Temporo-mandibular Joints Syndrome

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Some people with psoriasis and/or psoriatic arthritis can develop problems in the two joints between the skull (temporal bone) and lower jaw (mandible). These are known as the temporo-mandibular joints or TMJs for short.

The temporo-mandibular joint
The TMJs are shaped so that a cylindrical surface on the jawbone sits inside a curve on the skull. Each TMJ contains a disc of cartilage that acts like a washer and also increases the range of movement. As well as opening and closing in a hinge like the elbow, the jaw glides from side to side and can move forwards and backwards during chewing and grinding.

What problems can occur?
The TMJs are lined with synovial membrane, which can become inflamed in some people with psoriatic arthritis. This can cause symptoms of:

  • headache
  • tender jaw muscles
  • pain around the face, TMJ or ear
  • pain on opening the mouth wide and when chewing
  • joint stiffness
  • clicking as the jaw is opened or closed
  • difficulty in opening the mouth
  • locking of the jaw

If you need to have an operation, always warn your anaesthetist that you have a jaw problem.

Will my dentist recognise the problem?
In the early stages, inflammation of the TMJs may resemble ‘TMJ syndrome’. This is a relatively common condition caused by spasm of the chewing muscles. TMJ syndrome is linked with stress, clenching and grinding the teeth or an incorrect bite. TMJ syndrome can also be caused by the habit of holding a telephone receiver between your shoulder and cheek. In more advanced cases, psoriatic arthritis affecting the TMJs will produce changes that show up on x-rays.

What medical professional do I see for advice and treatment?
If you notice problems with your jaw, tell your dentist and rheumatologist that you have psoriasis ( in which TMJ syndrome, is more common) and are concerned about the possibility of psoriatic arthritis. Although it would be rare as the first presenting joint in psoriatic arthritis.

If troublesome symptoms persist, your dentist may refer you to a TMJ specialist. You may be offered a corticosteroid injection by an oral surgeon or rheumatologist to reduce the inflammation.