Is your jaw giving you a headache? By Lucy Elkins Last updated at 10:29 PM on 06th October 2008 For more than a year, teacher Pat Queen suffered from a severe throbbing pain in her ear and throat. As a result, she was off work for weeks at a time. 'It felt as if someone had tightened an elastic band around my throat,' recalls Pat, 65, from Glasgow. 'I was taking loads of painkillers, but that only helped a bit.' Earache, back pain or headaches could be caused by temporomandibular joint pain dysfunction syndrome where there are problems with the joint which connects the skull and the lower jaw to the side of the face (file picture) After three months of going back and forth to the doctor - who couldn't work out what was wrong - Pat saw a dentist. She was then sent back to the doctor, who sent her to an ear, nose and throat specialist. 'The consultant told me my throat looked inflamed, but he had no idea what was causing it,' she says. Pat ended up taking seven months off work before finally, a year after the problem had begun, she saw another dentist who immediately diagnosed what was wrong: temporomandibular joint pain dysfunction syndrome, or TMD. Few will have heard of it, but the condition is actually common. Experts say that as many as 70 per cent of the population suffer from it at some point. (It's four times more common in women and usually occurs between the ages of 20 and 50.) However, many people are undiagnosed, their symptoms put down to headaches, ear infections, problems with their teeth or even their back. As a result, they endure weeks, months, or even longer periods of debilitating pain. Yet once the correct diagnosis has been made, many cases can be easily and swiftly treated. The temporomandibular joint is the 'hinge' connecting the skull and the lower jaw at the side of the face. The jaw is not attached directly to the skull, but is held in place by muscle; sitting in between the skull and the jaw bone there is also a disc of cartilage, which acts as a shock absorber. TMD is a term used to cover a range of problems with the joint, the disc or the surrounding tissue, and it can be caused by a variety of factors. Frequently chewing gum and grinding or clenching the teeth can overwork the muscles, making them inflamed. This is the most common cause, says Professor Tara Renton, a pain specialist at the Dental Institute at King's College London. 'Some people grind their teeth at night and are unaware of it until they develop pain or stiffness in their jaws in the morning. 'Stress makes people more prone to this and the incidence of TMD peaks during exam times and when people feel under pressure at work.' A minor injury or even dental work, such as having a crown or multiple fillings, which throws the jaw slightly out of place, can also lead to TMD. Misalignment in the jaw can, in turn, pull other joints out of line, causing neck and back ache. 'Some TMD pain may also originate from poor posture which has had a subtle effect on the position of the jaw joint,' says Harley Street dentist Dr Malcolm Levinkind. 'Malocclusion - when the upper and lower teeth do not sit together properly - can also cause TMD,' says Dr Roy Higson, president of the British Society of Occlusal Studies ('occlusal' means relating to the biting surfaces of the back teeth). Other experts disagree with this. Misalignment But whatever the cause, the end result is the same: agonising pain. And what makes diagnosis difficult is that the pain is often 'referred'; many people suffer from headaches, earaches, neck ache or radiating pain through the shoulder blades and down their back. It can even cause aching eyes as a muscle near the jaw is linked to a nerve at the back of the eye. 'TMD is often misdiagnosed,' says Professor Renton. 'People go to the doctor complaining of earache or a headache, the doctor can't see anything wrong, so sends the patient away or advises them to go to a dentist. 'Ultimately, they might be sent to an ENT specialist, who finally works out the problem is coming from their jaw. 'But many of my patients have been to ten or 15 specialists before they get to me.' Dentists are often the first medic patients see, but they may not recognise the condition. 'Despite the pain TMD can cause and how common it is, many dentists receive inadequate training in the diagnosis and treatment of it,' says Dr Higson. 'A proper diagnosis is vital and yet can be very difficult. People may get told their pain arises from all sorts of things - even that it's psychological.' Some patients who complain of toothache may have their teeth removed unnecessarily, as the dentist has not realised the pain originates in the jaw muscles. 'We get a lot of calls about TMD, especially from those who have had dental work or teeth removed to try to relieve the pain in their jaw and, rather than making the problem better, it makes it worse,' says Heather Wallace, chairman of the charity Pain Concern. 'We had a call from one woman in Glasgow who, under recommendation from her dentist, over time had all of her perfectly healthy teeth removed to try to help stop the jaw pain that was leaving her in agony. 'Afterwards, she was in even more pain.' The good news is that, once diagnosed, the condition is treatable. As Professor Renton explains: 'Around 90 per cent of cases can be treated by simple steps - by no longer chewing gum or by using bite guards that prevent over-clenching of the teeth and so allow the muscles in the area to rest. 'Some people also take anti-inflammatory painkillers or mild anti-depressants which help relax the muscles.' Treatable Dr Higson says it's important to get the right bite guard. 'Soft bite guards, such as those bought off the shelf, softened in water, and when inserted, allowed to adapt to the shape of your mouth, do not work as well as a hard splint custom-fitted by your dentist,' he says. Jane Crawley developed TMD, she found the treatment using the Bowen technique - involving manipulation and massage - helpful. Jane, 44, a housewife from Birmingham, had woken up one morning unable to open her mouth without being in severe pain. 'On a scale of one to ten, my pain was an eight and everything else was being hampered by this,' she says. 'Yet my dentist just gave me a leaflet on TMD pain and showed me the door.' Out of desperation, last February Jane went to see a Bowen practitioner. By then the pain had spread to her neck and shoulder. 'I tried a night splint but it did not work. I read on websites that people with TMD found Bowen eased their pain, so I thought I'd give it a go,' she says. The treatment is said to help realign muscles and ligaments to their correct position using a gentle rolling massage technique. 'After one session I was able to open my mouth wide enough to eat a slice of cake. I couldn't believe it. I had treatments about once a fortnight for three months and I am now almost completely better,' she says. Some dentists, including Dr Levinkind, now work with specialists in muscle and joint manipulation, such as osteopaths. 'As a dentist, I can give a patient a splint to help her jaw, but by working with an osteopath who can improve someone's posture, we can also solve backache. This could also prevent TMD pain reoccurring,' says Dr Levinkind. Scientists don't fully understand TMD. 'There has been a great deal of simplification about it,' says Friedy Luther, a senior lecturer and honorary consultant orthodontist at the University of Leeds. 'We don't know why some people clench their teeth and get TMD and others do not. We don't really understand why women are so much more vulnerable. 'It may be that hormones play a part or that while some people are prone to headaches, others are prone to TMD.' Meanwhile, Pat Queen's problem has been cured with a combination of muscle relaxant pills and a night splint to stop her grinding her teeth. 'Within a week I was better, and I've been fine since,' she says. 'The relief has been extraordinary.'

PREVIOUS

NEWS-LINKS MAIN PAGE

WEBSITE HOME

NEXT