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ABSTRACT
Rheumatoid arthritis is known to afflict the temporomandibular joint (TMJ) with common symptoms including pain during function, tenderness on palpation, stiffness, and crepitus. New evidence suggests that metalloproteinases may be responsible for tissue changes that occur in rheumatoid arthritis. These enzymes are collagenase, gelatinase, and proteoglycanase. Anti-inflammatory drugs are the first line of management for pain and inflammation in rheumatoid arthritis. This paper, however, suggests that because increased joint load is believed to cause a greater expression of destructive metalloproteinase, it is appropriate to assess even the asymptomatic temporomandibular joint and the muscles of mastication for early objective signs of dysfunction or discomfort. Interceptive management, by the use of load-reducing appliance therapy, may enable reduction of the expression of destructive metalloproteinase within the joint, thereby reducing joint destruction.
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James E. Chenitz
Dr. James E. Chenitz received his D.M.D. degree from the University of Medicine and Dentistry New Jersey in 1970. He also completed the 2-year continuing education program in the Diagnosis and Management of Orofacial Pain and Temporomandibular Disorders at the New Jersey Dental School. He is currently in private practice in South Orange, New Jersey. He is a member of the American Academy of Pedodontics, the New Jersey Dental Association, and the Academy of General Dentistry.