Does advanced arthritis in the TMJ have to be treated with total joint replacement?
Rheumatoid arthritis isn’t as common in the TM joint as other joints in the body.
The TMJ is not a load bearing joint like most other joints in the body. Arthritic breakdown in the TMJ almost always starts with excess pressure on the joint; through clenching or bruxing or, with imbalanced growth of the jaws from early childhood allergies and the related jaw distortions it creates.
I’ve patients with severe, progressive systemic rheumatoid arthritis whose TM joints are perfectly normal and pain free. Weight bearing joints are always more susceptible to breakdown, whether rheumatoid arthritis, degenerative processes, or osteoarthritis. Avascular necrosis is a condition being seen with more frequency in teenage patients, usually females.
By age 7-10, the alignment of the TMJ is being positively or negatively influenced by the developing airway and occlusion. Earlier onset of estrogen hormones may be responsible for the aggressive degeneration of the TMJ’s when subjected to misaligned growth and loading of the TMJ.
Regardless of the triggering event, getting pressure off of the joint will help arrest the rapid breakdown of the bone. Proper use of medications is also indicated in some cases, such as steroids or other anti-inflammatory drugs.
TMJ joints develop as the facial skeleton matures. One of the most important factors in proper facial and TMJ growth is the airway.
By age 5, significant disturbances can be seen in the face, jaws, and dental arches due to allergies and enlarged tonsils and adenoids. The pathologic effect of even a mild airway obstruction has lifetime consequences of pre-disposing to TMD and sleep apnea as an adult.
Dentists with experience in TMD and sleep breathing disorders can recognize early growth problems, and help get them corrected before permanent changes occur in the jaws, and TMJ.
If you have advanced arthritis or bony damage in your TM joints, most cases can be improved and stabilized with proper decompression orthotics. Most patients I have treated are able to arrest the degenerative process, stabilize the damaged TMJ’s and provide stability in the “bite” without joint replacement surgery. Patients can function quite well even with severe condyle degeneration if proper non-surgical orthotics are consistently used, and radiographic monitoring.
If surgery is indicated, oftentimes a joint “flushing” procedure rids the inflammatory chemicals built up within the TMJ and can stop the loss of bone. In advanced cases, hi tech joint replacement can be done using 3-D technology to customize build a joint for your anatomy and needs.