The Multifactorial Nature of TMD
Waking up with a headache. Pain while you chew. The click of your jaw.
The reality of living with a temporomandibular joint disorder. It’s getting you down.
But what can you do about it? Popping painkillers doesn’t seem to help much, and you’re bored of soft food. You do your facial exercises diligently each morning – to no effect.
What you may not know is that your temporomandibular joint disorder has a number of causes – and the only way you can live your life pain-free is if you correct them all. Everything is connected, and those special exercises can’t help you if you’re not dealing with the underlying reasons for your pain.
So what’s causing your joint pain?
What Is TMJ Disorder?
Temporomandibular joint disorders (TMD) occur in a very important and frequently used part of your body. Your temporomandibular joints are like a pair of hinges, connecting your lower jaw to the temporal bone in front of the ear. They enable you to raise and lower your bottom jaw and also move it forward, back and to the side – working alongside facial muscles and bones.
Because your jaw is made up of two sets of bone interacting with each other, it has a special cushion to stop your lower jaw and temporal bone from wearing away. The temporomandibular joint incorporates this cushion, called the articular disc, which is made out of elastic fibrocartilage. But when something goes wrong with one or both of your articular disks it can cause clicking or tightness – telltale signs of TMD.
Do you struggle with:
- Jaw pain?
- Clicking, popping, or grinding noises as you move your jaw?
- Ear pain?
- Difficulty opening your jaw?
- A tight feeling across your face?
- A feeling of fullness in the ear?
- Pain when chewing?
- A locking sensation when you open your mouth?
- Pain in your jaw when stressed, or in the morning?
If you answered yes to more than one of these symptoms, you may have a TMJ disorder. But what caused it in the first place?
What Is the Main Cause of TMJ Disorders?
If you look up TMJ disorders online, you would quickly get the impression that the major cause of your jaw pain is having crooked teeth. Malocclusion is specifically a misalignment of your bite – where the teeth incorrectly meet when your jaws close. When your teeth fit together, your jaw is closed, and the ball joint of the lower jaw fits perfectly against the articular disk in the socket of the upper jaw.
But when you have an issue with your bite, the imbalance means that the ball joint doesn’t sit tidily in the upper jaw socket. Instead, there is a compression or small gap, affecting the articular disk. This slight slack between the jawbones also affects your masseter, pterygoid, and temporalis muscles, as they have to pick up the slack, stabilizing and holding your jaw in place.
It’s a subtle change, that you may not be aware of until the resulting symptoms begin: jaw pain, headache, clenching, and grinding.
However, malocclusion is only one part of the puzzle of TMJ, and it’s important to recognise that the condition can have a number of interlinked causes. A dentist who starts off with fixing malocclusion and pretty much ends their treatment after that doesn’t understand how these other factors come into play. My AirwayCentric® approach to TMJ disorders is to prioritize your airway then tackle TMD and teeth last.
My Teeth Are Straight but I Still Have Jaw Pain – What Could Be the Cause?
Unfortunately, I see it again and again in my practice: some cosmetic dentistry looks great, but is bad news for the jaw. I frequently see jaw changes in patients who had premolars removed for reasons of “overcrowding” which is like chipping away at the foundations of a building – affecting the jaw joints.
But sometimes your teeth are only part of the issue. Your dentist should pay attention to the following important contributors to temporomandibular joint disorders:
- Stress and adrenal fatigue – While you likely have first-hand experience of how stress can cause jaw pain directly, TMD can also be provoked by dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. Your HPA axis is responsible for the release of the hormone cortisol during the day – highest amounts in the morning, dropping to a lower level for the rest of the day. Your adrenal glands also release cortisol when you encounter a stressful situation, which temporarily dials back bodily functions such as digestion in order to direct energy elsewhere in the event of danger. In the event of adrenal fatigue, cortisol release is much higher than average, both in the morning, and in times of stress. TMD patients follow this pattern of cortisol in their bodies – even when the pain in their jaw has been resolved. Stress increases pain levels – and crucially alters the structure of the temporomandibular joint in rat models. The treatment of adrenal fatigue is a crucial factor in treating TMD.
- Changes in hormones – 40% of my patients are young women following puberty who are in high school and college , 50% are perimenopausal women most commonly 49 – 51 years old but my perimenopausal patients range from the age of 42 to 60 and beyond .
- Inflammation – Estrogen influences inflammation, and while high cortisol would usually counteract it, adrenal fatigue can often result in a loss of sensitivity to cortisol – resulting in increased systemic inflammation. Inflammation can occur within the temporomandibular joints, exacerbated by pressure on the articular disc, causing further pain, but it can also have wide-ranging consequences beyond the jaw.
- Clenching and Grinding – Microtrauma accounts for almost half of patients who involuntarily clench and grind at night or clench during the day.
All of these factors feed into each other – a hormone imbalance can affect your cortisol levels, and cortisol, in turn, can have a huge influence on inflammation and the development of autoimmune disease. As an airway sleep disorder can progress into a temporomandibular disorder, it’s important to treat the body as a whole, not just the jaw.
What Is the Best Way to Treat TMJ Disorders?
With the new understanding that your TMD is much more than a clicking sound when you eat, it’s crucial that you visit a functional dentist for treatment who can work with you to solve underlying issues.
Your treatment may include:
Using TMJ oral appliances during the day to realign your jaw and take the pressure off the joint, reducing painful and irritating symptoms.
Your dentist working with a functional medicine doctor who can run tests and check on your adrenal function and whether you’re experiencing an imbalance in hormones.
Botox or trigger point injections that specifically reduce pain and tightness in muscles.
Using AirwayCentric® sleep appliances when necessary to open up your airway at night, giving you much more restful sleep.
Physical therapy of the jaw, including functional manual therapy, but also including posture correction and a mixture of heat and cold therapy.
Finding a way to cope with stress, by seeing a therapist, or embracing practices such as meditation.
Individualized chiropractic treatment focused on spinal correction and cranial therapy.
My approach is extensive and doesn’t resort to invasive surgery. I prefer to concentrate on the underlying reasons for your TMJ disorder, working with you to create an individualized treatment plan. If you’re tired of the jaw pain, the headaches, and the discomfort when you eat, it’s time to make a change – get in touch today.
If you’d like to learn more about our AirwayCentric® approach, pick up a copy of GASP!: Airway Health – The Hidden Path To Wellness by Dr. Michael Gelb and Dr. Howard Hindin. If you’re struggling with TMD and headaches in the New York area and need a functional dentist, fill out our contact form, or call to make an appointment with Dr. Gelb on (212) 752-1662.