Stress

One of the most common afflictions affecting people is head and neck pain. Most pains we either learn to live with, or take a mild analgesic to control. When no recognizable medical cause is identified, we are conditioned to accept our ailments as either stress or psycho-emotionally induced. We are told that the pains are "in our heads". We therefore do not search further for other causes.

In modem western societies, stress related syndromes are on the increase. For many years stress has been known to play a role in the production and maintenance of many disease states.

When we talk of stress we are conditioned to bundle many stressors under one umbrella. The reality is that we can identify a number of major stressors, which can be grouped into some basic categories; Psycho-emotional, Environmental, Heavy Metals, Electrical, Toxins, Diet, Biomechanical.

Whatever the source of the stress, most people will have a similar physiological reaction. This is what Hans Selye calls a 'General Adaptation Syndrome'. It is the way we cope with stress at a cellular and biochemical level. If the stress continues for long enough (which is different for each one of us), we will then start exhibiting clinical symptoms. The symptom pattern will manifest according to our individual make-up.

Temporomandibular joint (TMJ) dysfunction falls into the category of BIOMECHANICAL stress. If the jaw joint is malpositioned it will act as a permanent, non-self-correcting stressor. Due to the complexity of this joint and its relationship to different body systems we see a great variety of symptoms. The most common is head and neck pain.

The Temporomandibular Joint

The Temporomandibular joint is the name of the joint formed between the base of the skull (temporal bone) and the lower jaw (mandible). Both the left and right joints must work in unison whenever we move our jaws. In effect these two hinge joints are really one related unit. The Temporomandibular joint is the most complex joint in the body. It is able to move in a multitude of directions which includes moving completely out of the joint space when the mouth is fully open. The resting position of the joint is determined by the condition of the bone, by the muscles which move the jaw and, in particular by the way the bottom and top teeth meet. This is called the occlusion. Any or all of these may hold the joint in an abnormal position.

If the joint is located in this abnormal position it will create a pattern of chronic stress on the whole of the body.

Traditionally, TMJ dysfunction was thought to cause only symptoms of pain in the joints and teeth and was sometimes associated with limited mouth opening. More up to date research shows us that due to the multiple relationships within the body, we must reassess the symptoms related to problems in the jaw joint. Of interest to most people is the strong relationship of the joint to chronic head, neck and shoulder pain.

Skeletal Relationships

When the mouth is opened just a few millimeters, the centre of rotation is roughly along the long axis of the joint. As the mouth opens further to a fully opened position the head of the jaw bone (condyle) translates forward. It actually moves out of the fossa at the base of the skull. This then causes a centre of rotation to be located between the first and second vertebrae in the neck.

In practical terms what this means, is that if the joint is malpositioned, the first two vertebrae in the neck will also undergo torsion and rotation to compensate. Biomechanically the first three vertebrae in the neck move in the same direction as the last three vertebrae in the lumbar (lowest) part of the spine. If the first two vertebrae are malpositioned, it will force a compensatory change all the way down the spine. If severe enough this may cause a tilt in the pelvic girdle and thus produce a functional short leg. Posture is directly affected. In the same way if you have a leg shorter on one side, this will also tilt the pelvis and cause a compensatory shift up the spine to the base of the skull. Such a situation may then influence the way you close your mouth and produce a malpositioning of the TMJ. If the vertebrae are chronically malpositioned we can expect symptoms of pain but also symptoms created by an impairment of either the blood or nerve supply which emerges between the vertebrae.

Muscular Relationships

The first muscles which contract when the mouth is closed (e.g. chewing, clenching or grinding) are all of the muscles at the back of the neck. In fact, even muscles in the leg will contract synchronously when the mouth is closed. The next muscles which contract are those at the side of the temples (temporalis) and lastly those directly next to the mouth (the masseters and pterygoids).

Any situation which causes clenching or grinding of the teeth will therefore cause a contraction of the muscles of the head and neck.

Another cause of muscle spasm is damage at the point of attachment of the muscles to the bone. This type of damage is common in cases of whiplash-type injuries and causes tears where the muscle attaches to the bone (called soft tissue lesions). These lesions will, in themselves, cause head and neck pain which may be referred widely. Spasm in the muscles of the head and neck will influence the way we clamp our teeth.

Chronic muscle spasm of the neck will cause a compression between the vertebrae of the neck and will result in associated problems.

Central Nervous System Relationships Temporomandibular joint problems will affect, in particular, that part of the central nervous system known as the Autonomic Nervous System. This is the part which controls all of the unconscious functions of the body. It has two functions similar to an accelerator in a car (sympathetic) and the brakes (parasympathetic). One of the typical physiological results of chronic stress of any sort is that the accelerator part of this system is activated. This is great in times of acute stress as it allows us to escape from danger. In chronic stress however, we have a fight between the two halves of the system. A great deal of energy can be used just to maintain a state of equilibrium in our bodies. Eventually the break pads wear out - clinical symptoms then become evident. These symptoms are those less commonly associated with TMJ problems such as hormonal disturbances, digestive problems, bright light sensitivity and sinusitis.

Some Symptoms

The most common dental symptoms are clicking or popping sounds in the joint chewing difficulty, and pain when chewing, jaw locking in either open or closed position and pain in or in front of the ears.

Often we see a wide variety of head and neck pain which may range from occasional headaches to chronic migraines. Pains may radiate down the arms and chest. Other symptoms may include dizziness, ringing in the ears, lethargy, depression, fatigue, cold hands and feet, kidney problems, PMT, and some learning disabilities.

Treatment

Treatment of TMJ dysfunctions must take a multidisciplinary approach. Generally the dental part of the treatment is to adjust the way the top and bottom teeth meet so that the joint may be correctly relocated.

In some cases we may simply need to adjust the height of an individual filling which may be interfering. Sometimes we may include the provision of a dental splint which is usually worn over the lower teeth and so provide a temporary relocation of the joint. It may need to be used full time, but in most it may only be necessary to wear it at night. Another way of providing the extra support on the back teeth, is to bond plastic filling materials to the biting surfaces of the teeth. This will have the same effect as the splint. If teeth are missing it may be necessary to provide a partial denture or more permanent crowns and bridges. In some situations, orthodontic movement of the teeth may be the preferred option. The forms of treatment are as varied as the individual condition. Each person must be individually assessed. The bottom line is how to reposition the joint in the most effective and long term way.

Other health care providers may also be called on. Often the services of a podiatrist will be needed to correct leg length discrepancies. Massage is always a great help in treatment and maintenance phases. Osteopathic and chiropractic maintenance may also be helpful. Sometimes acupuncture may be needed. We rely on the help of many different people depending on the individual case.

As with most health conditions, a team effort by the appropriate specialists is the preferred approach to treatment. TMJ problems are the special melting pot of traditional dental and medical skills and those of the natural therapies.

Go to top of page