Jaw Joint Diseases

Jaw joint diseases are an important problem as they cause nutritional problems. The main complaints are muscle and joint pain, tenderness, joint sounds, limitation and irregularity in jaw movements. Problems usually begin in the first youth years and become obvious due to pain due to deformities developing in the joint over time. Sometimes the sounds coming from the joint and the jaw locking are the reasons that bring the patient to the doctor.

The jaw joint is a joint located between the lower jawbone and the temporal bone, and functions during speech and chewing. Between the two bones, there is a structure called the disc that enables the two bone surfaces to work harmoniously during movement. Capsules and ligaments around the joint provide the joint to work harmoniously. The work of the jaw joint is regulated by the chewing muscles. Painful manifestations in the chewing muscles, clenching, grinding of the teeth, joint and alignment disorders in the teeth and some treatments for these cause strain on the muscles, joints and ligaments, causing the disease to occur.

Causes of jaw joint diseases

  • Continuous chewing on one side

  • clenching teeth,

  • teeth grinding

  • Accidents affecting the jaw and face (fractures, rupture of joint ligaments),

  • sports injuries

  • Tumors affecting the joint and its surroundings, systemic diseases (inflammatory rheumatism, etc.)

  • Long-lasting dental treatments that force mouth opening, excessive strain of the jaw in anesthesia

  • Habits such as biting pens and similar hard objects, chewing gum, thumb sucking, nail biting

  • Excessive forward bending of the shoulders and neck (posture disorders)

  • holding phone between shoulder and chin

  • some psychological disorders

  • Congenital joint disorders (such as incomplete development of the joint)

  • Fillings and coatings made at a height that will change the relationship of the teeth with each other

  • It can be listed as playing the violin (pressure on the chin due to the way it is held).

All of the above-mentioned reasons are due to mechanical reasons, and since the jaw joint is a joint that can be involved in common inflammatory rheumatic diseases such as Rheumatoid Arthritis, Psoriatic arthritis (psoriasis arthritis) and gout, careful evaluation should be made in this respect.

Another important reason is jaw joint calcification, which is usually seen in elderly patients. Degenerative changes detected in X-rays, pain in the jaw and limitation of movement make the diagnosis. It may adversely affect the general condition in elderly patients, as it may impair nutrition.

Symptoms in jaw joint diseases

  • Earache,

  • pain in cheeks,

  • tinnitus

  • dizziness

  • Headache intensifying at the temples,

  • Pain radiating to the neck

  • Difficulty in opening the jaw

  • Sound when opening and closing the jaw,

  • Jaw locking

  • Opening of the jaw by sliding to one side while opening the mouth

  • Impaired bite, bite and chewing functions

  • Impairment of the closure of the upper and lower teeth

  • Sensitivity, wear, rocking and breakage in teeth

Diagnosis of jaw joint diseases

In the vast majority of patients, the diagnosis is made by examination. In addition to the jaw joint, the neck, neck and shoulder muscles, and most importantly, the masticatory muscles should be examined for the presence of trigger points, and whether there is tension should be determined. It is appropriate to be evaluated by dentists, orthodontists or maxillofacial surgeons in terms of tooth alignment disorders and other dental diseases. If necessary, normal radiographs and MR can be performed. Blood tests may also be requested for the differential diagnosis of infectious and inflammatory joint diseases.

Treatment of jaw joint diseases

The goal of treatment is to relieve the patient’s pain and restore normal jaw functions. Painkillers/antirheumatic drugs, supportive treatments (adjuvant), muscle relaxants and even weak opioids, if necessary, can be used to relieve pain.

Physical therapy applications are very effective in reducing spasm, increasing blood circulation and thus reducing pain in these patients. Among physical therapy agents, especially hot applications (infrared, hot packs, deep heaters) can be used.

Complementary medicine methods: Complementary medicine methods such as acupuncture, neural therapy, ozone therapy, mesotherapy, prolotherapy can be used to control jaw pain. Among these treatments, acupuncture, electroacupuncture, neural therapy and ozone therapy are used in our clinic. These 3 methods are the methods we prefer because they allow the treatment of other systems that can cause jaw pain with their low side-effect profile, ability to control pain quickly, and a holistic perspective.

In the presence of tension and trigger points in the chewing muscles and neck-shoulder muscles, trigger point injections provide very effective support to complementary medicine methods. In addition to trigger point injections, dry needling can also be performed.

Botulinum Toxin (Botox) applications to relax the jaw chewing muscle in patients with excessive teeth clenching can provide very satisfactory results. After botulinum toxin application, the effectiveness of the drug continues for about 4-6 months, and it provides relief in jaw pain as it eliminates the tightening problem. Even after the effect of Botox wears off, the habit of clenching teeth can end and a full cure can be achieved. For this reason, consecutive applications can be made at intervals of 4-6 months.

Manual treatments (such as manipulation, mobilization, post-isometric relaxation) are among the treatments that can be applied.

Another important treatment method is exercises. Patients are taught stretching and relaxation exercises for the muscles that put a load on the jaw. Warm application before these exercises increases the effectiveness of the exercise. In addition to exercises for the jaw joint, stretching and strengthening exercises should be added to the neck shoulder girdle muscles. In addition, the patient should be taught to relax all muscles effectively with whole body relaxation exercises or biofeedback therapy. Aerobic exercises (such as running, swimming, walking, dancing) recommended for all musculoskeletal diseases are also recommended for these patients.

Considering the close relationship between the jaw joint and clenching and the close relationship between clenching and stress, it is recommended to seek psychiatric support and treat anxiety and depression if necessary. In addition, behavioral treatments can also be effective in teeth clenching problems. Sleep hygiene training should also be given to the patient in order to provide a quality sleep pattern with complete muscle relaxation.

If necessary, surgical treatment can be planned by maxillofacial surgeons or plastic surgeons.

In addition, it is recommended that all patients do not chew unilaterally and that both sides participate in chewing. The night apparatus can also be used for teeth clenching and grinding problems. Patients are recommended to avoid hard foods, break hard-shelled foods with their teeth, and stop eating hard fruits such as apples. The patient should be fed soft foods and pay attention to oral hygiene until the pain and dysfunction subsides.

Jaw joint diseases are a group of diseases under the umbrella of “central sensitivity syndromes” such as jaw joint dysfunction, fibromyalgia, chronic fatigue syndrome, migraine, and irritable colon syndrome.

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