Innumerable articles have been written since the onset of the pandemic about dentists experiencing a large increase in patients with cracked or broken teeth. The increase is usually attributed to the stress we’re all under due to the pandemic.
Yes, stress. Stress can cause you to grind or clench your teeth so vigorously that they crack or break. And stress causes other oral and facial problems, too. These are the types of problems that are the focus of my practice as an orofacial pain specialist.
Whether you unconsciously deal with stress by nail biting, chewing gum, or gnawing on pens – a painful TMJ jaw problem (also known as TMD*) could be in your future.
My patients seek care when they’re trying to understand and resolve a myriad of persistent problems such as jaw and facial pain, persistent toothaches, headaches, restricted jaw motion, jaw clicking or popping, unexplained bite changes. Other symptoms can involve the ears: pain, pressure, clogging and/or ringing.
All of these symptoms can be caused by their overworked or injured jaw muscles, tendons, ligaments, or joints.
In this article, I explain what causes stress-induced TMJ jaw problems – what you can do to prevent them.
Stress & TMJ Jaw Problems – They’re Linked
A great deal of research has been conducted over the past fifty years in an attempt to determine what TMJ problems truly are, why they arise, who is most susceptible – and of course, how they can be treated.
What we’ve learned through this research is the temporomandibular joint and its associated muscles, tendons, and ligaments are part of an orthopedic system – just like knees, shoulders, or elbows. As a result, the TM joints and associated muscles, tendons, and ligaments are subject to structural changes and injury. If symptoms develop and persist, the nerves serving your muscles, tendons and joints, can become sensitized – and lead to increased levels of suffering and treatment challenges.
While accidental trauma, underlying medical problems, and postural strain often cause TMJ jaw problems, the most common cause is stress and how it directly impacts your jaw and orofacial region.
The True Definition of Stress
Stress is your body’s reaction to harmful situations. When you’re stressed, your fight-or-flight system – your sympathetic nervous system – becomes activated. Your heart rate increases. Your muscles tighten-up. And, your blood pressure rises. These changes occur as a result of hormones such as cortisol and adrenaline being released into your bloodstream.
Prolonged activation of this fight-or-flight system, therefore, can cause physical wear-an- tear on the body, including the jaw muscles and temporomandibular joints. It also can cause changes in your brain which diminishes the effectiveness of the body’s natural pain modulation/dampening systems.
From a purely physical perspective, stress can cause your jaw muscles to tighten, which reduces blood flow and the delivery of oxygen. Over time, this lack of blood flow can result in jaw muscle soreness, spasm, pain, and fatigue. What often follows is reduced jaw motion and a changed bite.
Then, as your jaw muscles continue to malfunction, your jaw joints themselves can become unstable. You might hear and feel your jaw clicking and popping. Some people even experience ‘lockjaw.’
To make matters worse, your upper neck muscles might tense-up and cause stiffness and pain in your jaw muscles. It may even result in headaches focused in your temples.
Being in a constant fight-or-flight state can also lead to an increase in daytime behaviors you may already have – due to the normal stresses in your life. Daytime behaviors include teeth clenching, jaw muscle bracing, nail and/or cuticle biting, pen chewing, lip and cheek biting, and frequent gum chewing, etc.…
Not surprisingly, your overworked jaw muscles and jaw joints can begin to ache.
Accompanying these stress-driven behaviors, this fight-or-flight state can cause you to breathe faster and more shallowly. As a result, your body’s natural rest-and-digest response, which is designed to calm and deactivate the fight-or-flight system – may falter. This allows the stress/pain cycle to continue.
Stress, Sleep & TMJ Jaw Problems
Being in a constant fight-or-flight state can also negatively affect your sleep. Both sleep quality and sleep quantity have been shown to be adversely impacted by stress. Insomnia – the inability to get to sleep or stay asleep – often accompanies situational stressors such as the Covid Pandemic.
Endorphins, as you now know, are the body’s natural pain relievers. Disturbed sleep patterns cause a reduction in your body’s production of endorphins. Over time, this can cause you to feel muscle pain more intensely. This is common in the face and jaw.
Disrupted and poor quality sleep is also thought to increase sleep bruxism – teeth grinding and clenching at night – which is a common cause of jaw muscle and joint injury.
Working From Home & TMJ Jaw Problems
Millions of Americans have been working from home due to the pandemic. We’re spending hours upon hours at less-than-ideal workstations (such as the kitchen table). Working at your computer hour after hour can lead to poor posture and eye strain. Especially when you don’t take consistent or adequate breaks to mentally disengage and stretch.
The outcome is tension in your jaw and neck muscles. And, ultimately, the potential for TMJ jaw problems to arise.
So What Can You Do About It?
2020 has been a year of stress not only related to the pandemic but also due to the political climate in this nation. So, what can you do to prevent jaw symptoms from developing?
Here are 6 tips that I give to my patients that can help you avoid TMJ jaw problems:
1. Take Note If You’re Overworking Your Jaw During The Day
Are you biting your nails? Chewing on your cheeks or lips? Are you bracing your jaw muscles? Clenching your teeth? If you are, it may be surprising to learn that those stressed-induced behaviors can actually be changed. b It’s simply a combination of being aware and put a focus on your breathing.
Techniques such as one-nostril breathing, belly breathing, or the Buteyko Method can help you to disengage from the behavior. They help your body to be more relaxed. Many of my patients use an app called The Mindfulness Bell to get their attention at specific time intervals so they can stop what they’re doing and breathe.
2. Correct Your Computer Posture
Poor posture is a common culprit for TMJ jaw problems and other stress-induced disorders. There is a proper way to sit at your workstation. Here are some tips:
- Move your monitor to eye level so you aren’t tilting your head up or down to see it.
- Make sure your feet are flat on the floor. Don’t cross your legs or ankles.
- Keep your shoulders relaxed, down and back.
- Use a lumbar support tool to keep you from slouching (Amazon has many choices)
3. Force Yourself To Take Breaks
Taking breaks is crucial to keep your mind sharp and your body relaxed. Consider installing an app that gently forces you to stop and take a break from your screen at specific intervals. And, don’t worry – you can override the break if you’re on a Zoom call! Check out: 5 Free Apps for Reminders to Take a Break From Screens
4. Take Full Breaths
When we’re stressed we tend to breathe very fast and shallow. Instead, try some deep breathing exercises. A helpful app such as The Breathing App or Breath Ball can be helpful.
5. Try To Get Some Exercise
Your gym may be closed (or it’s open but you don’t want to risk going there) try not to eliminate exercise from your life. If you live in a warm climate, incorporate walking or running into your day. You don’t have to spend hours at it. Even a 20-minute walk will help regulate your system.
If you’re stuck indoors like so many of us this winter, perhaps try some online yoga. Do some simple calisthenics. Or take a class – there are tons of free ones online – from Pilates to hip-hop dancing. Any physical activity that gets you out of your head will trigger your body to produce more endorphins. And endorphins are what you need right now.
6. Talk To Someone
If the stress of the pandemic is taking its toll on every aspect of your life, it may be time to consult with a therapist. For a referral to a therapist who works with clients virtually, there’s a good list here: www.psychologytoday.com/us/therapists
The coronavirus vaccine is slowly being rolled out. There is a light at the end of the tunnel. In the meantime, it’s critical that you do at least one thing that will reduce the impact of stress on your body. If you’re suffering from TMD symptoms like the ones mentioned above – speak to your dentist or you can go to the American Academy of Orofacial Pain website where you can find an orofacial pain specialist, like me, in your area.
We will get through this!
Best of luck
* According to the American Academy of Orofacial Pain, TMD is defined as a group of disorders involving the masticatory muscles, the temporomandibular joint (TMJ) and associated structures. The symptoms most often reported by patients include pain in the face, TMJ, masticatory muscles and pain in the head and ear. Other symptoms reported by patients are ear manifestations such as tinnitus, ear fullness and vertigo.