Exploring Your TMJ: Clenching & Grinding Jaw Got You Down?
Anyone who has experienced jaw, mouth, tooth, or facial pain knows just how much it can decrease your quality of life. So how do you know when this pain is something to be concerned about? And what should you do if you are experiencing an increase or newfound pain?
To learn more about orofacial pain disorders, we talked with Mark Drangsholt, DDS, MPH, PHD, Chair of the UW Department of Oral Medicine. Dr. Drangsholt provides patient care in the UW Oral Medicine Clinical Service, the Dental Urgent Care Clinic, both in the UW School of Dentistry, and the UWMC Center for Pain Relief, where he diagnoses and treats temporomandibular disorders, oral-facial pain, oral mucosal lesions, and other oral-facial diseases. Dr. Drangsholt is an expert in this specialty and is often in the position of diagnosing and treating conditions that can be very difficult to diagnose and manage.
His current research projects include finding feasible and simplified ways to diagnose all types of orofacial pains, determining the global burden of orofacial pain, using N-of-1 designs or clinical trials within a person, and generally applying epidemiologic methods to major orofacial health problems.
What is TMJ and TMD/TMJD?
Many people call their jaw or mouth pain “TMJ”, but TMJ is actually the acronym for the joint in your jaw. It’s called the temporomandibular joint, and it allows your jaw to open and close, move side to side, and more. If you say, “I have TMJ”, it’s like saying, “I have knee”.
Whereas TMD or TMJD refer to the pain disorder(s) associated with the joint, called temporomandibular disorders or temporomandibular joint disorders. These include jaw pain, muscle pain, temporomandibular joint pain, and the locking or limited opening of the jaw.
TMD or TMJD shows up in different ways, and with varying severity, but the commonality is that it presents as pain in the muscles of the face, head, or jaw. For some people, this pain can be so severe that it becomes completely disabling. It usually interferes with talking and eating – but can also impact sleeping and become a continuous focal point of misery.
“Often times I describe it as a headache in your jaw, and since we use our jaws for eating, talking, and chewing, the pain often can’t and shouldn’t be ignored.”
Like many things, the pain and impact on a person’s daily life are on a continuum. For some, TMD is a mild nuisance, while for others it’s a chronic condition that impacts their ability to do regular day-to-day activities. Often the pain is episodic, ebbing and flowing with environmental factors, such as stress.
How common is TMD/TMJD?
Really common! About 20 percent of the population, or 1 in 5 people complain of orofacial pain which includes TMD, temple headaches, and other mouth, face, and tooth pain. It is more prevalent in women than men. TMD alone affects 10 percent of the population or 1 in 10.
Since the pandemic began there’s been an increase in people seeking treatment for the disorder, which makes sense given the factors that contribute to the condition such as stress, anxiety, or lack of sleep.
In addition to seeing more patients experiencing orofacial pain during the past two years, dentists are seeing an uptick in patients with fractures in their teeth resulting partly from emotional stress-related behaviors, such as teeth clenching and/or grinding – also symptoms of TMD.
What are the symptoms and causes of TMD/TMJD?
Any pain in your face, jaw, eyes, ears, or head could be due to TMD.
Symptoms of TMD/TMJD might include:
- Soreness in the temples or jaw muscles
- Jaw clicking or popping
- Difficulty opening or closing your mouth
- Jaw getting stuck in an open or closed position
- Pain while talking or chewing/eating
- A toothache without any cavity
- An earache without an ear infection
The variety of symptoms and pain locations sometimes makes it difficult for dentists and physicians to diagnose and treat TMD. Unfortunately, there are still a lot of misdiagnoses and well-intentioned, but ineffective, treatments. In some cases, patients attempt to self-treat with over-the-counter bite guards or alternative therapies.
People with severe chronic pain have often been told there’s nothing that can be done for them. When someone has undergone treatment for a presenting problem (for example, they had a toothache and were given a root canal or a tooth was extracted, but the pain persists) and still not found relief, they should seek out an Oral Medicine or Orofacial Pain Specialist, like Dr. Drangsholt.
Causes
The risk factors associated with TMD are similar to other types of muscle pain like back or neck pain. It’s the muscles, ligaments, and tendons in face, neck, mouth, and jaw that cause the pain, and most often the jaw joint is just an innocent bystander. Also, while many people are acquainted with the aches and pains of arthritis as they age, few realize that arthritis can affect the TMJ. Yes, you can get arthritis of your jaw joint and it may limit your mouth movement and may hurt.
We know from a 2005 NIH study that the vast majority of TMD cases are related to environmental factors, rather than genetic or hereditary ones. Things like:
- Stress
- Disrupted sleep
- A sedentary lifestyle
- Having anxiety or depression
What can you do?
The important thing for people with TMD to hear is their pain is real, and there are effective ways to diagnose and treat TMD pain.
In fact, most of the patients at the UW Oral Medicine Clinic or the UWMC Center for Pain Relief with TMD find treatment either substantially relieves their pain or decreases it enough that it no longer significantly impacts their daily lives.
Things to try on your own
Dr. Drangsholt recommends the following advice to patients in his practice, and these are things you can do on your own at home:
Stop clenching your teeth. One of the simplest things you can do is become aware when you’re clenching your teeth and STOP doing it. It sounds simple, but many people don’t realize clenching causes problems, and it helps to control it. If you are clenching your teeth when you sleep, see a dentist to get an accurate, customized, and professionally constructed mouth guard. The mouth guard will act as a “shock absorber” between your teeth and cushion your jaw joint while protecting your teeth from fracture and wear.
Teeth awareness. Our teeth are rarely meant to meet. Even when we chew, teeth briefly come together and separate again. There should be a space between your upper and lower teeth nearly all the time. By being mindful of where your teeth are in your mouth, and separating them when they come together, you can decrease a significant amount of muscle tension and protect your teeth.
Decrease stressors. Find an activity that allows you to blow off steam. Yoga, meditation, walking, or another form of exercise and recreation are proven ways to lower your stress. These activities are good for your mental and physical health and reduce stress.
Minimize sleep disruption/Improve your sleep. Sleep isn’t always simple, especially if you are a parent or have other factors that keep you awake. Do your best to minimize things within your control. Practice good sleep hygiene (e.g. reduce electronic use before bedtime) and get to bed earlier when you can.
When to seek further help
Your quality of life matters and living with pain isn’t necessary. If you are experiencing pain, it’s never too early to seek help from a professional.
Start by visiting a primary care provider. Depending on the location of the pain, that might be your dentist or physician. For example, if it’s an earache or headache, first see your physician; a toothache or jaw pain, visit your dentist. It may or may not be TMD, and treatment from your primary care provider may clear things up.
See an Oral Medicine or Orofacial Pain Specialist. If pain persists after treatment from your primary care provider; don’t give up. At this point, seek out treatment from specialist who is board certified in Oral Medicine and/or Orofacial Pain.
The UW Oral Medicine Clinic and the UWMC Center for Pain Relief are two options for care, but a board-certified dentist who specializes in Oral Medicine or Orofacial Pain can help.
Additional treatment options and diagnoses
Orofacial Pain Specialists or Oral Medicine Specialists might use some of the following treatments with patients:
- Use of Anti-inflammatories
- Use of Muscle Relaxants
- Trigger Point injections. Injecting local anesthetic into the muscle has shown great success in treating orofacial pain and can help between 50-60% of people.
- Increasing physical activity, Yoga, and PT.
- Botox injections. Botox, a type of neurotoxin is also used occasionally after trigger point injections, helping between 5-10% of people.
- Mouth guards
- Surgery (rare)
Pain disorders can move in predictable pathways throughout the body. For diagnosis and ongoing treatment, specialists might use simple drawings of the head or body to help patients show where their pain starts and where it moves.
Seeing these pain pathways helps the specialist narrow down the possible sources of the pain and identify appropriate treatment.
For most patients, TMD and TMJD is treatable with lifestyle changes and minor interventions. If you are experiencing jaw, face, ear, head, or mouth pain, take steps today to improve your quality of life.
If you’re ready to take the next step in your pain management by seeking an Oral Medicine Specialist, you can visit the UW Oral Medicine Clinic. Click here to learn more or e-mail oralmed@uw.edu.
Looking for a dentist? The UW Dentistry Faculty Dental Practice is close and on campus. Schedule an appointment with our expert dentists at 206-685-8258 or uwdentists@uw.edu.