May 24, 2023 – Toothache is the worst. It can seem to come back out of nowhere and interfere with eating, drinking and on a regular basis activities. But what happens when the pain is just not necessarily within the teeth, but somewhat within the face, jaw and neck?
Shane G., a 40-year-old finance manager from Austin, Texas, is painfully aware of this difference. After attending what he described as an especially stressful meeting in his office at some point, he decided to take his laptop to a bar and finish his work over a basketball game and a beer.
“I took a sip of beer and it was like the corners of my mouth were burning,” he said. “It was a sharp, stabbing pain with heat; something was definitely wrong.”
The kind of pain Shane felt is usually often known as orofacial pain and includes over 30 varieties of Temporomandibular joint disorders (TMDs) – Diseases of the 2 joints that connect the jaw to the skull (temporomandibular joint), in addition to the jaw muscles and tissue.
Around 5% to 12% of the U.S. population suffers from TMD. Because it's difficult to diagnose and might overlap with other conditions, patients often embark on a seemingly infinite seek for relief.
Fortunately for Shane and others like him, there are self-directed strategies that may also help alleviate the suffering.
He was in a position to make an emergency appointment with a reliable dentist, who suspected the issue was his jaw muscles. After x-rays were taken and a bite guard was measured to treat possible teeth grinding and clenching, Shane was referred to a massage therapist. Not only did she find the reason for his pain, but she was in a position to provide him with some relief after one session.
Not everyone seems to be so lucky.
There are “physicians who are simply not familiar with the diagnosis and react too quickly when it comes to initiating irreversible treatment,” says Clifford Chow, DDS, an orofacial pain specialist on the Center for Orofacial Pain and Dental Sleep Medicine and an associate professor on the University of California-San Francisco School of Dentistry.
“Unfortunately, with the delay, conditions can change and things can become worse and more difficult to treat,” he said.
Often misdiagnosed
Although they should not rare, orofacial pain disorders often missed or confused by dentists and doctors with other diseases. And TMDs are sometimes related to other diseases, equivalent to Fibromyalgia And migrainewhich makes diagnosis even harder.
“There’s a saying in dentistry: When you hear hoofbeats, think horses, not zebras,” says Lisa Crafton, DDS, a dentist in private practice in Columbia, MD.
“Most people who come to us with facial pain have primarily muscular pain,” she explained. “And I think most people have it after an episode of stress. For some, it may be 2 weeks after a stressful event and then suddenly their jaw hurts like hell.”
“If you think about a skull, the lower jaw is held together by muscles,” Crafton said. “So I always start with the thought, OK, let's try muscle relaxation.”
Katie Pudhorodsky, an Austin, Texas-based licensed massage therapist with a concentrate on head, neck and jaw work, has treated Shane and countless others with TMD pain. Pudhorodsky has turn out to be a go-to resource for a lot of dentists who, like Crafton, concentrate on the muscular component in certain TMDs immediately.
Massage can often help relieve the pain related to two of probably the most common TMJ disorders: myofascial pain (discomfort or pain within the connective tissues and muscles that control the jaw, neck and shoulders) and myalgia (muscle pain related to jaw movement – for instance, within the masseter muscles that enable chewing food).
Pudhorodsky explained that TMD pain presents itself in a wide range of ways and is usually referred, meaning it hurts in places apart from the precise locations of the jaw muscles, joints and tissues. Symptoms include headaches, neck pain or stiffness, toothache, sinus pain, a sense of fullness within the ears, ringing within the ears (tinnitus), numbness and/or tingling.
The general experience is that almost all of the patients Pudhorodsky sees in her practice are on the lookout for relief.
“They talk to their dentist or their doctor about their pain and they're put on hold. They're sent from one specialist to another until one says, 'Hey, these muscles are tight; maybe this is a piece of the puzzle,'” she said.
Nataly S., a 32-year-old researcher from Austin, said she ended up in Pudhorodsky's office after suddenly experiencing jaw pain and what she described as “jaw clicking.”
“I went through a particularly emotionally stressful time,” she said, reflecting on the experience. “I went to my dentist, who recommended that I wear a mouth guard. But he also asked me what my symptoms were, how long they had been like this, and said that I would benefit from a TMJ massage.”
Nataly felt relief after one session with Pudhorodsky and continued doing her exercises twice a day.
“By the end of the week the pain was gone,” Nataly said.
Four pillars of help
Pudhorodsky receives the patients personally, but in addition offers detailed information and Exercises onlineThe majority of her work is targeted on helping people achieve and maintain muscle leisure and relies on 4 pillars:
- “Pillar one is relaxing the muscles and reducing trigger points. And that's done through massage and stretching,” she explained. “This can be done by a professional or by you at home.”
- The second pillar consists of coaching the non-stressed muscles; these exercises also serve to stabilize the bite.
- Pillar three is maintaining an accurate mouth resting position. “This is about maintaining a correct mouth resting position. We want to have our tongue on the roof of our mouth, our lips together and our teeth slightly apart,” said Pudhorodsky.
- And “Pillar four is about addressing bad consumption habits. That's where you start to stop those bad behavior patterns.”
Managing expectations
Like other pain conditions, TMDs are complex and present otherwise in numerous patients. Massage is just not the reply for each type or for all and sundry. But by loosening tight muscles and training the joints to maneuver in a more balanced way, massage may also help correct among the problem, reduce pain and, as Pudhorodsky explained, “make room for healing.”
Chow said patients ought to be proactive and ask their doctor concerning the diagnosis.
“Just saying they have TMD is not a diagnosis. It's a broad term for conditions and often they are the ones who might miss something,” he said. “They need to be more specific in their diagnosis and treatment.”