Temporomandibular Joint Dysfunction and Psychology

by Paul Greene, Ph.D. & Barry August, D.D.S.

Temporomandibular Joint Dysfunction, commonly referred to as TMD or TMJ, is a musculoskeletal disorder that is associated with pain from the neck to the head. The TM joint itself is located just in front of your ear. By placing your first finger on that spot you can feel its movement when you open and close your jaw.

TMD occurs when these joints and /or the muscles and ligaments that support them are injured, causing dysfunction and pain. The degree of pain and suffering may range from intermittent and tolerable to chronic, excruciating and totally disabling.

Generally, the definitive diagnosis is made by a dentist after ruling out other possible causes like arthritis, infection, tumors or other infrequent possibilities. Surprisingly, the root cause of this problem often stems from trauma, a physical injury to that area of the body.

The trauma can be a direct blow to the head or face, an indirect blow like a whiplash injury, or a microtrauma such as clenching or grinding the teeth repeatedly when under emotional stress. Sometimes the pain may not start for several months or even years after the initial injury. Other times it may be a succession of individual traumas, until one finally initiates the dysfunction and pain.

TMD can be the source of complaints of headaches, earaches, facial pain, jaw clicking and popping, locked jaw, neck and shoulder pain, or even dizziness. The trauma leads to injury or spasms in the muscles used for chewing food and the neck muscles, and possibly additional injury to the tissues within the joints.

There are several ways in which psychological factors may play a role in TMD. Sometimes when people are under too much stress, they clench or grind their teeth together, or tense their muscles, knowingly or unknowingly, and cause injuries to themselves.

Other times, muscle tension caused by emotional stress, prevents a physically injured area from healing which results in continuing pain. Still other times, people who have had repeated treatment failures cannot trust their doctors and don't cooperate with the treatment plan. This prevents themselves from getting proper help. Whatever the cause of the pain, having pain causes changes in one's behavior, feelings and thoughts. It can damage every aspect of one's life.

The road to wellness begins by taking responsibility for your own health. Become part of the healing process with your doctor by making sure you feel confident in their expertise and capacity to help. If you have reason to trust the people who claim to be able to help, then you are more likely to follow their instructions and this will increase your chances to get well. If you find that you cannot get along with doctors, it is advised that you do some self-analysis to understand the reason.

Often, doctors give patients the feeling that if they are not getting well then it is the patient's fault rather than the doctors limitations. With many diseases and especially TMD, nothing is further from the truth. Generally, the pain and other symptoms are caused by real, physical tissue damage that can only be exacerbated by stress.

However, there are honest, sensitive doctors out there, and some of the problems may be related to your behavior and attitude. Honesty with oneself and with an impartial, confidential psychotherapist is useful to determine the cause of your conflicts with doctors. TMD can be frustrating to both patients and doctors.

When the suffering is so great as to cause disability, it is best to work with a team of professionals who will work with you to regain full functioning. A team may include a dentist, psychologist, physical therapist, neurologist and other specialists.

One of the simplest and most common procedures for treating some of the psychological aspects of this disorder is stress management. While the entire topic is too broad for this article, specific techniques for TMD have been developed and can be tried by anyone. Stress management may prove useful to you if you have found any of the following true:

• pain that gets worse with stress or tension
• certain people or situations make the pain worse
• work or family pressures are made more difficult because of the pain
• you find that the pain frequently makes you irritable
• you feel nearly out of control, with no idea how to cope with the pain
• others perceive you as being "stressed out"

Learn About Stress

Whenever there is something out of the ordinary to do, stress results. Major life events cause bigger changes, stronger feelings and more stress. Emotional stress increases physical stress, fatigue and depression.

Sometimes, nervous or depressed feelings are obvious, but they may go unnoticed. The jaw, head, neck muscles are especially prone to becoming tense from stress. This can cause or increase TMD and pain. It can also make treatment and recovery more difficult.

You Can Change Your Reactions

Notice what happens to your body when you become nervous, depressed or are under stress. Many people find that they are clenching or grinding their teeth, that tension builds around the head or neck, or through the shoulders. By recognizing when stressful feelings are reaching the affected areas of your body, you can start to change your response from a tense one to a more relaxed reaction.

Learn How to Relax: Relaxation Training

1. Sit comfortably in a chair or lie down on a bed or sofa. Turn off the TV, phone and radio.
2. Clear your mind of everything except for a single, calm word, like "relax."
3. Let all your muscles relax, from head to toe, let go and breathe comfortably.
4. As your mind drifts, gently bring your thoughts back to your calming word, "relax."
5. Continue to let your muscles relax even more deeply, let go.
6. When relaxed, notice the position and feel of your jaw, head, neck and shoulders.

Let yourself remain in this quiet, relaxed state for about 20 minutes each day. Relaxation is something we learn to do and get better at the more we practice.

Plan When and Where You Will Use The Relaxation Technique After you have mastered relaxation training, try to create a relaxed feeling when you notice yourself becoming tense. Practice keeping your jaw, head, neck and shoulders relaxed during stressful moments or when you anticipate one. By doing this, the injury or spasms in the muscles used for chewing food and the neck muscles, or the injury to the tissues within the joints, are less likely to become painful.

In general, most stress management techniques can assist your recovery. There are at least two other articles at this site that may be useful, 12 Suggestions for Taking Care of Yourself [1], by Thomas Wright and Relaxation for the Rest of Us [2], by Brendan Lloyd.

About the Authors:

Paul Greene, Ph.D.
Psychology Department
Iona College
New Rochelle, New York

Barry August, D.D.S.
Head and Facial Pain Management Program
in the Department of Neurology
New York University Medical Center
New York, New York