In late 2013, during a French lesson on the snow-swept grounds of the University of Mary Washington, you could have found me sitting slouched at a desk along the back wall of an oblong classroom, holding ridiculous, makeshift ice packs of Ziplock bags, rubber bands, and paper towels to both sides of my jaw.
It was one of those circumstances under which surviving the day entirely overrode any sense of social discomfort I would have typically felt; the sense of being mortified in this situation is undoubtedly strong, but wholly retrospective.
I was in dizzying pain, and if it hadn’t been for the fact that a) my school had a strict attendance policy and b) Madame had the icy gaze of an imperious hawk, effortlessly making me feel harshly judged for the slightest slip-up, I would have stayed home.
After some time, I would come to understand that the custom mouth guard my dentist had made me in an effort to save the integrity of my teeth was inadvertently but drastically exacerbating the existing dysfunction of my temporomandibular joint. Watching $800 swirl the drain has still yet to be such a crappy experience.
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What is TMJ Dysfunction?
Temporomandibular dysfunction is a condition that affects the joint and/or musculature in the area that connects the lower jaw (mandible) to the skull.
The joint itself is a special one. It’s among the strongest joints in the human body, and it’s also more complex than most.
In fact, it is the sole “biarticular” joint we have—“bi” of course meaning two, and “articular” being the fancy term for “interact” that is used when discussing how bones meet.
Boiled down, the TMJ being biarticular means that there are two areas where it interacts with another bone, rather than one. To give some life to the picture above, imagine a gliding rocking chair’s construction, but while the chair will only glide backwards and forwards, our jaws can also move left and right, up and down.
Thanks to the incredible range of motions our jaw’s design affords us, we can do things like chew, speak, sing, or create a variety of facial expressions.
The payment for that freedom comes in the need for a delicate balance. The bones, ligaments, and musculature involved with the joint need to be unharmed and unbothered to maintain fluidity and harmony.
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What are the Symptoms of TMJD?
We already know from my delightful college flashback that TMJ dysfunction can cause jaw pain. At that time, I was also experiencing toothaches, headaches, and ear congestion – which I had no idea were all coming from the same source.
If you’ve ever gone to the ENT or dentist in obnoxious or debilitating pain and they’ve told you you’re fine (i.e. no cavities, infections, etc.), you’re definitely not alone and you may also be suffering with TMJD.
Part of the sneaky nature of this dysfunction is that symptoms can vary depending on the severity; the severity can change in either direction; and some of the symptoms are things you can easily attribute to other causes.
You may experience:
…I mean, what the hell, right?
With that laundry list, you could see an eye doctor, family physician, dentist, psychotherapist, physical therapist, a neurologist, and a monk and still not connect these problems to each other, let alone their common root.
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What Causes TMJ Dysfunction?
As expected, there are a number of reasons why this joint can find itself in the weeds—none any less probable than the last, and some potentially flaring simultaneously or as a result of a preceding cause.
For example, the issue could be congenital; you could have been born with a jaw too small for your teeth. Alternately, you could have learned a distorted posture pattern over an extended period of time, eventually affecting the positioning of your jaw.
You could have sustained an obvious injury to your head or jaw, or have experienced whiplash that affected the joint without your immediate knowing.
Dental and orthodontal care can also provoke a lack of balance in the TMJ. This is the first major cause I can associate my own dysfunction with, as a matter of fact.
I had gotten braces put on at 12 or 13, and while they may have looked it, they were no ordinary braces.
Hidden behind those puffy cheeks, the sides of my braces had what’s called a “Herbst appliance.” These metal bars telescoped open and closed on an angle, and a palate expander rested along the roof of my mouth. A strong magnet likely could have held me hostage, but I digress.
Point being, my family decided to move before my braces treatment was set to be done, and it was unclear whether or not another orthodontist across the country was going to have experience with this odd contraption, so my orthodontist decided to “speed things up.”
I was forced to crank my palate expander open at an accelerated rate, leading to it rupturing into the roof of my mouth, where the skin grew back OVER the expander bar, and for some reason the adults involved were just dead set on getting this process done regardless.
When my orthodontist went to remove my apparatus just days before we moved, it did not go well.
The experience was so excruciating for me that my body still reacts to the thought of it. Good ol’ Dr. Connelly struggled to get the clamps off of my teeth, and then struggled even harder to get the expander out.
After some time, he decided one fell swoop would be his best bet, so he just told me to hang on tight and he yanked the metal through my healed gum tissue with a cracking pop to my jaw that I imagine could have been heard in the waiting room.
This experience constitutes another possible cause of TMJD: injury with emotional trauma.
In the years since, I have also experienced two more factors that can cause or contribute to the condition: mental/emotional stress and suppressed self-expression.
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The Mind-Body Connection Associated with TMJ Dysfunction
As we discussed in a previous post, our bodies absorb our emotions and experiences, as well as serve like gateways for them.
When it comes to the jaw, the correlations include aforementioned self-expression, as well as “nourishment.”
Makes sense considering our jaws help us speak and eat, eh?
If you cannot relate to any of the previous potential causes for TMJD, your symptoms may be triggered by a mark made on your spirit.
If you’ve decided, consciously or unconsciously, to limit your nutritional intake (be that in the form of actual food or experiences that nurture your being in other ways); or if you keep yourself from speaking your mind or expressing your true self; or even if you hold the belief that you don’t deserve the elements of life that make us whole, you can incite or worsen TMJD.
I did not feel heard or respected during my orthodontic experience, and as you can probably guess, this was a hallmark of my childhood in general. My feelings didn’t matter, even when there was physical evidence of pain.
Despite having worked through much of the twisted reality I was accustomed to, I can still find myself biting my tongue or ignoring my instincts in certain situations, and there is ALWAYS, without fail, a rise in my TMJ dysfunction symptoms during those times.
While some people may wave these emotional connections off and see them as too alternative or unconventional to have merit (with regards to Eastern medicine), at the very least, we can all agree that how we feel does affect our physical state.
We can get hot when mad, dizzy when irritated, shaky when nervous. We can also cause ourselves jaw pain when repressing desires that would typically utilize the mouth to fulfill – your jaw is clenched; there is none of the free movement, harmony, and balance we discussed earlier.
Look back at the previous picture of the three sad faces, and notice the positioning of the jaw. Recessed, clenched, locked. This is something we do unconsciously when we may want to cry out but hold back from doing so for whatever reason.
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If I have TMJD, What can I do?
A diagnosis may not be necessary to heal or manage your symptoms. If you want an official diagnosis, you may have to see multiple practitioners.
Dentists can easily point out this dysfunction if their patient has obvious signs of clenching and grinding, but assuming those are not among your noticeable symptoms, you may need another assessment.
In very severe cases of TMJD, patients will need to be involved with doctors who can make informed decisions regarding the various types of surgeries and injections available for treatment.
These treatments tackle different aspects of this complex joint, so specificity of dysfunction is necessary in this sort of situation. For example, whereas a Botox injection into the masseter muscle might be perfect for one person, the masseter may not be the source of the pain for another, who would be receiving the dose for naught.
Massage therapy is, of course, an option for mitigating discomfort and symptoms. I absolutely love giving TMJ massages because I know what a help they can be for me when I’m hurting.
TMJ massage can be practiced outside and inside of the mouth (your therapist should always create a sterile situation with clean, disposable gloves for the latter), and will often include massage of the scalp, face, and neck, as well.
If you’re dealing with some emotional/spiritual circumstances in your life, such as a break-up, death, hidden addiction, hidden sexual orientation, or indecision surrounding a major life choice, seeking mental health guidance is unavoidably critical to calming TMJD symptoms.
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It’s not unusual for multiple causes to be contributing to the rising pain and discomfort you’re feeling. In my case, there is a history of mechanical/medical trauma, emotional stifling, and lack of expressing facets of my true self – and all of these can and do crank up the heat of my symptoms.
The most important thing is to give yourself some time to connect with your own body and your own zeal for life and recognize your triggers.
Experiencing day after day with your TMJD symptoms is both harmful and miserable. Addressing this issue will save your teeth, your happiness, your spirit, and the way you affect others.
Resources: Mosby’s Essential Sciences for Therapeutic Massage, 5th ed. (Fritz); Deep Tissue and Neuromuscular Therapy Theory, Techniques and Applications (Aland)
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