Living with TMD
When you think of the term “bone joints,” the ones that normally come to mind are knees, elbows, ankles and hips. Everyone at some time or another has experienced pain in these areas. Usually, the pain comes from overuse or a minor injury and heals in a few weeks, or in severe cases is relieved by a replacement of the offending joint. But what are the options for the millions of people that suffer chronic pain of the jaws?
The jaw, or temporomandibular, joints (TMJ) are actually the most frequently used joints in the body. Eating, drinking, talking, laughing, singing, grinding your teeth, and a hundred other movements of the face require the use of the TMJs and muscles. Damage to these joints is excruciating and can be very difficult to treat. In 2004, I suddenly began having severe facial pain. It was so bad, all I could do was hold my face in my hands, rock and cry. I called a dentist who agreed to see me as a work-in. After talking to me about the pain and my medical history, he suspected a temporomandibular disorder (TMD) and referred me to a specialist. He also prescribed Darvocet for the pain, a common medication for treating TMD.
I took the Darvocet and a couple of days later traveled the 100 miles to the specialist. I spent probably close to an hour with the assistant as she went over every detail from having me describe and rate the pain to measuring how far I could open my mouth without pain, and then measuring how far I could open with pain. She examined my teeth, my bite, and sprayed my jaws with a freezing substance that instantly took the pain away (unfortunately, only for a short few minutes). The specialist reviewed everything, examined my teeth again, and began to explain TMD and the usual first treatments.
The causes of TMD can vary from person to person. Misaligned teeth may be a culprit as the jaws are not able to rest in the proper position. Grinding your teeth in your sleep, or clenching your jaw during the day, are another cause. Many people who have TMD often experience flare-ups during periods of increased stress for this reason. Injury to the jaw or face can also cause chronic pain. And, as suspected in my case, osteoarthritis (as well as rheumatoid arthritis) can affect the jaws just as it does other joints.
According the the National Institute of Dental and Craniofacial Research, only a small number of people develop significant long term difficulties. The disorder affects twice as many women as it does men, but the exact causes are unknown. Even the experts seem to be in dispute about causes and treatments. Unfortunately, I happen to be one of those “small number” of people.
I cannot remember a single day in the last two years when my face has not hurt. The pain radiates into my head and down my neck, causing headaches, earaches, stiff neck and muscle spasms. I had to give up singing, something I have done all my life and that was always a great joy and comfort for me. No choir, no singing in the car, no singing while cleaning or cooking, or in the shower. If I do forget and sing a couple of songs, it takes hours for the pain to subside to the “normal” level again. I do not eat steak. I get chills just watching someone else chew gum. I smile only briefly. I do not eat Tootsie Rolls, or sip frosties through a straw, or eat submarine sandwiches. My meals and activities are planned around my level of facial pain at that particular moment. Occasionally, this means that my activity consists of sitting on the couch, making sure the back of my head does not touch the cushion, and holding a homemade moist heat compress to my face. At times, I cannot bear for anything to touch my face or head, such as pillows, sun glasses, hats, putting my hair in a ponytail, or holding the phone to my ear. I had to give up certain duties on my job that required a lot of interaction with other people because talking was excruciating. Often, dinner consists of ice cream, yogurt, or scrambled eggs. I have read about other sufferers who resort to eating nothing but baby food.
The specialist I saw made a bite plate that fits over my misaligned teeth and helped briefly, and then oddly began to cause more pain. I had to stop taking Darvocet because it made me severely depressed, a rare but serious side effect. I now take half of a Demerol when the pain becomes unbearable, Flexeril each night, and rotate between ice or heat compresses. And I wait for the day that maybe I will wake up and the pain will be gone.
Fortunately, most cases of TMD are not as severe as mine and will alleviate over time. The symptoms of TMD are pain in the muscles of the jaws, limited movement or locking of the jaws, radiating pain in the face, neck or shoulders, and painful clicking or popping sounds in the jaws. Many people experience popping of the TMJs and never experience pain. As for myself, I never experienced the clicking and popping until after the severe pain began. Treatments vary for each case, and many previously used treatments are now being shown to have little or no benefit. If you suspect TMD, call around to find a dental professional that either specializes in the disorder or has experience in treating it.
The American Dental Association and the National Institute of Dental and Craniofacial Research are good places to start for information on the disorder. As for the homemade moist heat compress I mentioned, it is very simple to make. Use a soft tube sock, fill it approximately half full with uncooked rice, and then sew it shut. I also added a little potpourri to mine for “aromatherapy.” Heat the sock in the microwave for 30 to 40 seconds, and it is ready to use. It can be reused and reheated many times and is just as effective as expensive, store-bought versions. Learning to cope with the pain and learning your triggers are the best defenses in facing TMD. Relaxation techniques can help such as deep breathing and visualizing each muscle as it relaxes and finds a comfortable resting position. Your dental professional can teach you exercises to do every day that work the muscles without straining them. Ask your spouse, or your mother, if you grind your teeth in your sleep. Simple props can help, such as rolling a small piece of gauze and placing it between your teeth. And, as I have had to do, learn to accept the pain as a normal part of your life, rather than raging against it when you crave a steak. New research and scientific evidence are being developed all the time, so don’t give up hope.
