Ask The Doctor: TMJD

I have TMJD, and my dentist says I need surgery. There must be something less invasive I can do to ease the pain.
By Sam Dworkin, DDS, PhD

Assuming your dentist has already ruled out arthritis or a traumatic injury as the cause of your TMJD, yes, natural treatments will ease the pain without surgery or heavy drugs. TMJD (temporomandibular muscle and joint disorders) refers to problems with the chewing muscles (the masseter in your cheek and temporalis by your temple) or temporomandibular joint that cause persistent pain and even jaw lock. TMJD affects women much more than men (80 percent of people seeking treatment are female)—specifically women in their reproductive years (18 to 45). While no clear reason for this disparity exists, women appear to have less effective pain control during the low estrogen part of their cycle (right before and during menstruation), and the rapid fluctuations in estrogen throughout the reproductive years also seem to increase pain. This may partially explain why TMJD pain occurs much less frequently in postmenopausal women who are not on hormone replacement therapy—HRT has been linked to higher likelihood of jaw pain.

Unfortunately, despite decades of research, we still don’t know what causes TMJD. But strong evidence suggests excessive use of the jaw muscles (grinding or clenching the teeth and jaws, known as bruxis), trauma tothe joint from an accident, and, of course, stress all play a role. Stress causes widespread changes in your body—almost all of them negative—from increased muscle tension to neurological changes and even depression. Managing stress, dealing with bottled-up emotions, and a little TLC for your TMJ will help you alleviate, and possibly eliminate, your pain.

Getting to know your pain
Cognitive behavioral therapy (CBT) is particularly effective in treating chronic pain, anxiety, and depression. CBT helps you notice your body’s reaction to stress—how stress heightens pain and other symptoms (think tension in the body and jaw). It then offers simple techniques like guided imagery and relaxation exercises to reduce not only the experience of stress but also its impact on the body—increased muscle tension, heart rate, and blood pressure, all of which exacerbate pain everywhere in the body. It’s best to work with a trained CBT therapist, but start with this simple exercise:
Counter the tension in the jaw by licking your lips slightly and then swallowing. Allow the jaw to remain in the position it naturally takes immediately after swallowing—teeth slightly apart and lips lightly touching. This natural position leaves the big chewing muscles relaxed. Practice this for three to five minutes several times a day.
Monitor your pain. A couple of times a day, take a moment to rate your pain on a scale from zero to 10, and look for patterns over time. Is your pain worse in the mornings? Do certain emotions affect it? What seems to trigger or relieve the pain?

Think of depression and chronic pain as two sides of the same coin—they frequently appear together, and treating one helps the other. That’s why doctors often prescribe antidepressants for TMJD pain. But some of nature’s best cures for depression and chronic pain don’t come in a bottle.
Regular exercise releases endorphins and feel-good chemicals in the brain, and has been proven not only to help lift depression, but also to reduce pain. Aim for 20 to 30 minutes of low-impact aerobic activity each day—walking, swimming, and biking all do the trick.
Keep your muscles loose with regular massage. If you can afford to see a massage therapist regularly, do it—your whole body will benefit. But even a nice shoulder rub from your partner or simple self-massage will help.
Apply a warm, moist towel (or a hot water bottle wrapped in a towel) to the painful area for 20 minutes, two to four times a day. If icing your jaw brings more relief than heat, do that for 10 minutes at a stretch.
Sleep on your back to reduce jaw pain that can come from sleeping on your stomach or with your head to one side.

Eastern wisdom, Western relief
When energy pathways in the body (called meridians in traditional Chinese medicine) get blocked, chronic TMJ pain follows.
Acupuncture reopens these blocked meridians, releasing tension and emotional buildup in the body so that healing can begin. The best part: Since acupuncture addresses the root cause of TMJD, it offers long-term relief.
Yoga reduces stress, helps muscles stretch and relax, and promotes better body awareness so that you learn to release tension in the neck, face, and jaw as it arises. Poses that increase blood flow to the head help to flush toxins out of the jaw muscles and TMJ: Downward-Facing Dog, Shoulderstand, and Legs Up the Wall Pose work well. And of course, Savasana (Corpse Pose) completely relaxes the body; simply focus on your face muscles and imagine you’re breathing relief into your jaw.

By Sam Dworkin, DDS, PhD, professor emeritus of psychiatry, behavioral sciences and oral medicine at the University of Washington Schools of Medicine and Dentistry