Experimental Methods to Inform Diagnostic Approaches for Painful TMJ Osteoarthritis

Abstract

Temporomandibular joint (TMJ) osteoarthritis (OA) is a degenerative disease of the joint that can produce persistent orofacial pain as well as functional and structural changes to its bone, cartilage, and ligaments. Despite advances in the clinical utility and reliability of the Diagnostic Criteria for Temporomandibular Disorders, clinical tools inadequately predict which patients will develop chronic TMJ pain and degeneration, limiting clinical management. The challenges of managing and treating TMJ OA are due, in part, to a limited understanding of the mechanisms contributing to the development and maintenance of TMJ pain. OA is initiated by multiple factors, including injury, aging, abnormal joint mechanics, and atypical joint shape, which can produce microtrauma, remodeling of joint tissues, and synovial inflammation. TMJ microtrauma and remodeling can increase expression of cytokines, chemokines, and catabolic factors that damage synovial tissues and can activate free nerve endings in the joint. Although studies have separately investigated inflammationdriven orofacial pain, acute activity of the trigeminal nerve, or TMJ tissue degeneration and/or damage, the temporal mechanistic factors leading to chronic TMJ pain are undefined. Limited understanding of the interaction between degeneration, intra-articular chemical factors, and pain has further restricted the development of targeted, disease-modifying drugs to help patients avoid long-term pain and invasive procedures, like TMJ replacement. A range of animal models captures features of intra-articular inflammation, joint overloading, and tissue damage. Although those models traditionally measure peripheral sensitivity as a surrogate for pain, recent studies recognize the brain's role in integrating, modulating, and interpreting nociceptive inputs in the TMJ, particularly in light of psychosocial influences on TMJ pain. The articular and neural contributors to TMJ pain, imaging modalities with clinical potential to identify TMJ OA early, and future directions for clinical management of TMJ OA are reviewed in the context of evidence in the field.

Response to the Letter to the Editor: “Intra-articular Injection of Mono-iodoacetate and TMJ Osteoarthritis”

“…These include the presence of fibrocartilage, ginglymoarthrodial function, early age of disease onset, and strong female predilection (National Institute of Dental and Craniofacial Research 2014). As our article states, the artificial inflammatory condition—produced by an acute, high inflammatory insult—does not accurately model the early stages of TMJ pathology (Almarza 2018; Sperry et al 2019). Clinical research continues to support joint microtrauma, parafunctional loading, and overuse injury as the primary causes of TMJOA pain (Okeson 2004; Almarza et al 2018); yet, little is known about disease progression and biomarkers involved in prognosis.…”

“…We thank Dr. Galvão-Moreira for the thoughtful response to our article (Sperry et al 2019). We agree that validated guidelines for the histopathologic identification of temporomandibular joint osteoarthritis (TMJOA) should be adapted in animal modeling.…”

Possibilidades conservadoras para controle de osteoartrite em articulação temporomandibular: um relato de caso

“…6,7 No entanto, mais de 70% da população já relatou algum sinal ou sintoma. 8 A maior incidência de DTM está nos pacientes de 20 a 40 anos, atingindo, quando crônicas, duas vezes mais mulheres do que homens. 5 As DTM's são atualmente divididas em dois grandes grupos: as desordens articulares e as musculares.…”

Repeated Live Imaging in the Temporomandibular Joint of an Anterior Crossbite Mouse Model Using a 7T Magnetic Resonance Device

“…Internal derangement (ID) and osteoarthritis (OA) are relatively common diseases affecting the temporomandibular joint (TMJ). ID is a functional disorder of the articular disc, whereas OA is considered as a degenerative process, in which cartilage destruction of the mandibular condylar and articular joint surface is accompanied by bone resorption or addition (1)(2)(3). Histopathological examination of these conditions in humans is limited.…”