Health & Fitness

Clenching pain? It may be TMJ

For years, Kristie Eubanks was sure that her headaches were the result of sitting in front of a computer all day. Or maybe because of sinus problems, because her upper teeth hurt, too. But ergonomics consultants didn't relieve the pain, which typically was in the back of her head, "right under the ridge," and down into her neck.

Neither did surgery to enlarge her sinuses.

Nor muscle relaxers, nor shots for disc problems in her back, nor massage, nor chiropractic treatment.

Instead, the pain got worse.

"It's really ramped up in the last 10 to 12 years," says Eubanks, 47. "Literally, six out of seven days a week, I was in pain."

But recently, a remark by her physician produced a breakthrough.

And now, she is pain-free most days.

Eubanks made an appointment with her doctor a few months ago after developing a new symptom: pain at the back of her mouth, from the base of her tongue to her ear.

He said it could be any number of things. One of the things he mentioned in passing: TMJ.

Eubanks went online for some research. Her conclusion: "Huh, maybe."

TMJ stands for temporomandibular joint, the area just in front of the ear, where the upper and lower jaw meet. TMJ disorder can refer to a range of problems in and around the joint. Symptoms can include pain in the face, ear, neck, head or jaw, along with jaw clicking or locking, and difficulties chewing or biting.

TMJ problems are "very common," says Wichita dentist Roger Baker, who estimates he has treated more than 12,000 patients with TMJ disorders.

He did an informal study of 32 students at Wichita State University; 26 of them had a problem, he says — though he adds that not everyone with a TMJ disorder will have pain or discomfort.

Eubanks made an appointment with a dentist. As she was filling out her medical history, she convinced herself she was on another wild goose chase because she didn't have the jaw clicking or locking that can indicate TMJ disorder.

But when the dentist put pressure on the inside of her mouth, "I nearly came out of the chair," she says. He laughed and told her, "You're clenching and grinding your teeth at night.... And we can fix it."

He fashioned an appliance for Eubanks to wear at night. It helped, she says, but didn't totally relieve symptoms, so she made an appointment with Baker.

TMJ treatment isn't a dental specialty, but it makes up the majority of Baker's practice. He said a TMJ assessment is an option anyone with chronic headaches or neck pain might want to think about.

"The easiest way is to start off with a TMJ exam, and if they don't respond, then they can go on to other avenues," he says.

In fact, he says the majority of people with migraine headaches actually have TMJ problems instead. "The majority of time, we can eliminate them."

Baker made a new appliance for Eubanks' upper teeth. It resembles the retainers worn after braces are removed, but it has a couple of built-up places on it that prevent Eubanks from closing her jaw completely.

She wore it all the time at first but eventually will wear it only at night.

Not all dentists understand or appreciate TMJ disorders, Baker says, so patients may not get the correct diagnosis or appliance.

"As dentists, we very seldom would ask, 'Do you have headaches?' " But headaches, especially muscle-tension headaches, often are a clue to TMJ problems, he says.

For many patients, Baker says, a correctly designed appliance takes care of the pain. Some may need braces or other orthodontics.

Often, he says, just reassuring a patient that, yes, something is wrong is enough to help them feel better. "It's reassuring" that they're not just imagining it, he says.

Baker says medical or dental insurance occasionally — but not often — will help pay the average $1,500 cost of diagnosis and treatment.

Eubanks says the out-of-pocket cost was worth it to her. She feels like a different person without the chronic pain that had bugged her for years. "When it's gone, it's pretty amazing."