53. TMJ diseases: Osteoarthritis ± etiology, clinics, diagnosis, DDx, treatment, complications

Question 1

Osteoarthritis of the TMJ

Answer 1

• Non-inflammatory degenerative condition => deterioration and abrasion of articular tissue+ remodeling of the underlying subchondral bone=>
• Due to overload of the remodeling mechanism
• Production or release of free radicals, cytokines, fatty acid catabolites, neuropeptides, and matrix-degrading enzymes=>
• Degenerative state

Question 2

TMJ osteoarthritis classification

Answer 2

• Primary OA=> Etiolology unknown
• Secondary OA=>gout, Cushing’s disease, osteonecrosis, infections, and Charcot’s neuropathic pain
• Active OA=> degeneration in the articular tissues
• Stable OA (osteoarthrosis)=>Recortication of the articular osseous structure w/out further structural change

active and stable are additional classifications

Question 3

Clinical features of TMJ osteoarthritis

Answer 3

• Early Phase=>Lasts 2.5-4 years=>
• with clicking sounds and intermittent locking
• Intermediate Phase=> Lasts 6 months to 1 year=>
• TMJ destruction, spontaneous joint pain at rest or with function
• Limitation in opening, and grating sounds
• Late Phase=> Lasts 6 months, w/ absence of degenerative activity
• Joints stabilize, possibly w/out pain=>
• May have limitations or grating sounds.

Question 4

Treatment options for TMJ osteoarthritis

Answer 4

• Physical Therapy=>pulsed electrical stimulation, topical ointments
• Self-Management>Activity modification, soft diet
• Oral Appliances=> Joint stabilization appliances=>
• Protect teeth, redistribute forces, reduce bruxism
• Dental Procedures=> Avoided in the active phase
• Pharmacological Treatment=>
• Acetaminophen: Up to 4 g/day
• NSAIDs
• Surgical treatment