Arthritis is a condition that causes pain and swelling in the joints. It is widespread, with 10m people in the UK diagnosed with osteoarthritis, 450,000 adults diagnosed with rheumatoid arthritis (RA), and 190,000 adults estimated to have psoriatic arthritis (PsA). This high prevalence shows the need for a greater understanding of the disease.
The temporomandibular joint (TMJ) is the most used and complex joint in the human body, utilising a hinge and sliding movement that, if changed, can inhibit a patient’s ability to speak and eat. Arthritis can cause that change, leading to pain and discomfort that impacts quality of life if untreated. For dental practitioners, identifying at-risk patients for TMJ arthritis and finding solutions for them can restore function to the jaw and preserve their oral health.
Osteoarthritis
Osteoarthritis is the arthritis type that most commonly affects the TMJ. The process, which becomes an increasing likelihood with age, particularly for those aged over 50, is characterised as the destruction of soft and hard tissue around the joint. This abrasion of the cartilage leads to the changing of the shape and function of the jaw, such as reducing an overbite or increasing an overjet.
TMJ osteoarthritis can be the result of physical factors like disc dislocation, trauma, developmental anomalies or overuse, as well as more systemic risk factors such as autoimmune diseases, gender, and age. Wearing down the cartilage in the joints from clenching and grinding also sets the stage for arthritis to develop, putting bruxism patients at risk. Those with osteoarthritis in the TMJ may feel a stiffness or tenderness in the joint region, pain when opening the mouth, and grating sounds when moving the jaw.
Osteoarthritis, be that in the TMJ or in the hands, can impact the daily oral hygiene routine by limiting access. Difficulty opening the jaw can make brushing and interdental cleaning a hardship, whilst arthritic joints in the hand can also inhibit the mobility needed for an effective routine. The risk of developing periodontitis or caries is therefore higher for patients who may struggle to maintain a consistent oral hygiene routine.
Other arthritic diseases
Whilst osteoarthritis is the most prevalent form of arthritis, RA and PsA are also linked with temporomandibular disorders (TMDs). RA attacks the cells that line the joints, leading to inflammation. It is more prevalent in women, those with a family history and smokers. Of those with RA, 17 per cent had pain and swelling in the TMJ, though this is among the last joints effected by the disease.
RA is associated with periodontal disease, as bacterial growth in the oral cavity causes inflammation and tissue damage. At considerable risk of periodontal disease are the collagen-rich tissues around the joints; collagen is a protein used in tissue repair, immune response and cellular communication, meaning its decline or absence can magnify RA on joints like the TMJ. The interconnected nature of periodontal disease and RA means that practitioners must educate patients and provide solutions that promote an effective oral hygiene routine and/or stop the development of RA.
Psoriasis is a chronic skin condition that effects over a million people in the UK. Of that figure, 20 per cent develop PsA which can affect the TMJ. Whilst patients with psoriasis are just as likely to have a TMD as those without it, the symptoms of a TMD are worse for those with psoriasis due to the development of fibrosis that greater limits the jaw movement. Patients with psoriasis can therefore face a more uncomfortable experience, prompting the need for treatment.
An answer to arthritis
Many TMDs caused by arthritis can be alleviated at home, as directed by a professional. Physical therapy can help, and the OraStretch Press Jaw Rehab System from Total TMJ is an effective, user-operated device for treating TMD. Squeezing the handles moves the mouthpieces apart up to 50mm wide, stretching the tissues and keeping the joint active. The variety in exercises that can be done with the device work to strengthen the muscles and mobilise the jaw, allowing the system to help restore TMJ function so that patients can talk and eat with greater comfort.
Arthritis can change how people live each day. By identifying patients who may be at risk for arthritis in the TMJ, practitioners can guide them to solutions that can preserve their quality of life.
References available on request.
For more information visit https://totaltmj.co.uk/products/orastretch/