TMJ dysfunction - causes and consequences.

Osteogenic sarcoma

The tumor develops in the tissues of the jaw. The disease is manifested by deformation processes in those areas where the lesion appears. Patients experience pain in the facial area. Sometimes the problem is expressed in numbness, as well as in impaired sensitivity in the areas where the mental or infraorbital nerve fibers exit.

Inflammation of the lymph nodes

If the lower jaw hurts on the left, an enlarged node is often diagnosed. The disease has two forms - generalized and local. The nature of the disease is influenced by the type of infection. The problem may be caused by staphylococci, streptococci, untreated caries. Patients develop fever, mumps,

Arteritis of the facial artery

When the facial artery is damaged, patients experience a burning sensation in the area of ​​the lower jaw bone. Severe pain develops in the area where there is an inflection. An inflammatory process occurs in the blood vessels, which narrows the lumen and disrupts blood flow. This situation promotes the formation of blood clots. Tissues do not receive nutrients and oxygen. The pathology most often develops against the background of autoimmune diseases or infectious blood diseases.

Neuralgia

• The lower jaw often cramps when the laryngeal nerve is damaged. Soreness is noted in the throat, in the corner of the lower jaw bone. Patients complain of increased salivation and cough.
• With cranial neuralgia, the patient feels strong impulses from pathological cranial nerve fibers. Damage to the trigeminal nerve causes sharp and cutting twitching and burning.
• Sometimes the glossopharyngeal nerve is affected. Attacks of pain begin at the root of the tongue and radiate to the ear, pharynx, jaw, and neck.
• The pathology of the ear node is manifested by a prolonged burning sensation, pain in the temporal zone, lower jaw bone, teeth, and chin.

Myocardial infarction

This is a serious condition when blood flow in the vessels that feed the heart muscle is disrupted. Among the causes of the disease are a sharp spasm and blockage. This causes the heart to be in a state of oxygen deficiency. Patients experience pressing pain behind the sternum, radiating to the lower jaw bone and to the left shoulder. In such a situation, you should immediately call an ambulance.

Why does pain occur in the lower jaw?

Purulent diseases

The cause of pain is inflammation of the bone, periosteum or nearby soft tissue. In 70-80% of cases the disease is of odontogenic origin. Less commonly, the process is provoked by acute infections and jaw injuries. Complemented by edema, hyperemia, general condition disorder, intoxication syndrome, regional lymphadenitis. Pain is observed in the following pathologies:

• Periostitis.
  The symptom is more pronounced in acute purulent periostitis. The pain is sharp, pressing or boring, radiating to the eye, ear, temple, neck. Intensifies when opening the mouth. Weakness, low-grade fever, and swelling of the cheeks are noted. In chronic periostitis, the pain is periodic, moderate or mild, pressing or bursting. The contours of the face are slightly changed.
• Osteomyelitis.
  Characterized by a sudden manifestation with a rapid rise in temperature to febrile levels, chills, and severe intoxication. The pain is shooting, pulsating, diffuse, radiating to the neck and half of the face. They get worse when swallowing, limiting mouth opening. The teeth are mobile, pus is released from the gums. The oral mucosa and skin of the chin become numb. In chronic osteomyelitis, the symptom increases after closure of the fistula, decreases or disappears after the outflow of pus resumes.
• Perimaxillary abscess.
  The formation of an abscess is preceded by toothache. Then dense swelling occurs. The pain quickly intensifies, and the symptoms of intoxication increase. The patient refuses food. After spontaneous opening, the manifestations disappear; in the absence of treatment, chronicity with periodic exacerbations, resumption of pain and suppuration is more often observed.
• Perimaxillary phlegmon.
  Typically acute onset with rapid progression of local manifestations, purulent-resorptive fever. The pain is jerking, aggravated by talking, chewing, and moving the lower jaw, and is complemented by increased salivation and the formation of a diffuse infiltrate with a fluctuation zone. The condition continues to deteriorate due to severe intoxication.

Traumatic injuries

Injuries to the lower jaw most often result from fights. Damage due to falls, car accidents, or industrial accidents is possible. In case of a bruise, the asymmetry of the face is caused by swelling of the soft tissues; the closure of the teeth is normal. The symptom is moderate, quickly decreases, and does not create serious obstacles to articulation or food intake.

Among the fractures, injuries to the body predominate; violations of the integrity of the angle and branches are less common. Half of the fractures are bilateral. At the time of injury, a sharp explosive pain occurs, decreasing only slightly over time, intensifying when talking, biting, or chewing. Possible numbness of the chin and lower lip. Facial asymmetry, articulation disorders, stepped dentition, mobility, and sometimes tooth dislocations are noted.

Fractures of the alveolar process of the lower jaw are less common than the upper jaw; they develop from impacts, falls from a height, etc. They are accompanied by intense spontaneous pain, which intensifies when swallowing or attempting to close teeth. The mouth is half-open, and the protruding edge of a bone fragment can be seen under the mucosa. The bite is broken, the teeth are mobile, dislocations are possible.

Pain in the lower jaw

Neuralgia

The symptom is accompanied by trigeminal neuralgia involving the 3rd branch (n.mandibularis). It is provoked by external factors (shaving, cold air, water), stress on the masticatory muscles. Prosopalgia is paroxysmal in nature and is a series of pain impulses that are felt like a lumbago or electric shock from the side of the face along the lower jaw to the chin. The pain is sudden, lasts several minutes, reaches such intensity that the patient freezes, does not move, does not speak.

With neuralgia of the glossopharyngeal nerve, the pain impulse is caused by chewing, swallowing, talking, lasts from several seconds to 3 minutes, occurs at the root of the tongue, spreads through the tonsils, palate, pharynx, ear. Radiating pain in the lower jaw. In patients with ganglionitis of the submandibular node, the pain is paroxysmal, burning, boring, pulsating. Lasts from 1 minute to 1 hour. They begin in the tongue, spread to the lower jaw, temple, back of the head, neck, and shoulder girdle.

Muscle damage

Bruxism is formed due to spasm of the masticatory muscles. After night attacks, patients are bothered by pain in the jaws, caused by clenching and intense movements relative to each other. Muscle pain, dental pain, headaches, dizziness, and drowsiness are possible. With myofascial syndrome, pain develops due to overload of the masticatory muscles. It is perceived as moderately expressed and deep. At first it appears only under load (chewing, clenching the jaws), then it increases and becomes constant.

Dental reasons

The symptom is disturbing in the first days after tooth extraction. It is especially pronounced in the presence of an inflammatory process, removal of impacted or incorrectly erupted wisdom teeth. Some patients report pain due to wearing braces and dentures. Aching, pressing or pulling pain in the jaw and masticatory muscles, problems with chewing and swallowing, biting the cheeks and tongue are detected in children with malocclusion.

The cause of severe progressive paroxysmal pain, which spreads to the entire lower jaw and intensifies at night, is acute diffuse pulpitis. Prolonged intense pain under the influence of external stimuli, spontaneously occurring pain attacks are also observed during the period of exacerbation of chronic pulpitis. Irradiation along the trigeminal nerve is typical. Between attacks, moderate or minor aching pain is possible, aggravated by biting.

Tumors of the lower jaw

Pain syndrome is characteristic of a number of odontogenic and non-odontogenic benign neoplasms. Distinctive features of such neoplasias are slow growth and lack of germination of surrounding tissues:

• Odontogenic fibroma.
  More often diagnosed in children. The pain is aching, not intense, and does not occur in all patients. It can be combined with tooth retention and inflammation in the affected area.
• Cementoma.
  As a rule, it is localized in the area of ​​molars or premolars of the lower jaw. The course is asymptomatic or with minor pain that increases with palpation.
• Osteoma.
  Accompanied by pain, facial asymmetry, slowly increasing over months or years. Large tumors limit the mobility of the lower jaw.
• Osteoid osteoma.
  Unlike other neoplasms, the pain is sharp, intense, intensifying at night and when eating. The face is asymmetrical, in the oral cavity there is a bulge in the area of ​​premolars or molars.
• Osteoblastoclastoma.
  More common in adolescence and young adulthood. Facial asymmetry, tooth mobility, aching, bursting pain gradually progress. Over time, fistulas form over the neoplasia. Pathological fractures are likely.

Malignant neoplasms of the lower jaw are found less frequently than benign ones. Cancer is characterized by a rapid increase in pain, radiating to the cheek, ear, eye, and temporal region. Accompanied by mobility, tooth loss, germination of masticatory muscles, salivary glands, and ulceration. Osteogenic sarcomas rapidly progress and quickly infiltrate soft tissues. Over the course of several months, the pain increases from moderate, pressing, aching or bursting to constant, unbearable, and can only be eliminated with narcotic analgesics.

Cardiac ischemia

Irradiation into the lower jaw can be observed with angina pectoris and myocardial infarction. Painful sensations are caused by the spread of impulses from the heart to the upper thoracic segments of the spinal cord, from there, along other nerves - to the face, neck, left arm, left shoulder blade. The main symptom is burning, pressing, squeezing or bursting pain behind the sternum.

An attack of angina lasts several minutes and is eliminated after stopping physical activity and taking nitroglycerin. During a heart attack, the pain is wave-like, very intense, lasts more than 30 minutes, and does not disappear when using the methods listed above. In the atypical course of a heart attack and coronary artery disease, retrosternal pain may be absent, only reflected pain is observed, including in the jaw.

Diagnostics

Diagnostic measures are carried out by a dentist or maxillofacial surgeon. According to indications, a neurologist, cardiologist, and other specialists are involved in the examination. The doctor determines the nature of the symptom, its changes since its onset, and its dependence on external factors. Identifies other complaints, conducts a general and dental examination to detect objective changes (hyperemia, edema, decayed teeth, asymmetry). To make a final diagnosis, data from studies such as:

• Radiography
  . Informative for injuries, purulent processes (except for the acute stage), tumors, and some dental pathologies. Helps confirm the presence of a fracture, identify other bone changes, differentiate osteomyelitis and periostitis from inflammation of the surrounding soft tissues, distinguish between benign and malignant neoplasms.
• CT scan
  . CT scanning of the jaw provides more accurate data on the condition of hard structures compared to radiography. It is carried out when the diagnostic value of x-rays is insufficient, there is a need to clarify the location of fistulas, the nature of injuries and neoplasia. A CT scan of the skull makes it possible to determine the narrowing of the foramina, which causes compression of the nerve with the development of neuralgia.
• Magnetic resonance imaging.
  Recommended to exclude tumor and vascular origin of compression of the nerve trunk. Detects cysts, neoplasia, aneurysms, and tortuosity of vessels passing next to the nerve.
• Electrophysiological studies
  . Electromyography allows you to confirm pathological muscle activity during myofascial pain, bruxism, and assess the quality of neuromuscular transmission during neuralgia. Electroneurography makes it possible to determine the extent and level of nerve damage. An ECG is indicated for patients with suspected ischemic heart disease.
• Invasive techniques
  . A lymph node biopsy is performed when the submandibular or cervical lymph nodes are enlarged in patients with tumors. For perimaxillary phlegmon with a deep location of the purulent focus, a diagnostic puncture may be required to verify the diagnosis.
• Lab tests
  . The causative agent of purulent processes is determined by inoculating the discharge on nutrient media. For neoplasms, a morphological study is performed to determine the type and degree of malignancy of neoplasia.

Consultation with an oral and maxillofacial surgeon

Jaw fracture

This is perhaps one of the most obvious reasons for severe jaw pain. The cause-and-effect relationship between blow - jaw fracture - pain is clear to everyone. Among the first symptoms indicating a fracture rather than a bruise are: unbearable pain, difficulty opening the mouth, malocclusion, swelling, bruising. In this case, immediate contact with an ambulance and maxillofacial surgery is required.

If you feel that your jaw hurts, do not delay in seeing a doctor, as this symptom may be a sign of the onset of a dangerous disease.

You can also read the article “Surgical dentistry”.

Treatment

Conservative therapy

Therapeutic tactics are determined by the cause of the symptom. For patients with dental pathologies, local treatment is indicated. Removable dentures and orthopedic structures are replaced, and other types of prosthetics are selected. In case of pulpitis, the cavity is treated with antiseptics, antibiotics, proteolytic enzymes, pastes are applied to eliminate inflammation and stimulate regeneration, and after a few days a filling is performed. For other diseases, the following methods are recommended:

• Inflammatory processes
  . Antibiotic therapy is carried out in the pre- and postoperative period. At the initial stage, broad-spectrum drugs are administered parenterally. After receiving culture results, the medication is changed taking into account antibiotic sensitivity. Dressings are performed and rinsing is performed. Analgesics are prescribed to reduce pain.
• Traumatic injuries
  . In case of fractures of the angle, the body of the lower jaw without displacement, conservative immobilization is carried out by double-jaw wire splinting. To prevent inflammation, antibacterial agents are used, and painkillers are used to reduce pain.
• Neuralgia
  . Anticonvulsants are used to eliminate pain attacks. To enhance the effect, the treatment program is supplemented with antispasmodics, antihistamines, and microcirculation correctors. Trigger point blockade is carried out with a mixture of glucocorticoids and local anesthetics. They give a referral for ultraphonophoresis and galvanization with novocaine.
• Muscle pathologies
  . For bruxism, an integrated approach is effective, including medication, dental, physiotherapeutic, psychotherapeutic methods, and the use of protective mouthguards. Patients with myofascial syndrome are prescribed muscle relaxants, NSAIDs, and antidepressants.
• IHD
  . As part of drug therapy, antianginal agents, beta-blockers, calcium channel blockers, antioxidants, antiplatelet agents, and antisclerotic drugs are indicated.

Surgery

The choice of surgical technique depends on the cause of the symptom:

• Inflammatory diseases
  : opening, drainage of abscesses and phlegmons, sequestrectomy for osteomyelitis.
• Injuries
  : open osteosynthesis using bone sutures, polyamide thread, mini-plates.
• Neoplasms
  : curettage, excision of benign neoplasia within healthy tissue (often with extraction of teeth), resection or disarticulation of the lower jaw for a malignant tumor.
• Neuralgia
  : microsurgical decompression, percutaneous radiofrequency destruction, stereotactic radiosurgery.
• IHD
  : thrombolysis, emergency coronary angioplasty in the acute period of a heart attack; planned coronary artery bypass surgery, balloon angioplasty for angina pectoris, post-infarction conditions.

Causes of temporomandibular joint arthritis

Arthritis does not show pronounced symptoms immediately; its development can be asymptomatic for a long time or with minor pain. Out of habit, a person reacts to pain by taking painkillers, which only makes the situation worse. Anesthetics relieve symptoms, but do not remove the cause. The disease “takes over” more and more healthy tissue and, as a result, instead of treatment, the patient receives disability. Let's figure out why TMJ arthritis can develop.

1. 1. Mechanical injury. Impact, the habit of clenching teeth tightly, and active chewing of hard food can lead to damage to one or more components of the joint. Articular tissues respond to damage with pain and dilation of blood vessels. Simply put, blood enters from the vessels directly into the tissue, causing swelling, inflammation, and, if treatment is delayed, suppuration.
2. 2. Infection. The inflammatory process develops as a result of pathogenic microorganisms entering the joint through the blood or through direct and contact routes. The direct route of infection involves inflammation of the TMJ as a result of an open wound (knife or gunshot wound). If microorganisms have penetrated into the cartilage from infected muscle or bone tissues, then the pathology of transmission is called contact. All diseases of the oral cavity (as well as ear, nose and throat) can lead to arthritis of the temporomandibular joint through the hematogenous route, through the blood.
3. 3. Systemic inflammation. Some pathologies of an inflammatory nature (herpes, hepatitis, mycoplasmosis, chlamydia, lupus), if not treated in a timely manner, affect connective tissue throughout the body.