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oral pathology bone joint disorders.pptx
- 2. Contents Introduction Bony joints Tmj disorders *couses *symptoms *classification
- 3. Introduction Bone joints, also known as articulations, are the points where two or more bones come together and connect. Joints play a crucial role in the structural and functional integrity of the skeletal system, allowing for movement, stability, and support. There are several types of bone joints, classified based on the degree of movement they allow: 1.Fibrous Joints 1. Also known as fixed or immovable joints. 2. The bones are connected by fibrous connective tissue, such as in the joints between the skull bones (sutures). 3. These joints allow little to no movement.
- 5. Cont 2: Cartilaginous Joints 1. The bones are connected by cartilage, either hyaline cartilage (as in the pubic symphysis) or fibrocartilage (as in the intervertebral discs). 2. These joints allow for limited movement, mainly compression and stretching.
- 6. Synovial Joints 1. The most common type of joint in the body. 2. The bones are connected by a joint capsule lined with a synovial membrane, which secretes synovial fluid to lubricate the joint. 3. Synovial joints allow for the greatest range of motion, such as the shoulder, elbow, hip, and knee joints.
- 7. Temporomandibular joint (TMJ) disorders Temporomandibular joint (TMJ) disorders also known as TMJs, are a group of conditions that affect the temporomandibular joint, which is the joint that connects the jawbone to the skull. This complex joint allows for the smooth opening, closing, and movement of the jaw, which is essential for functions such as speaking, chewing, and swallowing.
- 9. Causes of TMJ disorders TMJ disorders can be caused by a variety of factors, including: 1.Trauma: Injuries to the jaw, head, or neck, such as from a car accident or a blow to the face, can lead to TMJ disorders. 2.Teeth grinding (bruxism): Excessive grinding or clenching of the teeth, often during sleep, can put strain on the TMJ and surrounding muscles. 3.Arthritis: Conditions like osteoarthritis or rheumatoid arthritis can affect the TMJ, causing pain and dysfunction. 4.Stress: High levels of stress can lead to muscle tension and grinding of the teeth, which can contribute to TMJ disorders. 5.Structural problems: Misalignment of the jaw or irregularities in the shape of the TMJ can also lead to TMJ.
- 10. Symptoms of TMJ disorders Pain or tenderness in the TMJ, face, neck, or shoulders Clicking, popping, or grating sounds when opening or closing the mouth Locking or limited movement of the jaw Headaches, earaches, or dizziness Difficulty chewing or opening the mouth wide
- 11. Classifications of TMJ disorders A. Developmental disturbances Hypoplasia of mandibular condyle Hyperplasia of mandibular condyle. B. Traumatic disturbances Luxation and subluxation (complete and incomplete dislocation) Ankylosis
- 12. Cont C. Inflammatory disturbances of TMJ Rheumatoid arthritis Osteoarthritis Gout Synovial Chondromatosis
- 14. A. Developmental disturbances Hypoplasia of the Mandibular Condyle: Definition: Hypoplasia of the mandibular condyle is a congenital or acquired condition characterized by the underdevelopment or decreased size of the mandibular condyle, the rounded projection at the end of the mandible that forms the temporomandibular joint (TMJ).
- 15. Causes: The causes of mandibular condyle hypoplasia can be classified into: 1.Congenital causes: 1. Genetic factors or chromosomal abnormalities 2. Intrauterine disturbances during fetal development 2.Acquired causes: 1. Trauma to the TMJ region, such as a mandibular condyle fracture 2. Infections or inflammatory conditions affecting the TMJ 3. Radiation therapy to the head and neck area
- 16. Signs and Symptoms: Facial asymmetry and micrognathia (small lower jaw) Limited mouth opening and restricted mandibular movement Malocclusion, with the affected side of the jaw being posteriorly positioned Deviation of the chin towards the affected side during mouth opening Pain and discomfort in the TMJ region
- 17. Oral Manifestations: Unilateral or bilateral absence of the mandibular condyle Altered jaw development and growth, leading to facial asymmetry Abnormal occlusal relationships and bite patterns Hypoplasia (underdevelopment) of the ipsilateral mandibular ramus and body
- 18. Treatment: Orthodontic treatment Prosthodontic rehabilitation Surgical intervention Physical therapy and rehabilitation
- 19. Hyperplasia of the Mandibular Condyle: Definition: Hyperplasia of the mandibular condyle is a rare condition characterized by the excessive growth and enlargement of the mandibular condyle, the rounded projection at the end of the mandible that forms the temporomandibular joint (TMJ).
- 20. Causes The exact cause of mandibular condyle hyperplasia is not fully understood, but it is believed to be associated with various factors, including: 1.Genetic factors: 1. Familial predisposition or genetic mutations 2.Hormonal factors: 1. Imbalance or abnormalities in growth hormone or other hormones 3.Trauma or inflammation: 1. Previous injury or inflammation to the TMJ region 4.Idiopathic: 1. No known specific cause can be identified in some cases
- 21. Signs and Symptoms: Facial asymmetry and progressive mandibular prognathism (forward positioning of the lower jaw) Limited mouth opening and restricted mandibular movement Malocclusion, with the affected side of the jaw being anteriorly positioned Deviation of the chin towards the non-affected side during mouth opening Pain and discomfort in the TMJ region
- 22. Oral Manifestations: Unilateral or bilateral enlargement and overgrowth of the mandibular condyle. Altered jaw development and growth, leading to facial asymmetry. Abnormal occlusal relationships and bite patterns. Hypoplasia (underdevelopment) of the contralateral mandibular ramus and body.
- 23. Treatment: Orthodontic treatment Prosthodontic rehabilitation Surgical intervention Physical therapy and rehabilitation
- 25. B. Traumatic disturbances Subluxation (Hypermobility): It is the unilateral or bilateral positioning of the condyle anterior to the articular eminence, with repositioning to normal accomplished physiologic activity. It is self- reducing incomplete dislocation, which generally follows stretching of the capsule and ligaments.
- 26. Etiology long continuous opening of mouth oral surgical procedures osteoarthritis psychiatric problem use of phenothiazine derivatives.
- 27. Clinical Features It may be unilateral or bilateral. Symptoms: Cracking noise temporary locking of the condyle immobilization of the jaw Patient describes weakness of the joint while yawning Pain is associated with last few millimeters of mouth opening
- 28. Treatment a. Conservative Treatment: . Occlusal Splint Therapy: Wearing a custom-made occlusal splint (also known as a stabilization or nightguard) to prevent tooth grinding and clenching, which can contribute to TMJ hypermobility. The splint helps stabilize the jaw and reduce stress on the TMJ. b. Physical Therapy: Exercises and manual techniques to strengthen the muscles and improve the range of motion of the TMJ. Includes stretching, strengthening exercises, and the use of modalities like heat or cold therapy. c. Medication: Anti-inflammatory drugs to reduce pain and inflammation. Muscle relaxants to help alleviate muscle spasms and tension.
- 29. d.Lifestyle Modifications: 1. Avoiding activities that exacerbate TMJ symptoms, such as chewing hard or sticky foods. 2. Applying hot or cold compresses to the affected area. 3. Practicing stress management techniques, such as relaxation exercises or biofeedback. e.Surgical Treatment: a. Arthrocentesis: 4. Involves the injection of saline solution into the TMJ to flush out any debris or inflammatory byproducts. 5. Can help reduce pain and improve joint mobility. b. Arthroscopic Surgery: 6. Minimally invasive procedure using a small camera (arthroscope) to examine and treat the TMJ. 7. Allows for the removal of adhesions, scar tissue, or other abnormalities within the joint.
- 30. Open Joint Surgery: More extensive surgical procedure, typically reserved for severe or complex cases. Involves the direct visualization and manipulation of the TMJ structures. May include procedures like condylectomy (removal of the mandibular condyle) or disc repositioning.
- 31. Ankylosis Ankylosis, a Greek word which means stiff joint. It is an abnormal immobility and consolidation of the joint.
- 32. Classification True (intra-articular): It is any condition that produces fibrous or bony adhesion between the articular surfaces of the TMJ. False (extra-articular): It is the one which results from pathologic conditions outside the joint, that result in limited mandibular mobility. Bony: If bone is present between the articulating surfaces and prevents movements, it is called as bony ankylosis.
- 33. Fibrous: If the medium which prevent, the movements is fibrous, it is called as fibrous ankylosis. Partial: If there is incomplete union between the articulating surfaces, it is called as partial ankylosis. Complete: If there is complete union between the articulating surfaces, it is called as complete ankylosis.
- 34. Etiology False Myogenic: The most common problem associated with muscle origin is fibrosis, which may result from chronic infection of the elevator muscles of mastication. Myositis ossificans can also produce limitation of opening. Neurogenic: They include epilepsy, brain tumor, bulbar paralysis and cerberovascular accidents. Psychogenic: Here the affected persons exhibit no pain, but cannot get the jaws separated also called as hysterical trismus and is apparently produced due to fright.
- 35. Bone impingement: The most common is coronoid impingement. Malformation of coronoid such as exostosis or elongation can cause the mandible to impinge on the posterior aspect of the zygoma, when opening is attempted.
- 36. True Congenital: Abnormal intrauterine development, birth injuries and congenital syphilis. Trauma: Trauma to the chin forces the condyle against the glenoid fossa, particularly with bleeding in the joint.
- 37. Inflammatory: Primary inflammation of the joint. Inflammation of the joint secondary to a local inflammatory process (otitis media, osteomyelitis, etc). Inflammation of the joint secondary to a blood stream infection (septicemia, scarlet fever, gonorrhea). Rheumatoid arthritis is the commonest cause of bilateral ankylosis. Gonococcal arthritis can also cause ankylosis of TMJ. Inflammation secondary to radiation therapy.
- 39. Clinical Features General: It is seen primarily in a young age or between 1 to 10 years. Pain and trismus is present which is directly related to the duration of ankylosis. Depending upon the duration, there may poor oral hygiene, carious teeth and periodontal problems malocclusion.
- 40. Unilateral: Unilateral ankylosis is more common than bilateral ankylosis. Mouth opening is impossible, but the patient may be able to produce several millimeters of interincisal opening (Fig. 27.1). Asymmetry of the face with fullness on the affected side and relative flattening on the unaffected side (Fig. 27.2). In unilateral ankylosis, patients face is deviated towards the affected side (Fig. 27.3).
- 41. Bilateral: Face is symmetrical with micrognathia. There is bird face appearance (Fig. 27.4). No gliding movement. With bilateral ankylosis, neither protrusive nor lateral movements are possible. An attempt at forced opening in bony ankylosis, there is no pain but in case of fibrous ankylosis, there is pain.
- 43. Management Brisement force Condylectomy gap arthroplasty is performed.
- 44. Osteoarthritis It is also called as osteoarthrosis or degenerative arthritis. It is primarily a disorder of movable joints characterized by deterioration and abrasion of the articular cartilage with formation of new bone at the joint surface. There is destruction of the soft tissue component of the joint and subsequent erosion with hypertrophic changes in bone. There is breakdown of the connective tissue covering of the condyle, articular eminence and the disk. Articular eminence shows resorption and the underlying bone becomes sclerotic.
- 45. Clinical Features It is common in many joints, but it is not frequently found in TMJ. It occurs in patients older than 40 years of age and 85% of them are older than 70, with a mean age of 53 years. Females are affected 6 times as frequently as males.
- 46. Symptoms: Unilateral pain over the joint, which may be sensitive to palpation, occurs. Pain on movements or biting occurs, which may limit mandibular function. Pain is usually located to the immediate preauricular region.
- 47. Signs: There is deviation of the jaw towards the affected side. Stiffness of the joint is present Early signs may progress to spasm of the masticatory muscles resulting in stiffness and locking of the jaw. If not treated at this point it may lead to irreversible changes in the TMJ.
- 49. Management Elimination of the cause: It includes occlusal adjustment or replacement of the missing teeth and ill fitting prosthesis, grinding, treatment of caries and periodontal disease. We can also give physiotherapy, myotherapy, medical therapy, corticosteroids and occlusal splints.
- 51. Rheumatoid Arthritis Rheumatoid arthitis(RA) is a chronic inflammatory disorders that primarily effects the joints. It is a systemic disease characteritized by progressive involvement of the joints. Rheumatoid arthitis affects the lining of the joints, cause pain full, swelling that can resulty in bone erosion and joint deformity.
- 52. Clinical Features General: It more commonly occurs in temperate climate and has its highest incidence in women from 20 to 50 years of age. In typical cases, small joints of fingers and toes are the first to be affected. Symptoms: It includes bilateral stiffness, tenderness and swelling over the joint. Fever, malaise, fatigue, weight loss, pain and stiffness in the limb are also evident. Signs: The joint may become red, swollen and warm to touch. Muscle atrophy around the joint is common.
- 54. TMJ Involvement It can be acute or chronic and usually, it is bilaterally involved Acute case: In acute cases, there is bilateral stiffness, deep seated pain, tenderness on palpation and swelling over the joint. There is limitation in opening of mouth. Chronic cases: In chronic cases, crepitus is the most frequent finding. Functional disturbances like deviation on opening and inability to perform lateral excursions are common.
- 55. Investigations Rose Waller test is positive in 70% of the patients with rheumatoid arthritis. Antinuclear antibodies are detected by indirect immunofluorescence. Analysis of synovial fluid is essential for the immediate diagnosis of joint infection, inflammation and degene-rative disease.
- 56. Management Adequate rest to the joint, soft diet is advocated. Treatment should be given for suppression of the active process, preservation of function and prevention of deformities. Intra-articular corticosteroid injections, nonsteroidal anti- inflammatory drugs, immunomodulator, slow acting antirheumatic drug can be given. Local treatment is done with heat, diathermy, jaw exercise or a mouth stretcher. Muscle strengthening exercise and hydrotherapy
- 57. Gout It is a chronic metabolic disorder characterized by acute exacerbations of joint pain and swelling associated with an elevated blood uric acid and deposition of crystals of monosodium urate. Predisposing Factors Drugs such as thiazide diuretics, operations, trauma, alcohol and rapid weight loss can lead to gout.
- 58. Clinical Features Acute gouty arthritis Initially, metacarpopha lyngeal joints are commonly involved. Later foot, ankles, hand, wrist and elbow may be affected. There is excruciating pain, which is worse at night Chronic tophaceous gout As the disease becomes chronic, pain and stiffness persist, with irregular swelling. Tophi are found in cartilage of the ear, nose or eyelids
- 60. TMJ involvement It is seen in middle age with equal sex distribution. It has a hereditary ten dency. Sudden excruciating pain in the TMJ, followed by rapidly developing swelling
- 61. Management Diet should be low in uric acid and fat, i.e. sweetbread, meat, extract peas, beans. Increased elimination of uric acid by uricosuric agents like colchicine 0.5 mg every 2 hourly, to a maximums of 6 mg in 24 hours.
- 62. Synovial Chondromatosis It is a benign chronic progressive metaplasia that will not resolve spontaneously. Although it is nonneoplastic, it may resemble a malignant condition histologically. Clinical Features Female to male ratio is 3:1 with greatest incidence at 40 to 60 years of age. Symptoms: Facial pain, limitation of motion and deviation towards the affected side. Signs: Crepitus, preauricular swelling, enlarged joint with effusion and local tenderness.
- 64. Management These bodies, if symptomatic, should be removed. Removal of metaplastic foci synovectomy