Critical Reviews in Oral Biology & Medicine, Vol 6, 248-277, Copyright © 1995 by International & American Associations for Dental Research
Pathogenesis of degenerative joint disease in the human temporomandibular joint
C. L. Haskin, S. B. Milam and I. L. Cameron
Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio 78284, USA.
The wide range of disease prevalences reported in epidemiological studies
of temporomandibular degenerative joint disease reflects the fact that
diagnoses are frequently guided by the presence or absence of non-specific
signs and symptoms. Treatment is aimed at alleviating the disease symptoms
rather than being guided by an understanding of the underlying disease
processes. Much of our current understanding of disease processes in the
temporomandibular joint is based on the study of other articular joints.
Although it is likely that the molecular basis of pathogenesis is similar
to that of other joints, additional study of the temporomandibular joint is
required due to its unique structure and function. This review summarizes
the unique structural and molecular features of the temporomandibular joint
and the epidemiology of degenerative temporomandibular joint disease. As is
discussed in this review, recent research has provided a better
understanding of the molecular basis of degenerative joint disease
processes, including insights into: the regulation of cytokine expression
and activation, arachidonic acid metabolism, neural contributions to
inflammation, mechanisms of extracellular matrix degradation, modulation of
cell adhesion in inflammatory states, and the roles of free radicals and
heat shock proteins in degenerative joint disease. Finally, the multiple
cellular and molecular mechanisms involved in disease initiation and
progression, along with factors that may modify the adaptive capacity of
the joint, are presented as the basis for the rational design of new and
more effective therapy.
