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Common Triggers for TMJ
I think it started about five years ago
when I became a body builder. I never had a headache before
—a 26-year-old teacher and bodybuilder
I don't know when this began. I think my
fingers and toes were always numb. I thought it was normal.
—a 45-year-old executive
The potential for TMJ problems exists in practically
everyone—80 to 90 percent of the population has a tooth-gearing
discrepancy. And day-to-day activities expose us to the common
triggering of at least some TMJ symptoms. The absence of major
symptoms in the vast majority of people is a tribute to our
neuromuscular system's ability to protect us.
When a typical dental patient has a TMJ screening
and is told that the potential for problems exists, this doesn't
mean that the potential will ever be activated. The information
simply lets the person know that if any of the mysterious
symptoms of TMJ begin, the condition should be investigated.
TRAUMA AS A TRIGGER
Some of the triggers for TMJ are dramatic.
A large number of patients seeking evaluation for TMJ can
trace the onset of symptoms to some kind of trauma. Car accidents,
sports injuries, a blow on the head or face, surgery, or loss
of teeth can all trigger TMJ symptoms in susceptible people.
Many other people suffer these traumas and do not become symptomatic.
We don't know why some people will be pushed over the edge
into symptom manifestation.
A common kind of trauma is automobile accidents.
Even when an injury isn't terribly serious, a TMJ-susceptible
person can become symptomatic. In a whiplash injury, the muscles
in the neck are jarred and pulled suddenly, often causing
severe stress. Sometimes the immobilizing collar that whiplash
victims wear triggers symptoms. The collar pushes the lower
jaw into the upper jaw and forces the lower jaw into a position
that may be so unnatural that the external pterygoid muscles
either go into spasm or increase their spasm.
Some people who seek a TMJ evaluation suffer
an injury long before they actually seek help for their problems.
At first the symptoms they experienced may have been minor,
and it is assumed that they will eventually go away. For many
fortunate people, they do, but for others, once the spasm
cycle begins, it becomes established and doesn't go away on
its own. For these people, the search for help begins when
the discomfort seems to have no rhyme or reason and doesn't
subside. They can trace their symptoms to some event, but
they are told there is no apparent reason for the connection,
especially if the injury sustained has healed normally.
Keep in mind that any kind of trauma can trigger
TMJ. One patient could trace the beginning of his symptom
cycle to a mugging. His attacker hit him in the face. He had
no broken bones, but the blow was enough to cause symptoms,
which included extremity numbness, neck and shoulder pain,
intermittent middle-ear symptoms, and mild headaches. At first
these symptoms were mild and infrequent, but gradually they
became more severe.
Other people who have sustained trauma to the
head and face will experience symptoms for a time, but gradually
the symptoms disappear. The body can break this cycle of painful
spasm on its own, and people forget these episodes ever occurred.
The body's ability to heal is amazing, and more often than
not, the TMJ symptoms triggered by trauma will eventually
Some sports, particularly sports that involve
clenching the teeth, will trigger TMJ in susceptible people.
This is a common occurrence among people who take up weight
lifting. Any time a person picks up a heavy object, he or
she clenches his or her teeth. This is a natural response
to the stress of lifting. When people take up weight lifting,
they may repeat this clenching activity many times in one
exercise period. I his is a perfect opportunity for the spasms
to begin or increase.
Scuba divers also are susceptible to painful
muscle spasms because of the biting down they must do on the
breathing apparatus. This puts stress on the jaw and forces
it into an arbitrary position that may trigger painful spasms.
Patients who are divers often report experiencing headaches
or other symptoms every time they dive. Many of them blame
the headache on the pressure of being underwater, but it is
likely that they are people susceptible to TMJ. If the headaches
go away fairly quickly, people who really like the sport will
consider it an acceptable price to pay for their hobby.
Any sport that involves either clenching the
teeth or having the jaw in an unnatural position because of
a mouth guard may trigger symptoms. Participation in various
sports is fine, but people who are experiencing these symptoms
should be aware of the possible triggers.
LOSS OF TEETH
Loss of teeth can trigger TMJ symptoms, although
it may take years for this to happen. Whenever a tooth is
lost, the teeth around it drift to fill the space. This changes
the gearing scheme. Sometimes the body can accommodate the
change, and no adverse affects are felt. Other times, a change,
even a very subtle one in the gearing of the teeth, can trigger
symptoms. Remember too, that even a minute gearing problem
can cause severe symptoms. Yet some people walk around with
severe gearing problems and no symptoms. We simply don't know
why some people are especially susceptible to muscle spasms.
DENTISTRY AS A TRIGGER
Dentistry itself can trigger problems. Restorative
work, as previously described, can trigger symptoms in patients
who never experienced them before. A particularly sensitive
patient can first experience TMJ symptoms during a period
when much dental work is done. For some people, the stress
of keeping the mouth opened wide is enough to make the muscles
go into painful spasm. Numerous patients have reported this
phenomenon. Something as minor as opening the mouth to bite
into a large sandwich is enough to give some people a headache.
Patients will sometimes say that they knew,
usually unconsciously, that certain activities put stress
on their jaws. Sometimes they simply call it an "odd
feeling" in the jaw when they have yawned widely, lifted
weights, or started a jogging program. Some people let their
mouths stay in a relaxed, slightly open position when they
jog; others clench and even grind while they jog. If you wish
to jog and you also experience even minor TMJ symptoms, try
to stay in the more relaxed group rather than join the "clenchers."
STRESS AND TMJ
It is common to blame stress for many physical
problems that involve muscle spasms, and patients often attribute
their problems to too much tension or an inability to handle
stress. However, this isn't a complete picture of how TMJ
is triggered. It is important to remember that in order for
stress to trigger muscle spasms in the Lateral pterygoid muscles,
a tooth-gearing problem must exist. TMJ is a tooth-gearing
problem overlaid by stress. This nebulous concept of stress
isn't a valid explanation for this muscle spasm cycle.
Consider a patient who gave birth to one of
her children before she had TMJ treatment. As any mother knows,
it is natural for the teeth to clench during labor and delivery.
When this patient gave birth the first time, she experienced
severe TMJ symptoms that never really went away, although
they did improve throughout the first year after the birth.
She had TMJ treatment before having reconstructive work done,
and her severe tooth-gearing problem was corrected. A year
later she had another child, and she described the labor and
delivery as much more difficult than the first. She clenched
every bit as much as the first time, yet she had no TMJ symptoms
whatsoever. Because she had no tooth-gearing problem, her
body didn't have the trigger to start the spasm cycle.
Childbirth is a major trigger for women with
untreated TMJ. If the spasm cycle becomes established and
the woman begins to experience severe back or shoulder pain
or headaches, then she is often told that it is the pressure
of having a new baby that is causing her symptoms. While it
is certainly true that the woman's stress level may be increased,
her pain threshold may be lowered, or the spasms may have
increased, it is the tooth-gearing problem that triggers the
symptoms in the first place.
The physiological cause of TMJ needs to be
emphasized when discussing triggers and stress, because many
people end up placing too much of the blame for their own
symptoms on some weakness in themselves. What they don't realize
or take into consideration is that millions of people without
gearing problems are experiencing stress too. These people
might be every bit as tense as these self-blaming patients.
However, those lucky enough to have proper gearing of the
teeth aren't going to walk around with muscle-contraction
headaches, and therefore they will avoid the stigma of having
symptoms so long and so routinely blamed on tension and stress.
Most patients can't place any specific trigger
on their TMJ symptoms. Many will say that the symptoms seemed
to begin out of the blue. Others will link them with a difficult
period in their lives; an equal number will say that the symptoms
can occur during calm times as well as stressful ones.
After a pain syndrome is established, it doesn't matter very
much what triggered it. What we do know is that undiagnosed
pain can have tremendous ramifications in a person's life.
One of the tragic outcomes of having undiagnosed TMJ is the
way it can destroy a person's ability to live normally. As
we'll see in the next chapter, TMJ can literally devastate