Arthritis Affects TMJ
Arthritis Affects TMJ and Leads to Jaw Pain
By Dr. Pathamas Mittman
Arthritis, a condition that causes inflammation of the joints, is often associated with aging. There are different types that can affect the temporomandibular joint at any age.
Arthritis is a condition that causes inflammation of the joints. The main symptoms of it are joint pain and stiffness, which typically worsen with age. Arthritis can affect the temporomandibular joint (TMJ) that connects the jaw to the skull. TMJ disorders can lead to early arthritis as well.
In this article, we will explore the complex relationship between them.
Table of Contents
- Arthritis Affects TMJ and Leads to Jaw Pain
- How can Arthritis Affect TMJ?
- What are the Symptoms of TMJ Osteoarthritis?
- How can TMJ Affect Arthritis?
- Can Children Get TMJ Arthritis?
- Can I Overcome TMJ Arthritis With Treatment?
- CONCLUSION: Managing Arthritis Can Improve TMJ Pain
How can Arthritis Affect TMJ?
The temporomandibular joint can become inflamed due to arthritis. This may cause TMJ disorders, which impact around 5–12% of the world’s population and are the second most prevalent musculoskeletal disorders. [1] Arthritis can also affect the TMJ by damaging the cartilage, synovial membrane, and other tissues.
TMJ osteoarthritis (TMJ OA) results from disc dislocation, trauma, functional overburden, and the development of jaw function anomalies. Mechanical factors that cause excessive or unbalanced joint loading influence the onset and progression of TMJ OA. Early diagnosis and TMJ treatments can maintain the balance of your jaw joint, function, and occlusion. [2]
“The predominant symptom in any TMJ arthritic condition is pain associated with joint. This pain emanates from soft tissues surrounding the impacted joint and the masticatory muscles, which go into a protective reflex spasm. This inherent self-preservation reflex safeguards an injured or pathologically affected joint by inducing reflexive contraction of the surrounding musculature in response to intra-articular injury or pathology. This protective mechanism aims to prevent further damage to the joint. Additionally, pain may also originate from subchondral bone as it deteriorates due to the arthritic process and has major nerve innervation.” – Degenerative disorders of temporomandibular joint [1]
What types of arthritis can affect the jaw joint?
The most common type of arthritis affecting TMJ is temporomandibular joint osteoarthritis (TMJ OA), which has a significant clinical prevalence and adverse effects on the TMJ. TMJ OA is a chronic degenerative disease affecting the cartilage and the subchondral bone needed for healthy jaw function.
“Infectious arthritis, traumatic arthritis, osteoarthritis, rheumatoid arthritis, and secondary degenerative arthritis can affect the temporomandibular joint. Pain, swelling, and limited movement are the most common findings.” – Arthritis of the Temporomandibular Joint (TMJ), Gary D. Klasser, DMD, Louisiana State University School of Dentistry, Sept 2023
Klasser went on to say that “The TMJ is affected in over 17% of adults and children with rheumatoid arthritis, but it is usually among the last joints involved.”
Knowing this, let’s look at some types of arthritis that may impact your jaw’s health.
What is the relationship between rheumatoid arthritis and TMJ?
Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects joints, characterized by joint swelling, joint tenderness, and destruction of the synovial joints (, which is the type of joint found between bones that move against each other). RA can affect any joint in the body, including the TMJ.
The exact cause of RA is unknown. It affects the TMJ in more than 17% of adults and adolescents, but TMJ is usually among the last joints involved. The most typical symptoms are pain, edema, and restricted movement. [5]
RA in children and young adults is called young-onset rheumatoid arthritis (YORA) or juvenile idiopathic arthritis (JIA). Rheumatoid arthritis is different from the daily wear-and-tear damage of osteoarthritis. RA affects the lining of your joints, causing a painful swelling that can, over time, result in bone erosion and jaw joint deformity. [6]
TMJ arthritis is not a condition exclusive to the elderly.
The exact cause of RA is unknown. It affects the TMJ in more than 17% of adults and adolescents, but TMJ is usually among the last joints involved. The most typical symptoms are pain, edema, and restricted movement.
Associations between osteoarthritis (OA) changes and gender, age, mouth opening and duration of disc displacement without reduction (DDw/oR) were analyzed. Condylar OA changes were present in 59.30% of the joints with DDw/oR. Early-stage OA changes constituted 45.67% of the alterations. DDWoR occurs when mouth opening is limited due to the inability of the jaw bone to glide forward.
Prevalence of early-stage OA increased from 24% to about 60% one month after TMJ closed-lock occurred. The risk of developing early-stage OA changes was 5.33 times higher one month after onset of DDw/oR.
A high prevalence of degenerative TMJ changes was observed with recent on-set DDw/oR in adolescents and young adults. Early diagnosis and intervention of DDw/oR is therefore prudent. [5]
What is the relationship between osteoarthritis and TMJ?
Osteoarthritis (degenerative joint disease) is the most common degenerative joint disorder affecting TMJ. It typically, affects people over 50. Patients will sometimes report slight pain, a grating sound when moving their jaw, or jaw muscle stiffness. TMJ disk degeneration or perforation that results in bone grating against bone can cause a cracking, crunchy noise, called crepitus.
In most cases, the symptoms will show on both sides of the jaw. In addition to clinical examination, we can use cone beam CT or X-rays to diagnose. The CT imaging reveals jaw bone flattening, condyle disintegration, called erosion, and dysfunctional changes, most likely brought on by jaw clenching/grinding or excessive joint loading.
What are the Symptoms of TMJ Osteoarthritis?
Osteoarthritis is the most common degenerative joint disorder affecting TMJ. Knowing the common symptoms of TMJ degenerative joint disease can signal the need to see an orofacial pain specialist. You may experience mild to moderate pain; it helps if you keep a log of your TMJ pain severity level. [5]
Symptoms of TMJ dysfunction in rheumatoid arthritis often include:
- Pain, swelling, and tenderness in one or both temporomandibular joints.
- Jaw muscle stiffness.
- Limited mobility in the jaw (trouble opening and closing your mouth).
- Aching in and around the ear.
- Aching facial pain.
- Difficulty chewing.
- Locking of the jaw joint.
- Clicking sounds emanating from the jaw.
- Grating sensations.
How can TMJ Affect Arthritis?
Untreated TMJ disorders, e.g., jaw locks, and long-term jaw clicking with clenching habits can lead to a person developing arthritis prematurely because clenching or grinding your teeth can cause the TMJ disc to deteriorate over time, causing contact between bones. Therefore, it is important to address TMJ disorders regardless of age.
What is the relationship between secondary degenerative arthritis and TMJ?
Arthritis that develops from other conditions such as TMJ disorders is called secondary degenerative arthritis.
Fibrocartilage metabolism in TMJ may also be influenced by systemic illnesses, potentially affecting the joint’s adaptive capabilities. Systemic conditions that may trigger TMJ-OA include autoimmune disorders, endocrine disorders, nutritional imbalances, metabolic diseases, and infectious illnesses. [3]
Who can have secondary degenerative arthritis?
Although it can occur in any age, research indicates that it usually develops in people aged 20 to 40, in women more often than men. We have seen it in patients younger than 20 years of age.
“TMJ-OA may be unilateral or bilateral and has a strong predilection for women of younger age and men and women of older age are equally susceptible to TMJ-OA.” – Degenerative disorders of temporomandibular joint [2]
Although people with a history of trauma or persistent temporomandibular myofascial pain syndrome are particularly, anyone with untreated TMJ disorders or long-term jaw clenching/grinding can develop it. [4]
Untreated TMJ disorders such as jaw locks, long-term jaw clicking with clenching, or grinding habits can lead to premature arthritis because clenching or grinding your teeth can cause the TMJ disc to deteriorate over time, causing contact between bones. [4]
What health history puts you at risk for secondary osteoarthritis?
If you have a history of trauma, injury, jaw clenching and/or grinding, persistent jaw muscle pain, or jaw locking, you might have secondary degenerative arthritis.
Anyone with untreated TMJ disorders or long-term jaw clenching/grinding can develop it. These can lead to the premature onset of arthritis because of TMJ slip forward, a condition where the shock-absorbing disc between the bones erodes or moves out of place, leading to bone-on-bone contact, which results in arthritis. [4]
These conditions may have contributed to the development of osteoarthritis early on because they can impair joint function and accelerate the degenerative process. The symptoms are demonstrated by joint soreness, jaw pain during movement, limited mouth opening, and crepitus.
According to a recent report [5], after the development of TMJ closed-lock, the prevalence of early-stage arthritis rose from 24% to roughly 60% in about a month, and a month after the commencement of jaw locks, there was a greater than 5-times increase in the chance of developing early-stage secondary degenerative arthritis. Early diagnosis and intervention of TMJ jaw locks are important.
Can Children Get TMJ Arthritis?
Juvenile idiopathic arthritis (JIA) is a chronic form of arthritis that can affect children and teens between the ages of 6 months and 16 years. [7] JIA is a chronic autoimmune disorder that causes the body’s immune system to attack the joints, resulting in inflammation and pain.
Up to 87% of JIA patients may have TMJ involvement. According to research, the TMJ may be the only joint affected by JIA. Some children with JIA may have no pain. In contrast, others may experience a range of symptoms, including pain, swelling, stiffness, warmth, and redness in the joints, especially in the morning, facial asymmetry and restricted jaw opening, as well as the gap between upper and lower front teeth, which could be the initial symptoms as well. [8]
Table: Temporomandibular Involvement in Children and Adolescents with Juvenile Idiopathic Arthritis
A 2-year prospective cohort study by Malin Collin, et al., published by the National Institute of Health, March 2024
Participant characteristics from baseline, n = 54. Data are presented as mean ± SD or number of children.
| Age (years) | All | 10.7 ± 2.1 |
| Girls | 10.8 ± 2.1 | |
| Boys | 10.6 ± 2.3 | |
| Duration of JIA (years) | All | 4.1 ± 3.5 |
| Girls | 4.2 ± 3.7 | |
| Boys | 3.9 ± 3.2 | |
| JIA subtype | Oligoarthritis | 25 |
| Polyarthritis RF neg | 18 | |
| Polyarthritis RF pos | 1 | |
| Enthesitis-related arthritis | 1 | |
| Psoriatic arthritis | 5 | |
| Systemic arthritis | 3 | |
| Undifferentiated | 1 |
What are the next steps if I suspect arthritis or TMJ disorder?
If you are experiencing jaw clenching, jaw pain, or jaw noise, you should consult an orofacial pain specialist to assess the TMJ, give you the correct diagnosis, and suggest proper treatment. No matter how old you are, if you clench/grind your teeth and hear jaw noise/ clicking, it could be causing jaw pain, jaw locks, arthritis, etc. Take action.
TMJ has unique features that distinguishes it from other human body joints. Therefore, this is why you need a TMJ pain specialist who understands arthritis of the temporomandibular joint and provides tailored pain management solutions. A TMJ specialist can develop and direct comprehensive, personalized TMD treatment solutions for your arthritic condition.
Can I Overcome TMJ Arthritis With Treatment?
Treatments to manage TMJ-OA focus on restoring function and reducing pain.
It’s possible to reduce the impact of TMJ dysfunction with appropriate treatment and management. While there’s no cure for TMJ arthritis, early TMJ disorders treatment can help reduce your risk of arthritis, reduce pain and other symptoms in more than 80% of patients. [9] Even if you have a diagnosis of inflammatory arthropathy, many patients have simple mechanical problems that usually can be treated by non-surgical TMJ treatment regimes.
Knowing the common symptoms of TMJ degenerative joint disease can signal the need to see an orofacial pain specialist. You may experience mild to moderate pain; it helps if you keep a log of your TMJ pain severity level.
Essentially, the TMJ OA pain disorder is treated symptomatically. There are multiple stable treatment strategies to relieve inflammation and prevent degradation of the joint complex. Treatment may begin with self-care practices, relaxing the jaw joint, and medications.
Other treatments to help manage arthritic TMJ pain include:
- Getting enough sleep.
- Sleeping on your back with pillows to support your neck.
- Using a hot or cold compress.
- Physical therapy to strengthen jaw muscles.
Our TMJ pain specialists believe in an interdisciplinary collaboration between physicians and dentists in order to choose the best conservative, evidence-based TMJ treatment to reduce the progression and pain associated with this type of disorder. Our treatment approach starts with non-invasive interventions depending on the severity of degeneration.
CONCLUSION: Managing Arthritis Can Improve TMJ Pain
Minnesota Head & Neck Pain Clinic is a comprehensive resource for jaw pain patients. One of our world-renowned TMJ pain experts will customize your pain management plan.
Understanding the connection between arthritis and TMJ disorders is crucial for early diagnosis and treatment. If you experience jaw pain, clicking, or clenching, consult with a qualified healthcare professional. At Minnesota Head & Neck Pain Clinics, our team of TMJ experts can provide a personalized treatment plan to help manage your symptoms and improve your quality of life.
Call our office at (763) 577-2484, or Request Your Consultation
About the Author
Dr. Pathamas Mittman, DDS, MS is a leading orofacial pain certified specialist at the Minnesota Head and Neck Pain Clinic. She also has a master’s degree in Orofacial Pain from the University of Minnesota and a certificate in periodontology. Dr. Mittman devotes herself to helping improve her patients suffering from TMJ disorders, TMJ arthritis, orofacial pain symptoms, snoring, obstructive sleep apnea, and CPAP non-compliant issues. She also offers interventions, including trigger point injections and Botox treatment.
References:
[1] Vaibhav Gandhi, et al, “Degenerative disorder of temporomandibular joint- current practices and treatment modality, Seminars in Orthodontics,” Dec 2023, https://www.sciencedirect.com/science/article/abs/pii/S1073874623001202
[2] Anca Cardoneanu, et al, “Temporomandibular Joint Osteoarthritis: Pathogenic Mechanisms Involving the Cartilage and Subchondral Bone, and Potential Therapeutic Strategies for Joint Regeneration,” Jan 2023, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9820477/
[3] Ehsan Shoohanizad, et al, “Nonsurgical management of temporomandibular joint autoimmune disorders,” Dec 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6940567/
[4] Caroline Mélou, et al, “Osteoarthritis of the Temporomandibular Joint: A Narrative Overview,” Dec 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9866170/
[5] Mansur Ahmad and Eric L Schiffman, “Temporomandibular Joint Disorders and Orofacial Pain,” Jan 2016, https://pubmed.ncbi.nlm.nih.gov/26614951/
[6] Lei Jie, et al, “Degenerative temporomandibular joint changes associated with recent-onset disc displacement without reduction in adolescents and young adults,” March 2017, https://pubmed.ncbi.nlm.nih.gov/28108240/
[7] https://www.hopkinsmedicine.org/health/conditions-and-diseases/arthritis/juvenile-idiopathic-arthritis
[8] L.G Mercuri and S. Abramowicz, “Arthritic Conditions Affecting the Temporomandibular Joint,” Jan 2019, https://link.springer.com/referenceworkentry/10.1007/978-3-319-72303-7_32
[9] Rory C O’Connor, et al, “Management of the temporomandibular joint in inflammatory arthritis: Involvement of surgical procedures,” June 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473455/
