Tissue issues

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  Posted by: Dental Design      10th December 2024

The human body is comprised of organs and bones bound together by tissue. There are four types of tissue: epithelial, muscle, nervous, and connective.[i] If the connective tissue is damaged, basic bodily functions can be impeded.

Connective tissue disease (CTD) encompasses a range of autoimmune diseases that negatively affect the connective tissue, often leading to inflammation and pain. For dental practitioners, the damage that a CTD can cause to the temporomandibular joint (TMJ) is essential to understand. A dysfunctional TMJ can inhibit mastication and limit quality of life. A greater awareness of the types of CTD can enable clinicians to better manage patients at-risk from temporomandibular joint disorder (TMD).

CTDs explained

There are more than 200 types of CTD.[ii] Some of the more prevalent examples include:

  • Polymyositis and dermatomyositis
  • Rheumatoid arthritis
  • Scleroderma
  • Systemic Lupus Erythematosus (SLE)
  • Mixed connective tissue disease (MCTD)
  • Sjögren’s syndrome

A CTD can be inherited, caused by environmental factors, or may have an unknown aetiology. Exposure to excessive ultraviolet light or toxic chemicals from pollution of cigarette smoke can be risk factors, as are poor nutrition and infection.ii The usual cessation and behavioural advice – stopping cigarette smoking, eating healthier foods – can be given to help reduce these risk factors.

Connective tissues are composed of two proteins: collagen and elastin. Collagen is found in the tendons, ligaments, cartilage, skin, bone and blood vessels. Elastin, as the name suggests, is a stretchy protein, resembling a rubber band, that is an integral part of the ligaments and skin. A CTD inflames these proteins, and this then harms the connected body parts, such as the TMJ.[iii]

85% of patients with TMD also suffer from other conditions.[iv] Many CTDs have a complex, overlapping pathogenesis with TMD; they are often comorbid.iv Identifying CTD patients can therefore help practitioners with managing the risk of TMD. For instance, despite its low prevalence, MCTD can massively affect jaw function due to its symptoms of polyarthritis. A study found that erosion of the TMJ was 19 times more likely in MCTD patients than those without it, as well as causing a much higher prevalence of pain from the jaw area.[v] Whilst the strong association between CTD and TMD development is not concrete, the significant increase in potential TMD risk must be noted for CTD patients.[vi]

Women at risk

Some CTDs have a much higher prevalence in women compared to men. For instance, among SLE patients, which causes widespread inflammation, 90% are women.[vii] Another is Sjögren’s syndrome which affects 1.2% of the UK population,[viii] with the highest prevalence in women aged 40-60.[ix] Causing chronic inflammation of the exocrine glands, Sjögren’s syndrome can have multiple impacts on a patient’s oral health. The reduction in bodily fluids like saliva can lead to xerostomia and dysphagia, leaving the oral cavity vulnerable to disease.[x] Dental caries has been reported in 56.9% of Sjögren’s syndrome patients and gingivitis in 75%.[xi]

Moreover, 91.7% of Sjögren’s syndrome patients have reported TMD symptoms – muscle pain when chewing and difficulty in mouth opening – which reinforces the impact the autoimmune disease can have on the oral cavity.xi Sjögren’s syndrome is therefore a condition that must be closely monitored among patients – particularly women. As it is incurable, practitioners and patients must counteract its symptoms with appropriate measures, such as chewing sugar free gum to combat xerostomia or regularly exercising the TMJ.

Giving patients a helping hand

To assist patients suffering from TMD, recommend the OraStretch® Press Jaw Rehab System from Total TMJ. The device is designed for simplicity – inserting the mouthpiece and squeezing the handles mobilises the jaw and stretches the mouth open. Repeated exercises with the OraStretch® Press throughout the day can assist in treating dysfunction, trismus and fibrosis. By regularly exercising the jaw muscles, patients can be on a quicker road to recovery. This ensures that patients will soon have optimal masticatory function, reduced pain and a better quality of life.

CTDs cover many health conditions. Patients effected by these diseases are at a greater risk of TMD, which is why practitioners must find and encourage appropriate solutions to reduce this risk. Whilst many can’t be cured, fighting CTD symptoms is vital for the ongoing preservation of the country’s oral health.

 

For more details about Total TMJ and the products available, please visit https://totaltmj.co.uk/products/orastretch/

 

Author: Philip Silver

 

[i] Medline Plus (2017). Tissue types: MedlinePlus Medical Encyclopedia Image. [online] Medlineplus.gov. Available at: https://medlineplus.gov/ency/imagepages/8682.htm.

[ii] Mary Anne Dunkin (2011). Connective Tissue Disease. [online] WebMD. Available at: https://www.webmd.com/a-to-z-guides/connective-tissue-disease.

[iii] Young, B. (2018). Diseases of Connective Tissue, from Genetic to Autoimmune. [online] Healthline. Available at: https://www.healthline.com/health/connective-tissue-disease.

[iv] The TMJ Association. (n.d.). TMJ Basics. [online] Available at: https://tmj.org/living-with-tmj/basics/.

[v] Sköldstam, J., Alsén, B. and Dahlin, C. (2019). Mixed connective tissue disease with temporomandibular joint ankylosis: A case report. Oral and Maxillofacial Surgery Cases, [online] 5(3), p.100109. doi:https://doi.org/10.1016/j.omsc.2019.100109.

[vi] Adrian Salinas Fredricson, Naimi-Akbar, A., Adami, J., Lund, B., Rosén, A., Hedenberg-Magnusson, B., Lars Fredriksson and Carina Krüger Weiner (2022). Diseases of the musculoskeletal system and connective tissue in relation to temporomandibular disorders—A SWEREG-TMD nationwide case-control study. 17(10), pp.e0275930–e0275930. doi:https://doi.org/10.1371/journal.pone.0275930.

[vii] CDC (2024). People with Lupus. [online] Lupus. Available at: https://www.cdc.gov/lupus/data-research/index.html.

[viii] Press Office. (n.d.). Hope offered to patients with a rare autoimmune condition. [online] Available at: https://www.ncl.ac.uk/press/articles/archive/2019/10/sjogrensyndromebreakthrough/.

[ix] NHS Choices (2019). Overview – Sjögren’s syndrome. [online] NHS. Available at: https://www.nhs.uk/conditions/sjogrens-syndrome/.

[x] www.nidcr.nih.gov. (n.d.). Sjögren’s Disease | National Institute of Dental and Craniofacial Research. [online] Available at: https://www.nidcr.nih.gov/health-info/sjogrens-disease.

[xi] Crincoli, V., Di Comite, M., Guerrieri, M., Rotolo, R.P., Limongelli, L., Tempesta, A., Iannone, F., Rinaldi, A., Lapadula, G. and Favia, G. (2018). Orofacial Manifestations and Temporomandibular Disorders of Sjögren Syndrome: An Observational Study. International Journal of Medical Sciences, 15(5), pp.475–483. doi:https://doi.org/10.7150/ijms.23044.

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