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. 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)
To decrease your inflammation, it is first crucial to get your HPA axis functioning normally, as HPA dysregulation increases inflammation.
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!
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Hormone Balance
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.
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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.
Are you gluten free grain free & night shade free?
This is very important for you to stop autoimmunity.
So glad to hear you’re pain-free, Lynn!
Hi! Do you recall what that exercise is with your mouth and tongue?? I know this is an old thread, but would love to know!
Thank you!
April
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!
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.
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.
Going Gluten Free eliminated my life-long migraines and other aches and pains, maybe it would help you.
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!
Awesome, Laurel!
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. 🙂
I agree completely Michelle.
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.
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.
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
Morton’s Toe can be a huge factor in TMJ. Just ask anyone with a long second toe!
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.
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.
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.
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.
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…..
Absolutely, Lee. This article is not to say there are no other causes, just pointing out some of the lesser known factors that contribute to TMD.
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.
There are certainly other factors here, malocclusion included. These are just some of the lesser-known factors!
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.
Glad to hear the article was useful for you!
Noticed I experience increased pain in my when my menstrual cycle begins. Any advice on how to balance?
Meant to type “in my jaw”
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.
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.
Totally agree with you.
I too have been a grinder my whole life and it’s completely gone since going paleo. Coincidence? I think not!
http://www.facialdevelopment.com/
Hi Lea. Take a look at the above website that explains how one can expand the palate and improve symptoms of sleep disordered breathing like UARS which is associated with TMJ .
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.
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, if you are looking for therapy, I’d suggest this.
http://www.myofascialrelease.com
They have a therapist directory per state.
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).