Why does it hurt?… TMJ pain series

Pain associated with either TMJ or muscle dysfunction can vary from a very localized feeling of stiffness of the particular muscle on only one side, to a headache of epic proportions!

You may not be able to open your mouth very wide, it may hurt to touch your face or to chew or you may be in the kind of pain which starts at your shoulders and wraps around from the back of your head, across the top, finally gripping at your lower jaw and trying to sling it over your face and towards your back. Sounds familiar, doesn’t it? For a large percentage of people, especially females, this is a pretty frequent occurrence.

Each of those muscles you saw in our part 2, on anatomy, has their insertion points where they are attached to the bone. Near these points are also very active muscle fibres which can easily be irritated and cause strong pain when activated. These are called “trigger points” and on our faces and in our mouths, they seem to be along the front of the Masseter muscle both where it joins the lower jaw and where it joins the top jaw (maybe put your fingers back in your mouth again and gently squeeze these areas, you will be able to feel similar pain as if you were suffering from muscle dysfunction). Often, this pain can be confused for a toothache, being that the trigger points are very close to your molar teeth.

No one really knows what causes this pain or dysfunction. Most researchers in the field agree it is caused by some sort of “parafunction”, or over-working of our facial and neck muscles. It is not our chewing and processing of food that causes these painful episodes. Rather, it is the working of the muscles “overtime”, when we don’t need their help to chew yummy delicacies. Usually, this parafunction occurs during the night, however some people grind and clench their teeth during the day as well. Why we have this overtime function, that is something not everyone can agree on.

Stress related grinding and clenching

Some researchers believe that counselling and stress management will eliminate parafunction or at least painful symptoms in 80% of cases of muscle and joint dysfunction. While there is no overwhelming evidence of this in the literature, it is not implausible that relaxation and de-stressing may work the same way on our jaw muscles as they do on our other muscles.

Some simple suggestions how to de-stress include:

Practice deep breathing through your nose, breathing in while counting to 5 and breathing out while counting to 7. Make sure your jaw muscles are relaxed and your teeth apart when you do this.
Keep your teeth apart during your day time activities, unless you are eating or chewing. You jaw muscles and joint are in their optimal position when your teeth are about 2mm apart!
Taking some time to unwind before going to bed
Turning down the lights and sounds
Choosing a book over watching TV
Turning off your mobile phone
Not taking your computer to bed
Meditation
Seeing a psychology or psychiatry professional
Wearing a nightguard if all else fails

Sleep apnea and sleep disturbances

Another school of thought proposes that sleep disturbances and especially restricted breathing and apnea contribute to frequent swallowing during the night. Some studies show that even this minor force applied to the muscles, but frequently throughout the night, can still cause painful symptoms and signs like clicking and limited function.

Some suggestions as to how to treat this include:

Obtaining a proper diagnosis of possible sleep apnoea in a sleep study and appropriate treatment
Consulting an ENT specialist regarding possible treatment of causes of restricted breathing
Wearing a nightguard, which keeps your teeth apart and your jaw slightly open, to allow your airway to remain open during the night

Bite interferences

If you have recently had a restoration (filling) placed in one of your teeth, which is slightly raised and contacts the opposing teeth prematurely (like an interference, not allowing your other teeth to touch at the same time) or like me, you are undergoing orthodontic treatment, you may be putting too much pressure on one side of your mouth and stressing those muscles over-time.
Solution for this is an adjustment of your filling or discussing with your orthodontist if there is anything that can be done about your bite interference during treatment.

Trauma

Accidents like a blow to the back of the head when the mouth is open, (an example would be if someone smacked you on the back of your head while you were drinking or about to drink from a glass) can cause jaw dislocation, which if severe enough, can cause damage to the disc inside the TMJ and possibly cause problems down the track. Usually, true dysfunction (which is a combination of symptoms and signs) arises when this type of joint damage is combined with parafunction, such as grinding or clenching.

Posture

Your facial muscles are indirectly connected to the muscles on the back of your neck. Your posture, especially the position of you head relative to the rest of your body (usually if head is too far forward) during your daily activities, especially if you have an office job where you sit in front of a computer all day, can cause a wider spread muscle dysfunction where not only your neck but also your head and face muscles become involved and spasm together. This can be temporarily relieved with muscle relaxants, chiropractic and physio-therapy but ultimately you must ensure that your screen and seat are in the most ergonomic position to allow you to type and view your screen without much lifting and twisting. Most workplaces do have dedicated people advising employees on ergonomics and health and safety, so talk to them today!