Jaw Pain: The Multifactorial Nature of TMD
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Jaw Pain: 3 Little Known Causes of TMJ

by Chris Kresser

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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?

137 Comments

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  1. As much as I didn’t want to take anything for menopause symptoms, my jaw pain flairs up when frequent hot flashes appear. And only Estroven works to calm both. Between all the science showing a preventative relationship between soy and breast cancer, and between menopause discomfort and soy, why would soy make hormones and pain worse?

  2. 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!

  3. 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!

  4. 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! 🙂

  5. 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.

  6. 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

  7. 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.

  8. 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

  9. 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.

  10. 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?

  11. 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]

  12. 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.

  13. 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:-)

  14. 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

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