EXPERIENCED JAW PAIN after I was involved in a car accident in 2014. My back upper molar became tender after the accident. I had recently had a crown placed on that tooth, so it had been more sensitive anyway. But over the weekend, it seemed more than sensitive; it was actually sore.
As it turned out, the nerve that supplied that tooth was being pinched by spastic muscles in the jaw (kind of like sciatica, but instead of the sciatic nerve being pinched by a buttock muscle to cause leg pain, a branch of the maxillary nerve was being pinched by a jaw muscle, causing tooth pain).
I have many patients who come to me when they have tooth pain because it is often a result of tight jaw muscles. If their tooth pain does not improve with their jaw treatment, then they see their dentist. If their tooth pain improves with their jaw treatment, they have saved themselves a trip to the dentist.
TMD may express as tooth pain with or without other jaw symptoms.
Figure 2‑1: Pain radiating from the jaw to different regions of the head.
TMD can also cause pain to radiate up into the head (Figure 3-1). Muscle tension in the face, neck, and upper back can refer pain into the head as well.
When someone is in a car accident, they can suffer whiplash. However, they can also sprain their jaw (temporomandibular joint, aka TMJ).
As your head whips back in the first milliseconds after an accident, the muscles in the front of the neck (like the digastric, omohyoid, and platysma muscles) that anchor to your jawbone (mandible) strain, abnormally pulling on your jaw. This can result in a sprain to your jaw and strain the jaw muscles. Injury to the jaw and its muscles not only causes pain in the jaw, but can also radiate pain to the head, teeth, neck, and more.
Injury to the muscles that control the movement of the jaw can lead to chronic TMD if not treated properly.
When a joint is sprained, it becomes looser and less stable. So, every time you chew when your TMJ is sprained, the mandible may wiggle funny, resulting in an audible sound (not a good popping sound). This unhealthy sound is from the articular disc slipping out of its mandibular fossa. I prefer to call this sound “clicking” versus “popping” to differentiate it from the good type of pop you get from stretching or adjusting a joint.
Differentiating Between a Click, a Snap and a Pop in a Joint
When you adjust a joint, gases come out of the joint’s liquid from a decrease in pressure, creating bubbles that pop, which facilitates healing. (I talk about these good pops in Chapter 10.) A joint makes a “snap” or a “click” sound when it moves abnormally.
An easy way to tell if you are experiencing a click or snap versus a pop is if the sound is repeatable. When a joint pops, it takes at least twenty minutes for the barometric pressure in the joint to build back up and for the stretch to cause a bubble to form and pop again. A click or snap can be done every time you move the joint abnormally because either a tight tendon snaps over the bone every time it moves (making a snapping sound) or a disc clicks out of place as in Figure 3-2.
A movement that creates a “pop” feels good. “Snap” and “click” movements can (but not always) hurt. In the case of TMD, the pain comes from the irregular pressure on the disc of the jaw, which causes inflammation. If the disc gets used to the irregular pattern, it no longer inflames, so it no longer hurts to click.
Even if your jaw doesn’t hurt when it clicks, the sound is a sign of jaw dysfunction, and you should look for treatments to help realign your jaw.
Other Causes of TMD
Believe it or not, you may be contributing to your jaw pain without even knowing it. How you talk on the phone, your posture, and what you eat can all cause tension in your jaw muscles. Additionally, when you are in pain in places other than your jaw, you are more likely to hold tension in your jaw muscles. It is common to clench your teeth with pain. So watch how you perform your daily activities. You may be negatively affecting your jaw!
Actions that contribute to TMD
Do you slouch while sitting and/or standing? Slouching can strain your jaw and neck muscles throughout the day. If you slouch, check out my Combat Slouching to learn how better your posture.
Do you rest your chin in your hand? If so, your head likely tilts, and your jaw deviates from its normal straight up-and-down hinge action. This puts extra stress on your jaw, which may cause your jaw to pop and/or be in pain.
Do you hold your phone by lifting your shoulder to your ear? This also strains the neck and jaw. When you talk with your head in an abnormal position, the neck muscles aren’t in a neutral position, making it difficult for your jaw to glide open without pulling to one side. Repetitive pulling on the jaw during use eventually sprains it, causing pain.
Do you pull on your jaw to stretch your neck? This can sprain your jaw. You don’t want to injure your jaw while attempting to stretch your neck.
Do you talk with tension in your jaw? Make sure your jaw moves freely when you talk. If your mouth doesn’t move much during articulation, you are likely straining your jaw muscles.
When chewing your food, do you chew on both sides evenly, or do you favor one side? Chewing on one side more than the other can lead to muscle imbalance and joint dysfunction.
Do you like chewy foods? Do you chew on ice? Excessive chewing can strain your jaw. Try avoiding chewy foods for a week. If your jaw is a lot of pain, avoid chewing for a week by eating soups and smoothies with a spoon. (Drinking a smoothie from a straw can irritate the jaw.) Resting your jaw for a week or two while doing the gentle massages and stretches in Chapter 6 should allow the jaw muscles to heal enough that you can reintroduce soft foods and eventually chewy foods. Just make sure you eat chewy foods sparingly (no more than a couple times a week) because it may cause your jaw symptoms to return.
Do you chew gum? If you do, you shouldn’t chew on a piece of gum for more than a minute and no more than three times a day. Preferably, you don’t chew gum at all.
Do you find yourself clenching your jaw? If you do, try pressing the tip of your tongue to the roof of your mouth. This should help you relax your jaw muscles.
Figure 2-3: Moldable Mouth Guard
The mouth guard will not stop you from clenching, so it will not fix your TMD, but it will save your teeth from cracking under the pressure.
Like any muscle that contracts for a long time without rest, clenched jaw muscles inhibit nutrient-filled blood from flowing in at a time when they need more nutrients for this chronic contraction. (Figure 3-4).
Figure 2‑4: Relaxed versus contracted muscle affecting blood flow.
Clenching also obstructs lymphatic drainage, which removes the excessive waste produced by these spastic muscles, and squishes the nerves running through the region, irritating the nerve and causing the muscle to contract further (Figure 3-5).
Figure 2‑5: A relaxed muscle and happy nerves versus a contracted muscle and irritated nerves, causing a vicious cycle of muscle contractions and nerves firing from the pressure of the muscles contracting making the muscles contract even more…
This creates a vicious cycle of starving muscles festering in their own waste, but they can’t stop contracting because the irritated nerves continue to misfire.
To break this cycle, you must consciously disengage the muscles and relax! The jaw muscles are small and mighty. To relax them, stick out your tongue as far as you can. Then curl your tongue so the bottom of the tongue is touching the roof of your mouth.
Try it. Feel how your deep jaw muscles have to relax to allow these actions.
I advise patients who clench their teeth at night to open the jaw straight with their toothbrush, and then stick their tongue out, holding that for five breaths, and then curl the tongue under the roof of the mouth.
This deep stretch will hopefully carry over, keeping the jaw relaxed well into sleep. If you wake up with a tense jaw, repeat these stretches.
The Key to Easing Jaw Pain
Basically, try to keep your jaw, neck, and upper back muscles relaxed. Jaw tension can also pinch nerves, resulting in jaw pain, tooth pain, and/or facial pain (like having sciatica of the face). Upper back tension can put pressure on nerves and send pain to the jaw.
If you have head, jaw, or neck pain, stretching and massaging your head, neck, and jaw muscles can help. I explain several stretches and massage maneuvers in this book for TMD, but to help determine which are best for your specific pain, seek the advice of a healthcare provider.
Teeth Affecting Jaw Pain
Sometimes TMD results from a misalignment of your teeth. If you cannot close your jaw completely because of crooked teeth, or if your jawbone has to shift so your teeth can touch, this misalignment puts abnormal stress on the jaw, causing pain. Your dentist or an orthodontist can determine if your teeth are affecting your bite; in such cases, straightening your teeth can help alleviate your jaw pain.