Temporomandibular Joint Disorder (TMD) and Rheumatoid Arthritis

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Your temporomandibular joint (TMJ) is one of the most used joints in your body.  You use it to talk, chew, yawn and bite.   Your TMJ is a sliding hinge joint, which allows you to move your jaw in many directions with the help of multiple muscles, and connective tissue.  When there are problems associated with this joint, they are referred to as Temporomandibular Joint Disorders (TMD).

Symptoms

Signs and symptoms of TMD include:

  • Jaw tenderness
  • Pain in one of both TMJs
  • Radiating pain and aching around your ear
  • Pain while chewing, or an inability to chew
  • Jaw stiffness
  • joint locking and an inability to open the jaw, or open it very wide.
  • Facial pain
  • Headache
  • Ringing in the ears (tinnitus)

Causes

The TMJ is a sliding hinge joint, which means you can open your mouth with a hinge action, but also slide the jaw back and forwards.  The bones of the joint are covered in cartilage and are separated by a small disc which absorbs shock and keeps the movement smooth.   Pain from the TMJ can occur if the disc becomes eroded and moves out of proper alignment, or if the joint is damaged or eroded by arthritis.

TMD also be caused by injury to the jaw, the joint or the muscles of your head and neck.  Grinding or clenching your teeth can put a lot of pressure on the joint, leading to pain.   Arthritis, particularly rheumatoid arthritis can affect the TMJ.  This article focuses on rheumatoid arthritis and the TMJ.

Rheumatoid arthritis and TMD

TMD is relatively common in RA, most studies putting the incidence at around 50%, some as high as 90%.  Difficulty in opening the mouth is common in RA due to pain, disc displacement, inflammation and degeneration of the TMJ.  Some studies have shown that joint damage in the hands and/or cervical spine can be predictors of TMD severity. Other studies find that TMD is more common with longer disease duration, often appearing later in disease progression.

Treatment

There are a number of self care treatments to help improve the pain of TMD including:

  • Resting the joint by eating soft foods for a few days, avoiding chewing and chewy foods or lollies or gum.
  • Heat packs or ice packs to the jaw.
  • Massaging the muscles of the jaw.
  • Avoiding opening the jaw too wide.
  • Relaxation exercises, if the pain is related to clenching or grinding teeth.
  • Exercises to gently work the joint.

Medical therapies for pain relief include:

  • Anti-inflammatory medications.
  • Muscle relaxants and
  • Tricyclic antidepressants.

Physical therapies include:

  • Oral splints and mouth guards. Your dentist can make these.
  • Physical therapy. There are a range of exercises that your physical therapist can teach you to improve jaw function and reduce pain.
  • Counselling can help reduce stress, as teeth clenching and grinding are common stress reactions and can make TMD worse.

Surgical  or other procedures:

Surgery is rarely required but when more conservative treatments fail, surgical options include:

  • Arthrocentesis. A minimally invasive procedure where small needles are inserted into the joint so that fluid be irrigated through the joint to remove debris and inflammatory byproducts.
  • Cortisone injection into the TMJ.
  • Botox injected into the muscles around the joint. This is particularly if TMD is caused by clenching and grinding of teeth.
  • TMJ arthroscopy. The joint is arthroscopically cleaned out.
  • Open joint surgery. If less invasive procedures are unsuccessful, or not indicated, open joint surgery can be performed to repair or replace the joint.

Complementary treatments:

There are some complementary and alternative medicine treatments that are helpful for some to manage the pain of TMD, including:

  • Acupunture
  • Relaxation techniques, meditation and guided imagery.
  • Biofeedback

When to see your doctor

If you have pain in your jaw for several days, and you’ve tried some home remedies with no relief, see your GP, or your dentist.  You may need a CT scan of the joint, which is painless, and will help determine what is causing the problem.

It is important to note that TMJ pain and dysfunction unresponsive to conservative treatment can be a sign of rheumatoid arthritis or other forms of inflammatory arthritis.

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