Clenching and grinding: How jaw pain can be treated

The joint in the jaw is known as the temporomandibular joint (TMJ) and problems in the jaw are commonly referred to as temporomandibular disorder (TMD). These problems typically include pain in the side of the face, grinding of the teeth, stiffness of the jaw muscles and locking, clicking and clunking of the jaw.

As TMD affects both the jaw and the teeth, you should see both a physiotherapist and a dentist to develop a treatment plan. If left unmanaged, TMD pain is notorious for seemingly improving over months but then worsening pain over the subsequent months.

If you are experiencing jaw pain or discomfort, it’s important to seek professional help.

How do TMJ problems start?

Like injuries to most joints, problems in the TMJ often have an exacerbating moment, such as a sporting injury, car accident, chewing very hard food and intensive dental work.

Despite the injury possibly being historic, ongoing niggles can occur if it was never treated and the discomfort may appear long after the original historic injury.

There are exceptions and these need to be identified by a qualified professional.

Clicking of the jaw is the result of components within the TMJ moving out of place and this needs to be addressed as early as possible before long-term damage occurs and the joint becomes arthritic.

"Due to the close anatomical relationship between the neck and jaw, the upper spine may contribute to jaw symptoms."

Diagnosis

TMJ problems are complex and difficult to treat and thus it is advisable to visit your GP or a specialist who has specific training in this area. Effective treatment is based on an accurate diagnosis, which involves taking a full history, measurements of all the TMJ movements and assessment of stiffness and muscle spasms.

Assessment of the neck, back and posture

A full assessment of the neck and back is also important and includes posture, range of movement, vertebral joint stiffness as well as muscle spasm, flexibility and strength. Due to the close anatomical relationship between the neck and jaw, the upper spine may contribute to jaw symptoms.

This is similar to someone who has knee pain and walks with a limp. It’s often a matter of time before the muscles and joints around the hip and feet start to hurt. If there is jaw pain, the other muscles should also be assessed.

Types of jaw pain treatments

• Physiotherapy treatment. Treatment is then very specific to each area and can involve stretches, mobilisations, posture correction, and releasing tight muscles with massage or dry needling. All of these can be applied to the jaw, neck or back, depending on the cause or causes of the TMD. A home program of advice, self-management strategies and exercise would also be prescribed.
• It is also important to avoid hard foods and chewing gum, and to practise relaxation techniques. In the more acute stage, ice may be recommended but once chronic, heat is more effective.
• Medication. Muscle relaxants and anti-inflammatory medication can reduce pain and are good for short-term use, particularly if the pain is severe. However, if the underlying cause is not managed, then the use of medication will become less effective over time. Therefore, treatment should be in combination with non-medication therapy.
• Occlusal splints. If your teeth are being worn down from clenching or grinding, you may need an occlusal splint, which is a custom-fit layer of plastic to wear between your teeth. This is useful to protect your teeth while you try to break the habit of clenching or grinding.
• If the cause of clenching or grinding is from problems in the TMJ, then the cause needs to be treated. If your teeth have already sustained substantial damage, your dentist will discuss ways to repair the teeth and prevent further damage.

But what about complex TMD problems?

The treatment suggested here is the baseline for most TMDs. Exceptional cases exist which may require further types of treatment including types of arthritis and jaw reconstructions. Further consultation with your doctor, physiotherapist or dentist is recommended.

This article was written with Debbie Hogg, Principle Physiotherapist at Hyperdome Physiotherapy.