12th October is celebrated as world arthritis day, celebrated to raise the global awareness about the existence and impact of rheumatic arthritis and musculoskeletal diseases. About 15% of the world population is suffering from arthritis.
In India, the epidemiology is even higher, affecting about 25% o f the population in the age range of 40 and above. The juvenile forms occur much earlier, with even more debilitating state of being, life changing effects due to constant pain and inflamed joints.
This world arthritis day, let us make people aware of the arthritis and the importance of healthy bones and joints as educating can make significant changes and alleviate human suffering.
Degenerative joint disease is one of the most common arthritic jaw problem in the class of TMD, degenerative joint disease is now called as osteoarthritis. Osteoarthritis, a form of arthritis is characterized by chronic degeneration of the various hard and soft tissues around the joint. This results in anatomical changes in the joint, and joint pain due to alteration in peripheral and central pain processing mechanisms.
Stress bearing joints of the body such as knee, hips, spine, and fingers are most commonly affected. Osteoarthritis can also affect other joints in the body such as wrist, shoulder, ankle and Temporomandibular joint (TMJ). TMJ osteoarthritis affects the cartilage, subchondral bone, synovial membrane, and other hard and soft tissues causing changes such as TMJ remodelling, articular cartilage abrasion and deterioration. Osteoarthritis localized to the TMJ may also be a part of this generalized condition.
What are the causes of osteoarthritis of jaw and how can you avoid it?
The etiology of osteoarthritis id complex and multifactorial, people with higher age, genetic susceptibility, history of trauma are at a risk. Traumas may not be limited to accidents but include, increased overjet (forwardly protruded teeth), prolonged microtrauma, and maybe due to occlusal interferences. Disturbances of joints and muscles (instability of joint, Inadequate strength / muscle endurance, internal derangements, ligament laxity, disectomy), systemic conditions such as generalized osteoarthritis, idiopathic degenerative disease, congenital or developmental abnormalities.
All these factors cause sustained inflammation, further cusing changes in the hard and soft tissues, triggering immune responses. Immune cells further trigger more inflammation by means of inflammatory mediators at the cellular level. The combined effect results in degradation and abrasion of joint cartilage and remodelling of subchondral bone.
The most common signs and symptoms are pain, restriction in joint function, joint sounds, stiffness, limitation in mouth opening. Joint sounds, skeletal remodelling may be seen on radiographic imaging, chin maybe deviated towards affected side, and occlusal changes i.e. the way in which teeth join maybe noticed.
How do we manage osteoarthritis?
Once the diagnosis is made, treatment is decided based on stage and symptomatology. Management is largely symptomatic. Non-surgical treatments such as physical therapy, pulsed electric stimulation, pharmacological, topical ointments, supplements, steroid injections, hyaluronic acid (HA) injections, acupuncture are effective in the initial phase.
Education and self-management coupled with muscle strengthening and appliance therapy, thermal modalities, TENS, Low-level laser therapy, are interventions that improve the outcome. Pharmacotherapy is the second line of treatment and if not then intraarticular injections and if all conservative therapies fail, surgeries are considered.
Successful diagnosis is the key to managing osteoarthritis. We at Neocare have the legacy of treating our patients effectively with conservative therapies, with least morbidity to the patients.