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Jaw Joint Injection (Arthrocentesis)

Have you ever woken up one morning with pain in your jaw and temples? Perhaps you didn't pay much attention to this pain, and while having breakfast, you started to hear clicking noises coming from your jawbone. Once again, you chose to ignore the pain, and the next morning, you found it difficult to open your jaw during breakfast. The pain continued to worsen, to the point where even yawning caused you to experience jaw pain. These symptoms indicate that you may have a jawbone joint disorder.

Jaw Joint Injection (Arthrocentesis)-turkey

The jaw joint, a complex assembly of the jawbone, muscles, cartilage, and elastic connective tissues situated anterior to the ear at the juncture of the lower and upper jaw, facilitates the opening and closing of the mouth, as well as speech, eating, and stretching. Consequently, the temporomandibular joint is a crucial component of the human body, and disorders affecting this joint substantially diminish our quality of life.

What are the definitions of jaw joint illnesses, what symptoms are associated with jaw discomfort, how are they diagnosed, and what treatment options are available? The subsequent paragraphs will address all your enquiries, specifically those pertaining to "Jaw Joint Injection (Arthrocentesis)," the subject of our title.

What is Jaw Joint Disorder?

What is Jaw Joint Disorder?-turkey

Jaw joint (TMJ-Tempromandibular Joint) disorders are disorders that occur in the jaw joints, jaw joint, jawbone, and adjacent tissues for various reasons.

Common symptoms of diseases of the jaw joint:

  • Difficulty breaking up food with the front teeth during eating
  • Pain in the jaw during chewing
  • Pain in the jaw during mouth opening and yawning
  • Clicking sound in the jaw during jaw opening and eating
  • pain in the jaw when you wake up in the morning
  • Teeth clenching and grinding
  • Pain in the neck, back, and head
  • Facial swelling
  • Dizziness
  • Ringing or pain in the ears
  • Pain in the eyes

If you have one or more of the above symptoms, you should see a dentist without delay. Through examination and various imaging methods, your dentist will determine whether you have a jaw joint disorder.

Causes of jaw joint disorder:

There are two known causes of jaw joint disorder. The first is anatomical and physical causes, and the second is psychological causes. We can summarize these causes as follows:

  • Malocclusion of the jaw,
  • Teeth clenching and grinding,
  • Tooth deficiencies,
  • Poorly made veneers and dental fillings, partial or complete dentures that do not fit properly
  • Continuous one-sided chewing,
  • Keeping the mouth open for too long during wisdom tooth extraction or similar treatment,
  • Sitting or sleeping with the hand under the chin,
  • Constant chewing of gum,
  • Biting habits such as pens or pencils,
  • Trauma to the jaw area, injuries, etc.
  • Slouching,
  • Joint diseases such as arthritis,
  • Stress.

Techniques for identifying jaw joint disorders:

    Physical examination:

    Before starting the physical examination, the doctor listens to the patient's relevant history. This gives an idea of whether the disease is acute or chronic, whether it originates in the muscles or the jaw joint, and whether there are any underlying causes.

    The doctor then starts the physical examination. In this examination, he/she looks for signs such as a limitation in the patient's mouth opening, any sound in the movement of the jaw joint, etc. Then a detailed examination of the mouth and teeth is performed. The examination also determines the presence of missing teeth and orthodontic problems.

    Radiologic Imaging:

    The dentist may order extra examinations. These are panoramic radiography and MRI. If a jaw joint disorder is detected as a result of the examination and examinations, it is decided which treatment will be applied.

Treatment methods for jaw joint disorders:

Once a diagnosis of a jaw joint disorder has been made, a treatment methot is determined according to the causes and severity of the symptoms. The aim of treatment is to normalize the patient's lost jaw joint functions. First of all, dental and orthodontic problems should be addressed and corrected. Other factors that cause jaw joint discomfort should then be addressed and treated. Treatment may require single or combined methods. Because the only treatment method may not relieve the symptoms and give the patient relief. In more severe cases, open joint surgery may be required Treatment methods for jaw joint disorder:

  • Treatments to reduce pressure on the jaw joint (soft diet, Botox application to chewing muscles, etc.)
  • Treatments to relieve pain (medications, ultrasound, ice packs, heat application, trigger point injections, physical therapy)
  • Treatments to relax the facial muscles and jaw joint (Transcutaneous electrical nerve stimulation (TENS), exercises, splints: injections into muscles and joints)
  • Treatment of disc-related disorders (intra-articular injections called arthrocentesis )
  • Surgical procedures to remove damage in and around the jaw joint (Arthroscopy, open joint surgery)
  • Psychiatric treatment

Need for Jaw Joint Injection (Arthrocentesis):

Temporomandibular joint injections are one of the methods to eliminate problems arising from the jaw joint. The aim is to relieve pain in the jaw, head, and face, increase the viscosity of the joint fluid, temporarily relax the muscles supporting the jaw joint, heal the tissues, and restore the impaired jaw joint function with substances injected directly intraarticularly into the TMJ. Thus, temporomandibular inflammation is suppressed and degeneration can be prevented. The substances injected are:

  • Corticosteroid
  • Hyaluronic Acid
  • Botulinum Toxin
  • PRP (Platelet Rich Plasma)
  • Hypertonic Dextrose
  • Anti-inflammatory drugs
  • Local anaesthetics
  • Stem cell

One can inject any of the above substances directly into the jaw joint using a variety of methods. One of these is arthrocentesis.

What is Jaw Joint Injection (Arthrocentesis)?

Arthrocentesis is a procedure that involves cleaning the jaw joint with two sterile needles and sterile washing solutions, with the aim of removing infected fluid and reducing joint inflammation in patients who do not respond to conservative treatments such as medication or exercise.

In this technique, one needle administers a flushing solution into the joint, while the other expels the flushing fluid. Lubricant solutions may also be employed to enhance joint mobility following flushing.

Arthrocentesis was first introduced in the medical literature in the 1960s. With the introduction of arthroscopic lysis and lavage in the TMJ described by Sanders in 1986, significant progress was made in the treatment of internal irregularities. After Nitzan's publication in 1991, in which he named the technique of washing the upper joint cavity as arthrocentesis, the application has developed and become widespread, and successful results have been obtained.

In which cases is arthrocentesis applied?

In which cases is arthrocentesis applied?

    Elimination of structural and functional disorders of the condyle (jawbone head)-disc (cartilage structure acting as a cushion) complex:

  • In cases such as damage or degeneration of the bone, disc, and ligament structures that make up the joint, incompatible functioning of the muscles and ligaments surrounding the joint, or excessive muscle tension, it can cause symptoms such as pain in the jaw joint, limitation of movement, difficulty chewing, and sound in jaw movements. This condition can prevent the jaw joint from working harmoniously, leading to pain and limitation of movement.

    • Correction of disc disorder such as disc displacement

      In cases that prevent the jaw joint from functioning properly, problems such as pain in jaw movements, clicking sound, and jaw locking may occur.

        Reduced disc displacement

        The disc slippage during jaw movements is temporarily corrected. The disc returns to its normal position when the jaw opens or moves. A "click" or "pop" sound occurs during this return. The articular surfaces snap into place during the correction of the slipped disc, causing this sound. Occasionally, the jaw may feel locked, but opening the jaw allows the disc to return to its normal position, temporarily resolving the locking.

        Disc displacement without reduction

        Disc displacement without reduction refers to a condition where the disc slips permanently, failing to return to its original position during jaw movement and remaining in an incorrect position. In this case, jaw opening becomes limited and pain increases. Opening the jaw does not produce a clicking sound, as the disc does not return to its original position.

      Elimination of internal irregularity in the temporomandibular joint

      A loss of normal position or function of components in the jaw joint, such as the condyle, disc joint fluid, and surrounding muscles, causes internal irregularity in the TMJ. This leads to symptoms such as pain, noise, locking of the jaw, or limitation of movement in the jaw joint. These irregularities are caused by:

      Condyle, disc disorders,
      Tension or dysfunction in the muscles surrounding the joint:

      Excessive tension or dysfunction in the muscles of the jaw leads to a disturbed balance in the joint. Stress, teeth clenching (bruxism), or misuse of the masticatory muscles can contribute to this condition.

      Inflammation or degeneration of the jaw joint:

      Wear of the surface of the jaw joint (osteoarthritis) or inflammation of the joint (arthritis) can lead to disruption of the structural arrangement of the jaw joint and cause pain.

      Trauma or Injuries:

      Impacts to the jaw joint, accidents, or sudden movements of the jaw can lead to deterioration of the joint structure and cause internal irregularities.

The benefits of arthrocentesis:

With arthrocentesis:

  • The removal of inflammatory cells in the jaw joint relieves pain.
  • The removal of the accumulated infected fluid in the joint allows for the formation of new, healthy fluid.
  • Washing pressure removes the hardened or adhered tissues in the joint, allowing the restricted joint disc to move more easily. Thus, jaw mobility is increased.
  • The cartilage damage in the joint is removed, and the cartilage disc returns to its normal position in the joint.
  • Injecting fluid into the upper cavity of the temporomandibular joint allows the surfaces to open apart through hydro-dissection. Flushing under sufficient pressure opens the narrowed joint space and dissolves adhesions.
  • It enhances mandibular movement by alleviating joint pain and facilitating mouth opening.
  • It can provide long-term improvement in pain and dysfunction in patients with internal irregularities of the temporomandibular joint.
  • It eliminates inflammatory mediators, including cytokines and interleukins, that cause chronic pain.

Advantages of arthrocentesis:

  • The procedure is easy and requires minimal surgery.
  • It has few complications.
  • It is cheaper than any other surgical technique.
  • The physiology of the joint is restored and preserved without changing its normal anatomy.
  • It does not require special equipment and hospital conditions, it can be easily performed in office conditions.
  • General anesthesia is not required. It can be easily performed in the clinic/hospital under local anesthesia or conscious sedation.
  • Arthrocentesis can be performed prior to surgical treatment procedures in patients with radiographically severe degenerative osteoarthritis or in patients whose limitation of function has not been corrected and pain relief has not been achieved.

How is arthrocentesis performed?

How is arthrocentesis performed?

    Preparation:

    The patient to be injected is screened in advance and it is determined whether the patient has chronic diseases such as heart diseases, diabetes, etc. and whether there are any allergies. If the patient's chronic diseases are under control and there is no allergy, the arthrocentesis procedure can be started. The patient is placed in a side sitting position. After the skin of the ear and periauricular region is cleaned with antiseptic solution, the areas outside the procedure area are covered with sterile drape.

    Anaesthesia:

    The patient is positioned in a side-sitting position with the head turned to the side where the procedure will not be performed. Local anaesthesia is applied to the patient's jaw joint area, and pain sensation is eliminated.

    Injection:

    In arthrocentesis, two thin needles are usually inserted into the jaw joint. One of these needles is used to drain and clean the fluid inside the joint and the other is used to inject a saline solution or other therapeutic fluid into the joint.

    The first entry point is below the tragus-canthus line. Lactated ringer's solution, saline, or local anesthetic is injected into the area. The aim is to widen the upper joint space.

    The second entry site is the articular eminence. Following injection of the solution, negative aspiration of the pressurized fluid into the injector confirms entry into the upper joint space. As a result of the hydraulic pressure, the second needle is inserted for the flow of fluid from the joint cavity. Lactated ringer's solution is used for this purpose for 15-20 minutes. During the procedure, the patient is instructed to open and close the mouth to create the normal maximum mouth opening.

    If necessary, the jaw joint receives injections of anti-inflammatory medications or therapeutic fluids like hyaluronic acid. These fluids reduce inflammation in the joints and protect the joint surfaces, which helps reduce pain.

    Completion of arthrocentesis:

    When performing an intra-articular injection after arthrocentesis, one must inject into the upper joint cavity without removing the needles and then withdraw them.

    Maintaining the position of the needles in the upper joint cavity during the withdrawal of solution into the syringes and the renewal of the solutions is a crucial aspect to consider during arthrocentesis.

    After arthrocentesis procedure:

    A sterile bandage covers the treated joint area. After the procedure, the patient should rest for a while and do the jaw exercises recommended by the doctor.

Are there risks associated with arthrocentesis?

Arthrocentesis must be performed by an experienced specialist and under sterile conditions Arthrocentesis of the jaw joint may have some rare risks. These risks are:

  • Infection (since the needle is inserted into the jaw joint, there may be a risk of infection in the joint)
  • Mild bleeding (mild bleeding may occur in the surrounding tissues during the insertion of the needle into the joint and usually resolves spontaneously)
  • Tissue damage surrounding the joint (misplacing the needles or applying too much pressure can cause harm or irritation to surrounding tissues and structures)
  • Allergic reactions (some patients may have allergic reactions to the drugs used or substances injected during arthrocentesis)
  • Temporary pain or swelling (pain, tenderness, or mild swelling may occur in the jaw joint area)
  • Temporary limitation in jaw movements (after arthrocentesis, there may be a short-term temporary limitation of movement in the jaw).

Considerations after arthrocentesis:

After the procedure, patients can quickly resume their daily activities. However, some temporary situations may occur. It is therefore important that you follow the recommendations below.

  • There may be a short period of pain or tenderness after the procedure, but this usually resolves within a few days. You can take pain medication.
  • You can use ice packs for 24 hours to reduce swelling, which is common. Keep your head elevated with two or three pillows to help reduce swelling.
  • For the first 24 hours following the procedure, you should avoid yawning, chewing, or trying to open the mouth. Avoid heavy physical activity for the first 3 days.
  • In the days following the procedure, drink plenty of fluids and eat nutritious soft foods (soft foods that do not require heavy chewing, such as pasta, egg salad, mashed potatoes, etc.).
  • In some cases, you may feel that your bite has changed temporarily. Don't worry, this will gradually improve.
  • Following surgery, you may experience temporary hearing loss and a blocked feeling in your ears. However, this will gradually improve.
  • You should strictly adhere to your doctor's advice.

FAQs

How long does Jaw Joint Injection (Arthrocentesis) take?

The duration of jaw joint injection (arthrocentesis) may vary depending on the extent of the procedure, the patient's condition, and the severity of the joint disorder. It takes a maximum of 45 minutes on average, including anesthesia, needle insertion, washing the joint, and injecting therapeutic fluids if necessary.

How long after the Arthrocentesis procedure is the recovery time?

Expect mild aches and pains for 2-3 hours after the procedure. Your doctor can recommend painkillers to alleviate the pain. The recovery period may take a few weeks.

Is there pain during TMJ injections?

Patients typically experience no pain due to the application of local anaesthesia. However, patients may often feel a slight pinprick during the application of local anaesthesia.

When can I eat normally after arthrocentesis?

You will need to follow a soft diet until your doctor instructs you that you can eat normally.

Is the recovery following jaw joint injections (anaesthesia) permanent?

Jaw joint injections offer enduring enhancement for certain patients. The permanence of this improvement is contingent upon the patient's overall health, the nature of the injection, the underlying causes, and the precautions observed post-treatment.

Are TMJ disorders more common in men or women?

Studies show that TMJ disorders are more common in women than in men. This is due to two factors. The first is that women tend to stretch their jaw muscles more. The second factor is hormonal effects. The effects of the hormone estrogen on the jaw joint can increase women's susceptibility to joint disorders.

What does intense stress have to do with jaw joint disorders?

Since a person under intense stress is constantly contracting the facial muscles, the jaw joint is put under more stress than normal.

What is the duration of hospital stay following a jaw joint injection?

Patients usually leave the hospital the same day after the procedure.

When should I go back for a follow-up visit after my jaw joint injection?

Your doctor will check the healing process and the effectiveness of the treatment by recommending a follow-up appointment a few weeks after the procedure.

Jaw Joint (TMJ) treatment is performed by our experienced dentists. Make an appointment for your dental check-up at one of our Dentapolitan Oral and Dental Health Hospitals in Turkey, Istanbul.