Degenerative Disorders of the Temporomandibular Joint: Etiology, Diagnosis, and Treatment

Abstract

Temporomandibular joint (TMJ) disorders have complex and sometimes controversial etiologies. Also, under similar circumstances, one person's TMJ may appear to deteriorate, while another's does not. However, once degenerative changes start in the TMJ, this pathology can be crippling, leading to a variety of morphological and functional deformities. Primarily, TMJ disorders have a non-inflammatory origin. The pathological process is characterized by deterioration and abrasion of articular cartilage and local thickening. These changes are accompanied by the superimposition of secondary inflammatory changes. Therefore, appreciating the pathophysiology of the TMJ degenerative disorders is important to an understanding of the etiology, diagnosis, and treatment of internal derangement and osteoarthrosis of the TMJ. The degenerative changes in the TMJ are believed to result from dysfunctional remodeling, due to a decreased host-adaptive capacity of the articulating surfaces and/or functional overloading of the joint that exceeds the normal adaptive capacity. This paper reviews etiologies that involve biomechanical and biochemical factors associated with functional overloading of the joint and the clinical, radiographic, and biochemical findings important in the diagnosis of TMJ-osteoarthrosis. In addition, non-invasive and invasive modalities utilized in TMJ-osteoarthrosis management, and the possibility of tissue engineering, are discussed.

Addressing the Gaps: Therapeutic and Prognostic Considerations in Temporomandibular Joint Osteoarthrosis

“…Patients were advised to avoid gum chewing and excessive mouth opening [10]. In some patients automassaging helped and reduced pain and stiffness of the TMJ.…”

“…Trauma includes past fractures, jaw trauma, repetitive high-impact and torsional loads. Ligament laxity, internal derangements and inadequate muscle strength are examples of joint and muscle disorders [8][9][10]. The natural course of the disease consists of periods of remission.…”

“…Occlusal discrepancies like malocclusion are not uncommon [12]. Occlusal changes include reduced overbite and anterior open bite [10,13]. Internal derangements occur in about one-third of the patients [14].…”

Trastornos temporomandibulares: algunas consideraciones de su etiología y diagnóstico

“…Se ha propuesto que los trastornos de atm derivan de una sobrecarga [9] que provoca un colapso en la lubricación articular y en la emisión de radicales libres, los cuales generan hipoxia tras la superación de la presión de perfusión capilar [10]. Sin embargo, a nivel bioquímico es importante conocer cuál es el comportamiento y la composición del líquido sinovial, que es el lubricante de las superficies articulares y el responsable de la protección y nutrición del cartílago articular [11].…”

Open-Mouth Bone Scintigraphy Is Better than Closed-Mouth Bone Scintigraphy in the Diagnosis of Temporomandibular Osteoarthritis

“…Bone scintigraphy is a highly sensitive imaging method that requires an increase in osteoblastic activity of only about 10 % to detect early changes in the bone [6][7][8]. The early diagnosis of osteoarthritis is clinically important, because it allows control of disease progression from an early stage and invasive surgery to be avoided [9,10].…”