Long-term management of temporomandibular joint degenerative changes and osteoarthritis: An attempt

Background: Osteoarthritis is the inflammation of body joints characterized by chronic degeneration of various hard and soft tissues around joint. Stress-bearing joints of body such as knee, hips, spine, fingers, and temporomandibular joint (TMJ) are commonly affected. Aims and Objectives: The aims were (1) to study whether constant masticatory mechanical overloading causes osteoarthritis and degenerative changes of TMJ in patients who underwent segmental mandibulectomy with primary repair (without microvascular free flap reconstruction) for malignancies of the mandible, floor of the mouth, and lower gingivobuccal sulcus; (2) to evaluate the effect of nutrition supplements such as glucosamine, chondroitin, and esterified fatty acids in reducing TMJ osteoarthritis and internal derangement; and (3) to assess whether joint flexibility and function improved after using the above medication. Materials and Methods: Patients with osteoarthritis and internal derangement of TMJ as well as patients who underwent segmental mandibulectomy followed by postoperative radiotherapy were randomly selected and included in the study. Age group of the patients ranged between 20 and 76 years. Results: One hundred and ninety-two patients of segmental mandibulectomy were screened and 79 patients were found to develop osteoarthritis in the longer contralateral mandibular segment (41.14%). This finding was statistically significant in our study (P < 0.05). Thirty-six patients of primary TMJ osteoarthritis and internal derangement were also included in the study. The efficacy of oral regimen with glucosamine with chondroitin and esterified (acetylated) fatty acids was found to be effective and satisfactory in controlling the progression of osteoarthritis and degenerative changes in TMJ in patients of both categories. Conclusion: Osteoarthritis of TMJ is a degenerative disorder. Age and masticatory load are one of the main contributing factors for its progression. TMJ internal derangement in chronic condition can lead to osteoarthritis. Conservative methods to control its progression will improve joint flexibility and longevity of joint function. Oral regimen of glucosamine with chondroitin and esterified fatty acids has shown satisfactory results in treating TMJ osteoarthritis and internal derangement.