Jaw Pain: It's Not "Just Stress"
Five years ago Stephen, a 40-year-old business manager, started having occasional pain in his jaw and the muscles of his face and neck. Sometimes he'd have trouble moving his jaw and would hear clicking sounds while he was chewing. His doctor and dentist told him to reduce the stress in his life and make sure he wasn't clenching his teeth. Despite his best efforts, the symptoms got so bad that his work performance suffered. Another doctor suggested he see a dentist who had experience treating orofacial pain. This dentist diagnosed Steve's problem as a temporomandibular disorder (TMD) and recommended a combination of treatments that finally relieved his pain and chewing difficulties.
What's in a Name?
There has been a great deal of controversy among clinicians and researchers about the name, definition, symptoms, causes, and treatment of temporomandibular disorders. As a result, many people with TMD have gone to several medical and dental providers before getting a correct diagnosis and treatment.
The temporomandibular joint (TMJ) is the jaw joint. Temporomandibular disorders (TMD) refers to a group of conditions that affect the temporomandibular joint as well as the muscles that control chewing. Although the terms "TMJ" and "TMJ Disorder" are sometimes still used to describe disorders associated with this joint, "TMD" is becoming the accepted term.
Because of a lack of agreement about these disorders, we don't really know how many people have TMD. Millions of Americans report some TMD symptoms, but in most cases the discomfort is temporary and fluctuates over time. Only a small percentage of people with these symptoms develop serious, long-term problems, and TMD appears to affect twice as many women as men.
Details of the Temporomandibular Joint
The temporomandibular joint connects your lower jaw (mandible) to the temporal bone on the side of your head. You can feel it on each side of your head by placing your fingers just in front of your ears and opening your mouth or moving your jaw from side to side.
The TMJ is made up of two sections separated by a disc, which absorbs shock to the joint from chewing and other movements. This system, along with the muscles attached to and surrounding the joint, allows the jaw to move up and down, forward, and sideways. This movement enables you to talk, chew, and swallow. Anything that prevents the joints and muscles from working together properly may contribute to TMD.
Experts feel that TMD is caused by several interacting factors. However, there is disagreement about the specific factors involved and the roles they each play. The factors most commonly considered include:
- Injuries to the jaw, such as a from a heavy blow or certain lengthy or forceful dental and medical procedures have been scientifically associated with the development of TMD symptoms.
- Oral habits such as clenching or grinding the teeth, gum chewing, and lip or fingernail biting are often associated with TMD. Although not thought to cause TMD, they can make the symptoms worse.
- Bite problems that affect how the teeth fit together (malocclusion) have historically been seen as a primary cause of TMD. However, recent studies do not confirm this view.
- Diseases of the TMJ such as arthritis in the jaw joints, and diseases that can lead to excessive or uncontrollable jaw movements, such as Parkinson's disease, may also be contributing factors.
- Psychological factors such as emotional stress, depression, and/or anxiety are sometimes associated with the onset or worsening of TMD symptoms. However, it is not clear whether these problems are present prior to the TMD and contribute to its cause or whether the pain and dysfunction from TMD leads to these problems. Many people increase their tooth grinding and clenching when under stress.
What Are the Symptoms?
There are a variety of symptoms associated with TMD, including:
- Pain or discomfort in and around the jaw joints, ears, or muscles of the jaw, face, temples, or neck is the most common symptom
- Swelling on the side of the face
- Limited movement or locking of the jaw
- Chewing problems
- Painful clicking, popping, or grating sounds when moving the jaw joint
A Complex Diagnosis
Diagnosing TMD can be difficult due to the lack of scientific evidence and the controversies over the disorder. Most cases are diagnosed based on your own description of symptoms, your medical and dental history, and a physical examination of the jaw, head, and neck. According to James Fricton, DDS, a professor at the University of Minnesota School of Dentistry, "the key to properly diagnosing [TMD] is to understand the patient and the individual contributing factors—medical, dental, emotional, and/or behavioral."
Treatment should be tailored to your individual symptoms and contributing factors. Since it is often difficult to "cure," treatment focuses on management of the disorder. Simple treatment to relieve the discomfort and restore proper functioning is often all that is needed. Most clinicians and researchers strongly recommend conservative, reversible treatment that causes no permanent changes in the structure or position of the jaw or teeth.
Self-care practices that often ease TMD symptoms include eating soft foods, applying heat or ice, and avoiding movements that strain the jaw, such as chewing gum and laughing or yawning with your mouth wide open. Other conservative treatments include stress management, physical therapy with exercises you can do at home, and medications to reduce pain and inflammation. Oral appliances, commonly referred to as splints or night guards, can help decrease clenching and grinding and ease the strain on the joints and muscles.
A small percentage of people don't respond to conservative, reversible treatments. For them, other options are available, including bite adjustment, injections, and surgery. Although these treatments may help in a limited number of cases, they may also cause additional problems. If you're considering any of them, it's crucial to get a reliable second opinion.
Although many people have been misdiagnosed in the past, clinicians and researchers are actively working to clarify the causes of TMD, the diagnostic criteria, and the most effective treatments. Some doctors and many dentists are able to diagnose TMD and begin treatment or provide conservative treatment. So, if you think you have TMD, talk with your dentist or primary care doctor. If necessary, they will refer you to a dentist who specializes in orofacial pain. If your complaints are shrugged off as 'just stress,' you may want to consider getting a second—or even a third—opinion. Or contact one of the resources listed below. Chances are you can get the relief you need.
American Academy of Orofacial Pain (AAOP)
Jaw Joint & Allied Musculo-Skeletal Disorders Foundation (JJAMD)
Canadian Dental Association
TMD Tutorial. American Academy of Orofacial Pain (AAOP). Available at: http://www.aaop.org/tmd_tutorial.htm.
TMJ and Jaw Joint Disorders. Jaw Joint & Allied Musculo-Skeletal Disorders Foundation (JJAMD). http://www.healthtouch.com.
Last reviewed May 2008 by Marcin Chwistek, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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