Psoriatic arthritis (PsA) is an autoimmune disease that most often attacks and damages joints in your hands, feet, wrists, knees, neck, and spine. Yet it also can affect the temporomandibular joint (TMJ) in your jaw.
You actually have two temporomandibular joints — one on either side of your head, in front of your ears. The TMJ connects your jawbone to your skull. It allows your jaw to open and close like a hinge.
Problems with the TMJ are referred to as temporomandibular joint disorder (TMD). TMD causes pain and difficulty moving your jaw.
TMJ pain makes it hard to eat and enjoy food. If you don’t get treated, damage to your jaw could be with you long term. That’s why it’s important to let your dentist and rheumatologist know if you have joint pain or any other TMD symptoms.
PsA can cause TMJ pain. It often starts in the morning or late afternoon. It may hurt more when you chew.
The pain can spread from your jaw to other parts of your face, as well as to your shoulder, neck, or back. Some people with TMD report having headaches or earaches.
Other symptoms of TMD are:
- a clicking, popping, or crackling sound when you open and close your jaw
- trouble opening and closing your mouth
- a feeling like your jaw is stuck or locked
- grinding your teeth, called bruxism
- tooth sensitivity and pain
- a misaligned bite
TMD can make you tense or clench your jaw. In turn, clenching makes TMD worse.
Eventually your TMJ can wear out completely, at which point you may need surgery.
There’s also a link between PsA and gum disease (periodontitis).
Periodontitis starts when bacteria build up on your teeth and gums. These bacteria release toxins that produce inflammation, which damages your gums and can lead to tooth loss.
Psoriasis and PsA are inflammatory diseases, and they increase your risk for periodontitis and tooth decay. The more severe your PsA symptoms, the more likely you are to have gum disease.
Dental implants are part of the treatment for tooth loss. These synthetic roots go into your jawbone to hold artificial teeth called crowns.
The biologic drugs you take to treat PsA may cause problems with dental implant surgery. These drugs dampen your immune system, which could increase your risk of infection.
So, you may need to switch arthritis drugs or take antibiotics before oral surgery to prevent infection.
It’s unknown whether having PsA might make dental implants more likely to fail. Still, it’s a good idea to let your dental surgeon know about your PsA before you have any surgery.
- Their body doesn’t heal as quickly as usual.
- They have gum disease.
- They don’t make enough saliva.
The anti-inflammatory drugs and disease-modifying antirheumatic drugs (DMARDs) that treat PsA can also prevent jaw damage. These medications bring down inflammation to relieve pain and protect your joints.
Physical therapy is another treatment for TMD. The therapist can teach you exercises to stretch your jaw and strengthen the muscles that support it. You’ll also learn how to keep your head and neck in better alignment to avoid putting extra strain on your jaw.
Along with taking medication, try these lifestyle changes:
- Rest your jaw until your symptoms improve.
- Avoid eating nuts and other hard foods and chewing gum. Stick to soft foods.
- Practice relaxation techniques, such as meditation and deep breathing, to help ease tension in your jaw.
- Ask your dentist to fit you for a mouthguard. You can wear this device when you sleep to stop you from grinding your teeth.
- Hold an ice pack or heating pad to your jaw.
- Rub on an arthritis pain cream (but ask your doctor first).
It’s rare to need surgery for TMD, but it may be an option if these treatments don’t improve your symptoms.
Arthroplasty is done through small incisions. The surgeon removes scars and thick areas of tissue that prevent your jaw from opening and closing as it should.
Open surgery may be an option if the surgeon needs to repair or replace the damaged joint. Open surgery is riskier than arthroplasty, however, and it’s only done when absolutely necessary.
Early treatment of TMD is key to preventing long-term joint damage.
If you notice any clicking, popping, or pain in your jaw, see both a dentist and the rheumatologist who treats your PsA. They might send you to a specialist called an oral and maxillofacial surgeon.
Prevent gum disease by practicing good oral hygiene. Brush after every meal, and floss once per day to remove food particles between your teeth. See your dentist for regular check-ups.
If you plan to have oral surgery, let your surgeon know that you have PsA. You may need to go on antibiotics beforehand or take special precautions to prevent infection and other complications.