Jaw Pain: The Multifactorial Nature of TMD

Jaw Pain: 3 Little Known Causes of TMJ

by Chris Kresser

Last updated on

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For years doctors and dentists believed that malocclusion (teeth that don’t line up correctly) cause pain in the TMJ. However, newer research shows that while structural abnormalities may be part of the picture, this disorder is also associated with biological, behavioral and cognitive factors.

Temporomandibular joint disorders (TMD) cause pain in the temporomandibular joint (TMJ), and those with TMD usually have difficulty opening their mouths widely and may experience clicking or popping of the joint. TMD is also associated with neck and tooth pain, as well as dizziness and tinnitus.

In this article, I’ll describe some of the current theories regarding TMD and what you should do to improve your symptoms if you suffer from this painful condition.

HPA Axis Dysregulation

Anyone with TMD can attest that stress tends to make their symptoms worse. When you’re stressed your muscles tense, and in the case of TMD, this clenching can cause pain. But stress also causes physiological changes in the body that can lead to symptoms.

Those with TMD have been shown to have altered cortisol rhythms indicative of HPA axis dysregulation (i.e. “adrenal fatigue”). They have high levels of cortisol in the morning, and also exhibit an enhanced release of cortisol when stressed. (1, 2) Pain itself is a stressor, so it’s important to note that there have also been studies looking at TMD patients who had resolved their pain that also show elevated levels of cortisol, indicating that it is not just the pain causing higher levels of this stress hormone. (3)

While the normal response to acute stress is an increase in pain tolerance, researchers have shown in rat TMD models that chronic stress causing HPA axis dysregulation can actually decrease pain tolerance. (4)

Can adrenal fatigue cause TMJ pain?

Sadly, stress not only increases pain in those with TMD; it actually changes the structure of the temporomandibular joint. (5) It is vital to keep your stress under control if you want healthy temporomandibular joint structure and function.

If you suffer from TMD, it’s a good idea to check up on your adrenal health – if you suffer from HPA axis dysregulation it’s likely that improving your adrenal status will improve your symptoms. You can learn more about HPA axis dysregulation and what to do about it in Laura’s and my free eBook, but one of the best ways to improve your HPA axis activity is to implement mind-body activities like yoga, deep breathing, meditation, etc. These are simple things to incorporate and can often be done in the comfort of your own home. Here are some of my favorite resources if you’re new to mind-body activities:

Inflammation in TMD

When you are subject to chronic stress, your body becomes resistant to the effects of cortisol. When this happens, inflammation is allowed to run rampant as the normal processes that keep it in check don’t function as they should. (6)

Inflammation and oxidative stress are associated with TMD, and it is thought that these inflammatory processes that takes place within the TMJ may be a cause of the pain patients experience. (7)

To decrease your inflammation, it is first crucial to get your HPA axis functioning normally, as HPA dysregulation increases inflammation. You can learn more about how to get tested for HPA axis dysregulation and how to treat it naturally in our eBook and video series.

It is also important to eat a healthy diet high in antioxidants – a Paleo diet is a perfect place to start, but make sure to get lots of fruits and vegetables of different colors to increase your antioxidant intake.

There have been limited studies on supplements that can help alleviate TMD. However, one study showed that N-acetyl-cysteine (NAC) helped to alleviate oxidative stress on TMJ cells. (8) This has yet to be studied in animals or humans, but it’s likely that supplemental NAC may reduce the oxidative stress associated with TMD and help to relieve symptoms.

Sleep deprivation has also been shown to increase pain in those with TMD, which is thought to be because sleep deprivation increases inflammatory markers as well as estrogen (that part will make more sense in the next section). (9) To reduce inflammation in the body, it’s vital to get enough sleep. Make sure to listen (or read) Chris’ podcast with Dan Pardi on sleep to learn how to get restful sleep.

Mind-body activities are also great for not only improving HPA aHxis function but also lowering inflammation. Both yoga and meditation have been shown to lower inflammatory markers. (10) Yet another reason to practice!

Hormone Balance

The prevalence of TMD is 1.5 times higher in women than in men. This, coupled with the fact that other pain disorders like fibromyalgia are also much more common in women, made researchers believe that hormones may play a part in these diseases.

Both male and female TMD patients show high levels of estrogen, and estrogen seems to have a damaging effect on the TMJ while testosterone seems to inhibit damage. (11, 12) Research also shows that women who have genetic polymorphisms in a specfic estrogen receptor are more likely to have TMD than controls. (13) In addition to this, women who are exposed to estrogen via hormone replacement after menopause or through oral contraceptive use are more likely to suffer from TMD than those who haven’t been exposed to exogenous estrogen. (14)

Because estrogen seems to have such a significant impact on damage and pain in TMD, it’s crucial for both men and women suffering from TMD to make sure their hormones are balanced. Hormone balance is a topic unto itself and is best done with the help of a practitioner, but Chris gives a great primer on the topic in this podcast.

To help balance your hormones yourself, you’ll want to make sure:

  • You’re at a healthy weight
  • You avoid estrogen-like compounds in your environment as much as possible (BPA, birth control, soy, fat from non-pastured animals, etc)
  • Your HPA axis is functioning properly and you keep stress to a minimum
  • Your gut is healthy and you eat adequate fiber

TMD is a multifactorial disease that can be complicated and difficult to treat. However, with newer research we have a better understanding of the many factors that lead to the development of this condition. Given this newer research, it’s likely that treating HPA axis dysregulation, controlling inflammation, and balancing hormones will bring relief to those that suffer from TMD.

My question to you: Do you have TMD? Is your treatment plan addressing these factors?

136 Comments

Join the conversation

  1. I was diagnosed with TMD and had chronic pain for 14 years, I was taking over the counter and prescribed pain meds the whole time. 3 years ago I did an elimination diet and gluten was part of what I cut out, as a result my TMD went away. All those years and it was never more than a gluten sensitivity. I love living pain free now!

  2. I haven’t been officially diagnosed with TMJ yet. Seeing a so called TMJ specialist next week but am doubtful of how helpful they will be. I am currently eating complete mush and even that is uncomfortable. I have never had this before and it has been going on over 5 weeks now. Starting to lose it and panic a bit.
    I started taking magnesium a few weeks ago at a dose of 200mg a day. I am just wondering if that is a high enough dose to be helpful? I am also exploring my diet and practicing better posture as well as seeing an osteopath and receiving laser treatments for pain. Any advice would be appreciated on dosage. Thanks!

  3. I was marveling today at how I no longer have what I thought was TMJ pain. I was thinking it was because when I had my amalgams removed in April I was made aware that I have a food trap between my last two teeth on my right upper side. I had learned about how to be hypervigilant in removing food from between there after most meals.
    Upon reading this article I learned that taking NAC might be helpful as well as balancing your hormones. Both of these things I happen to be working on with practitioners these last several months.
    Whichever thing it was, I highly recommend all 3 things. I’ve had breast and uterine fibroids decrease by doing dr Teresa dale’s hormone protocol through a practitioner, and taking DIM. A ways to go on the hot flashes.
    At any rate it is great to be pain free in this regard which will help me get off the vicious cycle and heal my HPA regulation.
    Thank You for this very informative article!!!

    • Hi Suzanne,

      I just read your comment and noticed you mentioned having problems with hot flashes. I was having them every 10 minutes or so. It was crazy! Anyways, my naturopath put me on licorice root, and within 2 weeks they were completely gone! Let me know if you have any questions. I hope this helps! 🙂

  4. I’ve been suffering form Tinnitus for about a month now. .Is there any advice you can give me to help deal with this? I’ve heard diet can play a big part in Tinnitus.

  5. Hi – can I ask if anyone out there gets the feeling of swollen cheeks or ‘puffiness’ around the mouth and lips in the morning after sleep? I don’t get a locked jaw but am generally quite physically tense and have some other symptoms recently that seem to fit with the TMJ descriptions including pains in the jaw/teeth, neck tightness, apparent teeth grinding and a variety of tinnitus that I have partially pinpointed to the neck problems. The swollen cheek feeling is a new one but it might tie in with digestive problems as I also suffering a bad patch of reflux at the moment. Any comments welcome! Thanks!

    • I get the swollen (on the inside) cheeks. It is worse on the side that I clench my jaw the most. I do have it a little worse in the morning and I have always wondered if I am biting my cheek in my sleep.

      • All tmj sufferers should look into DTR Therapy. It will be tough to find a practitioner who knows about it let alone who is adequately trained to preform it, but if your tmj issues are due to occlusion this can help and even take away your issues! The video link is below and there are several more.

        https://m.youtube.com/watch?v=YHPHL2GmnoA

    • Hi, yes I suffer from clenching. I get a burning pain in my left cheek.I also feel like I get swollen lip feeling. I also get altered taste from drinking something hot. I have suffered with bruxism as a teen.Fortunately it went away for 20 years or so. But came back with a vengence last year. I have been to several Doctors and there is no cure, it can be managed. I recently signed up for a sleepstudy at home. Im still waiting for results, because sleep apnea can cause clenching as well. I also have Gerd but take nexium.I also have a burning pain in my tongue and chin area.It isthe most difficult sleep disorder to beat. I live in pain everyday. Iam wondering if it is genetics from my parents, but cannot ask them cause im adopted. I just try to hang in there, but it is tough, thanks for reading, John

      • All tmj sufferers should look into DTR Therapy. It will be tough to find a practitioner who knows about it let alone who is adequately trained to preform it, but if your tmj issues are due to occlusion this can help and even take away your issues! The video link is below and there are several more.

        https://m.youtube.com/watch?v=YHPHL2GmnoA

        • Hi there
          I’m from Melbourne, Australia & have ongoing jaw problems.. does anyone know of any dentists in Australia that offer this therapy…
          thanks

      • re: GERD
        I have suffered from this myself.
        Most GERD is caused by a LACK of hydrochloric acid, not too much.
        What causes the lack? Often it is the H. Pylori bacteria.
        To clear H. Pylori bacteria without anti-biotics, try mastic gum.
        Taken in capsules, the gum kills off the bacteria.
        Be careful with doses though.
        I was taking too much, and it caused liver pain.
        Stick to 1-2 capsules, once or twice per day, for at least 2 weeks.
        I have had no return of my GERD since taking mastic gum.
        I hope this helps.

    • All tmj sufferers should look into DTR Therapy. It will be tough to find a practitioner who knows about it let alone who is adequately trained to preform it, but if your tmj issues are due to occlusion this can help and even take away your issues! The video link is below and there are several more.

      https://m.youtube.com/watch?v=YHPHL2GmnoA

  6. Are there any studies that link TMD with hypothyroidism? I have been having problems for a few years with bad jaw/ facial pain. My jaw pops all the time and occasionally gets stuck. I have been showing increased symptoms of hypothyroidism for the last year and all my blood work comes back normal. Every woman in my family has hypothyroidism and it took years to diagnose for some. I have an appointment this week for more tests and maybe a referral to endocrinologist. So I was just wondering if somehow the two problems could be related. And if I should mention the tmj pain at my appointment. Thanks.

    • Hey Ashley

      I was having a bunch of weird symptoms that seemed related to hyperthyroidism – overheating, excessive sweating, brainfog, restlessness, so I saw my doctor and got it checked. All of my bloodwork came back normal.

      However I’ve recently I’ve been looking into TMJ stuff and am finding more and more reasons to suspect the TMJ as the source of a lot of my issues.

      The martial art I train puts a lot of pressure and strain on my neck and jaw, and after seeing my massage therapist and talking to him about it I’m convinced the problem is in my jaw, as I also have problems swallowing and light sensitivity, like in this image: http://drhoustonanderson.com/wp-content/uploads/2015/10/tmj-symptoms.jpg

      I’d highly recommend seeing a massage therapist who has experience working on the Jaw and seeing what they can do for you before going down the endocrinologist route.

  7. I believe many people suffering with TMJD actually have Chronic Lyme Disease. My jaw has been locked since May 2014 and my joints dislocated. only this year did I find out all the symptoms I was experiencing in my body was not just TMJD but it was Chronic Lyme Disease along with Babesia and Bartonella coinfections. I wasted a year of my life focusing on splints and my new bad bite when I was infected and losing my whole body to the disease. Lyme threw off adrenals, hormones, gut, everything in the body. Dentists are not educated on the subject the medical world needs to accept this as a main cause to many illnesses. Not all TMJD is lyme but if you were fine and one day just woke up with a ton of teeth and jaw issues and have other issues everywhere else in the body please test through igenex immediately.

    • you need to be aware igenex is being investigated for high number of false positives as I was misdiagnosed with limes and treated with heavy antibiotics among other horrible medications for over a year and am just lucky to be alive and trying to heal from all the damage!

      • I was dying. I stopped walking. I couldn’t use my fingers. I couldn’t chew. I couldn’t talk. I couldn’t do anything. Perhaps you were with the wrong type of person to treat you but treatment saved my life. My jaw is still partially locked but as time goes by I improve. I can chew, I can talk, I can smile, I can walk, I can write, I can sleep, I am starting to have more energy. It’s a slow process but I’m healing. May is Lyme disease ,not Lyme’s disease ,month. Getting a positive test even from igenex is hard if the immune system is very supressed. It’s very hard to get a false positive that is why it has become a clinical diagnosis by symptoms. the CDC chooses to stand by the idea of false positives those are guidelines from 2006. ILADS guidelines have become standard. You probably felt like death with treatments because of a healing crisis or lack of proper detox and/or Lyme diet. There’s a lot to Lyme that mainstream has no understanding. I stand by my comments. It should be considered with severe tmd. Search for an llmd

  8. I have suffered from TMJ jaw pain for many months now and it is really annoying. It is made worse by stress and other things and I haven’t been able to find any home remedy that works for me. I might go talk to my dentist about it when I go in for my next cleaning. Hopefully he can help me out here in Edmonton.

  9. My dentist told me I had TMJ and was grinding my teeth at night. I had no pain or other issues, so I didn’t believe him. He insisted I needed a bite splint, but I very rarely wore it. While pregnant with my son 2 years ago, I suddenly found one day that I couldn’t close my jaw. I asked my chiro if she could help, but her adjustments did nothing. She suggested massage, and the therapist said I was very tense in the neck/jaw/upper back. I had maybe 3 massages, but they only helped a little. I assumed that after my son was born my jaw would go back to normal but unfortunately that didn’t happen. I finally started to notice that I was grinding my teeth and night and have now chipped one of my molars (the dentist is trying to crown that tooth, but I’m very against that and hoping to avoid it). I’ve had a few TMJ RESET treatments, but although the first one a year ago helped the last treatment did nothing and my bite is in worse shape than ever before. It’s really difficult to chew food properly because only my back teeth come together. The strange thing is that I don’t really have any jaw pain or other problems. I know the next step is that my dentist will suggest I see the orthodontist to adjust my bite, but I really want to avoid that. Has anyone else experienced this and resolved the bite issue on their own?

  10. I have had a condylar resorption ,and the structural problem ( severe open bite) affects my daily life, creating insomnia, tensions in my face and back, impossibility to exercise and … Depression … Which I try to hide. Even though I am managing my life with diet, lifestyle, meditation, yoga …. i am thinking about having a surgery to replace my tmj . If anyone had asurgery to replace the joint please let me know. I d love to hear your experience.

    • Hi,
      I had idiopathic reabsorption of the tmj’s joints along with an overgrowth of my upper jaw. .. it started when I was 18, I’m now 36. Its was a long road but I’m out the others side and still seeing the consultants every 6 -12 months. I had a brace for 5 years and 4 surgeries. 1st was to correct my over grown upper jaw (osteotomy) then a septoplasty to realign my nose, the swelling from the previous surgery had made it wonky. I then had my dual bilateral tmj replacement surgery, it wasn’t as bad as I feared and reduced the pain tenfold, so much so that I barely have any. I have the odd bad day but that’s nothing compared to the pain I used to have. Of course eating an apple or anything to chewy like well done beef is a no no (much like before surgery)but a small price to pay.

      • What I’m trying to say is, although it’s ur choice, way up the pros and cons, I did and came to the conclusion that these surgeries are out there to help, u are never going to be totally back to the way u were before this but they can bring to damn close. I looked at this way, I’m in pain, I possibly have the chance of being relieved of some if not most/all. I’m in no worse position if it doesn’t work. I believe it has been the best thing I ever did, I’ve heard some people haven’t had as good an experience. But u need to discuss this with ur surgeon/consultant. If u need any advice if u decide to go through it or have had the surgery after woods don’t hesitate to find me on Facebook, louise McGill (kettering, uk) [email protected]

  11. Taking magnesium glycinate religiously (and more if I’m stressed) has really helped my jaw. I’ve had TMJ and been a tooth grinder. I no longer need the mouth guard to save my teeth from the grinding which is great as it wasn’t good for the alignment of my jaw.

  12. TMJ was one of the many health challenges I had where sometimes my jaw locked up so I couldn’t eat. 10 years ago I changed my diet drastically. I’d been raised a vegetarian and had always eaten a diet rich in carbs. I transitioned to a very nutrient dense-WAPF inspired-modified paleo type diet. I also discovered 10 years ago that I’m gluten intolerant. I am now TMJ symptom free with almost no hypoglycemia or constant sinusitis and I feel pretty balanced and healthy. Change didn’t happen overnight though. It took years before I realized i was basically TMJ free. Hypothyroidism is still something I need to work on:-)

  13. I had this jaw joint pain so bad I wondered how I would tolerate it for the rest of my life, it started after taking antidepressants and snowballed, I had it for 3 years quite badly, sometimes I could not open my mouth to eat. 2,000 dollars later after a dentist suggested a plate worn 24/7 would help , I tried a Botox injection deep into that big jaw muscle, it went away after a few weeks and it’s like I never had it . I had that injection at a dentist. Best thing I ever did, I could hardly chew watermelon sometimes the pain was that bad.

    • Hey Jenny, this is exactly the sort of life-changing effect I have been getting with my patients when I give them deep Botox injections into the masseter muscles. It’s like a silver bullet. Glad it was so effective!

    • I agree, botox works very well for this, I hope regulatory bodies take this off the “experimental” list. I have quite a few patients that get tremendous benefits.

    • Botox injections saved me thousands. I have had my jaw lock closed 3 times, and when the last time it happened, my oral surgeon had to put me under to get it back in. I was told I would need surgery and a lifetime of therapy. My dentists asked if I was being interested in being part of a test group treating tmj with Botox. Within a week of that first injection, I was pain free and CURED! I only wish insurance would cover some of the costs. Even paying 100% out of pocket it is completely worth it.

      • I have been giving Botox to my patient,s for Bruxism for the last 10 years. It helps with the pain and TMJ problems BUT it doesn’t fix the underlying cause such as Sleep disordered breathing disorders such as Obstructive Sleep Apnea OSA and UARS. One grinds / clenches one’s teeth at night to ” open ” the airway. It’s an instinctive process to try and get air during and apnea, hypopnea or a RERA . Dr Maureen Allem
        More information on
        http://www.sleeprenewal.co.za/upper-airway-resistance-syndrome-uars

  14. I developed pain in my upper right jaw about 6 months ago at the age of 62, and after xrays and an MRI discovered that my jaw was deteriorating (osteoarthritis). I’ve been taking lots of joint supplements and seeing a specialist (cranial massage and lidocaine injections). Doing better, but with this diagnosis, isn’t my jaw permanently damaged? Would any of these suggestions help with my diagnosis?

  15. While I know alcohol in general, and beer in particular are not Paleo, I do think they should be mentioned when discussing phytoestrogens. I know people who are Paleo except for their beer. Hops are a much more powerful phytoestrogen than soy, and modern beers are much hoppier than traditional beers. If you have TMJ, try cutting beer down or out as well as following the other suggestions mentioned in the article.

  16. I am very surprised this article doesn’t mention mineral loss as a cause of TMJ. I love chiropractic care – but adjustments for me would not last long when I was eating high oxalate foods. What works for me with TMJ and most pain is magnesium…and also a low oxalate diet. I really believe that high oxalate foods play a large role in many health issues including TMJ as well as crowded teeth. Too many high oxalate foods (spinach, rhubarb, beets, sweet potatoes, nuts, chocolate, chia seeds, quinoa, buckwheat, teff, etc.) rob your body of needed minerals. When I first went gluten-free I ate a lot of high foods and ended up needing to get braces (and I’m in my 50’s). The same thing happened to a friend of mine. Join the free group [email protected] to learn more and get access to a free foodlisting spreadsheet. High phytate foods would also be an issue.

  17. As a hypnotherapist, I have been treating clients with TMD, Bruxism and related conditions and symptoms (anxiety, anger, lost confidence, etc) with a great deal of success. It`s not new that every condition has psychological and emotional factors in addition to the physical ones and hypnosis, and self-hypnosis which is taught to the client, have been well documented as viable solutions. As doctors and dentists become better informed, they are also referring clients to hypnotherapists in increasing numbers, As you may not have been aware of the effectiveness of hypnosis, I look forward to seeing you include it as a reference in your future articles on this and other topics.

  18. My research, articles and podcasts show totally different. TMJ pain is a GABA neurotransmitter issue. Support GABA with Passion Flower and read more on GABA deficiency.
    And it is a narrow palate that crowds the teeth and jaw. I write on both of these extensively, chronicaling my own recovery.

  19. My TMJ was bad. 3 times I had to go to the emergency room because my jaw locked open. Then when I was stressed it would also lock closed. It clicked and I was always afraid it would lock open especially at the dentist. Then I found out I was gluten sensitive. After I went on a gluten free diet the inflammation went away and the TMJ went away. I have been problem free since then.

    • That’s great. How long were you on the gluten free diet before you noticed the improvement? Or were totally pain free?

  20. I’ve had a clicking jaw with tight muscles under the chin, and distended right neck for over a year. No pain though. A few months ago I had a parathyroidectomy. My hormone and electrolyte levels have changed since and I’ve started to get pain on both sides of my neck.

  21. all the above information and comments have been very helpful to understanding many of my long-standing problems dating back to my early childhood (I am neary 74 yrs. now). I had braces on my teeth for 3 years starting when I was 9, because of my malaclusion, and then when the braces were removed and teeth very straight, after I was 15 the teeth moved back out of alignment and I had braces on again for 2 years. Have had lots of trouble with sinus all my life, weak immune system due to being a non-secretor (blood group), and after I got lyme disease very bad in 2002, still have it, my teeth have moved a lot out of alignment, still moving. Had periodontal gum disease very bad and lost a lot of bone and gums. I am grateful for all the info you give on this site. Thank you.

    • TMJ is one of the numerous Functional Somatic Syndromes found in a sleep disorder called UARS .- upper airways resistance syndrome

      Your prosthodontic history suggests that your could have the airflow limitation of UARS which can also constantly stimulate the HPA ( adrenals ) via stimulation of the limbic system via olfactory bulb in the nose

      Get a sleep trudy done but make sure that the sleep clinic you choose is able to manually measure the RERAS ( respiratory effort related arousals ) to diagnose UARS ( upper airways resistance syndrome ) . If they only measure the apneas and hypopneas – AHI index , they may miss the UARS diagnosis .

      For more information on this syndrome there is a great book Sleep Interrupted by an ENT dr Steven Park. He interviews many experts on this subject including Dr Christian Guilleminault who first identified this syndrome in 1993 . Check it out on his website http://www.drstevenpark.com or search for this on the Podcast app .

      The following is from a flyer on UARS that I prepared and hand out to my patients who I suspect of this syndrome : A lot of my information was supplied from a paper written on UARS by Dr Clyde Keevy.

      Hope this helps
      Dr Maureen Allem

      UARS is classified under Obstructive Sleep apnea OSA and is a Sleep Breathing Disorder SBD that is associated with numerous FSS Functional Somatic syndromes and Anxiety disorders .

      Symptoms of UARS can overlap with OSA . UARS patients are more likely to complain of daytime fatigue rather than sleepiness.

      UARS is a form of sleep disordered breathing associated with fragmentation of sleep and is associated with inspiratory flow limitation whilst breathing during sleep . This inspiratory airflow limitation does not drop the oxygen saturation as per OSA .

      Chronic insomnias are more common with UARS . These patients find it difficult to fall asleep (Sleep onset) and then find it difficult to stay asleep ( sleep maintainance ) These patients have nocturnal awakenings and find it difficult to return to sleep .
      Studies report that Chronic insomnia is more prevalent with UARS than OSA

      50% of UARS have cold hands and feet especially in childhood
      30 % have light headedness when standing up or bending over abruptly due to parasympathetic over activity
      UARS patients have more sleep disturbance than OSA patients
      UARS patients have more sleep fragmentation that causes daytime sleepiness/ fatigue

      What initiates the UARS ? Any Physical or emotional trauma can sensitize the limbic system which modulates emotions .The limbic system then activates the HPA axis .
      The physical trauma can be a Motor vehicle accident , physical abuse, assault , home invasion , hijackings, rape , attempted rape etc . The initial trauma can also be emotional abuse . These traumas activate the HPA axis and sensitize the olfactory bulb and then the the limbic system thereby altering the brain response to external or internal stimuli .
      This activation can also lead to the Functional Somatic Syndromes FSS

      Patients with UARS have usually consulted numerous doctors who are not able to diagnose the condition as they are unaware of this newly documented condition . These doctors have not manage to improve their patients symptoms of anxiety , depression, insomnia, ADHD and these FSS disorders .

      Antidepressants are usually prescribed to alleviate symptoms but the underlying cause goes undiagnosed until a sleep study is ordered by a doctor who is aware of this new sleep disordered breathing called UARS . The sleep study is usually a last resort .
      Once diagnosed, UARS is better treated with a mandibular advancement device which opens the airway and up improves these FSS symptoms . USARs patients usually do not tolerate CPAP

      The sleep study must measure RERAS ( respiratory effort related arousals ) manually . Automated computer analysis of polysonograms PMG do not measure RERAs and are unable to diagnose the sleep disordered breathing of UARS .
      PSG have to be manually analyzed to diagnose this condition

      What are the Main FSS symptoms ?
      Body pain/ Fibromylagia , headaches , insomnias and irritable bowels IBS

      What are the main anxiety disorders that UARS is associated with ?
      Anxiety, depression, Bipolar , ADHD and Insomnia

      Other FSS syndromes that doctors must be aware of that are associated with UARS are:
      Insomnia
      Chronic fatigue syndrome
      IBS
      Restless leg syndrome
      Gastrointestinal Hyper mobility / Hypomobility
      Joint hyper mobility syndrome
      Mitral valve prolapse syndrome
      Fibromyalgia
      TMJ syndrome
      Sick house syndrome / multiple chemical sensitivity syndrome
      Gulf war illness
      Tension headaches / migraines
      Problems of concentration and memory
      Hyper somnolence / sleepiness
      Daytime fatigue

      Improvement of sleep disordered breathing with a mandibular advancement device improves symptoms . However one must Identify and manage the the initial trauma that activated the limbic system and HPA axis . There will be little success if the patient continues to suffer emotional/ physical stress

  22. I have had TMJ all my adult life. Recently I had orthodontia, which corrected my bite. This has not eliminated TMJ, but it has greatly improved it. Now that my teeth close down in a more normal position, the tension in my jaw muscles is reduced. Emotional stress Is certainly a factor, but fixing the bite problem was something I could control, and I’m glad I took action.

    • That is the same routine I have had done. Bad TMJ (wanted to pull my hair out) due to the pain. I am getting better through the “invisilign” system and mood stabilizer pills. I really have to concentrate on staying “stress free” or the clenching and grinding starts all over again..

  23. I too am a dentist but over the past 5 years have veered away from the older way of thought that you refer to, the occlusion/stress etiology model. TMD and facial pain are extremely complicated and hence are difficult to treat (let alone diagnose). However, I’d like to add one more thing to the this complex equation. People with airways prone to obstruction while asleep tend to suffer from bruxism, TMD and facial pain pain. Why is this you may ask? Grinding your teeth at night has the ability to reopen the airway ending an apneic event. If one has severe OSA for example, they would be grinding/clenching their teeth 75 times per hour. This of course is hard on the jaw joint itself and the muscles of grinding/mastication, and even on the muscles of facial expression.

    However, defining TMD and its causes is a real “chicken or egg” conundrum? Is it the grinding or is it the hormonal (cortisol) levels elevated by lack of deep sleep (no activation of growth hormone) that causes TMD directly? In my experience it’s surely multifactorial. However, clearly bruxism and its sleep interruption based etiology needs to be included in this discussion. If I see a patient with signs of bruxism, I typically think thyroid and sleep interruption, not occlusion and stress. My, how things have changed in the TMJ/TMD/Facial Pain world!

    Thanks Chris for the ever stimulating discussion of we healthcare practitioners often get set in our ways and need to keep an open mind when treating our patients.

    • Have you heard of Dr. Farrand Robson, and Oral Systemic Balance? If not, I would highly recommend researching his work 🙂

    • For me it’s caused by sleep apnea, elevated cortisol, insomnia, occlusion, (a lifetime of traumatic) stress, and adrenal fatigue. A specialist told me he suspects I don’t make much hgh. It all fits.

    • Thanks for chiming in here – always great to hear a dentist’s perspective as well.

      And as I mentioned to a commenter above, this is definitely not to say that there aren’t some physical causes/contributors like malocclusion and bruxism, but it’s multifactorial for sure.

    • There appears to be a sleep disordered breathing syndrome called UARS – upper airways resistance syndrome which is well described . See my previous post in this thread

      For more info and for interviews with experts on this subject … See this website http://www.drstevenpark.com
      Or search for dr Park’s interviews with experts on the Podcast app ( sleep apnea and UARS )

      Hope this helps

  24. hmm, no thoughts about breastfeeding? they taught us about all the teeth, palette, and jaw deformities that are caused by not breastfeeding (or not breastfeeding long enough) at a recent La Leche League International conference (it was taught by an M.D. / Ph.D. who is a leading expert in the field). i was sure that i was going to see something about breastfeeding in the list. is this not one of the things connected to facial deformities caused by not breastfeeding, or is this information just not as widely known? i think it’s a totally relevant topic to the primal community, that our babies are evolutionarily adapted to suck only on a breast, not a bottle or pacifier, and so of course their faces develop properly when they breastfeed and problems arise otherwise. i’m SO surprised this didn’t come up in this article.

  25. For many years I had TMJ pain. I wore splints, have had my teeth straightened, surgeries to repair disc. They said it would come back again. I read everything on it and discovered in old medical texts that chronic sinusitis was a major cause. I proceeded to treat the latent sinusitis with surgery, antibiotics, nasal spray etc. This kind of sinusitis is caused by slow growing staph (not acute infection) that effects the muscles around the jaw causing contractions. Sometimes CS is treatable but mostly just managed. Bromelain is helpful. Get a sinus xray.

      • Anyone who has had acute sinusitis should consider it as a possible cause of their TMJ. These bacteria do not go away, but live within us suppressed by our immune system. I want a complete resolution of this latent infection and I’m trying to do that by a paleo or ketogenic diet with lots of probiotics.

    • Interesting…I also had misaligned teeth in my teens and at school one day found I could not open my mouth to eat lunch! I got splints as well as my braces and then a retainer…it wasn’t so bad that I needed surgery but they said I would probably always have it. It’s manageable now but I still wear my splint every night (ugh), and a couple years ago I opted for a sinus surgery to clear up my constant congestion problems. They reduced the right turbinate and removed some bone spurs. Now I’m pregnant so I get to deal with congestion again but it’s certainly better than it would have been. Not sure if I fall into the chronic sinusitis category though since my CT scan said they were “perfectly clear.”

  26. For any fellow TMJ sufferers out there, I highly recommend this book; “The TMJ Healing Plan” by Cynthia Peterson, PT. Cynthia gives a thorough look at all the possible causes of jaw issues and ways to fix them yourself. Her encouraging, supportive tone was exactly what I needed when I was suffering and my dentist was “clueless”.

  27. My TMD kept getting worse and worse. I tried anything – like you’ve listed above. Finally out of desperation I got braces 6 months ago as a 33 year old adult. And within a short period of time my pain and aching was diminished or gone completely (depending on the orthodontist status for that time). Everyone is different but that’s what worked for me!

  28. For me, night grinding and sore masseter muscles following day all started when I started nursing school and when I’m in ketosis. Hmmm.

  29. All the above postings are blaming numerous factors for TMJ pain. The real issue here is DIAGNOSIS( or lack of). This can only be accurately accomplished by analysis of facebow articulated teeth models, postural and intraoral photos, CT and MRI of the Temporomandibular joints. Once a diagnosis is made, the structural components are assessed and the factors that exacerbate the problem can be discussed. With a stable “foundation” harmony should exist among all the body’s physiological factors.
    …..and BTW…..all clenching and grinding is not bad, as it helps the TM joint to adapt to a change in its structure. Any dentist who just places a splint is practicing blindly and could in fact create more harm.

    RTWylie DDS

    • I agree Robert. I don’t think many people understand the true functional cause(s) of TMD. It’s not their fault! There is way too much mis-information about this condition and I would guess that the author, although well-meaning, does not have direct experience working with TMD patients and likely no understanding of occlusion. But honestly where would she learn it? Certainly not in nutrition school! I just wish there was more education on this topic.

    • Thank you Dr. Wiley for this response. I’ve been saying this for so long! As a patient who was totally blown off by her providers and told that I essentially had anxious women disorder, I had to advocate for myself…….I had to go a long ways from where I was living but I found a doctor who required a TMJ MRI, cone beam CT scan, intraoral pictures, and models and it was shown that both of my discs were permanently displaced, my condyles were flattening and I’m bone on bone. I continue to advocate for dentists and doctors to have all of those measures be the standard of care for TMJ-because just as you have said, otherwise they are treating blindly and could cause more damage. I’m so grateful I listened to my gut before jumping into a treatment option.

      As for this article-I liked it, I’ve seen how my hormone levels and other factors like diet play a large role in my pain but I also have had the validation of the fact that I have a true joint issue.

  30. I gave myself a case of TMJ with a new pillow. I’m a side sleeper, and a bought a fat pillow to prop my head up more. It felt comfortable, but it was rather stiff and pushed my jaw sideways (a problem only on one side, oddly enough). So I added the skinny, soft, goose-down pillow I had been using on top of the new pillow. The fat pillow tends to shift up, leaving just the goose down under my jaw. Cured my problem.

  31. Have any ideas about Trigeminal Neuralgia? What appeared to start as TMJ, became Trigeminal neuralgia. Pain management with gabapentin, which involves numerous sideeffects. Ideas?

    • (Sandi, I’ve been told Trigeminal Neuralgia can be successfully treated naturally through chiropractic & acupunture treatments.)

    • Hi Sandi,
      I’ve worked previously with an Osteopathic practitioner and a Craniosacral therapist whom had great success with relieving Trigeminal Neuralgia as well as TMJ. Misalignment or restrictions in the C-spine can affect the nerves and muscles in the neck, head and face.
      All the best, Teresa

  32. I have suffered TMJ pain with migraines for the past several years. Have many health issues including Hydrocephalus, Ehlos-Danlos, Sjogrens, Hashi’s and more. Recently worked with a PT,who educated me on diet, soft foods, did some ultrasound and massage as well as talked to me about how important posture is as related to TMJ. She taught me one exercise with my mouth and tongue and has me doing shoulder rolls and shrugs. I am 2 months pain free. I have tried opiates, acupuncture, liquid diet. Was told to see oral surgeon, but read that rarely helps. If I feel my jaw tensing up, I do my tongue exercise, which increases blood flow and that clears it up.
    Chris, do have widespread pain, and have noticed while driving that I often am clenching my glutes and leg muscles and have to conciously relax them.

  33. It is nice to read an article about TMJ that does not blame it on grinding teeth and tells you to eliminate chewing gum. I have mild jaw pain on my right side. I’m sure caffeine does not help. I’m thinking my cortisol is out of whack since my blood glucose in the morning is usually around 115.

    • I eliminated gluten to drop my 114 blood sugar. In 21 days it dropped to 100 but I also noticed my TMJ has almost disappeared after years and years of it happening, even with an expensive nightguard. Possibly the inflammation in my body decreased with I eliminated gluten? No idea, but it is life changing and worth a try. 2 birds with that stone!

  34. I had TMJ years ago. Dentist did the splint mouthpiece to wear nightly and helped, but like a chiropractor, it only lasted a short time and then was back. I finally found the problem. I drank alcohol and caffiene and allot for me. I was always tense. The problem was as I drank these daily over a long time as I aged, I was slowly depleting minerals and this lack of or purging my body of these important minerals, mainly Magnesium, Sodium, Potassium and Calcium and many other Trace Minerals, was causing my body to react. Not only this but I was always thinking of keeping my sodium low and that was a bad idea, plus I used general table salt bleached of all minerals. So the key thing for me was building back up all the lost minerals. And I also believe this caused acid reflux. Get your minerals back up and use Himalayan or Celtic salt daily. It won’t increase BP either. But make sure you use a good Magnesium that will help relax your whole body. I prefer di-magneisum malate that is time released. search for that in Google and you will likely find the one I use out of Phoenix AZ. Really good stuff. I have no interest in the company. Or any others that might work for you. If you have Fibromyalgia this is the way to go. Helped me allot.

  35. Though unfortunate It is comforting to hear that others experience severe TMJ and helpful to hear what works for others. I have been struggling with TMJ for the past 15 years (since puberty) and have undergone two surgeries which elevated my TMJ issues for about five years. I struggle with weekly head aches/migraines and find that stress exacerbates them. I am constantly looking for ways to reduce the pain. Daily exercise, particularly yoga and eating well have been the most helpful. I briefly tried anti-anxiety meds, they eliminated much of the physical tension I experience but if anything made my symptoms worse due to other side effects.

  36. I had severe jaw pain for a couple of years that occurred during an incredibly stressful time of my life. Shortly thereafter I had underactive thyroid and adrenal fatigue. I felt that all these problems were tied to the stress. My chiro was able to realign my neck & jaw. The thyroid trouble went away although I did self-medicate for a while and maybe shouldn’t have, who knows. The adrenal fatigue eventually went away too. My php said to sleep as much as possible and that’s what I did. These problems are all resolved now, thankfully!

  37. Having worked in neuromuscular dentistry for over 15 years I can say that malocclusion is a true cause of TMD. It’s sort like the chicken and the egg story. Which comes first? The pain of malocclusion or the stress and adrenal fatigue because of the pain? The answer is not always so cut and dried. I have seen thousands of TMD patients get better when they address both the functional and the emotional aspects. Most get better with the functional aspects alone. All the the meditation in the world won’t fix a bad bite! Additionally many TMD cases are caused by bad dentistry and bad orthodontics. It might surprise people to know that most dental schools teach only one semester of occlusion – meaning they don’t know much about how teeth fit together. Almost none teach neuromuscular principals. This is akin to an architect not knowing much about building foundations. Many people are put on antidepressants, anxiety and pain meds or told to go meditate or manage their stress when there is a very real structural issue. It’s not all in their head. 🙂

      • this is what I am sure happened to me “Additionally many TMD cases are caused by bad dentistry and bad orthodontics. It might surprise people to know that most dental schools teach only one semester of occlusion – meaning they don’t know much about how teeth fit together. Almost none teach neuromuscular principals. This is akin to an architect not knowing much about building foundations”

        my natural bite and shape of my mouth was stolen from me by aggressive orthodontics at age 8-11 and a dentist for a father who filed down all my natural teeth causing major occlusion issues.

        I have been suffering from left side facial/ear pain for almost a year—had clicking on that side without pain for a decade previous. I just had a root canal tooth extracted on that side because the holistic dentists I saw thought that might be the cause of the pain. Unfortunately the pain persists, though it got much worse initially after extraction.

        I have seen a TMJ doctor who made me a hard appliance to wear at night but I find it to be very uncomfortable and I cannot keep it in, I take it out in my sleep every night.

        I will never let anyone play with my kids’ bites with traditional orthodontia or occlusion filing, but I wonder what if anything can help the damage that was caused to my own bite as a child. My braces were so aggressive, fast, and at such a young age that they actually killed the nerve in one of my front teeth. My teeth don’t match up at all as an adult. I have no idea where to go from here. I think if I could fix my bite I could fix the ear pain.

    • True, but I’ve gone to Pettibon Chiropractors for years, a bite specialist for TMJ, orthodontists. They worked wonders, but I never really got permenant results until I removed gluten, and went to a Paleo-ish diet. Even now, stress can bring back the TMJ, muscle tension, and headaches.

    • Excellent reply, Michelle. I completely agree – malocclusion absolutely is a cause for some people and should be addressed, but often the most healing comes when both malocclusion and the factors I’ve listed in the article are all dealt with together.

  38. Mine showed up after a forced 650 mile motorcycle ride via several cups of coffee. I was gritting my teeth while I rode. Within days my mouth was very hard to open. Scary actually. Real tight and painful. Within a week I could open it fairly wide but the MAJOR Clicking was very evident….loud actually. On my left jaw. That was 1982-3. Today, 2015 and still clicking away. I ignore it most of the time as it is NOT painful at all. ZERO stress for years now and no noticeable difference.

  39. Thanks for this, Chris.
    TMJD was one of the presenting issues with what turned out for me to be chronic Lyme. Removing food triggers (for me, dairy is main offender but nightshades and grains as well) has brought 90% relief.
    I’ve found TMJ issues very common with Lyme patients and think all dentist should suggest testing.
    I wish I better understood the neuro inflammation and if there are other factors at play for me.
    Am working with Dr Schweig so am hopeful for more answers. Am in the “test, don’t guess” phase! :O
    Rebecca

  40. I’ve had TMJ my whole life & just believe it is a congenital malformation of the jaw. Sure, it is made worse by stress but so is everything.

  41. I had terrible TMD for several years (during which I also had chronic daily headache, severe carpal tunnel syndrome, migraines, and probably fibromyalgia) and all of them resolved when I addressed: gut health, inflammation, and malnutrition. Turned out I had celiac and was extremely deficient in a number of nutrients. But I suspect one could end up in a similar state even without the celiac.

  42. I have found through an elimination diet that nightshade spices caused increased jaw inflammation and pain for me. I was surprised at that, and my dentist was too. But I have repeatedly tried these spices with the same results. I was hoping it was a fluke. I so miss my cayenne and paprika.

  43. Fascinating information. Will check this out in more detail.

    Had bad headaches over 20 years ago, which became much better with a mouth guard (for German knischerschiene). And daily excercises also help.

  44. This is not covering all causes of TMJ. Mine came on after a 2 hour dental extraction and having my jaw clamped open the whole time.

    I agree with what you are saying for people who have TMJ from stress but there are other groups, Micro/Macro Trauma for example who this has nothing to do with grinding…..

  45. Sorry, while I agree that these might be contributing factors, they are not the cause.

    Bottle feeding of babies leading to lower toungue posture, lack of chewing (processed foods), extractions and orthodontics, and mouth breathing due to allergies or other factors, have led to an epidemic of weak long-jawed humans whose phisilology is all out of whak.

    Small upper jaw (toungue no longer sits snugly up against roof of mouth as it should) and so falls back into airway (sleep apnea). vertical lower jaw (rather than horizontal) closing of air ways and squeezing of sinuses, facial deformities like retruded chin and long face. Extractions and orthodontics pushing the mandible back.

    This is where you should be looking for the cause. Check out the work of Dr. MIKE MEW. He’s leading the way.

  46. As a dentist I have been frustrated for years at not being able to give patients a decent answer regarding TMD. This article is very useful, thank you.
    Incidentally, I have had wonderful success in the last 3 months in getting relief in my TMD and chronic headache suffering patients by administering botulinum toxin A into their masseter muscles.

    • Hi Mark,

      After several X-rays, CT scans, etc. it was determined my TMJ pain was all muscular, not joint related. I’ve been clenching my teeth at night ever since I was a kid. Botox has saved me from a lifetime prescription of muscle relaxants. Five years ago, I was lucky to find an Asian doctor experienced in doing the procedure for cosmetic reasons. The dose at the beginning was fairly high (90 if I remember correctly) and has now been reduced to 20 every 3 months (half on each side, in 4 injections total). I’ve played around with the dosage and tried to reduce it over the past 5 years, but that seems to be the winning dose for me. Anything less and the pain comes back earlier.

      I hope this testimony helps and encourages more to give it a try. A permanent treatment would be preferable by far, but in the meantime…

      • Yep it’s unbelievable. I was taken aback by the high proportion of patients that came back with no morning headaches for the first tie. They can remember (my wife is one such patient, it has been life changing for both of us) and waking up fresher and without facial tension either. I’m convinced a. Lot of chronic headaches including migraines might have their origin in jaw muscle spasm. I’ve recently injected my own masseters. Obviously this is an interceptive treatment (albeit a wonderful one) and it’s important to try to get to the root causes, hence the value of Chris’s article.

    • Be carfull of Botox in people with gut issues IBD and auto immune conditions as I went into a full blown flare of my IBD for 3 months after injections. Never again! I have only gotten relief from my TMJ and jaw clenching by increasing my magnisium the topical works best for me( though dries my skin some)! I do think Adreanal health oils be. A contributing factor and am continually trying to address this.

    • Hormone changes during menopause contribute to blood sugar dysregulation which can contribute to stress. Cutting back on carbs might help, although if you are reading Chris’s website, you probably already have!

    • The beginning of your cycle is when progesterone drops very low and estrogen starts to come back up. For some people progesterone is insuffiecinent relative to estrogen. But Kelsey is right: this might possibly trace back to an adrenal problem.

  47. I have been a “grinder” since I was a child (now 36). I never felt I was particularly stressed…at least not more the average. I have a very narrow lower third portion of my face. I have crowded teeth. Much of my grinding stopped when I changed my diet, the other percentage of grinding I have been able to manage with regular chiropractic adjustments. I believe a large part of the problem with my malocclusion/grinding issues is with the lack of “width” in my palate. I’m currently wearing a retainer (DNA Appliance) which is slowing opening/widening my palate to make room for my tongue and to help line everything up correctly. What are your thoughts on TMD/TMJ and palate width (if any)? Is there any research out there that supports this? I think the WAPF is right on with the whole nutrition/facial bone structure concept.

  48. For anyone’s interest, TMD is a reflection of unresolved hypertension in a person. Inflammation increases this tension. And the source is not always reflected in the jaw. It can be a result of an off-balance pelvis. Scar tissue, whether local or not. Trauma like a car crash or falling off a horse. Birth trauma. Etc., etc.

    One can chemically cope with TMD or surgically attack it, but if you don’t treat the person as a whole mind-body being, TMD can come back or manifest in tension elsewhere and create a new symptom or syndrome to distract.

    What reflects tension in the body at a physical level? Consider fascial system.

  49. This is fascinating and helpful. I developed intense intermittent pain in my left ear after a traumatic experience 6 years ago. My holistic dentist said there was no mechanical problem with my TMJ. I mentioned it to the chiropractor who is helping treat my Hashimoto’s and adrenal fatigue, and he pinpointed my TMJ as the origin of my ear pain. He performed several techniques that relieved my pain immediately and it has not returned since. Of course, I have also made great gains in stress management as part of my healing protocol. It makes so much more sense to me now. Thank you!

    • This makes me hopeful. I have really bad ear pain that I have been told is tmj related but I haven’t found a practitioner that can really help me yet. It started after the birth of my son and I also have hip pain at times. I will keep looking for the right person to help get me back in balance.

      • Rebecca,
        Ear pain that started postpartum…and hip pain?
        Test for chronic Lyme! (using Western Blot through IgeneX lab with Lyme knowledgeable practitioner)
        In the meantime…do an elimination diet. Dairy and nightshades are my trigger foods. Dairy gives me facial and ear pain within 5 minutes.
        Good luck!
        Rebecca : )

        • What is the correlation of Lyme and post partum? I have done many elimination diets and they don’t seem to have an effect beyond helping inflammation. I do not eat dairy. I should say I had hip dispalcia as a child and carrying a baby to term seems to have thrown me off.

          • Hi Rebecca,
            Postpartum depression lowers the immune system. When your immune system is lowered, the body becomes more susceptible to Lyme. Postpartum can come about from a hormonal imbalance post-pregnancy or fatigue from a lack of adequate support in child-raising. If not from this, perhaps ask for a thyroid check-up.

    • Me too. My chiro was able to help realign my jaw after it had been pulled out of alignment by stress (tightening of masseter muscle).

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