Temporomandibular joint (jaw joint) disorders can be short-term or chronic and severe enough to affect the quality of life. The pathophysiology of temporomandibular joint dysfunction and pain is not fully understood. Stress and depression are very effective in this disease. Due to this, there may be pain in the jaw joint due to teeth clenching (bruxism). A difficult tooth extraction or trauma are among the causes. Examining the patient, taking his/her history, timing the pain, its relationship with eating, questioning his/her psychological state and careful oral and jaw examination are extremely important. Jaw pain affects the patient's "quality of life" greatly. Severe pain while eating results in not eating, and constant pain weakens the nervous system and creates unhappiness. Since these patients do not know who they should go to, they go to many doctors, including "orthopedic specialists (because they deal with bones), dentists, ear, nose and throat specialists (because there is pain in the ear), neurologists, brain surgeons" and generally receive painkillers and muscle relaxants. Medicines are given and sent away. Since the patient is not told about additional treatments, such as how long they will use these medications, that they should eat soft food, that they should avoid excessive yawning, that they should not chew gum, that they should not eat seeds (which is a cause of myctotrauma), that they should start treatment for this because they are not questioned whether they are clenching their teeth or not; There is a group of "HAPPY and HOPELESS" patients walking around because they are given two boxes of medicine and every doctor they see gives them the same type of medicine and sends them away. Therefore, it would be appropriate to refer a patient with jaw joint pain to a plastic surgeon. If necessary, the plastic surgeon will meet with the orthodontist and treat the patient with occlusion problems together.
The main cause of pain is the wear and tear of a thin cartilage disc in the structure of this joint, its displacement, and damage to its ligaments. In the same knee joint, there is a cushion with a cartilage-like structure called "Meniscus", known to the public. This cartilage moves synchronously with jaw movement, preventing the two bones from rubbing against each other. In times of stress (trauma, difficult tooth extraction, tightness due to constant jaw clenching, natural fluid that lubricates the cartilage) This structure is damaged due to reasons such as deterioration of the joint fluid found in the joint. Recently, research has focused on the biological and biochemical parameters of the temporomandibular joint.
In patients who complain of temporomandibular joint pain due to reasons such as acute trauma, stretching, tooth extraction, there is no limitation in mouth opening, no click (a sound heard when opening the mouth), no pathological examination findings and radiologically temporomandibular joint pain. If no pathology is detected in the joint, it heals in a short time with the use of nonsteroidal anti-inflammatory drugs (painkillers) and the recommendation of eating soft food. However, if there is a click during our examination, there is a limitation in mouth opening, if the symptoms have a chronic course, if there are also bruxism (teeth clenching) and occlusion problems (incomplete closure of the teeth due to deformity in the tooth structure), and if pathology is detected radiologically, then the treatment strategy must be planned well. Treatment should be planned according to the cause.
This disease can sometimes occur in depression or anxiety due to psychological reasons, as explained above. If the patient's history is not taken well, everything will appear normal on examination and the cause of the pain cannot be found. If this story is learned from the patient, the patient is contacted with the psychiatrist through psychiatric consultation, and the medications given will both improve our psychological state and treat the jaw pain. In fact, the underlying cause of this condition is teeth clenching (bruxism), which the person may not be aware of. Pain occurs especially when waking up as a result of jaw clenching, which occurs especially at night and is not noticeable during the day. These patients describe morning pain, and their pain decreases during the day.
If the patient who describes teeth grinding (bruxism) has had this condition for many years, it can be recognized by the wear of the front teeth. A "bite plate, bite splint" placed between the teeth in case of teeth clenching reduces the pressure on the jaw joint, thus reduces pain, protects the joint and prevents the progression of the disease. The bite splint is custom made. It is usually done by dentists. After the impression of the jaw is taken by biting a special paste with the teeth, it can be soft or hard (depending on the patient). e selection is made) a plate-shaped splint is prepared. Before going to bed, the patient places a plate between his teeth and sleeps. When you try to clench your teeth at night, thanks to this plate, the load on the joint is reduced and the joint is protected.
All these steps are questioned one by one when choosing treatment. Preventable causes are eliminated. (such as clenching teeth, psychological support, preventing chewing gum or eating seed-shelled fruit). After this, a treatment is planned according to the patient and your clinical experience. If there is no pain and only a sound is heard from the jaw, after these precautions are taken, the protection of the jaw is explained and no medication is given. However, if there is pain, it must be stopped. There are two approaches here. Firstly, a muscle relaxant and painkiller is given and it is explained that it should be used for 6 weeks. If the pain has disappeared at the end of 6 weeks, there is no problem, but if the pain has not disappeared, imaging methods are used and the joint is examined with MRI. Advanced treatments are applied depending on the structure of the disc. The other approach is to request an MRI at the first examination and start treatment directly according to the results. It can be both approaches.
The first of the advanced treatments is Hyaluronic acid (it is a high molecular weight polysaccharide and is synthesized from type B synovial cells. Its main function is to protect the cartilage tissue and provide lubrication (lubrication) of the joint.) treatment. However, in case of arthritis, it is seen that its level decreases in the joint and its structure deteriorates. In the group of patients who present with temporomandibular joint pain and are planned for conservative treatment (surgery is not considered), for whom surgery is not indicated, but who have not benefited from nonsteroidal anti-inflammatory and muscle relaxant drugs, hyaluronic acid treatment will protect the disc from arthritis in that period and protect the patient from permanent degeneration.
Planning the treatment based on the cause is the first important step in the treatment of this disorder. The necessity of orthodontic help if there is an occlusion problem, the necessity of psychiatric support due to a major depression underlying bruxism, the bite plate due to bruxism, etc. It should not be forgotten that applications can help the current treatment and a multidisciplinary approach is necessary.
Again, endoscopic imaging and lavage of the joint will prevent the release of intra-articular free oxygen radicals into the environment. It has been shown in previous studies that it is effective in removing In this way, the patient gets rid of pain and lives a comfortable life.
Open jaw joint surgery is needed in the group of patients who do not benefit from all these treatments, who now have very severe pain and whose mouth opening has decreased to 1-2 centimeters. In this case, the articular cartilage is often removed and replaced with a silicone or autogenous material (from the person's own tissue) structure. Sometimes excision of the jawbone (cutting out the deformed part of the lower jaw tip that forms the jaw joint) may be required. However, we consider surgery as a last resort and follow a more conservative (non-surgical) approach.
Read: 0
