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The Missed Appointment
Several years ago, a patient called in to cancel her appointment. The cancellation was not due to any dissatisfaction with our chiropractic services. She had to visit her oral surgeon first.
She was going through a difficult time, including a contentious divorce and a rough time at work. As a result, she suffered from very disturbing dreams. What did this have to do with her oral surgeon?
The Skull’s Most Movable Joint
The bone that holds the lower set of teeth is called the mandibular bone or mandible. It forms a joint with the skull bone that forms the temple – the temporal bone. The anatomical name for this jaw joint is the temporomandibular joint, often abbreviated TMJ.
Most of the skull bones are connected by tight joints with very little movement. These are called sutures. The TMJ is unique. It is very movable, allowing the actions necessary for such activities as speech and chewing.
Symptoms Near to and Far from the Jaw
Any joint in the body can develop problems, and the TMJ is no exception. When your TMJ is not functioning properly, the symptoms can include jaw pain, headache, neck pain, shoulder pain, an inability to open the mouth completely, and difficulty in chewing. Because the TMJ is located just behind the ear, joint dysfunction can cause or aggravate problems with hearing or balance. This can include ringing in the ears, dizziness, or the sensation of the room spinning (vertigo).
Because the jaw has powerful reflex interactions with the rest of the body, TMJ dysfunction can even contribute to back pain. According to a 2019 study, back pain among TMJ patients was significantly more frequent than among people without TMJ problems. Furthermore, the more severe the TMJ problems, the more severe the back pain.
Dreaming and Grinding
People with TMJ problems often experience a worsening of their symptoms due to clenching and grinding their teeth at night. This is called nocturnal bruxism. When emotional stress enters the picture, bruxism tends to worsen.
Consider the phrases in the English language that indicate facial expressions of stress: being down in the mouth, keeping a stiff upper lip, baring one’s teeth. Not surprisingly, researchers have found convincing evidence of a stress-TMJ connection. For example, a paper published in 2022 found that post-traumatic stress disorder (PTSD) aggravates nocturnal bruxism and other TMJ problems.
Let’s return to the patient I mentioned at the beginning of the article. She was already under care for TMJ dysfunction. Her dentist had prescribed a night guard – an appliance to reduce jaw stress during sleep. She had chewed her night guard to pieces and damaged her bridge work in her sleep. She woke up with a mouth full of debris. Needless to say, I completely agreed with making a visit to the oral surgeon a priority.
Before It Gets that Bad
If you are suffering from symptoms that suggest a TMJ problem, don’t demand too much from your jaw. Avoid hard or tough, chewy food for a while. Take small bites that don’t require you to force your mouth wide open.
A simple exercise can ease TMJ stress somewhat. It takes advantage of the close relationship between your jaw and your ears. Pull down on your earlobes (not your earrings!) firmly, but not to the point of pain. Slowly open and close your mouth one time. Pull back on the ears and repeat the opening and closing of your mouth. Pull up on your ears, and repeat. Place the tips of your fingers just barely in your ears (use your knuckles instead of your fingers if you have long fingernails). Press forward gently, using only the amount of pressure that would be comfortable for rubbing your eyes. Open and close your mouth.
If these diet and exercise approaches do not help, a consultation with your dentist or an oral surgeon may be in order. Doctor of Chiropractic can often help TMJ patients with adjustments, exercises, and other non-surgical interventions.
Sources for this Article
Kim, D., Ko, SG., Lee, EK. et al. The relationship between spinal pain and temporomandibular joint disorders in Korea: a nationwide propensity score-matched study. BMC Musculoskelet Disord 20, 631 (2019). https://doi.org/10.1186/s12891-019-3003-4
Al-Khudhairy MW, Al-Mutairi A, Al Mazyad B, Al Yousef S, Hatab Alanazi S. The Association Between Post-Traumatic Stress Disorder and Temporomandibular Disorders: A Systematic Review. Cureus. 2022 Nov 26;14(11):e31896. The Association Between Post-Traumatic Stress Disorder and Temporomandibular Disorders: A Systematic Review - PMC (nih.gov)
Trager RJ, Vincent DA, Tao C, Dusek JA. Conservative management of pediatric temporomandibular disc displacement presenting as juvenile idiopathic arthritis: a case report. J Can Chiropr Assoc. 2022 Apr;66(1):92-101. Conservative management of pediatric temporomandibular disc displacement presenting as juvenile idiopathic arthritis: a case report - PubMed (nih.gov)
About the Author
While serving as a medical specialist (MOS 91-B) in the U.S. Army Reserve, Dr. Masarsky earned his Doctor of Chiropractic degree from New York Chiropractic College in 1981. He is in the private practice of chiropractic in the Virginia suburbs of Washington DC with his wife and partner, Dr. Marion Todres-Masarsky. Visit his practice’s website: www.viennachiropractic.com.
