tress levels have been running a lot higher these past several months with the uncertainty, health and safety worries, and economic concerns surrounding this tragic pandemic. And over the holidays, tensions were also elevated trying to ensure you have your to-do list completed checked off. Clenching and grinding, while not mutually exclusively, are very often related to increased stress and anxiety. We tend to hold more tension in our jaw and neck during times of worry and we are often unaware that we are doing so, particularly when we are sleeping. Many of us have been faced with job uncertainty, fear of COVID-19 infection of both ourselves and our loved ones and many more are working in new work environments which often are not ideal set ups. All these factors accumulate and exacerbate what is often an underlying concern in the jaw and or neck areas. The temporomandibular joint (TMJ) is a joint between the condylar head of the mandible and the mandibular fossa of the temporal bone. It is a bi-arthroidal hinge joint which make it special and complex as it can act as a lever, can shift from side to side and can also slide forward and backward. This complexity makes it very adaptable to the tasks that are required of it – breathing, eating and speech, but can also make it more vulnerable to injury.
Temporomandibular Dysfunction (TMD) is characterized by any combination of:
Pain and tenderness in the jaw, face or neck musculature and ear
Difficultly or pain on opening the jaw
Clicking, locking or popping of the jaw
While there are conditions that may lead to TMD such as structural anomalies like degenerative joints and disc displacement, a large portion of cases are the result of stress and anxiety. Often times we may be clenching or grinding our teeth, known as bruxism, without even being aware of it. Increased stress places tension on the musculature of the face and neck which may contribute to the urge to grind our teeth. Common signs that you may be clenching or grinding include waking up with headaches or jaw/face pain, tooth sensitivity and your dentist may point out that your teeth show signs of wear.
If any of these symptoms sound familiar to what you’ve been experiencing you too may be suffering from TMD. Common treatment options for TMD include medications such as anti-inflammatories, antidepressants and muscle relaxants. In some more severe cases local injections of corticosteroids or botox may be used. The use of bite plates or splints as prescribed by your dentist are often recommended to help correct misalignment and to help protect the teeth from further damage.
Another treatment option that has been shown to have great efficacy with less side effects that I often incorporate into my treatment of TMD is acupuncture. Acupuncture can be used as a stand alone treatment or as part of integrated approach to treating TMD so if you are utilizing other treatment methods, it works well in conjunction and is not a contraindication. I practice what is known as Contemporary Medical Acupuncture which utilizes traditional Chinese medicine concepts in conjunction with current research on neurophysiology, neuroanatomy and pathophysiology to stimulate healing, decrease inflammation, and decrease pain based on the particular diagnosis. Acupuncture helps to reduce pain sensation through nerve stimulation which changes the nerve signals to the brain and therefor how the brain interprets that pain. It has also been shown to simulate the release of endorphins and neurotransmitters which help lessen the body’s perception of pain.
The needles typically are inserted in the facial and neck musculature and sometimes into the joint itself. They help to decrease the tension in the supportive musculature of the temporomandibular joints as well as the capsule surrounding the joint. If the cause of the TMD is stress and tension in nature the acupuncture in combination with myofascial work and supportive lifestyle changes can have excellent results in decreasing the tension. If the nature of the TMD is more degenerative or discal in nature, acupuncture can help alleviate some of the chronic inflammation and additional stresses placed on the disc and joint.
When treating TMD I strongly encourage my patients to do as much self and adjunctive care as possible to compliment the treatment and improve the overall outcomes. Excessive chewing or eating larger bites can both be aggravating factors and as such eliminating gum chewing and taking smaller bites are encouraged. Applying ice packs for 5 min intervals helps to decrease inflammation in the area and avoiding large jaw movements such as yawning and singing help decrease excess strain placed on the joint. A key element to dealing with TMD that is not structural in nature, such as stress and anxiety, is first addressing the underlying cause. Stress relieving techniques such as meditation and journaling are often recommended. Eliminating screen time 30 mixtures prior to bed and has also shown to help calm the mind and therefore decrease tension and the urge to grind and clench during the night. A supportive pillow that helps maintain a proper neck alignment will also help decrease unnecessary tension and stain in the neck and jaw.
Practicing jaw stretching exercises may also help decrease muscle tone and increase jaw range of motion. Some exercises to try at home include:
Jaw Opening Stretch – Place your fingers on the top of your front bottom teeth and gently pull down until you feel a slight stretch in your jaw and hold for as close to 30 seconds as possible.
Tongue Press – While pressing your tongue to the roof of your mouth slowly open your mouth until you feel a stretch in the jaw. Close and repeat
Jaw Range of Motion – Place a 1/4 inch object between your front teeth gently open your jaw and slide your bottom teeth forward to be in front of your top teeth until you feel a stretch. You can then shift your lower jaw from side to side until again you feel a gentle stretch in the jaw. Gradually increase the height of the object as you feel it becomes easier.
Massage – Using a circular motion gently massage the muscles in front of and above your jaw
Myofascial release – Gently drop down off your cheek bone with your thumb and slide down with a slight tension. While holding this slowly open your jaw while maintaining the contact on the muscle.
These stretches not only help alleviate pain and tension in the jaw but also help prolong the effects achieved from treatments.
If you are experiencing any of these TMD symptoms it is important to deal with them as soon as possible to help lessen the overall repercussions. Chronic headaches and migraines can become a big concern and the constant grinding and clenching can lead to early degeneration and arthritis of the TMJ joint itself. Try these techniques at home but also have a health care provider assess your condition to help find the best course of action to resolve the problem as soon and as effectively as possible. I see TMD in my practice quite regularly and have had great success in helping these patients get to the root cause of the issue and get them out of the cycle and pain and back to their active lives.