Arthritic Temporomandibular Joint Disorders

Arthralgia or Capsulitis

Arthralgia/Capsulitis is defined as a painful joint (even without any osseous changes) with increased tenderness to palpation pressure.

The clinical history and examination evidence needed for this diagnosis includes:

1. A unilateral or bilateral presentation of temporomandibular joint pain which is aggravated by function and opening wide
2. Moderate pain elicited from TMJ capsule on palpation
3. Palpation is performed with 1 kg of pressure for 2 seconds applied to the lateral and/or dorsal capsule

Localized Osteoarthritis

TMJ radiographs confirm the diagnosis of osteoarthritis (whether it is localized or polyarthritic) by revealing degenerative bony changes in the joint. Radiographic findings include loss of joint space, flattening of the articulating surfaces, bony spurs, sclerosis of bony surfaces, or discrete erosive bony lesions. The crepitation is usually indicative of radiographic change in the surface of the joint when imaging is collected.

The clinical history and examination evidence needed for this diagnosis includes:

1. Unilateral or bilateral presentation of temporomandibular joint pain which is aggravated by function and opening wide
2. crepitation noises are evident on jaw motion using a stethoscope
3. in some cases, the joint will not make crepitation sounds but radiographically the joint surface will show flattening, erosive changes and/or sclerosis and joint space narrowing
4. moderate tenderness, stiffness, brief locking are common in OA, but rarely a swelling or effusion of the joint
5. pain elicited from the TMJ capsule on palpation with 1 kg of pressure for 2 seconds

Polyarthritis

Pain, swelling and disability in multiple body joints are evidence of polyarthritis and there are several types. Depending on the type of polyarthritic disorder (Rheumatoid, Psoriatic, Lupus) the problem may have hematologic-based markers. However, if it is a Polyjoint Osteoarthritis, there are no serologic markers but usually there are clear radiographic indications (e.g., flattening, loss of space, spurs, erosive lesions, and sclerosis) of arthrotic changes of the TMJs and of the fingers (distal interphalangeal joints).

Like what you’re learning?  Download a brochure for our online, postgraduate Orofacial Pain and Oral Medicine degree program.

Generalized Osteoarthritis

Generalized Osteoarthritis is characterized by involvement of three or more joints or groups of joints. Most commonly, generalized osteoarthritis occurs in the spine, knees, hips, base of the thumb, proximal interphalangeal joints, the distal interphalangeal joints, and in the big toe. The wrists, elbows, and shoulders are typically not involved in generalized osteoarthritis.

The clinical history and examination evidence needed for this diagnosis includes:

1. Multiple sites of joint pain in joints that are commonly affected by osteoarthritis
2. a unilateral or bilateral presentation of temporomandibular joint pain which is aggravated by function and opening wide
3. crepitation noises are evident on jaw motion using a stethoscope
4. in some cases, the joint will not make crepitation sounds but radiographically the joint surface will show flattening, erosive changes and/or sclerosis and joint space narrowing
5. moderate tenderness, stiffness, brief locking are common in OA, but rarely a swelling or effusion of the joint
6. pain elicited from the TMJ capsule on palpation with 1 kg of pressure for 2 seconds

Rheumatoid Arthritis

This is an autoimmune disease, which principally attacks flexible (synovial) joints. It can lead to substantial loss of functioning and mobility if not adequately treated. The joints become swollen, tender and warm, and stiffness limits their movement.

Most commonly involved are the small joints of the hands, feet and cervical spine. The joints are often affected in a symmetrical fashion, although this is not specific, and the initial presentation may be asymmetrical. Rheumatoid Arthritis patients have positive serologic markers for autoimmunity (elevated Erythrocyte Sedimentation Rate and Rheumatoid factor). A diagnosis of rheumatoid arthritis of TMJ is labelled with ICD-10 code M06.80.

The clinical history and examination evidence needed for this diagnosis includes:

1. multiple sites of joint pain in joints that are commonly affected by rheumatoid arthritis and positive blood tests for rheumatoid arthritis
2. a unilateral or bilateral presentation of temporomandibular joint pain which is aggravated by function and opening wide
3. crepitation noises are evident on jaw motion using a stethoscope
4. in some cases, the joint will not make crepitation sounds but radiographically the joint surface will show flattening, erosive changes and/or sclerosis and joint space narrowing
5. moderate tenderness, stiffness, brief locking are common in RA, and often these joints have a swelling or effusion of the joint
6. pain elicited from the TMJ capsule on palpation with 1 kg of pressure for 2 seconds

Other Polyjoint Arthritic Diseases

The only way to determine if a patient has lupus, gout or psoriasis is via a rheumatologic work-up. Unfortunately, these disorders do not have a characteristic clinical or radiographic appearance.

If the patient has psoriatic arthritis, they will generally know they have this disease because the psoriasis is diagnosed based on the skin lesions by a dermatologist. If the patient has lupus that is affecting their joints, again, they will have a multitude of symptom indicative of lupus and they will usually have a positive ANA (anti-nuclear antibody) titer that is high and indicative of autoimmune disorders.

Finally, if the patient has gout, again, the jaw joint is uncommonly affected in gout and they will have other joints (especially the big toe) which are painful long before the TM joint is affected. Gout patients are diagnosed based on blood work, looking for the serologic markers of gout.

The clinical history and examination evidence needed for this diagnosis includes:

1. usually multiple sites of joint pain
2. sometimes but not always crepitation noises
3. pain elicited from the TMJ capsule on palpation with 1 kg of pressure for 2 seconds
4. a clear swelling or effusion of the TM joint
5. positive blood tests for the specific disease (except for psoriasis)

Related Reading: Internal Derangements of the Temporomandibular Joint

Earn a Master’s Degree in Orofacial Pain and Oral Medicine Online

Like what you’re learning?  Consider enrolling in the Herman Ostrow School of Dentistry of USC’s online, competency-based 1-year certificate program or 3-year Master’s program in Orofacial Pain and Oral Medicine.

Disclaimer

The information and resources contained on this website are for informational purposes only and are not intended to assess, diagnose, or treat any medical and/or mental health disease or condition. The use of this website does not imply nor establish any type of provider-client relationship. Furthermore, the information obtained from this site should not be considered a substitute for a thorough medical and/or mental health evaluation by an appropriately credentialed and licensed professional. Commercial supporters are not involved in the content development or editorial process.