Taking the Bite Out of Jaw Pain

Dental experts used to think that the chronic jaw pain of temporomandibular disorders (TMD) was caused by teeth that didn’t fit well together. But they now know that misaligned teeth are only a small part of the problem, and they’ve begun applying a team approach to treat other possible causes on an individual basis. “This is a biological problem that is really influenced by the patient’s lifestyle, especially behaviors,” says Eric Schiffman, DDS, associate professor and director of the division of TMD and Orofacial Pain at the University of Minnesota School of Dentistry. “By applying a team approach to them, we’ve seen significant improvement in their treatment outcome.”

TMD refers to pain in the jaw joint as well as the muscles that move the jaw. The term TMJ, which is shorthand for temporomandibular joint, is used loosely by the general public to refer to jaw problems in general. TMD symptoms include jaw pain, noises in the jaw like popping and clicking, and limitations in opening the mouth. These symptoms are associated with oral habits (including clenching and grinding), stress, trauma, or, in some cases, even anxiety and depression.

Many people with TMD get better on their own or find that the application of heat or cold, avoiding hard and crunchy foods and chewing gum, and consciously relaxing their jaws are all they need. In other cases, their dentist may recommend the use of a mouth guard. Seventy-five percent of the patients at Schiffman’s clinic also are referred to a physical therapist to learn jaw exercises to decrease pain and improve functioning of the jaw, and 50 percent see a health psychologist for cognitive behavioral therapy, including relaxation techniques and biofeedback. Acupuncture—inserting a needle into the jaw muscle to stop muscle spasm—can help alleviate pain, and Botox injected into the jaw muscle has been very effective for some patients. Hypnosis is another option. “We often can help them find out why they’re clenching through hypnosis,” Schiffman says. “If we don’t, we can use it as a form of self-relaxation, and it can be quite beneficial.”

If the patient still has some persistent pain, there are still other options. “If they’re still having problems, we go with what their belief is,” Schiffman says. “If they believe that they need medication, we may add that, or if they’re getting migraines, which aggravates TMD, we may send them to a neurologist, which helps the TMD get better.” Surgery is typically a last resort, and used in less than 5 percent of cases.

Mary Van Beusekom is a Twin Cities freelance health editor and writer.