Inflammatory and degenerative pathologies of the ATM
INTRODUCTION :
The ATM, like any joint, can be the site of inflammatory, degenerative and other lesions. It is essential to know them in order to diagnose certain pathologies expressed at the level of the ATM.
1/ Septic temporomandibular arthritis:
Definition: it is the consequence of the invasion of the synovium by living microorganisms.
Etiology:
-Local causes: open trauma of the articular region. -Therapeutic causes: articular infiltrations.
-Superinfection: propagation of a neighboring infection.
-Localization II hematogenous area.
Bacteriology:
Staphylococcus, streptococcus +++ ¸ Actinomyces¸ KOCH’s bacillus¸ Treponema pallidum¸ Gonococcus¸ Certain viruses.
Clinic:
-Intense pain limiting oral movements ¸
-Limitation of mouth opening
-Mouth half open and any attempt to close it results in a paroxysm ¸
-Pretragal edema ¸ Edema of the anterior wall of the EAC ¸
-General signs sometimes marked Rx: late widening of the arterial line.
Treatment :
Puncture: identification of the germ in question (antibiogram).
Relieves the patient (evacuation of the purulent collection: drainage).
Rest of the joint + ATB, NSAIDs and analgesics.
2/ Rheumatic arthritis:
Definition: Acute or chronic inflammation of the joints.
They are suspected by:
Discreet pain at rest, increased by mandibular movements and Intense during a rheumatic crisis.
– Light joint cracking.
– Rheumatic history.
RAA
Rheumatoid arthritis
Ankylosing spondylitis
Chronic juvenile arthritis
Connective tissue disease.
RAA:
This is a multi-system inflammatory disease, it is a non-suppurative complication of untreated pharyngitis, due to Streptococcus pyogenes (group A streptococcus).
The involvement is mainly at the expense of the large joints.
The temporomandibular location is always associated with involvement of the latter.
Biological diagnosis: ↑ ESR, streptolysins
Treatment: ATB + NSAIDs.
Rheumatoid arthritis:
This is a destructive poly synovitis mediated by the immune system, it ends up causing cartilage, bone and ligament lesions.
Clinical:
Unilateral involvement, becomes bilateral after several years.
Pain predominantly nocturnal and morning .
Mainly affects small joints.
Radiography:
– Rheumatoid synovitis. X-ray is normal.
– Advanced forms of periarticular erosions.
Biological diagnosis:
VS↑, Specific immunological reactions
Cloudy synovial fluid; more fluid containing leukocytes .
Treatment:
1/ symptomatic: Analgesics, NSAIDs, resting the TMJ.
2/ background: corticosteroid therapy, gold salt, antimetabolites,,,,,,
Ankylosing spondylitis:
This is a chronic inflammatory rheumatism that mainly affects the axial structures with an estimated TMJ involvement of 10 to 24%.
X-ray: Condylar erosion.
Diagnosis: Based on pain and genetics (presence of HLA B27 antigen).
Treatment: NSAIDs, analgesics and physiotherapy.
Chronic juvenile arthritis:
– Affects children under 4 years old.
– Symmetrical polyarthritis associated with ADP, splenomegaly + skin rashes
Major bone destruction Causes disruption of mandibular development resulting in micrognathia following ankylosis.
The etiology is unknown.
Connectivitis:
-Inflammatory and immunological damage to connective tissues.
3/ Degenerative diseases:
Structural modification of the articular surfaces, which develops when adaptation capacities are exceeded.
Osteoarthritis:
Definition: Chronic, non-inflammatory degenerative arterial disease , resulting from the disruption of the balance between degenerative and repair processes.
Etiology: -Loss of post-locking. -Mechanical overload -Para- functions.
Clinical:
Cracking and intense pain: appear after any effort and disappear at rest On waking: Painful for a few minutes.
Radiological signs: Late and typical
Pinching or disappearance of the arterial space. – Flattening of the arterial components. – Sub-articular erosion. – Subchondral sclerosis.
Treatment: Symptomatic + etiological
Inflammatory and degenerative pathologies of the ATM
Conclusion:
The manifestations of inflammatory and degenerative pathology of the ATM remain rare. The patient may present following pain, joint noises, he needs to be relieved whatever his pathology.
Our role is to plan to diagnose the pathology without missing it.
Inflammatory and degenerative pathologies of the ATM
Deep cavities may require root canal treatment.
Interdental brushes effectively clean between teeth.
Misaligned teeth can cause chewing problems.
Untreated dental infections can spread to other parts of the body.
Whitening trays are used for gradual results.
Cracked teeth can be repaired with composite resins.
Proper hydration helps maintain a healthy mouth.