Degenerative Arthritis Of The Temporomandibular Joint
What can I expect if I have degenerative arthritis on the left side of my face?
Degenerative arthritis or as it is referred to now, Osteoarthritis (OA) can effect any joint in the body and the joint closest to the face is the temporomandibular joint (TMJ), so I will assume that you are referring to arthritis in the TMJ. Symptoms vary in different people, or for that matter in an individual person over time, and the remedies that apply to other joints of the body apply to the TMJ as well.
Education about the natural history of OA and the therapy for problems in the TMJ is important, since so much of the treatment involves changes in basic habits of chewing and moving the jaw.
The goals of therapy are reduction of stress on the TMJ, maintenance of function, and reduction of pain. The therapy can be broken down into several parts:
Protect the joint to the extent possible. For the TMJ this means eating softer foods, taking smaller bites, and chewing more slowly during periods of increased symptoms. But parafunctional activities of the jaw — that is clenching and grinding the teeth, biting your fingernails or lips, and biting pencils or pens — are considered to be much more detrimental than functional activities such as chewing. Since these are activities that people are not normally conscious of, it can be difficult to develop direct ways to combat them. Dentists commonly use orthotics (i.e. splints, bite planes, or bite guards) which reduce these habits to some extent. They have also been shown to have a relaxing effect on the muscles of the jaw thus reducing strain on the TMJ.
Physical therapy (PT) is quite useful in improving any limited range of motion of the mandible, improving function and reducing pain. Active treatments such as moist heat/ice and ultrasound can also be very useful in controlling symptoms. A customized home exercise program (HEP) can be used to augment the active treatments, and is critical for the person to learn to become self-managing.
Anti-inflammatories like ibuprofen are commonly used, however, I recommend that people with this condition rely on the physical therapy, home exercise program, and reducing parafunctional activities as the key treatments, using medications only sparingly.
You should also be aware that OA might be used by doctors in a general sense to suggest any condition that affects the bony integrity of a joint. Therefore, it is prudent to rule out other conditions, which might be causing pain in the TMJ.
If you indeed have OA and you and your doctor are having difficulty managing the condition, I would recommend seeking out a doctor who has experience in problems of the TMJ. Prolonged symptoms and the associated degenerative changes can affect your dental occlusion, creating a malocclusion over time. Severe malocclusion or facial deformity happens only rarely but if any changes in your bite start to develop seek appropriate care as soon as possible. OA is normally a relatively simple condition to control.
This response was largely written by Daniel F. Tylka, D.M.D., M.S. Head, Section on Temporomandibular Disorders & Orofacial Pain, University of Nebraska Medical Center, who graciously offered to serve as a consultant for this case.