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Temporal Mandibular Joint Disorder Tmj
 

Temporomandibular joint disorders Introduction

Temporomandibular joint disorders (TMJD) refer to any pain in the jaw or face that occurs in or around the temporomandibular joint (TMJ). This condition can include pain from the muscles of mastication (medial and lateral pterygoids, masseter, and temporalis), the overlying fascia, or any combination of the joint, muscles, and fascia. The main classifications of Temporomandibular joint disorders include:

  • internal joint derangement (dislocation)
  • myofascial pain syndrome
  • agenesis (no bone)
  • hyper and hypo-plasia of the condyle
  • fusion of the joint or ankylosis
  • and arthritis.

For the purpose of this article discussion will be focused on internal joint derangement (dislocation), myofascial pain syndrome, and arthritis of the temporomandibular joint.

Internal joint derangement is the dislocation of the articular disk (cartilage) in between the bones. It is displaced anteriorly and then pops back in during the opening-closing cycle of the mouth. It can also remain anterior and not pop back into place, which results in a decreased range of motion for the temporomandibular joint. Internal joint derangement affects about 1/3 of the population at some point in time. It affects men and women equally.

Myofascial pain syndrome is the most common disorder of the temporomandibular joint. It is the result of bruxism, or grinding and clinching the jaw, usually at night. It affects women more than men. Occurrence peaks in the 20’s then again during perimenopause.

Arthritis is another disorder of the temporomandibular joint. Several different variations of arthritis can occur and include; infectious, degenerative, and rheumatoid. Degenerative, or osteoarthritis, of the temporomandibular joint occurs primarily in individuals over the age of 50. The temporomandibular joint will be affected in over 50% of patients with rheumatoid arthritis, though it is usually one of the last joints to be significantly affected. [1]

Temporomandibular joint disorders Symptoms

The most common symptoms of Temporomandibular joint disorders are a popping or clicking when opening and closing the mouth, and radiating pain. Each of the different classifications can present similarly or differently, and symptoms are dependant upon the individual. Persons with myofascial pain syndrome will often complain of soreness, headache, and decreased ability to open the mouth. All three classifications can result in localized swelling around the joint and supporting structures. [2]

Temporomandibular joint disorders Statistics

  • Currently it is estimated that more than ten million individuals in the US have a temporomandibular joint disorder.
  • Women are affected twice as often as men. [3]

Temporomandibular joint disorders Treatment

Routine treatment of Temporomandibular joint disorders involves the use of analgesics, usually NSAIDs, to reduce the pain and swelling that occurs as a result of this condition. Individuals with myofascial pain syndrome may be prescribed a sedative to limit the amount of clenching and grinding of the teeth at night. All of the disorders are usually treated with some type of mouth or bite guard that limits the pressure and use of the Temporomandibular joint. In severe cases, surgery can help repair damage to the joint structure. [4]

Alternative treatment of Temporomandibular joint disorders should focus on treating the underlying cause. In many cases, the underlying cause is structural. Therefore, therapy should be supportive to the tissues and designed for promoting healing.

Supplements helpful for Temporomandibular joint disorders

Glucosamine sulfate

Glucosamine is responsible for the gel like cushion of cartilage, and is nutritive to the articular disk in between the bones of the Temporomandibular joint. Often with arthritis of a joint, as in the case of Temporomandibular joint disorders, the cartilage will become hard and absorb less shock from excessive use. This can result in symptoms of pain, clicking, popping, and decreased mouth opening.

In a study of 50 patients with osteoarthritis of the Temporomandibular joint, significant improvement occurred with supplementation of glucosamine sulfate. Glucosamine caused a decrease in the noises, pain, and swelling in the joint. [5]

SAM-e (S-adenosylmethionine)

SAM-e is formed from the amino acid methionine, and ATP, our body’s primary source of energy. It is necessary for the proper formation of cartilage components. SAM-e may be especially protective of cartilage. SAM-e has also exhibited mild analgesic and anti-inflammatory properties, which make it a relevant treatment option for those suffering from Temporomandibular joint disorders.

In a study that compared SAM-e to Celebrex, a popularly prescribed NSAID, supplementation resulted in the improvement of overall symptoms. It was found to be as effective as Celebrex, though its onset of action was slower. [6] Another study also found that supplementation with SAM-e can cause a reduction in pain. It also showed an improvement in joint function and a decrease in joint limitation. SAM-e has not been proven to have any side effects. [7]

Vitamin E

Vitamin E is anti-inflammatory and potent anti-oxidant. It helps to maintain cell membranes. Vitamin E stimulates healthy cartilage production. [8] The dietary supplementation of Vitamin E would be beneficial for any of the disorders of the Temporomandibular joint. In fact, one study showed that supplementation with Vitamin E resulted in a 52% reduction in pain compared to only a 10% reduction with placebo. [9] In another study, Vitamin E was equally successful in increasing joint mobility, reduce swelling around the joint, and increasing walking times. [10]

Vitamin C

Vitamin C supports connective tissue metabolism. It is believed to be protective for cartilage. It not only aids in the repair of cartilage, but also helps to incorporate cellular components that help cartilage hold water. Vitamin C is also considered a potent anti-oxidant. [11]

Boswellia serrata

Boswellia is anti-inflammatory, analgesic, and anti-arthritic agent. It can be used for internal joint derangement, myofascial pain syndrome, and arthritis of the Temporomandibular joint. It prevents the age related decline in cartilage production and improves blood supply to joints. In one particular study, supplementation with boswellia decreased pain and increased range of motion of affected joints. There were also marked decreases in the amount of swelling around the affected joint. [12]

Piper methysticum (Kava)

Kava is a useful treatment for myofascial pain syndrome. It is an effective sedative, anxiolytic, and skeletal muscle relaxant. It has been proven in clinical trials to decrease anxiety and to relieve nervous tension that results in muscle spasm. [13]

References

[1] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Chapter 108: Temporomandibular Disorders; pp: 772-776.

[2] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Chapter 108: Temporomandibular Disorders; pp: 772-776.

[3] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml The National Institute of Health. December 2004.

[4] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Chapter 108: Temporomandibular Disorders; pp: 772-776.

[5] Shankland WE 2nd. The effects of glucosamine and chondroitin sulphate on osteoarthritis of the temporomandibular joint: a preliminary report of 50 patients. Cranio. 1998 Oct; 16(4): 230-235.

[6] Najm WI, Reinsch S, Hoehler F, Tobis JS, Harvey PW. S-adenosylmethionine versus celecoxib for the treatment of osteoarthritis symptoms: a double blind crossover trial. BMC Musculoskelet Disord. 2004 Feb 26; 5(1): 6.

[7] Soeken KL, Lee WL, Bausell RB, Agelli M, Berman BM. Safety and efficacy of s-adenosylmethionine for osteoarthritis. J Fam Pract. 2002 May; 51(5): 425-430.

[8] Pizzorno J, Murray M, Joiner-Bey H. The Clinicians Handbook of Natural Medicine. 2002; Churchill Livingstone New York. Osteoarthritis: 364-371.

[9] Machtey I, Ouknine L. Tocopherol in osteoarthritis: a controlled pilot study. J Am Geriatr Soc. 1978; 26: 328-330.

[10] Scherak O et al. High dose vitamin E therapy in patients with activated arthritis. Z Rheumatol. 1990; 49: 369-373.

[11] Sowers M, Lachance L. Vitamins and arthritis: The roles of Vitamins A, C, D and E. Rheum Dis Clin North Am. 1999 May; 25(2): 315-332.

[12] Kimmatkar N et al. Efficacy and tolerability of boswellia serrata extract in treatment of osteoarthritis of the knee: a randomized double blind placebo controlled trial. Phytomedicine 2003 Jan; 10(1): 3-7.

[13] Mills S, Bone K. Principles and Practice of Phytotherapy. Churchill Livingstone London; 2000. page 456.