Chronic Jaw Pain And Associated Conditions
What We Know — And Don't Know — About TMJD
Dear Doctor,
I am a fifty-five year old woman, and I've been suffering from TMJD pain for many years. I also have arthritis, chronic fatigue and headaches. Are these conditions related, and what would help?
Dear Joan,
Many people who suffer from temporomandibular joint disorders (TMJD) do indeed find that they have other health problems of the type you describe. Let me sum up for you what we know about TMJD, what has proven helpful in treating it, and how it relates to other painful conditions.
TMJD refers to a group of ill-defined, painful, even debilitating disorders that affect the jaw joints, muscles and other surrounding tissues. Some people use the acronym TMJ to refer to the disorder, but TMJ is actually the abbreviation for the temporomandibular (jaw) joint itself. Health care professionals prefer to use TMD or TMJD. Whatever names it goes by, the common thread is pain or limited function in and around the jaw. There also may be popping, clicking or grating sounds when the jaws open or close, but this is not cause for concern unless accompanied by pain or limited jaw movement.
Many people suffer from TMJD. Estimates range from over 10 million to as many as 36 million U.S. adults. Most are women of childbearing age; we do not exactly know why. The consensus today is that TMJD comprise a complex family of conditions influenced by genes, sex, environment and behavior. It is also becoming increasingly apparent that some TMJD patients may experience a variety of other painful conditions that affect other areas of the body.
To begin to quantify the association between jaw pain and other health conditions, we surveyed people with chronic TMJD problems. A total of 1511 people were surveyed; they were, on average, 41 years old and predominantly female (90%).
When asked what they believed had caused their TMJD, the survey respondents most frequently cited trauma (65%), stress (49%), and teeth clenching (47%). Other less frequently listed factors that they perceived to be causative included arthritis (17%), orthodontics (11%), dental problems (9%), and heredity (9%).
Interestingly, almost two-thirds of those suffering from chronic jaw pain and/or dysfunction reported three or more associated health conditions, with the most frequent being fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, rheumatoid arthritis, chronic headaches, depression, and sleep disturbances. Clearly, more research across a variety of medical disciplines is needed to advance our understanding of this complex situation and to develop better strategies for diagnosis, treatment, and prevention.
In the meantime, what can help patients with TMJD? Again, we turn to our survey, in which we found that survey respondents reported that the most effective relief for affected individuals (91%) was the use of thermal therapies — i.e., hot or cold compresses to the jaw area, or hot baths. This actually confirms the most recent scientific research in this emerging field.
Surgery, on the other hand, had very mixed results for our group of respondents. In fact, only 32% of those who had more invasive surgical procedures reported some improvement, and only 6% experienced significant improvement. In contrast, 28% reported no change and 46% considered themselves worse or significantly worse after surgery!
The best advice we can give is to begin by seeing a medical doctor to rule out some of the conditions that may mimic TMJD. If you are diagnosed with TMJD, initially try conservative remedies such as thermal therapy in the form of moist heat or ice. If you can tolerate over-the-counter anti-inflammatory medications such as ibuprofen, or acetaminophen for pain, these may help to relieve symptoms. Other medications may also help with TMJD and associated conditions — but you should seek medical help in order to get an appropriate prescription for that purpose.
A temporary switch to a softer diet may reduce stress on your muscles and jaw joints. There is some debate within the dental profession about whether custom-fitted bite guards are effective. If patients are offered this treatment, they should question their doctor to make sure that it will be used only as a reversible jaw-muscle-relaxing orthotic (supporting) device; no irreversible bite changes or jaw-position shifting should occur, or be contemplated as a result of using it.
If extensive bite treatment or even jaw surgery is recommended to you, be sure to get a second opinion. Irreversible TMJD treatments don't have a good track record, and in general they are not necessary for resolving or improving TMJD symptoms. You can also go to The TMJ Association's website (www.tmj.org) to connect with other chronic sufferers dealing with this sometimes debilitating and disheartening condition. Sharing information with peers and professionals is often helpful as we seek more definitive answers.
