Could My Jaw Pain Be Coming From Arthritis ?
Most people know that TMJ stands for Temporo-Mandibular-JOINT. Arthro is the Greek word for joint, and "itis" means inflammation. Arthritis = Inflamed Joint. Arthritis can happen in any joint of the body. There are many different kinds of arthritis, most of them fairly rare. For the most part, unless a person has been diagnosed with one of the rare sub-types, arthritis usually refers to osteoarthritis, or more commonly called degenerative arthritis. This is usually determined by changes on various types of imaging; x-ray, CT scans or MRI. Commonly there is a thinning or obliteration of the cartilage that covers the ends of the bones that form the joint. Osteoarthritic joints may also show fluid filled cysts in the bone ends, and small spurs (extra calcium) deposited around the joint. Sounds pretty nasty huh ? But does this always mean the joint must hurt ? Not necessarily. Most clinicians that work directly with joint issues (chiropractors, physical therapists, orthopedic surgeons) can tell you that just because the patient has a lot of arthritis on an x-ray it does not mean they are in a lot of pain. In fact one of the things we often discuss with our spine patients is that if we take an x-ray of your spine after you are feeling better, your arthritic changes will still be there! In addition, most people as they age expect to have more arthritis and stiffness. That is generally what the literature bares out; as we age, things start to breakdown. There are definitely things that speed it up (injury, poor nutrition, bad mechanics) and things that can slow it down (good nutrition, proper mechanics, exercise), but our bodies aren't made to last forever, and joints are part of the body. I read a great description of joint arthritis: wrinkles on the inside! As I age I see more wrinkles, but my skin still works fairly well. Joints are the same way, you might see a few wrinkles, but usually that doesn't mean pathology / disease.
What About The TMJ ?
In my literature reviews relative to TMJ Issues and arthritis , I found a really nice article in The International Journal of Research and Orthopedics. It was titled Prevalence and Diagnostic Features of Osteoarthrosis Of the Temporomandibular Joint, A review. This paper reviewed a number of different scientific papers on the subject of osteoarthritis, and looked at it relative to the TMJ. They noted the following: Approximately 15% of the world's population is suffering from osteoarthritis Though there is no age bar, it occurs with greater frequency as we age At 40 years of age about 20% may have osteoarthritis In the age group of 73-75 years, 70% of the people showed radiographic (x-ray) evidence of osteoarthritis, However symptoms manifest in only 9.6 % of men and 18% of women greater than 60 years of age Epidemiologic findings of TMJ osteoarthritis are similar to generalized osteoarthritis The clinical evidence of TMJ osteoarthritis occurs in 8-16% of the population It appears that the osteoarthritis effects the TMJ in a similar fashion as it does other joints: The older we get, the more likely we are to have it, but its presence does not necessarily mean the joint is going to be painful (and need direct intervention).
To be sure, some TMJ issues are caused by arthritic changes, and some TMJ sufferers have some advanced degeneration and need direct intervention on the bones of the joint itself. If you think TMJ surgery is complicated, you would be right, it is reported to be used in only about 10% of TMJ issue cases.
Let's Back The Train Up a Bit.......
One of the things that is important to remember, is that while osteoarthritis may occur with no known injury, it is very often accompanied by bad mechanics around the joint ( short and tight or weak muscles, misalignment, etc.). It is often these bad mechanics that cause the surfaces of the joint to wear abnormally in the first place ! In fact, often it is the muscle and ligament structures that are producing pain, while the joint surfaces are not. These leads to three important clinical pearls:
- When someone presents with TMJ pain, while the presence of osteoarthritis may be noted, it should not be assumed that it is the source of pain.
- Addressing the soft tissue issues (muscle, ligament, inflammation etc.) first would be the most logical approach in most cases.
- Considering direct surgical approaches (open or closed) should be reserved for those cases that do not respond to conservative care.
If you have questions on any of the information covered in this article, or would just like to run your concerns by somebody, we would be happy to talk with you. Feel free to contact us and we can set up a time to answer your questions.
Yours in Health,
Doug Williams, D.C.
TMJ Relief Center at Care Chiropractic
134 Executive Drive #3
Lafayette, Indiana 47905
(765) 448-6489
