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The Scoop on TMD Pharmaceuticals

Let's say the National Institutes of Health just handed us a multi-million dollar grant to get to the bottom of TMD and find a cure once and for all. I mean, we could start handing out heating pads left and right, but that kind of relief can only get us so far. Whenever I try a different form of therapy or medication, I like to think about the biology, right down to the cellular and molecular level. Why are the cells that make up my jaw region being such jerks?

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Sustained and Repeated Mouth Opening Leads to Development of Painful Temporomandibular Disorders Involving Macrophage/Microglia Activation in Mice

Temporomandibular disorder (TMD) is a set of heterogeneous musculoskeletal conditions involving the temporomandibular joint (TMJ) and/or the masticatory muscles. Up to 33% of the population has had at least one symptom of TMD with 5-10% of them requiring treatment. Common symptoms include limited jaw movement, joint sound, and pain in the orofacial area. Once TMD becomes chronic, it can be debilitating with comorbidities that greatly reduce one's overall quality of life. However, the underlying mechanism of TMD is unclear due to the multicausative nature of the disease.

Prevalence of TMD in Sjӧgren Syndrome Patients

Sjӧgren's Syndrome seems to play a role in temporomandibular joint disorders.

Early Molecular Response and Microanatomical Changes in the Masseter Muscle and Mandibular Head After Botulinum Toxin Intervention in Adult Mice

The Botox-injected masseters had greatly increased expression of genes involved in muscle atrophy at the 1 week time point compared to the control side muscles. At the end of the study, 2 weeks after injection, the Botox-injected masseters were about 20% smaller than the control side masseters, and the Botox-side condyles had lost about 40% of relative bone area compared to the control side condyles.

Katie's Story

  • May 13, 2015

Pain

My TMJ pain comes in many forms.  It starts with soreness in my jaw, usually one side or the other, not both at the same time.  As it worsens it feels like tooth pain.  Terrible tooth pain that moves from tooth to tooth so you can’t tell which it is.  When it’s really bad the entire side of my face is in pain.  My teeth, my cheeks, my jaw, my ear.  It can feel like an earache or a headache.  It can feel like my teeth are going to fall out of my head.  My neck hurts, my back hurts, my shoulders hurt.  I think that I will die before the pain goes away. 

Beginning

My pain started in high school about a year after I had my braces removed.  I had no idea what was wrong and my dentist said it was TMJ and to stop chewing gum.  He also fit me for a mouth guard.  With advil, the pain eventually went away.

Braces

I now realize that having braces was the ultimate beginning to my pain.  Some people will say it’s because when you have braces your bite changes, which I guess is true for me because I had two teeth removed when I got braces.  However, I think the real reason having braces started my TMJ pain was because I clenched my teeth to cope with the pain of braces.  I distinctly remember that clenching my teeth together to relieve the pain.  I got in a bad habit of clenching my teeth night and day, which I have yet to break.

Popping

Yes, my jaw does “pop” or “click” but only if I open it too widely, move it side to side, or try to make it happen.  I’ve learned to avoid all situations where popping or clicking might happen, because it can trigger the pain.  No huge yawns, no trying to see if I can get it to pop for others to hear, no massive bites, and reminding the dentist that, “Sorry, I cannot open my mouth any wider.” 

Dentist

The pain would come back after every time I went to the dentist.  To this day, I am guaranteed to be in terrible pain for at least two weeks after a trip to the dentist.  Keeping my mouth open for a cleaning or a filling just for half an hour will trigger the pain.  Dentists tell me to take advil before I come and after, and try to be quick, but the pain is inevitable.  Every dentist I have gone to has said I have jaw pain associated with TMJ. 

Guards/Splints

I have had several dentists make me mouthguards over the years.  Right now I have one, and I do use it, but I know that it doesn’t stop me from clenching my teeth.  It’s the clenching that causes the pain, and sometimes I think having the mouthguard in triggers the clenching.  But, if I’m going to clench, I know it is better to have the guard in so it’s a catch-22.  

Cycles

My pain comes in cycles or episodes.  After going to the dentist, when I am stressed out, when I have pain other places in my body.  The problem is that I cope with stress by clenching my teeth.  I will be in terrible pain for several weeks or sometimes months and then I will relax enough for it to be dormant for a while.  But it comes back.  I think of it like spraining your ankle.  You sprain it by putting too much stress on it, or tweaking it the wrong way.  If you keep walking or jumping or standing on your sprained ankle the pain is never going to go away.  You have to stop using it, rest it, take care of it and the pain will go away.  But that ankle will always be weak and prone to sprains. 

Stress

As I’ve gotten older I’ve realized that I hold my stress in my shoulders and jaw.  I can clench my jaw without my teeth even touching just by putting stress on it.  It is an unconscious behavior that I am constantly telling myself to stop.  When I have greater than normal stress levels the pain is almost certain to come back.

Sleep

When I’m in pain, I can’t sleep on my side or stomach because that side of my face hurts to even touch.  I hate sleeping on my back, but I do it.  I’ve read that sleeping on your back helps your jaw to relax into a more natural position.  I don’t know if this is true, but I do know that sleeping on my side leads to jaw pain in the morning. 

Relief

By now, I’m sure you are all wondering what I do to make it better.  Well, I have tried lots and lots of things.  Mouthguards don’t make it better but they keep me from ruining my teeth.  I’ve tried weekly massage, and it helps with the back and should pain, but not the teeth pain.  I regularly exercise and do yoga, but neither prevent the pain.  Probably because I still clench at night, immediately counteracting everything else.  Taking advil/ibuprofen (150mg every 4 hours) can keep the pain at bay if I catch it early enough. For example, if I’m going to the dentist but have no other large stressors, taking advil alone for a few weeks can keep the pain mild and help it go away.  When the pain is terrible though, the kind of pain where I can’t sleep for days and I’m walking around like a zombie, I have tried taking more heavy-duty drugs.  Vicodin will help with the pain for a few hours, but it comes back.

Last Time

During my last episode, I was in gradually increasing pain for nearly six months.  Advil worked for several months to keep the pain tolerable, even forgettable during the day while I was busy.  But my life got extremely stressful during that time for other reasons and the pain just wouldn’t go away and in fact got worse and worse. I went to the doctor to have her check out my ear because it was aching terribly in addition to the mouth pain.  I thought maybe I had burst my eardrum while scuba diving a few weeks previous.  She said it was slightly inflamed, but I must be experiencing jaw pain.  It only got worse. 

After searching online I decided to try some new things.  I tried jaw exercises, I cut out all caffeine and alcohol from my diet, and I listened to a “stop bruxism” hypnosis every night.  Nothing helped.

I went to the dentist thinking I must need a rootcanal because the pain was more intense than I had ever felt.  He did several x-rays and told me I had a small cavity on the opposite side but it certainly wasn’t causing this pain.  He told me it was my jaw.  Stupidly, I let him fill the cavity thinking the pain couldn’t get any worse and I should still take care of my teeth.  Well, that just sent the pain to a new level.  

I couldn’t sleep. I could barely open my mouth to eat.  I was a walking zombie.  It felt like a terrible muscle cramp that wouldn’t go away.  I would be up all night pacing the apartment in tears, getting in hot showers, and icing my face. During this period of time, I also stopped eating solid food.  I lived on smoothies and yogurts and even those still hurt to swallow.  I wouldn’t have eaten anything, but I was starting to have blood in my stool from all the ibuprofen.  My husband (a medical student) was very worried. 

Finally, I went back to the doctor.  She immediately could tell that something was terribly wrong because I looked like hell.  She listened to my story, said that it was my jaw causing TMJ pain and then she said four magic words, “Let me help you.”  Bless this doctor.  She immediately gave me a shot of anti-inflammatory drugs and I was able to go home and really sleep for the first time in days.  She also prescribed a pain reliever (opiate) called Tramadol and an anti-inflammatory drug called Diflofenac.  After several doses of the Tramadol I started to feel really loopy and high, but with much much less pain.  It was more like pressure than pain, it was still there but it didn’t bug me, sort of like when the doctor gives you a shot before they fill a cavity.  The Diflofenac is what really helped though.  After taking it twice a day for a week, the pain lightened.  I was able to stop taking the Tramadol after the first week.  I kept taking the Diflofenac for seven days after the pain went away on doctor’s orders.

Looking back, it’s hard to say if it was the Diflofenac that helped stop the pain or if it was the fact that I stopped eating, or both.  In the future, at the first hint of jaw pain I plan to stop eating food that requires much chewing and start taking Diflofenac.

This was definitely the worst and longest lasting cycle of pain I have had, but it also helped me find some more solutions to the problem.  On a daily basis, I wear my mouthguard, I exercise and practice yoga, I try to be consciously aware of if I’m clenching my jaw during the day, and I drink plenty of water.   I am still trying to break myself of the nighttime clenching habit because I know it is the root of all my TMJ problems. 

A Note about Prescription Drugs

Although I’ve said above that the Tramadol helped, I don’t recommend taking it or any prescription pain reliever if you don’t have to.  Like all opiates, there is the potential for dependency.  It also caused internal stomach bleeding.  I recommend reading up on any drugs you are given and being sure to ask the doctor about dependency, side effects, dosage, and how long you can safely take them.

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