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Although you often hear TMJ pain linked with stress, that’s just one possible cause. Malocclusion – literally, a bad bite, when your teeth don’t come together properly – is another. In other cases, it may be the result of habitual clenching and grinding – a/k/a bruxing – or injury.

temporomandibular jointIn any case, pain – in the jaw joints, head, jaw, face, neck, and/or down into the back – is the most common sign of TMJ troubles. (“TMJ” stands for temporomandibular joint, and you have one on each side of your head. They’re the hinges that connect your jaws to your skull and let you move them up and down or side to side.) You may also hear clicking or popping when you open and close your jaw or experience ringing or buzzing in your ears.

While TMJ disorders (TMD) are quite common, they’ve been on the upswing lately, thanks to the historic stress we’ve been living under for the past year. Barely a week has gone by without one dentist or another talking with a reporter about the uptick they’ve seen in problems from stress-related bruxing, from TMD to broken teeth.

The human jaw can be quite strong, after all…even THIS strong:

But even the average person’s jaws can still exert a lot of force – 70-some pounds per square inch on the molars while chewing, roughly double that when clenching, and potentially far more when bruxing during sleep.

That the emerging stressors of the pandemic might lead to a rise in TMJ problems was something that was actually discussed pretty early on in scientific journals. This paper, for instance, projected problems lingering for some time afterwards.

One concern was with a possible rise in bruxism during waking hours – different from sleep bruxism, which is often a reaction to a blocked airway as the body goes into survival mode, doing what it can to bring in more oxygen.

Awake bruxism, in contrast, has psychosocial factors such as anxiety, stress and difficulty in identifying and describing feelings as important as somatic causes in its occurrence and maintenance. Patients with high levels of stress are almost 6 times more likely to report awake bruxism.

More, our muscles contract when we’re stressed – an important part of the fight-or-flight response – and this can worsen both bruxing and pain.

Similarly, the authors noted a marked association between anxiety, depression, and TMJ pain (something we’ve blogged about a bit before). “All psychological issues involved in emergency and threatening situations like the ones faced with [the] COVID-19 pandemic,” they write, trigger the body’s stress response. Adrenaline surges. Blood vessels narrow. Blood pressure rises.

Feelings of warmth and cold, palpitations, tachycardia, nausea, abdominal pain, diarrhea, and constipation can all be the consequences of autonomic stress responses. All these events are supposed to create/perpetuate a situation of system overloading, a common finding in TMD patients. The autonomic impairment may also lead to increased sympathetic drive and sensation of hyperarousal which create and perpetuate any sleep disturbance. If maintained, this cycle may play an important role in pain maintenance, especially in psychological[ly] vulnerable individuals. Hence, the occurrence of post-pandemic signs and symptoms of chronic orofacial pains, including TMD, is expected in a very similar pattern to well described posttraumatic stress syndrome.

And, indeed, a rise in these problems is exactly what we’ve seen happening, and not just here in the US. An Israeli study published last fall in the Journal of Clinical Medicine, for instance, found that during the first COVID lockdown, there was “a considerable rise” in these types of behaviors.

The prevalence of symptoms rose from about 35% pre-pandemic to 47%; the prevalence of jaw-clenching in the daytime rose from about 17% to 32%; and teeth-grinding at night rose from about 10% to 36%. People who had suffered from these symptoms before the pandemic exhibited a rise of about 15% in their severity.

Fortunately, we have a range of treatment options that can help bring relief to painful jaw joints holistically, without drugs or invasive procedures. Whether your TMJ pain is due to stress or some other cause, it’s not something that you just have to live with, by any means.

But if the cause is stress, any dental therapy will also mean finding healthier ways of handling that stress and increasing resilience, with options ranging from mindfulness to regular exercise, from nutritional interventions to gratitude practice, and plenty in between.

For truth be told, there’s no escaping stress. It’s a normal part of life, even without a pandemic going on. But you CAN proactively face it in ways that diffuse its impact on body and mind alike.

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