also typical. In a dream, a person with such disorders snores.

Features of the disease

Dysfunction of the temporomandibular joint is due to the fact that the lower jaw, under the influence of various factors, can change its position - distalize, that is, move back, or turn around, but only within the capsule. In such a situation, the interarticular type disc is exposed to quite significant pressure from the lower jaw (head). This often provokes its displacement forward, which leads to dislocation.

Such negative manifestations can form every time active movement jaws, which will provoke chronic changes and more serious pathologies.

The main symptom of the disease is the appearance of a peculiar crunch, often clicks. There is also an unpleasant sensation in the ear area. The element of the lower jaw, namely the head, can move deeper into the cavity on one or both sides. This, in turn, provokes compression of the bilaminated zone, in which a significant number of nerves and various vessels are located. Since the area does not have the necessary protection due to the dislocation, pressure is applied to it, which creates very noticeable pain.

At the moments of swallowing or eating, the temporomandibular joint begins to move; with dysfunction, it is formed each time dislocation. Over the years, the disc wears out, and the ligament that holds it in place also breaks and becomes thinner. After which, a fairly active process of destruction of the surface occurs (since the movement of the head will occur without shock absorption).

Causes

1. Often, dysfunction of the temporomandibular joint (TMJ) is provoked due to nervous irritations and stress.
2. Arthrosis, various types of arthritis become the basis for the occurrence of this pathology, and the manifestation begins with the appearance of a minor pain syndrome and gradually develops into the pathology in question.
3. Scoliosis of the spine, as well as various pathologies pelvis They seriously affect muscle tone and posture. Against the background of these changes, the development of compensatory dysfunctions of the skull is formed.
4. Any injuries can become an undeniable basis for the occurrence of serious side effects, including TMJ. A serious pain syndrome immediately arises, after which a dislocation can appear instantly, often accompanied by swelling and significant changes in the bite.
5. Various bite pathologies that may be associated with a violation of the position of the jaw, in the absence of chewing teeth.
6. Incorrect treatment dental diseases, prosthetics, etc. Difficulties in adaptation often arise, which provokes pathologies of the jaw.
7. The increased load that can occur when various loads, in particular when playing athletic sports.

Symptoms

Temporomandibular joint dysfunction is characterized by the following symptoms:

• Severe pain when eating or swallowing. The symptom appears gradually. Immediately the symptoms are minor, but as the disease progresses they become more pronounced.
• Formation of extraneous sounds when moving the jaw. Most often, clicking and a certain crackling sound appears. In certain cases, the clicks can be extremely loud and can be heard strangers. At the same time, the sound phenomenon is not always combined with the manifestation of pain.
• Headache and slight dizziness. If the pathology is not treated, then these symptoms appear more often and more vividly.
• “Locking”, a kind of “jamming”. That is, uneven movement appears when opening the mouth. In certain cases, the patient cannot turn the jaw from side to side when opening.
• The disease often manifests itself as pain in the ears, and carved toothache, is formed high blood pressure In eyes. Against the background of pathology, otitis media, arthritis, and osteochondrosis may develop.
• Pathologies also appear in the form of bruxism, depression, there are situations of sleep disturbance, photophobia, paresthesia, and snoring are formed.

Diagnostics

Diagnosis of the disease is quite complex, and it is impossible to do without special examinations:

1. An examination by a therapist, neurologist, dentist, or rheumatologist is recommended.
2. After a visual examination, as well as studying the symptoms, an examination is prescribed.
3. X-rays are required.
4. Computed tomography and ultrasound examinations are also used.
5. Orthopantomography is used.
6. In certain cases, a number of clinical tests are prescribed.

First aid

If injuries occur, you should immediately contact a specialist to reduce the load using mechanical methods. You can also use cold to relieve swelling. If a crunching sound, extraneous sounds and significant pain occur, you can take a painkiller and consult a doctor for a diagnosis. Self-medication in this situation is unacceptable.

Features of treatment

• During the treatment period, the load on the temporomandibular joint is necessarily reduced. It is recommended to eat soft foods and reduce speech load.
• Depending on what caused the development of the disease, symptomatic treatment is prescribed. Taking non-steroidal anti-inflammatory drugs, agents that restore cartilage tissue, special drugs are prescribed to relieve muscle spasm.
• To eliminate pain, sedatives can be prescribed, special blockades and intra-articular injections can be made, painkillers can be prescribed, and glucocorticosteroid injections can be performed.
• Physiotherapy is used for recovery (laser and ultrasound are most often recommended).
• Psychotherapy, as well as dental treatment(if it became the basis for the occurrence of pathology).
• In certain cases, surgery may be required.

Prevention

1. Elimination of excess loads on the joint.
2. Reducing the manifestation of stress and depression.
3. Correction of bite and other dental diseases.
4. Posture correction.

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

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

What is dysfunction (impaired function) of the temporomandibular joint

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

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

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

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

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

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

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

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

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

Varieties

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

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

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

Etiology (causes)

The causes of TMJ dysfunction can be divided into groups:

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

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

Symptoms

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

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

Diagnostics

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

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

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

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

Treatment methods

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

Orthodontics

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

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

Conservative

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

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

How to eliminate pain

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

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

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

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

Using folk remedies at home

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

Features of treatment in children

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

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

Recovery

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

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

Physiotherapy

Physiotherapy procedures are performed at the stages of treatment and rehabilitation. The average course of procedures is 15 – 20 times.

Actively used:

Myogymnastics

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

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

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

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

How to live with pathology

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

Conclusion

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

The most common reasons

• Injuries, which are divided into microtraumas and macrotraumas.

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

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

Causes of pathology

• Trauma to the head or neck, for example, severe bruises that lead to displacement of the intra-articular cartilage disc;
• bruxism - spontaneous night grinding of teeth;
• malocclusion or missing teeth;
• low-quality dentures or fillings that are too high;
• one-sided type of chewing food;
• a state of stress in which a person tenses his facial muscles and clenches his teeth;
• rheumatoid arthritis, osteoarthritis and other diseases.

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

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

Myofunctional habits such as bruxism or teeth clenching, mouth breathing

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

JAWS

Incorrect jaw alignment

Injuries, such as from a car accident

Specific diseases, such as arthritis

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

Most often we are talking about cases where the shape and size of the glenoid fossa do not correspond to the same parameters of the head.

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

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

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

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

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

As for the second group of factors, they include:

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

According to psychogenic theory mental stress, stress leads to disruption of muscle function and joint movement.

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

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

Symptoms of TMJ dysfunction

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

Other symptoms:

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

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

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

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

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

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

Diagnosis of TMJ dysfunction

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

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

In some cases, computed tomography, MRI, and ultrasound of the jaw are prescribed.

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

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

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

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

Diagnosis of TMJ dysfunction includes the following measures:

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

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

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

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

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

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

TMJ treatment

Anti-inflammatory drugs are usually used for treatment medicines, physiotherapy, as well as wearing a special splint (mouthguard).

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

Reflexology for TMJ dysfunction

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

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

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

Operating principle of the joint splint

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

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

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

DIAGNOSIS AND TREATMENT OF TMJ DYSFUNCTION

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

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

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

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

Providing first aid for pain syndrome

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

The recommendations below will help temporarily alleviate the patient’s condition, but it should be borne in mind that first aid measures are effective only in the early stages of the development of the pathological condition, so you should not postpone a visit to the doctor.

So, first aid for pain caused by TMJ dysfunction:

Physiotherapy

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

The doctor selects a physical factor to be used for therapeutic purposes, based on the nature and stage of the disease.

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

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

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

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

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

Forecast and prevention of TMJ dysfunction

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

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

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

Prevention of TMJ dysfunction involves following the following recommendations:

We offer the following healing methods for jaw dysfunction:

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

Muscle relaxant Sirdalud price 350 rubles

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

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

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

Based on these generally mechanistic ideas, many clinicians have developed various schemes orthopedic treatment of Costen's syndrome, or temporomandibular joint pain dysfunction syndrome.

Rubin and L.E.

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

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

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

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

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

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

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

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

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

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

If you see a doctor, he may prescribe you a pain reliever or a brace that will help relieve pressure on your jaw. Oral and maxillofacial surgery is sometimes used to straighten the jaw, which is performed in special centers with appropriate equipment.

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

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

Consequences (complications) of TMJ dysfunction

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

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

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

megan92 () 2 weeks ago

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

Daria () 2 weeks ago

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

megan92 () 13 days ago

Daria () 12 days ago

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

Sonya 10 days ago

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

julek26 (Tver) 10 days ago

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

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is really not implemented through pharmacy chain to avoid overpricing. Currently you can only order from Official website. Be healthy!

Sonya 10 days ago

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

Margo (Ulyanovsk) 8 days ago

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

Andrey A week ago

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

Ekaterina A week ago

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

Maria 5 days ago

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