Soft tissue causes of TMJ and jaw pain

Clenching your jaw is a natural response to a stressful or frustrating event but imagine if your jaw was permanently stuck like this.

Millions of people find themselves in a cycle of jaw clenching and tooth grinding (called bruxism) which impacts not just on their teeth, but also their general health. The Mayo Clinic lists the following common symptoms of bruxism:

• Tooth grinding or clenching which may be loud enough to wake up your sleep partner;
• Flattened, fractured, chipped or loose teeth;
• Worn tooth enamel exposing sensitive tooth pulp;
• Tooth pain and sensitivity;
• Pain and tightness in the jaw, neck or face;
• A locked jaw that won’t open or close properly, or that clicks and pops when it does;
• Earache and dull headaches;
• Damage to the inside of your cheek from chewing;
• Sleep disruption.

People can be affected by some or all of these seemingly unrelated symptoms and therefore the diagnosis does not always point to jaw problems.

When tooth pain is the main symptom, the first stop is usually a dentist who may prescribe a night-splint or mouth guard to prevent further tooth damage. However it doesn’t always stop the grinding and people describe chewing their way through a succession of splints. Sometimes a dentist may adjust your bite by reshaping the surfaces of your teeth, moving your tooth alignment with a brace, or even surgery to adjust the shape of your jaw.

If people have jaw pain and other symptoms, but not necessarily bruxism, they may be given a diagnosis of TMJ pain or TMJ syndrome. TMJ stands for the temporomandibular joint, or jaw joint, and the term TMJ is often used as shorthand to refer to problems related to the jaw.

Medical approaches to TMJ include muscle relaxants, anti-anxiety drugs or Botox injections.

Some people who have TMJ, bruxism, or in some cases both, try some or all of the above treatments but still have symptoms. This can be because their problems are caused by restrictions and trigger points in the soft tissues (muscles and fascia) of their jaw, neck and shoulders.

The primary culprit is usually the masseter muscle. You have two masseters, one on either side of your face, which connect your cheekbone to your jawbone. You can feel them if you place your hands on the side of your cheeks and clench your jaw.

The masseter is a multi-layered muscular arrangement which makes it one of the strongest muscles in the body. It has a bite strength of 25kg on your front teeth and 90kg on your molars. It is also one of the most active muscles, almost constantly in use when you are awake. Not only does it enable talking and eating, masseter tension keeps your mouth shut, and it also helps posture by stabilising your neck.

If the masseter is designed to do this much work, why does it lead to problems for some people?

Your soft tissues are meant to be reactive, tightening when needed for movement and then returning to a relaxed state. Sometimes when we are stressed, anxious or under pressure, the tissues don’t have this opportunity to let go as your body is constantly on high alert.

This is particularly the case for the masseter where it doesn’t take much to move it into a permanent state of tension. It is very reactive to stimulants such as caffeine, alcohol and some medication, and is one of the first muscles to tighten when we are stressed or angry.

Even when you sleep a tight masseter can’t switch off and instead goes into uncontrolled overdrive, leading to tooth grinding and clenching. Over time fascial restrictions and trigger points in the masseter can lead to many of the typical symptoms of bruxism and TMJ listed above.

How to help yourself

If dental or medical interventions aren’t helping, then there are other self-help techniques that can be effective to help reduce symptoms. Self-help myofascial release stretches and exercises can help to release trigger points and restrictions. These are particularly effective when combined with mental relaxation to reduce stress and anxiety such as meditation, relaxation breathing or simply going for a walk.

Whatever combination you use, the key is to develop a regular daily practice as this will help to overcome your learned tension habits and replace them with helpful patterns of movement and relaxation.

You can find out more information about self-help myofascial release and relaxation in our Living Pain Free video programme HERE.