TMJ – The Mouth Joint

Some of you are aware that I’ve been struggling with incredible pain this week – so much so that I literally lost a day on my writing spreadsheet!

So, what is TMJ?

TMJ actually stands for temporomandibular joint.
The term actually refers to the joint where your jaw hinges – just in front of your ear. TMD is the correct term for the dysfunction or disorder where the TMJ causes you excruciating pain!
However, I rapidly discovered that when referring to the disorder, I had to be less exacting as many people simply call it TMJ.

Here is a diagram of the joint and the muscles attaching to it. There is also a little disc which can get worn or dislodged.

(Image from WebMD used for educational purposes – see the rest of the slide show.)

According to the National Institute of Dental and Craniofacial Research (part of the National Institute of Health), there are three main kinds of TMJ dysfunction, and you can have more than one kind at a time.

Researchers generally agree that the conditions fall into three main categories:
1. Myofascial pain involves discomfort or pain in the muscles that control jaw function.
2. Internal derangement of the joint involves a displaced disc, dislocated jaw, or injury to the condyle.
3. Arthritis refers to a group of degenerative/inflammatory joint disorders that can affect the temporomandibular joint.

What causes TMJ?

Apparently more than 10 million Americans (of 360 million residents) suffer from some form of TMJ and it affects women much more frequently than men, despite the fact that injury to the jaw is one way of causing it. Yet, there are many other factors including genetics, arthritis, teeth grinding (bruxism) or simply stress. (No, it’s not caused by talking too much!)

I could tell you one of the main things which caused mine, but it’s not for polite conversation and has something to do with a domineering ex-husband’s personal demands. Yet, this was the first time I noticed difficulty with my jaw function, including clicking, popping and occasionally simply not being able to open my mouth very wide.

Stress is a major cause because even if you’re not actively grinding your teeth, simply clenching the jaw muscles can cause damage to the jaw or over-tightening of all those muscles that attach to it. These muscles go all the way into your forehead and can cause a tension headache for the duration of your bout with TMJ.

What are the symptoms of TMJ?

According to the Mayo Clinic:

Signs and symptoms of TMJ disorders may include:
• Pain or tenderness of your jaw
• Pain in one or both of the temporomandibular joints
• Aching pain in and around your ear
• Difficulty chewing or pain while chewing
• Aching facial pain
• Locking of the joint, making it difficult to open or close your mouth

The reality is much more excruciating!

My symptoms:

Years and years ago: clicking, popping and difficulty opening the jaw. (At this point, there was no pain with it.)
Months ago: occasional pain of the jaw. Upon palpating it, I found that the pain was not near my gums at all (so, not tooth pain,) but in my cheeks, and the muscle attachments to the lower jaw. I also had numbness to the right side of my lips. (Hot/Cold/Sweet sensitivity – common in tooth decay – was not an issue, so I concluded it was not anything to do with a tooth that I’d been avoiding work on.)
This week: severe pain in all the muscles involved in the TMJ. Muscular pain all the way up to my head (i.e. constant headache) and all the way down into my neck and shoulders. Pressure in my ear, like it wants to develop an infection. Inability to chew – even canned tuna caused an increase in pain. Discomfort when talking, smiling, laughing. Even some difficulty swallowing anything larger than 200mg of ibuprofen.

Check out Katie’s story to see more about the level of pain that is felt with this problem. I literally started crying as I read it because it’s exactly what I’ve been feeling! (You can read part of her story without registering, but I decided to register since this is a problem I’m suffering from.)

What really caught my attention from her story was the fact that going to the dentist can make things worse!!! Simply from aggravating the problem muscles. It’s something I will have to mention when I go in to the dentist this week.

Treatment of TMJ

According to the Mayo Clinic website, there are a few standard treatments for TMJ.

Pain relievers and anti-inflammatories such as ibuprofen. Prescription pain relievers are also available.
Tricyclic antidepressants.
Muscle relaxants – ibuprofen helps on this, I’m well aware. I guess the others are prescriptions though maybe some muscle rubs function this way. This isn’t an area I know a lot about.
Mouth guards – these protect the teeth, perhaps, but from what I’ve read, they have limited effect on pain as it’s not helping you relax. (Extra important if you have bruxism which can be connected to sleep apnea!)
Physical therapy – exercises, moist heat and ice. Exercises are great for minor pain or between episodes, but I couldn’t do any of these exercises when I was in severe pain. Moist heat helped me a lot. Cold made it worse.
Counseling – I guess as long as it’s centered on stress reduction, it might be helpful. Many, however, seem to treat TMJ as a “behavior” that you can control rather than a medical condition.
Injections – corticosteroid shots into the joint may be helpful. There are other treatments such as botox and ozone which are not well-substantiated and not generally recommended.
Surgical procedures
(I have heard some thought that cranial osteopathy might help – especially if the TMJ is caused by alignment or disc issues.)

What helped me

Ibuprofen – maximum daily dose for about three days. (I had to google it.)
Acetaminophen/paracetamol helped a little for the breakthrough pain.
Cat’s Claw – an herbal anti-inflammatory
Oregon Grape Root extract – just happened to have it on hand and it turned out to be very beneficial
Licorice root tea – to keep away any strep mutans (the tooth decay bacteria) floating around.
Calcium-magnesium supplements – to help nourish the muscles.
Scalding hot wet washcloths pressed against the muscles and very hot baths.
Lemongrass oil (I put about half a dozen drops in a small baby-food jar of olive and coconut oil) massaged into my shoulder, neck and more gently on my cheek.
Hot drinks – I drank copious amounts of tea, hot chocolate, anything hot. While the mug was still hot, I would roll it across my cheek muscles to help soothe them
Relaxation – some of the TMJ was caused by stress in my jaw, clenching my teeth. Every time I found myself clenching, I would deliberately relax the muscles. Only a small amount of relief, but most importantly, it helps to undo what caused it to begin with.
Sleep hypnosis and similar videos – These had a minor impact to be completely fair. Partly because my ear was so sensitive at this point that even listening to music hurt! Putting an earbud in my ear also hurt because of swelling there.
Different sleep positions - The worst night, I gave up trying to sleep at all and sat on the couch – strangely, I was able to drift off in the position. Thankfully, that morning, the pain suddenly let up. It wasn’t gone, but it was no longer the defining part of my day.

Note: at one point, after the slight swelling around the ear and getting water in my ear from the hot bath, I was starting to worry that my ear was heading for infection. (Some of the wax was discolored.)

So, I used some drops of hydrogen peroxide in my ear. I left it there until the fizzing stopped (or I couldn’t stand it any longer.) This breaks up the ear wax and allows it to come out. Very important!

Caution: not everyone can use this treatment and it should not be used if there’s actual injury to the ear. As always, Google is your friend.

Other factors in my case of TMJ

It is important to figure out what caused your TMJ as it will have an impact on your treatment plan. I had two events lead to this crisis. One was a very stressful week including a “friend” threatening my family. (She is no longer our friend – though it’s not that simple because her husband is a good man.) The other was the loss of a filling in my wisdom tooth. This caused my jaw to close differently with a sharp point left by a stupid dentist 25 years ago. I was able to handle that one by itself, but not with the “friend issue as well.”

Of course, this being America (land of the free – if you can pay) and us being low-income, I couldn’t just go in and demand things get fixed – NOW – even once I worked out was going on. No, I had to fill out forms and make an appointment – for a week later! (At this point, I’d already been in pain and on a mostly-liquid diet for a week.)

Because I could not see a dentist immediately to deal with that tooth, I now have the suspicion that it’s broken and partly loose as well as starting to abscess. (I can keep that draining with a salt rub, so I’m not overly worried about that right now – it’s causing very little pain.)

But now, because there’s a minor infection going on, I highly expect that Tuesday’s appointment is going to result in me being sent home with antibiotics and a new appointment in another week for an extraction. (Root canals are bad news anyway, so this is probably the only sensible option now.)

Additional treatments for the abscess:

Sea salt – fine salt rubbed directly onto the swelling of the abscess. (Can be mixed with clove oil, raw honey, garlic oil, cinnamon, things like that for the antibiotic effects.) This helps keep it drained and keeps the danger to a minimum.
Hepar Sulph Calc. 30X – I have a friend on Facebook who is a homeopath. She recommended this remedy for the abscess. Hourly the first day, bi-hourly the second, then re-evaluate.

Here is what I’m eating right now:

Nothing!
Not quite true. Anything that is liquid or dissolves easily in my mouth.

Bone broth – I heat up a mugful, stir in an egg yolk or two and drink that. Sometimes, I add some crackers to soften with the soup.
Cocoa – high in magnesium and potassium if I remember correctly. Adding milk and/or cream to it helps make it even more nourishing.
Jello – I make my own with fruit tea, honey and good quality gelatin that I get at Natural Grocers. The only bad thing is that it doesn’t dissolve quite so perfectly, and actually sometimes makes me hit my teeth wrong – but then, I do make it extra thick. The gelatin also nourishes the joints and cartilage, so should be actively useful in TMJ, long term.
Chocolate chips – they dissolve and give pleasure. Need I say more?
Ice cream – without nuts!!! I found the cold to be unpleasant, so I’ve only eaten a tiny bit of ice cream.
Pretzels – strangely, they dissolve well in the mouth – especially if they’re slightly stale first. The salt has anti-bacterial properties, so is useful.

Despite the fact that I’m consuming well under 1000 kcal daily right now, I’m not overly hungry. I don’t know if that’s because the bone broth is so nourishing that it fills most of my basic needs or whether my body has (temporarily) adjusted to the fact I can’t eat.