Chronic Pain

What Is Temporomandibular Joint Disorder (TMJ)?

The Temporal Mandibular Joint is a hinge that connects the jaw to the temporal bones in the skull, which are in front of each ear. It lets you move your jaw up and down and side to side, so you can talk, chew, and yawn. Its also the joint most affected when we grind our teeth, something I’d hazard to say starts in our 20’s.
Bone, cartilage, muscle and nerve tissue can be seriously damaged by the tremendous forces generated by grinding and clenching.
Life is complex and challenging. Most of us take it out on our muscles and joints. Every time we grind, gnash and clench our teeth (called bruxism) we’re exerting as much force as 400 to 600 pounds per square inch of tooth surface.  This takes a toll on the jaw and teeth. Look around for that telltale sign: the 2 front teeth getting shorter and shifting back, and the rest of the upper teeth moving forward. I was shocked to learn I had lost a good portion of length in my two front teeth length over the last few decades just from from grinding!
Temporal mandibular joint and muscle disorders, commonly referred to as TMJ, cause pain and dysfunction in the joint and muscles that control jaw movement. The National Institute on Health estimates over 10 million people have TMJ disorders, and it appears to be more common in women then men.
You’re probably asking why I’m discussing a dental issue?  Our dental health impacts our overall health in significant ways and vice versa. In this case, Jaw Joint Pain (TMJ) is often connected to clenching and grinding. People with frequent headaches, neck pain, ear pain, popping or clicking in the joint are likely to be damaging the jaw joint daily with the trauma associated with the same forces that wear away the teeth. Bone, cartilage, muscle and nerve tissue can be seriously damaged by the tremendous forces generated by grinding and clenching. Doctors don’t completely understand what causes bruxism, but it may be due to a combination of physical, psychological and genetic factors.
According to the Mayo Clinic, top reasons for bruxism include:
  1. Teeth problems: Perhaps your teeth don’t line up correctly or you have teeth that are missing or crooked. The misalignment means that the teeth don’t meet when the jaw opens and closes. This could also be due to an issue with the temporal mandibular joint, or the muscles around the jaw. 
  2. Anxiety and stress: When we worry excessively, we often clench the jaw and work it back and forth wearing down our teeth. Problems at work, in relationships, or due to finances don’t just go away. The more the stress, the likelier you are to be a heavy tooth grinder. 
  3. Personality type: Having a personality type that’s aggressive, competitive or hyperactive can increase the risk of bruxism. 
  4. Medications and other substances: Bruxism may be an uncommon side effect of some psychiatric medications, such as certain antidepressants. Smoking tobacco, drinking caffeinated beverages or alcohol, or using recreational drugs may increase the risk of bruxism.
  5. Family members with bruxism: Sleep bruxism tends to occur in families. If you have bruxism, other members of your family also may have bruxism, or a history of it.
  6. Other disorders: Bruxism can be associated with some mental health and medical disorders, such as Parkinson’s disease, dementia, gastroesophageal reflux disorder (GERD), epilepsy, night terrors, sleep-related disorders such as sleep apnea, and attention-deficit/hyperactivity disorder (ADHD). 
These self-care steps may prevent or help treat bruxism:
  • Reduce stress: Listening to music, taking a warm bath, or exercising can help you relax and may reduce your risk of developing bruxism.
  • Avoid stimulating substances in the evening: Don’t drink caffeinated coffee or caffeinated tea after dinner and avoid alcohol during the evening, as they may worsen bruxism.
  • Practice good sleep habits: Getting a good night’s sleep, which may include treatment for sleep problems, may help reduce bruxism.
  • Talk to your sleep partner: If you have a sleeping partner, ask them to be aware of any grinding or clicking sounds that you might make while sleeping so you can report this to your dentist or doctor.
  • Schedule regular dental exams: Dental exams are the best way to identify bruxism. Your dentist can spot signs of bruxism in your mouth and jaw during regular visits and exams.
  • See your healthcare provider: A thorough history and exam can help define if this is the cause of ear, neck, head, jaw pain.
  • Only chew food: Avoid chewing anything that is not food, including gum, as it allows your jaw muscles to get more used to clenching and makes you more likely to grind your teeth. Stay away from chewy foods i.e. licorice, taffy, and caramels.
  • Train yourself: If you notice that you clench or grind during the day, position the tip of your tongue between your teeth. This practice trains your jaw muscles to relax.
  • Relax: Ease strain on your muscles at night by holding a warm washcloth against your cheek in front of your earlobe.
I see countless patients who never knew their head and neck complaints were affected by their jaw and teeth. After multiple neck surgeries and fusions, there’s no question clenching has clearly contributed to my pain. If I’d intervened sooner, my teeth and jaw might have been spared the deterioration suffered to date. Dental splints, muscle relaxants, injections, and antiinflammatories have all helped. If you think there’s an issue, check it out with your healthcare provider.
    –Dr. Courtney
Sources:
MayoClinic.org
Medlineplus
National Institute of Health 
Main image courtesy of Myosa.com

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