Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis-Review of the Literature

Abstract

Background and objectives: There are an increasing number of patients applying for dental treatment who suffer from temporomandibular joint osteoarthritis (TMJOA). Osteoarthritis may be the cause of the pain in the area of temporomandibular joints, but its course may also be absolutely asymptomatic. The aim of this study was to present an interdisciplinary approach to TMJOA, including current diagnostics and treatment modalities on the basis of the available literature. Materials and Methods: PubMed and Scopus databases were analyzed using the keywords: ((temporomandibular joint AND osteoarthritis) AND imaging) and ((temporomandibular joint AND osteoarthritis) AND treatment). The bibliography was supplemented with books related to the temporomandibular joint. After screening 2450 results, the work was based in total on 98 publications. Results and Conclusions: Osteoarthritis is an inflammatory, age-related, chronic and progressive degenerative joint disease. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT), together with clinical symptoms, play significant roles in TMJOA diagnosis. Current MRI techniques seem to be clinically useful for assessment of bony changes in temporomandibular joint (TMJ) disorders. Treatment of TMJOA requires a complex, interdisciplinary approach. TMJOA treatment includes the cooperation of physiotherapists, rheumatologists, gnathologists, orthodontists and quite often also maxillofacial surgeons and prosthodontists. Sometimes additional pharmacotherapy is indicated. Thorough examination of TMJ function and morphology is necessary at the beginning of any orthodontic or dental treatment. Undiagnosed TMJ dysfunction may cause further problems with the entire masticatory system, including joints, muscles and teeth.

Keywords: TMJ imaging; osteoarthritis; temporomandibular joint; temporomandibular joint dysfunction; temporomandibular joint osteoarthritis treatment.

Figure 1

Systematic review flow diagram.

Figure 2

MRI images coming from dynamic sequences, presenting condyle and articular disc movements during mouth opening in two different conditions: (a–d) Normal disc position (the disc moves above the condyle forward to the top of the articular eminence); (e–h) Anterior disc displacement without reduction with osteoarthritic change-osteophyte (the disc is positioned anteriorly to the condyle; while the mouth is being opened, the articular disc does not reduce to its central position above the condyle); /1/Articular disc; /2/Articular eminence; /3/The roof of glenoid fossa; /4/Condyle.

Figure 3

Osteoarthritic changes in the temporomandibular joint cone-beam computed tomography (CBCT) images: (a) Subcortical cyst; (b) Osteophyte; (c) Subcortical sclerosis; (d) Generalized sclerosis; (e) Articular surface flattening; (f) Erosion.