Diseases of the Mandibular Joint

By Dr. Vishaal Bhat on Tuesday, 4 December, 2007 with 0 comments

The mandibular joint is a complicated structure of the oro-facial area and that is why diagnostics and therapy of its diseases are difficult. Several factors with potentially additive effects play a role at the origin of problems. Causes of joint difficulties are occasional or chronic traumas, recurring luxations, lowering of the vertical mutual position of jaws, psychogenic factors resulting in bruxism (grinding and clenching of the teeth) and muscular spasms, infectious diseases ( acute rheumatic disease), degenerative processes (osteoarthritis), congenital disorders (joint head hyperplasia) and others.

Among the clinical manifestations, the pain (arthralgia) at the mandibular joint area is on the first place. It is mostly localized directly inside the joint, it is either one-sided or double-sided and increases upon its function. Sometimes the pain gets transferred into a temple, ear or lower jaw. The joint sound effects - cracking and screeching during its movements - are very disturbing. These sounds can be often heard at a close distance from a patient. Another sign is a restricted mobility of the joint, associated with muscular spasms and tenderness of some of the chewing muscles (especially pterygoid muscles). This painful tension of chewing muscles is mostly felt by patients in the morning after waking up and it gradually decreases later during a day. If one observes a slow mouth opening movement at these patients, deviation from the center or S-like movement of the lower jaw can be noticed. Clinical examination should be completed by an X-ray exam of the mandibular joint. The described symptoms are typical for the syndrome of mandibular joint dysfunction and pain. This syndrome occurs preferably at young age (between 20 and 40 years), more often at women. A characteristic feature for its identification is a negative X-ray finding at bone structures of the mandibular joint. Therapy of the above problems is tedious and needs a patience. The basis of therapy is adjustment of articulation and occlusal malfunctions by an occlusion splint made of resin and 3-6 mm thick. After the difficulties diminish, the increase in height of the occlusion can be maintained by prosthetic treatment. Supplemental therapy includes symptomatic influencing of particular problems. It includes ionophoresis with Mesocain, Solux lamp, diadynamic currents, 1% Mesocaine shots in the area around the mandibular joint, transcutaneous neurostimulation (Analgonik).

Acute inflammations (arthritis) that appear during an acute rheumatic disease, general infectious diseases or by transfer of infection from adjacent areas undergo therapy according to general rules with use of antibiotics, analgesic and antiphlogistic drugs. A temporary immobilization of jaws is made with the aim of reducing pain at the time of movements. A puncture of the joint exudate is less common.

Osteoarthritis of the mandibular joint is a degenerative disease, even though it may originate from chronic traumatization of the joint structures at habitual or recurring luxations. Besides the corticoid therapy (Kenalog), a surgical extirpation of a threaded joint meniscus or the condylar process is performed in some cases.

Category: Oral Medicine Notes



Post a Comment