I hope I don't need to get the procedure done again for the second time. *sighs.
Well here's a post about Jaw Arthritis.
There are many types of arthritis that affect the jaw and cause pain. The jaw joint is called the temperomandibular joint.The temporomandibular joint is the joint that allows interaction between the temporal bone of the skull and the lower jawbone (mandible). There are two temporomandibular joints, one on each side of the face just in front of the ears. Ligaments, tendons, and muscles support the joints and are responsible for jaw movement.
Within the temporomandibular joint there are moving parts that allow the upper jaw to close on the lower jaw (i.e. biting and chewing, talking and yawning). It is one of the most frequently used of all the joints in the body.
Many TMJ-related symptoms are caused by the effects of physical and emotional stress on the structures around the joint. These structures include the muscles of the jaw, face, and neck; the teeth; the cartilage disc at the joint; and nearby ligaments, blood vessels, and nerves.
All of these stresses can result in muscle spasm. This muscle spasm causes the formation of trigger points -- contracted muscles and pinched nerves in the jaw, head, and neck. Trigger points can refer pain to other areas, causing a headache, earache, or toothache.
Other possible causes of TMJ-related symptoms include arthritis, fractures, dislocations, and structural problems present since birth.
Most often, the cause of a temporomandibular disorder is a combination of muscle tension and anatomic problems within the joints. Muscle pain and tightness around the jaw (myofascial pain syndrome) come mainly from muscle overuse, often brought on by problems of misalignment of the upper and lower sets of teeth, missing teeth, injury to the head or neck, or even toothache. Pain is also produced by trying to open the jaw too widely. Muscle pain and tightness can also result from clenching or grinding the teeth (bruxism) at night due to psychologic or sleep-related stress. Clenching and grinding while asleep exert far more force than clenching and grinding while awake.
Poor posture can also be an important factor. For example, holding the head forward while looking at a computer all day strains the muscles of the face and neck.
Other factors that might aggravate TMJ symptoms are inability to relax, poor diet, and lack of sleep.
In internal joint derangement, the disk inside the joint lies in front of its normal position. Internal joint derangement can occur with or without reduction. In internal joint derangement with reduction, which is the more common type (occurring in about one third of the adult population), the disk lies in front of its normal position only when the mouth is closed. As the mouth opens and the jaw slides forward, the disk slips back into its normal position. As the mouth closes, the disk slips forward again. In internal joint derangement without reduction, the disk never slips back into its normal position, and the degree to which the mouth can be opened is limited.
Arthritis in a temporomandibular joint may result from osteoarthritis, rheumatoid arthritis, infectious (septic) arthritis, Lyme disease, or injury. The cartilage in the temporomandibular joints is not as strong as the cartilage in other joints. Osteoarthritis, which is due to wearing away of cartilage, can result.
Jaw discomfort with chewing may be a symptom of giant cell arteritis, a potentially severe inflammatory condition that affects blood vessels.
Rheumatoid arthritis affects the temporomandibular joint in about 17% of people with this type of arthritis. The temporomandibular joint generally is the last joint to be affected by rheumatoid arthritis.
Ankylosis is loss of joint movement resulting from fusion of bones within the joint or calcification (the deposit of calcium into body tissues) of the ligaments around it.
Hypermobility (looseness of the jaw) results when the ligaments that hold the joint together become stretched. In hypermobility, dislocation is usually caused by the shape of the joints, ligament looseness (laxity), and muscle tension. It may be caused by trying to open the mouth too wide or by being struck on the jaw.
Symptoms of temporomandibular disorders include headaches, tenderness of the chewing muscles, and clicking or locking of the joints. Sometimes the pain seems to occur near the joint rather than in it. Temporomandibular disorders may be the reason for recurring headaches that do not respond to usual medical treatment. Other symptoms include pain or stiffness in the neck radiating to the arms, dizziness, earaches or stuffiness in the ears, and disrupted sleep.
People with temporomandibular disorders have difficulty opening their mouth wide.
People with muscle pain usually have very little pain in the joint itself. Rather, they feel pain and tightness on the sides of the face upon awakening or after stressful periods during the day. Nighttime clenching and grinding of the teeth may cause a person to awaken with a headache, which may slowly diminish over the day. As the jaw opens, it may move slightly (deviate) to one side or the other. The chewing muscles are typically tender to the touch.
Internal joint derangement with reduction usually causes a clicking or popping sound in the joint when the mouth opens wide or the jaw shifts from side to side. In many people, these joint sounds are the only symptoms. However, some people experience pain, particularly when chewing hard foods. In a small percentage of people who have missing teeth and who grind their teeth, there is progression to locking of the joints.
With osteoarthritis, the person feels a grating sensation in the temporomandibular joints when opening and closing the mouth. When osteoarthritis is severe, the top of the jawbone flattens out, and the person cannot open the mouth wide. The jaw may also shift toward the affected side, and the person may be unable to move it back.
Rheumatoid arthritis usually affects both temporomandibular joints about equally. When rheumatoid arthritis is severe, especially in young people, the top of the jawbone may degenerate and shorten. This damage can lead to sudden misalignment of many or all of the upper and lower teeth. If the damage is severe, the jawbone may eventually fuse to the skull (ankylosis).
Typically, calcification (the deposit of calcium into body tissues) of the ligaments around the joint (extraarticular ankylosis) is not painful, but the mouth can open only about 1 inch or less. Fusion of bones within the joint (intraarticular ankylosis) causes pain and more severely limits jaw movement.
In a person with hypermobility, the jaw may slip forward completely out of its socket (dislocate), causing pain and an inability to close the mouth. Dislocation may occur suddenly and repeatedly.
A physician diagnoses a temporomandibular disorder based on a person's medical history and on a physical examination. Part of the examination involves gently pressing on the side of the face or placing the little finger in the person's ear and gently pressing forward while the person opens and closes the jaw. Also, the doctor gently presses on the chewing muscles to detect pain or tenderness and notes whether the jaw slides when the person bites.
When a doctor suspects internal joint derangement, further tests can be done. Magnetic resonance imaging (MRI) is now the diagnostic procedure of choice.
A doctor suspects osteoarthritis when a creaking sound is heard when the person opens his mouth (crepitus). X-rays and a computed tomography (CT) scan or MRI can confirm the diagnosis. If hypermobility is the cause, the person generally can open the mouth wider than the breadth of three fingers; the jaw may be chronically dislocated. If ankylosis is the cause, the jaw's range of motion tends to be markedly reduced.
Treatment varies considerably according to the cause. Two common treatments are splint therapy and analgesics to relieve pain.
Splint therapy usually is the main treatment for jaw muscle pain and tightness. For people who realize that they clench or grind their teeth, splint therapy can help them break the habit. A thin plastic splint is made to fit over either the upper or the lower set of teeth and is adjusted to give the person an even bite. The splint, usually worn at night (a nightguard), reduces grinding, allowing the jaw muscles to rest and recover. For pain during the day, a splint allows the jaw muscles to remain relaxed and the bite to be stable, thereby reducing discomfort. The splint can also prevent damage to teeth that are under exceptional stress from the grinding. Day splints are worn only until symptoms subside, usually fewer than 8 weeks. Longer use may be warranted depending on the severity of symptoms.
Physical therapy may also be prescribed. Physical therapy may involve ultrasound treatment, electromyographic biofeedback (in which the person learns to relax the muscles), spray and stretch exercises (in which the jaw is stretched open with a passive jaw motion device after the skin over the painful area has been sprayed with a skin refrigerant or numbed with ice), or friction massage. Transcutaneous electrical nerve stimulation (TENS) also may help. Stress management, sometimes along with electromyographic biofeedback, often brings dramatic improvement.
Drug therapy may also be helpful. For instance, muscle-relaxing drugs, such as cyclobenzaprine, may be prescribed to ease tightness and pain, particularly while the person waits for a splint to be made. However, these drugs are not a cure, generally are not recommended for older people, and are prescribed for only a short time, usually for a month or less. Analgesics such as aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) also relieve pain. Sleep aids (sedatives) may be used occasionally and for a short time to help people who have trouble sleeping because of the pain.
Injection of the jaw joint with lidocaine and glucocorticoid may be helpful.
Regardless of the type of treatment, most people experience significant relief within about 3 months. If the symptoms are not severe, many people recover without treatment within 2 to 3 years.
In internal joint derangement with or without reduction, treatment is needed only if a person has jaw pain or trouble moving the jaw. If a person seeks treatment right after symptoms develop, a dentist or doctor may be able to manually move the disk back into its normal position. If a person has had the disorder for fewer than 3 months, a splint may be applied to hold the lower jaw forward. This splint keeps the disk in position, permitting the supporting ligaments to tighten. Over 2 to 4 months, the splint is adjusted to allow the jaw to return back to its normal position, with the expectation that the disk will remain in place.
A person with internal joint derangement with or without reduction should avoid opening the mouth wide—for instance, when yawning or biting into a thick sandwich—because injured joints are not as protected in these activities as would be a normal jaw. People with this disorder are advised to cut food into small pieces and to eat food that is easy to chew.
Sometimes the slipped disk becomes stuck in front of the temporomandibular joint, preventing the jaw from opening fully. The disk must then be manually moved out of position to allow the joint to move fully. Passive jaw motion devices, which stretch the jaw, have been used to slowly increase jaw motion. These devices are used several times a day. One such device is a threaded screw-type instrument that is placed between the front teeth and turned, much like a car jack, to gradually create a wider opening. If such a device is not available, then a doctor may use a stack of tongue depressors placed between the front teeth, with an additional tongue depressor being added to the middle of the stack.
If internal joint derangement cannot be treated by nonsurgical means, an oral-maxillofacial surgeon may need to reshape the disk and sew it back into place. However, the need for traditional surgery is relatively rare since the introduction of procedures such as arthroscopy All surgical procedures are used in combination with splint therapy.
A person with osteoarthritis in a temporomandibular joint needs to rest the jaw as much as possible, use a splint or other device to control muscle tightness, and take an analgesic or another nonsteroidal anti-inflammatory drug for pain. The pain usually goes away in 6 months with or without treatment. Even without treatment, most of the symptoms subside, probably because the band of tissue behind the disk becomes scarred and functions like the original disk. Usually, jaw movement is sufficient for normal activities, though the jaw may not open as wide as it used to.
Rheumatoid arthritis of the temporomandibular joint is treated with the drugs used for rheumatoid arthritis of any joint Maintaining joint mobility and preventing fusion of the joint are particularly important. Usually, the best way to accomplish these goals is by exercising the jaw under a physical therapist's direction. To relieve symptoms, particularly muscle tightness, the person wears a splint at night that does not restrict jaw movement. If joint fusion freezes the jaw, the person may need surgery and, in rare cases, an artificial joint to restore jaw mobility.
Occasionally, stretching exercises help people with calcification, but people with calcification or bone fusion usually need surgery to restore jaw movement.
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