The human body is a mix of organs and bones bound together by tissue. There are four types of tissue: epithelial, muscle, nervous, and connective.i Damaged connective tissue reduces how well the body functions.
Connective tissue disease (CTD) encompasses a range of autoimmune diseases. These affect the connective tissue, often leading to inflammation and pain. For dental clinicians, 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. Clinicians with a greater awareness of CTDs can better manage patients at-risk from temporomandibular joint disorder (TMD).
There are more than 200 types of CTD.ii Some of the more prevalent examples include:
A CTD can be inherited, caused by environmental factors, or may have an unknown aetiology. Risk factors include excessive exposure to excessive ultraviolet light or toxic chemicals, such as those found in cigarette smoke.ii Infection and a poor diet can also contribute. Giving the usual cessation and behavioural advice – stopping cigarette smoking, eating healthier foods – can reduce CTD development.
Two proteins make up connective tissues: collagen and elastin. Collagen is found in the tendons, ligaments, cartilage, skin, bone and blood vessels. Elastin is a stretchy protein that resembles a rubber band. It 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 are comorbid with TMD.iv Identifying CTD patients can thus help practitioners with managing the risk of TMD. For instance, MCTD can 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.v It is also caused more pain in the jaw area. The strong association between CTD and TMD development is not concrete. But, noting the significant increase in potential TMD risk for CTD patients is important for their oral health.vi
Some CTDs have a much higher prevalence in women compared to men. For instance, 90% of SLE patients are women.vii Another is Sjögren’s syndrome which affects 1.2% of the UK population.viii Its highest prevalence is in women aged 40-60.ix Causing inflammation of the exocrine glands, Sjögren’s syndrome can have many impacts on a patient’s oral health. The reduction in fluids like saliva can lead to xerostomia and dysphagia.x This leaves the oral cavity vulnerable to disease. 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.xi These include muscle pain and chewing, reinforcing the impact that CTDs have on the oral cavity. Monitoring Sjögren’s syndrome among patients – particularly women – is therefore essential. As it is incurable, practitioners and patients must counteract its symptoms. These include chewing sugar-free gum to combat xerostomia or regularly exercising the TMJ.
To assist patients suffering from TMD, recommend the OraStretch® Press Jaw Rehab System from Total TMJ. Designed for simplicity, the device is easy to use. 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 treat dysfunction, trismus and fibrosis. By regularly exercising the jaw muscles and moving the TMJ, patients can be on a quicker road to recovery. This ensures that patients will soon have 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. Practitioners must find and encourage appropriate solutions to reduce this risk. Whilst many can’t be cured, fighting CTD symptoms can help preserve the country’s oral health.
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.