Reviewed and approved by Dr. Cory Herman
How to Overcome Psychological Distress Triggered by TMJ Dysfunction and Remain Positive
There is a strong relationship between stress and the development of chronic TMJ. A TMJ associated mood disorder is treatable.
Temporomandibular disorders or TMD refers to an orofacial pain condition in which pain and discomfort affect the temporomandibular joint, the related jaw muscles, or the adjoining tissue components. It can be challenging to remain positive during the treatment when suffering with face, head, or neck chronic pain and its associated limitations. Understanding the correlation between TMJ and psychological distress or TMJ and anxiety can help a person deal with TMJ pain better. First, let’s gain a definition and the basic concepts of what is psychological distress triggered by TMJ dysfunction.
What is TMJ Dysfunction?
It is called a TMJ dysfunction when the muscles and ligaments around a person’s jaw joints become inflamed or irritated. The condition may be diagnosed as acute or chronic, and the related pain may be mild or severe. The complex interrelationship between oral and psychosocial health may surface when sustained muscle activity associated with bruxism is known to cause tenderness in the TMJ as well as chewing muscles. Further, it may lead to functional disorders of the jaw joint, often manifesting through a jaw clicking or popping sound.
Pain patients often report challenges to remain positive and consistently engaged during extensive TMJ treatment. With a pain management team or personal counselor, it is easier to anticipate and gain progress. Going at it alone, or worse – without the correct diagnosis, may contribute significantly to feelings of being overwhelmed, discouraged, or depressed and the jaw joint dysfunction may progress.
“An orofacial pain specialist has additional education and training which allows them to offer an evidence-based standard of care needed to accurately diagnose and treat both simple and complex orofacial pain disorders. Orofacial pain specialists serve as a consultant to other dentists and physicians. They may direct treatment, prescribe medication or rehabilitation services, perform pain-relieving procedures, counsel patients and family, direct a multidisciplinary team, or coordinate care with other healthcare providers as necessary. Prolonged distress can be a barrier to managing chronic pain. Clinical pain management in a positive and professional environment may contribute to an individual’s success in overcoming the challenges when suffering from ongoing orofacial pain.” – Dr. Cory Herman
Psychological Distress is Associated with Painful Temporomandibular Disorder
Jaw limitation and a person’s pain coping skills have a high impact on their quality of life
The Characteristics associated with high-impact pain in people with TMD: a cross-sectional study first published on October 4, 2018 discusses how high-impact pain diminishes a TMJ patient’s quality of life. The study’s objective was to discover the variables that distinguish between high- and low-impact pain among individuals with painful temporomandibular disorder (TMD). It was determined that “one-third of the participants had high-impact pain”.
The characteristics that identify coping capabilities between people with low- and high-impact TMD pain include their personal ability to cope with pain. Study findings also emphasize the importance of correcting jaw limitation and early identification of painful body sites associated with pain-related impact. The NIH study states that “Approximately 70% reported having ever seen a health care provider for facial pain. Among people with high compared to low-impact the frequency of reported treatment seeking was 76% and 67% respectively”.
The struggle to stay positive if you face psychological distress triggered by TMJ Dysfunction is very real.
When ongoing jaw pain negatively impacts someone’s quality of life, a person’s psychological stress state when facing TMJ Dysfunction commonly includes anxiety and depression. NIH also determined that “Besides, psychological stress can cause spasms and disharmony in the chewing muscle groups. Clinical studies have shown that higher prevalence rates of psychiatric disorders among patients with TMD when compared to healthy people.”
“Depressive and anxiety symptoms should be considered as risk factors for TMD pain. Depressive symptoms are specific for joint pain whereas anxiety symptoms are specific for muscle pain, findings that deserve detailed examination. These findings may support decision-making in treating TMD.”
Additionally, the NIH study found that “among orofacial pain patients, movement from low to high GCPS status results in a $525 increase in healthcare costs over 6 months”. Additional out-of-pocket costs may further exacerbate stress levels.
How is a Cycle between TMJ and Stress Created?
When you experience stress, your muscles including those in your temporomandibular joint or TMJ tighten up and may hurt. Over a period of time that your muscles continue to be overworked, this causes pain and stiffness. Likewise, if you are experiencing TMJ symptoms, it impacts your daily routine activities and may induce stress. This is how a cycle between TMJ and stress is created.
TMJ pain may be a physical symptom of both depression and anxiety. Accompanying mental health conditions may lead to increased activity in the jaw muscles which in turn causes jaw muscle inflammation and pain. It’s also thought that chemical imbalances in people’s brains when suffering from depression and anxiety may lead to abnormal processing of pain sensation.
“Stress can therefore be understood as a perceived imbalance between the demands encountered in daily living and a person’s capability to respond. Stress, somatic distress, and depression may be potential etiological risk factors for TMDs-related pain.” – Ines Heinen, Department of Medical Psychology, University Medical Center Hamburg
Can Untreated TMJ Dysfunction be Debilitating?
Yes. For some TMJ patients, the pain that comes with having TMJ dysfunction is severe, unrelenting, and debilitating. Undiagnosed and untreated TMJ pain or delayed treatment not only affects a person’s sleep, but also your mood, eating habits, and may impact if you sit and walk with good posture. Insufficient sleep alone can be debilitating. While TMJ is not a life-threatening disorder, if left untreated, your pain symptoms are harder to manage and can negatively affect your quality of life over time.
Why Internal Derangement of the TMJ may Impact Mood
A TMJ-associated mood disorder is not uncommon; physical progress is easier when you overcome anxiety.
Many people dealing with TMJ find that it’s a chronic pain issue. Any time that a person experiences ongoing chronic pain it is possible to have depression and or mental health problems develop. If you are suffering from extended chronic pain, you probably have struggled with mental wellness to some extent.
People left to face anxiety caused by pain alone commonly have a tougher TMJ treatment journey.
Research shows that stress can cause or magnify or extend TMJ symptoms. We hear complaints of pain more often when stress levels are higher. I know that personally, the more stressed I am, the more I feel pain in my jaw. With higher stress levels reported due to the pandemic and its uncertainty, many have reported more pain and locking of the jaw.
Our pain specialists believe that there is a link between depression and anxiety symptoms and temporomandibular joint (TMJ) disorder pain. TMJ pain may be a physical symptom of depression or anxiety and trigger more health issues if untreated. No one should face mental health conditions alone and without hope of improvement. It could lead to increased jaw muscle activity that causes further inflammation and pain.
Patients at the MN Head & Neck Pain Clinic report that consistent TMJ exercises relieve pain. They’re found to help: strengthen jaw muscles, stretch the jaw, relax the jaw, increase jaw mobility and range of motion, and improve a person’s outlook.
What are Common Pain Symptoms of TMJ Dysfunction?
Symptoms of TMJ Dysfunction may include:
- Decreased jaw mobility.
- Excessive clicking or popping of the TMJ.
- Unusual pain in or around the jaw joint and attached muscles.
- Jaw locking or limited opening range of the mouth.
- Pain that feels like it coming from behind the eyes.
- Prolonged dizziness.
- Experiencing earaches or ringing in the ears.
- New habits of clenching or grinding of the teeth.
- Feeling neck, shoulder or back pain.
- Fingers feel numb or tingle.
What to Avoid that may Hinder Jaw Function?
Practical things to NOT do that may be contributing to a lack of jaw function:
- Biting your finger nails.
- Chewing or compressing your lower lip.
- Compressing your top and lower teeth together when they should rest between use.
- Running your tongue between your front teeth and biting on it.
TMJ Patients may Face a Cluster of Related Disorders
The National Institute of Dental and Craniofacial Research provides this image that explains the muscles that move the jaw and the joints which connect the mandible to the skull. Frequently, TMD is treated as a single syndrome, but the prevailing current approach is that that the person suffering from it faces a cluster of related disorders with many common features.
Emotional stress may manifest in anxiety, depression, or anger. It may increase pain by causing unconscious, inward feelings that defy the intellect and increase skeletal activity. The interactions within a person’s biological systems can be described as a vicious “anxiety-pain-tension” cycle which is thought to be often involved in TMD.
A person who has experienced a traumatic event may not realize the extent that it impacted how the jaw opens and closes. Too often the person’s contributing factors are poorly understood without the care of an Orofacial Pain Specialist. Treatment of TMD, anxiety disorders, and facial pain may use anti inflammatories, a jaw device, or an intra articular disc. Whether the patient experiencing emotional distress is more of a consequence of pain rather than a cause, it remains a significant factor in their recovery and well-being.
Steps to Overcome TMJ Dysfunction and Related Psychological Distress
Psychological distress triggered by TMJ jaw issues can be overcome in most cases.
- Regular exercise, meditation, laughing out loud, getting some fresh air, etc., can help a person handle stress better.
- Making conscious efforts to remain calm especially before bed time. Simple breathing or jaw exercises and calming aroma therapy can help ease jaw pain.
- Create a log of your jaw pain to identify if jaw locking occurs on a daily basis.
- Touch your tongue to your top front teeth to relieve jaw stress and avoid teeth clenching.
- Do exercises designed to strengthen your upper back muscles and improve posture.
- Ask you orofacial pain specialist about taking over-the-counter pain relievers.
- Try limited use of ice packs or a heating pad and record if it helps.
- Follow through with your Orofacial pain specialist’s recommended treatment, prescribe medication, or rehabilitation services.
- When eating, be alert to how you chew; use on both sides of your mouth simultaneously.
- Avoid leaning on your jaw and slumping.
- Control your TMJ symptoms to help reduce secondary symptoms as well. Even if the jaw disorder isn’t the main cause of your anxiety or depression, it can contribute to psychological distress worsening.
Learn to Spot Depression from TMJ Dysfunction
Identify when you or someone else is depressed from chronic pain. Get information on the types of depression and how to overcome it. It takes more than a positive outlook, especially for the person who is suffering from pain and compromised movement of the jaw joint and the surrounding muscles. Worries of facing a TMJ surgery are most often unnecessary and only increase pain levels.
It’s unusual for major jaw surgery ever to be necessary in a case of TMD. We recommend first trying the wide range of conservative, reversible treatments available. When given sufficient time to work they almost always prove effective.
SUMMARY: You Can Beat Psychological Distress Triggered by TMJ Dysfunction
TMD is a common disease of the oral and maxillofacial region. Our pain experts are continually exploring better therapeutic approaches for TMJ patients; we understand its associated psychological distress triggers.
About the Author/Reviewer
Cory Herman DDS, MS manages the MN Head & Neck Pain Clinic and works to coordinate both simple and complex chronic pain disorder treatments.