Out of Joint

Stress can cause severe jaw pain, and women are often the victims. Now, researchers are seeking to take the bite out of a problem called TMJ Syndrome.

November 04, 2005|By KAREN BLUM | KAREN BLUM,SPECIAL TO THE SUN

Stress takes its toll on the human body in many ways. It can cause heart palpitations, headaches and stomachaches, sweating and irritability. Some people overeat while others lose their appetite.

For about 10 million Americans - many of them women of childbearing age - stress causes severe jaw pain, a condition called TMJ Syndrome.

The term refers to a host of problems affecting the jaw muscles and temporomandibular joint, the hinges located adjacent to the ear that connect the lower jaw to the temporal bone at the side of the head and allow freedom of movement to chew, speak and swallow.

TMJ symptoms include jaw muscle tenderness, difficulty opening the mouth, jaws that lock and a clicking or popping noise heard when opening and closing the mouth.

Though TMJ isn't new, it continues to be poorly understood, says Jennifer Haythornthwaite, a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.

"TMJ is kind of a challenging problem," she says. "It affects work, family and moods, and there aren't any really good treatments."

In women ages 25 to 55, TMJ is often associated with depression, anxiety, sleep disturbances, gastrointestinal symptoms or frequent infection.

"My jaw feels very tight," says Judy Roos, 52, who has had jaw pain for more than 10 years. Over time, it's become so difficult for the Perry Hall resident to open her mouth wide that she put off going to a dentist. "It's almost like my face is in a vise and being squeezed."

To find answers regarding the causes and prevention of TMJ, the National Institutes of Health is currently funding at least six clinical trials of potential treatments, from an injected arthritis medication to acupuncture and even spiritual healing.

How the joints work

The TM joints are among the most complex joints in the body. When a person opens his or her mouth, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone at the side of the head. When the mouth is closed, the condyles slide back to their original position. To keep this motion smooth, a soft disc that lies between the condyles and temporal bone absorbs shocks from chewing and other movements. Any problem that prevents the complex system from working properly may result in TMJ.

In Baltimore, two NIH-funded studies are evaluating pain management for TMJ and the interaction between TMJ pain and sleep disorders.

In the first study, funded by a $2.4 million grant from the National Institute of Dental and Craniofacial Research, Haythornthwaite is working with dental experts at the University of Maryland Dental School to evaluate whether a combination of pharmacological and psychological treatments for TMJ is better than either one alone in reducing pain and disability associated with the condition.

Study participants from 18 to 65 who have had TMJ pain for at least three months are randomly assigned to take either the antidepressant nortriptyline - which has been shown to relieve TMJ pain - or a placebo once a day for eight months. Participants are also randomly assigned to receive either education about the condition or a series of cognitive-behavior therapy sessions with a psychologist for stress management.

The therapy sessions use relaxation techniques to help participants break bad habits, says study co-investigator Michael Smith, an assistant professor of psychiatry at Hopkins.

"We teach them to be more aware of what they're doing, like clenching their teeth or biting pencils," Smith says.

So far, investigators have enrolled more than 100 of 140 targeted patients. The volunteers range from "single moms of teenagers to college students struggling to pay bills and set up a life," Haythornthwaite says.

About 80 percent of the participants have had treatment for TMJ before, says co-investigator Dr. Edward Grace, director of the Brotman Facial Pain Center at the University of Maryland Dental School.

Managing stress

One study participant under heavy stress is Joanna Gaitens.

The 32-year-old Baltimore resident faced numerous deadlines while completing a graduate program at Hopkins' Bloomberg School of Public Health this year. She also worked part time for a children's environmental health organization. On top of that, her younger brother, a Marine, was deployed to Iraq and in occasional phone calls home expressed feeling scared.

Over the past two years, Gaitens noticed a gnawing pain in her jaw.

"On days when it was really aggravated, I avoided chewy foods like bagels because it was just too much effort," she said.

Gaitens' boyfriend referred her to the study, where she was diagnosed with TMJ. Nine months later, she says, "most days, my pain level is zero. I also notice when I'm doing things to worsen it, like clenching my teeth or resting my head on my hand."

Gaitens says deep-breathing strategies helped her manage stress, and the mouth guard she wears to sleep prevents her teeth from clenching.

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