May 24, 2023 – Tooth pain is the worst. It can come seemingly out of nowhere and interfere with eating, drinking, and daily activities. But what happens when the pain isn’t necessarily in your teeth but rather around your face, jaw and neck?
Shane G., a 40-year-old CFO based in Austin, TX, is painfully aware of the distinction. After attending what he said was an extremely stressful meeting one day at his office, he decided to take his laptop to a bar and finish his work over a basketball game and a beer. .
“I took a sip of beer and it felt like the corners of my mouth were on fire,” he said. “It was a sharp, sharp pain with heat attached to it; there was clearly something wrong.
The type of pain Shane was experiencing is more commonly referred to as orofacial pain and includes over 30 types of temporomandibular disorders (TMD) – conditions that affect the two joints that connect the jaw to the skull (temporomandibular joint), as well as the muscles and tissues of the jaw.
In regards to 5% to 12% of the US population has TMD. Because they are difficult to diagnose and can overlap with other conditions, patients often embark on what can seem like a never-ending quest to find relief.
Fortunately for Shane and others like him, there are self-help strategies that can help ease the misery.
He was able to schedule an emergency appointment with a competent dentist who suspected the problem was in his jaw muscles. After taking x-rays and arranging for a night watchman to treat any grinding and clenching, Shane was referred to a massage therapist. Not only did she identify the root of his pain, but he was able to find some relief after one session.
Not everyone is so lucky.
There are “practitioners who simply don’t know the diagnosis and are a little too quick on the trigger to provide irreversible treatment,” said Clifford Chow, DDS, orofacial pain specialist at the Center for Orofacial Pain and Dental. Sleep Medicine and Associate Professor. at the University of California San Francisco School of Dentistry.
“Unfortunately, with delay, conditions can change and things can get worse and harder to treat,” he said.
Often misdiagnosed
Although not uncommon, orofacial pain disorders are often missed or mistaken for other conditions by dentists and doctors. And TMDs are often accompanied by other conditions, such as fibromyalgia And migrainemaking diagnosis even more difficult.
“In dentistry, we have this saying: If you hear hoofbeats, think of horses, not zebras,” said Lisa Crafton, DDS, a dentist in private practice in Columbia, MD.
For “the majority of people who present with facial pain, most are muscular,” she explained. “And I feel like most people get it after a stressful episode. Or for some it could be 2 weeks after a stressful incident and then all of a sudden their jawbone kills them.
“If you think of a skull, the lower jaw is held together by muscles,” Crafton said. “So I always start by thinking, OK, let’s try muscle release.”
Katie Pudhorodsky, a licensed massage therapist based in Austin, TX specializing in head, neck and jaw work, has treated Shane and countless others with TMD pain. Pudhorodsky has become a reference for many dentists who, like Crafton, recognize the muscle component in some TDGs right away.
Massage can often help relieve pain related to two of the most common TMDs: myofascial pain (discomfort or pain in the connective tissue and muscles controlling the jaw, neck and shoulders) and myalgia (muscle pain related to the jaw movement). – for example, in the masticatory muscles, which make it possible to chew food).
Pudhorodsky explained that TMD pain manifests in a variety of ways and is often referred, meaning it hurts in areas other than the exact location of jaw muscles, joints, and tissues. Symptoms include headache, neck pain or stiffness, toothache, sinus pain, fullness in the ears, ringing in the ears (tinnitus), numbness and/or tingling.
The universal experience is that most of the patients Pudhorodsky sees in his practice are looking for relief.
“They’ve brought up this conversation with their dentist or health care provider that they’re having pain, and they’re being bamboozled. They’re moved from specialist to specialist until someone says, “Hey, those muscles are tight; maybe it’s a piece of the puzzle,” she said.
Nataly S., a 32-year-old researcher from Austin, said she landed in Pudhorodsky’s office after experiencing sudden pain in her jaw and what she described as a “clicking jaw.”
“I was going through a particularly emotionally stressful time,” she said as she reflected on the experience. “I went to my dentist, who recommended that I wear a mouth guard. But he also asked me what my symptoms were, how long it had been going on and said I would benefit from a specific ATM massage.
Nataly was relieved after a session with Pudhorodsky and continued to do her exercises twice a day.
“By the end of the week, the pain was gone,” Nataly said.
Four pillars of relief
Pudhorodsky sees patients in person, but also provides detailed education and online exercises. Much of his work focuses on helping people achieve and maintain muscle relief and is based on four pillars:
- “The first pillar is to relax the muscles and reduce the trigger points. And this is done through massage and stretching,” she explained. “It can be done by a professional or by yourself at the House.
- The second pillar is to retrain the muscles that were engaging; these exercises are also used to stabilize the bite.
- The third pillar is to maintain good oral resting posture. “It looks at good oral resting posture. We want our tongue to be on the roof of our mouth, lips together and slightly apart,” Pudhorodsky said.
- And “the fourth pillar is to tackle bad usage habits; that’s when you start to stop making those bad patterns continue.
Manage expectations
Like other pain conditions, TMDs are complex and appear differently in different patients. Massage is not the answer for every type or for every person. But by loosening tight muscles and retraining joints to move in a more balanced way, massage can help solve part of the problem, ease pain and, as Pudhorodsky explained, “make room for healing.” .
Chow said patients should be proactive and ask the person treating them what their diagnosis is.
“If they just say they have TMD, that’s not a diagnosis; it’s a general term for unrest, and often they’re the ones who might miss something,” he said. “They need to be more precise in diagnosis and more specific in treatment.