Arthritis

By Dr. Vishaal Bhat on Friday 11 April 2008 with 0 comments



Various types of arthritis can affect the TMJ.

Infectious arthritis: TMJ infection may result from direct extension of adjacent infection or from localization of bloodborne organisms. The area is inflamed and jaw movement limited. Local signs of infection associated with evidence of a systemic disease or with an adjacent infection suggest the diagnosis. X-rays are negative in the early stages but may show bone destruction later. In suppurative arthritis, joint aspiration may confirm diagnosis and identify the causative organism.

Treatment includes antibiotics, proper hydration, control of pain, and restriction of motion. Penicillin G is the drug of choice until a specific bacteriologic diagnosis can be made on the basis of culture and sensitivity testing. Suppurative infections should be aspirated or incised. Once the infection is controlled, jaw-opening exercises help prevent scarring and limitation of function.

Traumatic arthritis: Rarely, acute injury (eg, due to very forceful pressure during tooth extraction or endotracheal intubation) may lead to arthritis of the TMJ. Pain, tenderness, and limitation of motion occur. X-rays are negative except they occasionally show a widened joint space due to intra-articular edema or hemorrhage. Treatment includes NSAIDs, application of heat, a soft diet, and restriction of jaw movement.

Osteoarthritis: The TMJ may be affected, usually in persons > 50 yr . Occasionally, patients complain of stiffness, grating, or mild pain. Crepitation results from a hole worn through the disk, causing bone grating on bone to be heard and felt. Joint involvement is generally bilateral. X-rays may show flattening and lipping of the condyle. Treatment is symptomatic.

Rheumatoid arthritis: The TMJ is affected in > 50% of adults and children with RA, but it is usually among the last joints affected . Pain, swelling, and limited movement are the most common findings. In children, destruction of the condyle results in mandibular growth disturbance and facial deformity. Ankylosis may follow. X-rays of the TMJ are usually negative in early stages but later show bone destruction, which may result in an anterior open-bite deformity. The diagnosis is suggested by TMJ inflammation associated with polyarthritis and is confirmed by laboratory findings.

Treatment is similar to that of RA in other joints. A night guard or splint is often helpful. In the acute stage, NSAIDs are given, and jaw function should be limited. When symptoms subside, mild jaw exercises help prevent excessive loss of motion. Surgery is necessary if ankylosis develops but should not be performed until the condition is quiescent.

Secondary degenerative arthritis: This type of arthritis usually develops in persons aged 20 to 40 yr after trauma or in those with persistent myofascial pain-dysfunction syndrome. It is characterized by limited opening of the mouth, unilateral pain during jaw movement, joint tenderness, and crepitation. When it is associated with the myofascial pain-dysfunction syndrome, symptoms intermittently become more severe. X-rays generally show condylar flattening, lipping, spurring, or erosion. Unilateral joint involvement helps distinguish secondary degenerative arthritis from osteoarthritis.

Treatment is conservative, as for the myofascial pain-dysfunction syndrome, although arthroplasty or high condylectomy may be necessary. An occlusal splint (mouth guard) usually relieves symptoms. It is worn constantly, except during oral hygiene and appliance cleaning. When symptoms resolve, the length of time it is worn can be gradually reduced. Intra-articular injection of corticosteroids may relieve symptoms but may harm the joint if repeated often.

Category: Oral Medicine Notes

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