By Dr. James Fricton
It is well documented that stress triggers or worsens TMDs and TMJ.
What the MN Head & Neck Pain Clinic often hears is confusion about the seriousness, diagnoses, and prevalence of TMJ pain when life is more stressful than usual. The COVID-19 experience is an extremely stressful time for many. Currently, many people who are experiencing jaw pain and headaches are more focused on relieving pandemic-related stressors and are unaware of how or when to seek care with a TMJ and orofacial pain dental specialist. In the midst of multiple reports that teeth grinding increases TMJ cases, our pain specialists are here to help.
This article hopes to reach and encourage that underserved patient population. In-office jaw pain diagnosis and treatment, telemedicine pain consultations, and at-home jaw sprain tools are available.
Subconscious Bruxism and Teeth Grinding Issues Triggered by Stress
The New York Times February 16, 2021, Grind Your Teeth? Your Night Guard May Not Be the Right Fix article [3] states, “dentists have reported an increase in patients with tooth fractures since the start of the pandemic, which they attribute to bruxism, the technical term for gritting, grinding, or clenching your teeth. Thought to be precipitated or exacerbated by stress and anxiety, bruxism is largely subconscious and often occurs during sleep.”
Temporomandibular, or TMJ, disorders are dependent on a number of factors or causes that trigger both physical and psychological outcomes. Recent studies cover early research on the relationship that COVID-19 is playing as a major life stressor that is escalating the number of jaw pain patients. Additionally, we see the number of sports-related TMJ issues on the rise.
Health professionals at MN Head & Neck Pain Clinic treated many more TMJ cases during the pandemic.
This aligns with findings at the American Dental Association – stress-related jaw and oral problems are up across the United States.
Slightly over 70% of dentists surveyed report an increase of patients experiencing teeth grinding and clenching. These are conditions often associated with stress — up from just under 60% from the previous fall. To be more accurate statistically, “71% of dentists surveyed reported an increase in prevalence of teeth grinding and clenching”, reported Kimber Solana on March 02, 2021.
The HPI poll: HPI poll: Dentists see increased prevalence of stress-related oral health conditions also states that 63% reported chipped teeth; 63% reported cracked teeth; and 62% indicated temporomandibular joint disorder symptoms (which includes headaches and jaw pain).
The November 30, 2020, MDPI article titled “Coronavirus Lockdown as a Major Life Stressor: Does It Affect TMD Symptoms?” by Dr. Sabina Saccomanno and 6 additional healthcare entities in Italy.
“The results of this study seem to support the hypothesis of a lockdown as a major stressful event that may trigger temporomandibular disorders or increase their reported symptoms in subjects already suffering from this dysfunctional pathology. Almost all of the 51.4% of subjects who reported a worsening of TMD symptoms in the last month related this condition to the coronavirus lockdown and to the stress experienced in that period. These subjects seem to be characterized by greater depressive symptoms, greater stress experienced, and greater painful symptoms affecting the temporomandibular joint.”
It also helps a person suffering from jaw pain in discussing their TMJ condition with medical professionals when they understand some core medical terms.
Are Bruxism and TMJ the same thing?
TMJ Disorders and Bruxism diagnosis have a difference.
Individuals that have bruxism grind their teeth. A TMJ disorder describes a condition that involves pain and incorrect functioning of the muscles and joints that connect the lower jaw to the skull. Bruxism is often triggered by TMD, but bruxism can in turn also cause or exacerbate TMD.
How is COVID-19 Causing Increased Jaw Pain Cases?
Here are potential ways that COVID-19 is contributing to the increase in jaw pain patients:
- Excessive mouth breathing strains the TMJ joint.
- Neck muscles strained due to breathing problems.
- teeth clenching is a response to stress and/or pain.
- Teeth grinding is a response to secondary stresses.
- Isolation and loneliness escalate anxiety.
Let’s walk through each stress-induced trigger more in-depth.
Excessive mouth breathing strains the TMJ joint
The jaw pain that the MN Head and Neck Pain Clinic is seeing among some of our chronic pain patients is likely stemming from excessive mouth breathing in patients diagnosed with TMJ. Where a person’s ear and jaw meet is commonly the source of jaw pain. When the body feels forced to rely more on mouth breathing, it may cause additional strain on the TMJ joint. Many COVID-19 patients face this additional strain. Whatever causes a persons’ mouth to be open much more than normal, it places exceptional strain on the jaw.
Neck muscles strained due to breathing problems
“With mouth breathing, it can cause strain on the TM joint since the mouth is open much more than usual”, explains Dr. Bradley Eli, DMD, MS [1].
A number of physical therapists believe they are seeing that COVID-19 infections make it more challenging to breathe. This in turn forces patients to rely on neck muscles to facilitate breathing. In turn, the neck muscles that pull on the jaw may trigger excessive stains and create pain in the jaw and neck.
Teeth clenching is a response to stress and/or pain
Many COVID-19 patients find that the disease and its prevention with social isolation and wearing masks are highly stressful and/or painful, which causes them to clench or grind their teeth more. When the mouth and jaw are put through this strain for extended time periods, pain specialists are seeing this affect the jaw joints. This may be true whether they are personally experiencing COVID-19 symptoms, caring for coronavirus patients, or worried about someone they love is ill with it.
Teeth grinding is a response to secondary stresses
Some people are not directly sick themselves, but due to work or life changes caused by the pandemic, they face new challenges. For example, the parent who is now working from and managing their children’s education at the same time. Or a person who lost their job due to this global crisis. Even trimmed work hours or adds stress to financial needs. Or, some folks forced to work overtime, such as many in the healthcare niche, have to manage increased trauma-induced pain, exhaustion, and loss of life balance are causing them to grind their teeth unknowingly.
Isolation and loneliness escalate anxiety
How might COVID-19 isolation impact TMJ jaw pain?
The trickle-down problems of loss and of interpersonal relationships when you are in isolation and stressed can amplify jaw pain. Stressful life events are magnified when alone – making them harder to cope with.
A recent American Psychological Association (APA) survey “Stress in America: January 2021 Stress Snapshot” assesses how our recent collective pandemic-induced stress relates to social and cultural upheaval. The APA reported, “84 percent of adults said they experienced at least one emotion tied to prolonged stress in the prior 2 weeks, with the most common being anxiety at 47 percent, sadness at 44 percent, and anger at 39 percent”.
Additionally, 67 percent said that the challenges the United States currently faces are “overwhelming”. So don’t be too hard on yourself if you think you fall in this group and might be grinding your teeth too much. It is a lot for most people when pain, anxiety, and isolation-induced loneliness intersect.
The February 2, 2021 summary article by Brian Mastroianni underscores the belief that social relationships are a fundamental source of well-being and refreshment for most people. The duration of the pandemic and ongoing social restrictions continue to disrupt many people’s healthy and previously well-established social routines. Dr. Michael Young, service chief of The Retreat at Sheppard Pratt, in a Baltimore, Maryland psychiatric hospital, finds it of no surprise that the survey signals that over 4 in 5 adults in this country are displaying “signs of prolonged stress.”
Stress and pain often seem to intertwine. They can trigger pain in the TMJ muscles alongside your cheeks and on the sides and top of your head, causing significant cluster-like headaches.
How to Treat a Stress-Induced TMJ Disorder?
Helping you to stop unknowingly grinding your teeth is a top priority.
When a TMJ disorder is indeed caused by stressful teeth grinding, there are several ways to manage it:
- First, Identify habits like clenching your jaw or grinding your teeth. Becoming aware is vital to stopping unconscienced actions.
- Eliminate excessive chewing by avoiding tough or sticky foods, such as steak or taffy.
- Learn how to massage your jaw, head, and facial areas in a manner that reduces TMJ pain and headaches.
- Ask your pain specialist or doctor about an oral appliance to help prevent you from grinding your teeth while you sleep.
- If needed, get help to manage the stress of illness, unemployment, or whatever it may be in your life. We will get past this pandemic. If there are other stressors, get to the root stress generator so you can manage your TMJ and overall health better.
- Obtain a firm pillow, or use a travel pillow to place under your head while sleeping can help relieve jaw strain and to avoid sleep apnea.
- Establish a daily routine of orofacial, neck, and airway stretching and strengthening exercises. Consider a series of chin tucks during your routine.
- Deep diaphragmatic breathing and belly singing can strengthen and expand your airway muscles; this may help reduce both snoring and bruxism.
Like many others, you may long to have a sense of “normal”. You can take a proactive approach that works for you until the unusual stressors of new vaccines, filled hospital beds, and personal lifestyle losses subside. If you have concerns, get checked for a hidden TMJ disorder that may have been brought on by stress.
How to Establish a New Normal when Life is Topsy-turvy
Teeth Grinding Increases TMJ cases in the US – but you can do a lot to prevent it from happening to you.
Create new daily structure and routines: People often do best with some core structure for themselves and their family. Illness or remote work mandates may have triggered your need to do business from home. Then if you add in kids schooling from home, as well as a partner also working from home, demands on your attention may be high. Routines of eating out and visiting with family and friends may need adjusting. Plan for healthy homemade meals and scheduling phone calls and virtual chats. Maintain healthy sleep routines; on-going exhaustion can lead to fibromyalgia or even TMD.
Limit your news intake: The daily news reports alone are upending some people’s sense of security; such interruptions of normal routines have put some folks on the edge. Frayed nerves may only show up at night in the form of teeth grinding, overly tense neck and shoulders, and locked jaws. News of new variants or flu strains can be unnerving and cause higher stress levels.
Don’t skip on seeing medical professionals when needed: Knowing that you have professional support that can point that way to pain recovery makes a difference. Head, neck, and jaws all too often take the brunt of higher stress levels. You may think that delaying routine medical checkups, cleaning your teeth, or going out to refill a prescription helps you avoid risks of germs, but that may not be wise. Delayed TMJ treatment leads more often to surgery.
In the case of a developing TMJ issue, delaying professional diagnosis and treatment may only escalate your pain and cause psychological distress issues.
Plan for breaks and fun: Schedule fun breaks, get some fresh air and sunshine and focus on what is good and positive in your world. Share a good laugh with someone. Long-term stress can be so focus consuming that people forget how poor posture can lead to neck pain and other spinal issues. But most of all – take care of your health and don’t let stress nibble away your energy and body’s ability to function optimally.
We urge you to take a spa day at home. Nurture yourself by connecting with the people you love and engage with projects and safe outdoor outings that bring joy. For some individuals that are taking a walk, cooking, online aerobic dance classes, jamming to music, creative art, and/or getting your home better organized to feel on top of things. You have a significant and active role in reducing the need for surgical TMJ intervention.
Many specialists agree that the pandemic is one reason why teeth grinding is increasing TMJ pain cases.
“Stress, clenching, bruxism, and TMJ syndrome are nothing new, but they have most certainly been exacerbated by the pandemic. When patients present with these complaints, most dentists will try to treat them by making a “bruxism” appliance. It has been my experience that most dentists do not realize the patient’s airway should be their concern.” –Louis Malcmacher, DDS, MAGD 12.1.2020 [2]
Most patients with jaw and TMJ problems can recover from these conditions. Thus, it’s important to have access to the right answers and treatment as soon as possible through the care of a TMJ and orofacial pain specialist.
Teeth Grinding Increases TMJ SUMMARY
As you seek relief from your jaw pain, feel free to call our expert team at Minnesota Head and Neck Pain Clinic to set up an appointment. Our pain specialists know exactly how to treat TMJ disorders.
Gain the relief you need and deserve!
Call (763) 577-2484 or Conveniently Schedule a Clinic Visit
About the Author
James Fricton DDS, MS is a leading orofacial pain specialist at the Minnesota Head and Neck Pain Clinic, Chair of the Specialty Committee for the AAOP, and University of Minnesota Professor Emeritus.
Jeannie Hill, a Minnestoa digital marketing consultant, sourced and checked factal content.
References:
[1] https://www.drbradeli.com/
[2] https://www.dentaleconomics.com/practice/article/14189625/covid-clenching-patients-and-your-practice
[3] https://www.nytimes.com/2021/02/16/well/live/tooth-grinding-night-guards.html
