Diagnosis and treatment of temporomandibular joint disorder syndrome

The main function of the temporomandibular joint is to participate in chewing, pronunciation, swallowing and expression. Temporomandibular joint disorder syndrome is one of the common diseases of the oral and maxillofacial region. It commonly occurs in young adults, with the highest prevalence among those aged 20 to 35 years. It usually occurs on one side, but some can gradually involve both sides. Temporomandibular joint disorder syndrome generally has a long course and often relapses. It is mostly a functional disorder. It may also involve joint structural disorder or organic damage, so it should be paid attention to and treated as early as possible.

1. Causes

(1) Mental factors: Clinically, patients with temporomandibular joint disorder syndrome often have symptoms such as anxiety, irritability, nervousness, excitement, and insomnia.

(2) Occlusal relationship: Patients often have obvious disorders of the occlusal relationship, such as occlusal interference, early cusp contact, severe locking, deep overbite, missing most of the posterior teeth, and excessive wear of the occlusal surfaces. wait.

(3) Joint overload: Frequent biting of hard food, grinding teeth at night, and the habit of clenching teeth when nervous will overload the temporomandibular joint, which will lead to the occurrence of this disease.

(4) Bilateral chewing habit: Unilateral chewing habit will cause unbalanced movement of the joints on both sides and affect the development of the jaws and the balance of muscle strength on both sides. Long-term chewing habits can easily lead to temporomandibular joint dysfunction.

(5) Trauma, yawning, excessive mouth opening, sudden cold stimulation, poor sitting posture and dental disease, etc., can also cause damage to the temporomandibular joint, surrounding muscles and ligaments and lead to disease.

(6) Malnutrition and endocrine disorders are also related to the occurrence of this disease.

2． Clinical manifestations: The development process of temporomandibular joint disorder syndrome generally has three stages: functional disorder stage, structural disorder stage, and joint organic destruction stage.

The clinical manifestations generally include the following three main symptoms:

(1) Abnormal mandibular movement: the average natural opening of a normal adult is about 3.7 cm, the opening shape is not skewed, and it is "↓ ". Patients with this disease will have abnormal opening degrees (too large or too small), abnormal opening shapes (deviated or distorted), and joint locking when opening and closing the mouth.

(2) Pain: Mainly manifested as pain in the joint area or peri-articular muscles during opening and chewing movements. If there is organic damage to the joint or muscle spasm, there will be tenderness in the corresponding joint area and muscle tissue.

(3) Joint snapping and murmur: Normal temporomandibular joint does not have obvious snapping or murmur during mandibular movement. The common abnormal sounds of this disease include ① snapping sound, which is a "clicking, clicking" sound during the opening movement; ② breaking sound: a "clicking, clicking" sound during the opening movement; ③ friction sound, which is a "clicking, clicking" sound during the opening movement. There is a continuous friction sound like rubbing cellophane during the opening movement.

(4) In addition, it is often accompanied by many other symptoms, such as various ear diseases, various eye diseases, as well as dysphagia, language difficulties, chronic general fatigue, etc.

3. Classification

(1) Masticatory muscle dysfunction category: mainly characterized by functional incoordination, hyperfunction and spasm of each masticatory muscle, which is actually an extra-articular disease. The structure and tissue of the joint are normal, and the main clinical manifestations are abnormal opening degree and opening type and pain in the involved muscles.

(2) Joint structural disorder: It is the most common type of joint disorder syndrome. It is a normal structural disorder between the articular disc, condyle and glenoid fossa. It is mainly characterized by snapping at various stages during the opening movement. It can be accompanied by varying degrees of pain and abnormalities in opening degree and opening type.

(3) Organic changes in joints: Organic changes in articular bones, cartilage and articular discs can be found through X-rays, angiography and arthroscopy. In addition to the above two categories, In addition to the symptoms, continuous grinding or cracking sounds can be heard during joint movement.

4. Self-diagnosis

(1) It usually occurs in young adults and is more common in women.

(2) Generally there is a history of temporomandibular joint dysfunction.

(3) Main complaints include joint snapping and pain. The pain is related to mandibular movement and chewing.

(4) Abnormal movement of the temporomandibular joint was found during the examination (the opening was too large or too small, and the opening type was skewed and distorted).

(5) X-ray examination: X-ray examination can detect joint space changes and bone quality changes, and arthrography can detect articular disc displacement, perforation and changes in surrounding tissue.

(6) Arthroscopy: It can directly observe the lesions in the joint cavity and make a diagnosis directly based on the observed results. It can also take samples for biopsy under the microscope.

Family treatment

1. Principles of prevention and treatment

(1) Mainly conservative treatment, using a comprehensive approach that combines symptomatic treatment with eliminating or weakening the causative factors treat.

(2) While treating local symptoms of joints, the general condition and the patient's mental state should be improved at the same time.

(3) Educate patients on medical knowledge so that they understand the nature and pathogenic factors of the disease, enhance their confidence, cooperate with doctors in treatment, and conduct self-treatment and self-protection of joints under the guidance of doctors.

(4) Step by step, determine a reasonable treatment plan.

2． The current treatment methods are:

(1) Medication: The commonly used ones are indomethacin, tablets, 25 mg per tablet, 25 mg each time, 3 times a day, 5 consecutive days as a course of treatment; Diazepam, tablet, 2.5 mg per tablet, 2.5-5 mg each time, 3 times a day, 5 consecutive days as a course of treatment.

(2) Physiotherapy: Local infrared irradiation and helium-neon laser irradiation can be used, 20 minutes each time, once a day, and continuous irradiation for one week is a course of treatment.

(3) Magnet therapy: Suitable for home treatment. Patients can apply magnet sheets to the most obvious pain points. It is easy to use and has good analgesic effect. It is often used in the treatment of this disease. The pain and mouth opening are limited, and it also has a certain effect on relieving joint snapping.

(4) Sealed therapy, adjustment, orthodontic correction and other methods can also be used. If there are obvious indications for surgery, surgical therapy can also be used.

3. Treatment points

(1) Hyperfunction of the lateral pterygoid muscle: Mainly to adjust the function of the lateral pterygoid muscle. 5 ml of 0.5% or 1% procaine can be used to seal the lateral pterygoid muscle, once a day, 5~ 7 times constitute a course of treatment.

(2) Lateral pterygoid muscle spasm: mainly to relieve muscle spasm. ①Physiotherapy: 15% calcium chloride solution can be used to introduce calcium ions into the joint areas and chewing areas on both sides, once a day, 7 to 10 times as a course of treatment; ②Occlusion therapy: use 2% to 3 ml of procaine The lateral pterygoid muscle is closed, once a day or every other day, 5 times as a course of treatment. If the pain does not improve significantly, closed therapy should be abandoned. ③Chinese medicine local hot compress, medicine pot, massage, etc. also have certain curative effects.

(3) Spasm of masticatory muscles: Treatment is the same as spasm of lateral pterygoid muscles, but mild physical therapy is appropriate. At the same time, you can take sedatives and muscle relaxants, such as diazepam and enteric-coated aspirin.

(4) Reducible anterior disc displacement: Patients in the early stage of snapping can be treated with a reduction plate. If the articular disc is obviously forward and cannot be treated with a plate, then the articular disc can be treated. Reduction surgery.

(5) Irreducible anterior disc displacement: First, manual reduction can be used. The method is the same as the manual reduction method for acute anterior joint dislocation. If the reduction is successful, a snapping sound can be heard, and then the reduction can be restored by pressing again. Treatment of anterior disc displacement of sexual joints. If the joint cannot be reduced by manipulation, a pivot plate can be used. In severe cases, articular disc reduction surgery can be performed.

(6) Articular disc perforation and rupture: Comprehensive treatment based on conservative treatment should be followed according to the procedure. If comprehensive treatment is ineffective, articular disc repair or articular disc removal may be considered depending on the condition.

Notes

(1) There are no dietary restrictions in principle, but chewing of raw, cold and hard food should be avoided.

(2) Eliminate the mental state of mental stress and maintain an optimistic, relaxed and open-minded mental state. Pay attention to the balance between work and rest, and actively participate in cultural and sports activities.

(3) Don’t develop the habit of gritting your teeth when you are nervous at work.

(4) Do not open your mouth wide, and pay attention to protecting the mandibular joint when yawning.

(5) Pay attention to keeping your face cold and warm in winter.

(6) When removing impacted teeth, care should be taken to protect the mandibular joint; during other intraoral treatments, care should be taken not to allow the patient to open his mouth wide for a long time.

Yin Weidong

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