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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 that.
—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 subside.

SPORTS INJURIES

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 its victims.