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May 24, 2023 – Tooth pain is the worst. It can appear seemingly out of nowhere and interfere with eating, drinking, and daily activities. But what happens when the pain isn’t necessarily in the teeth but rather around the face, jaw, and neck?
Shane G., a 40-year-old finance manager living in Austin, TX, is painfully aware of the distinction. After sitting through what he explained was an extremely stressful meeting in his office one day, he decided to take his laptop to a bar and end his work with a game of basketball and a beer.
“I took a sip of the beer and it was like the corners of my mouth were on fire,” he said. “It was a sharp, sharp pain with heat attached; There was clearly something wrong.”
The type of pain Shane was experiencing is more commonly known as orofacial pain and includes more than 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.
About 5% to 12% of the US population have 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-directed strategies that can help ease the misery.
He was able to schedule an emergency appointment with a knowledgeable dentist who suspected the problem was his jaw muscles. After taking X-rays and fitting a night guard to address possible grinding and clenching, Shane was referred to a massage therapist. He not only identified the root of his pain, but he was able to find some degree of relief after one session.
Not everyone is so lucky.
There are “clinicians who are simply not familiar with the diagnosis and are too quick on the trigger to provide irreversible treatment,” said Clifford Chow, DDS, an orofacial pain specialist in the Center for Orofacial Pain and Dental Sleep Medicine and an associate professor. . at the University of California-San Francisco School of Dentistry.
“Unfortunately, with the delay, conditions can change and things can get worse and more difficult to treat,” he said.
often misdiagnosed
Although not rare, orofacial pain disorders are often lost or confused with other conditions by dentists and doctors. And TMDs often come along with other conditions, such as fibromyalgia and migrainesmaking diagnosis even more difficult.
“In dentistry, we have this saying: If you hear hooves, think horses, not zebras,” said Lisa Crafton, DDS, a dentist in private practice in Columbia, MD.
For “most people who come in with facial pain, most of it is muscular,” he explained. “And I feel like most people have it after a stressful episode. Or for some, it could be 2 weeks after a stressful incident and then suddenly their jaw is killing them.”
“If you think of a skull, the lower jaw is supported by muscles,” Crafton said. “So, I always start off thinking, okay, let’s try muscle release.”
Katie Pudhorodsky, a licensed massage therapist based in Austin, Texas who focuses on head, neck, and jaw work, has treated Shane and many others with TMD pain. Pudhorodsky has become a go-to for many dentists who, like Crafton, recognize the muscular component in certain TMDs immediately.
Massage can often help treat pain related to two of the most common TMDs: myofascial pain (discomfort or pain in the connective tissue and muscles that control the jaw, neck, and shoulders) and myalgia (muscle pain that has to do with jaw movement). – for example, in the masticatory muscles, which allow you to chew food).
Pudhorodsky explained that TMD pain appears in a variety of forms and is often referred, meaning it hurts in areas other than the exact location of the jaw muscles, joints, and tissues. Symptoms include headaches, 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 seeking relief.
“They’ve brought up this conversation with their dentist or their medical provider that they’re in pain, and they give up. They move from one specialist to another until someone says, ‘Hey, these muscles are tight; maybe that’s a piece of the puzzle,’” she said.
Nataly S., a 32-year-old Austin investigator, said she landed in Pudhorodsky’s office after experiencing sudden pain in her jaw and what she described as a “jaw snapping.”
“I was going through a particularly stressful time emotionally,” she said, reflecting on the experience. “I went to my dentist, who recommended that I get a mouth guard. But he also asked me what my symptoms were, how long it had been going on and he said I would benefit from a specific TMJ massage.”
Nataly felt relief 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 relief pillars
Pudhorodsky sees patients in person but also offers detailed education and online exercises. Most of his work is geared towards helping people achieve and maintain muscle relief and is based on four pillars:
- “Pillar one is to relax the muscles and reduce trigger points. And that is done through massages and stretching, ”he explained. “This can be done by a professional or by yourself at home.
- Pillar two is to retrain the muscles that were compromised; these exercises are also used to stabilize the bite.
- The third pillar is to maintain a proper oral rest posture. “That’s looking at proper oral rest posture. We want our tongue to be on the palate, lips together and slightly parted,” Pudhorodsky said.
- And “the fourth pillar is to address bad usage habits; this is when you start to stop making those bad patterns continue.”
Managing 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 relaxing tight muscles and retraining joints to move in a more balanced way, massage can help fix some of the problem, relieve pain and, as Pudhorodsky explained, “make room for healing.”
Chow said patients should be proactive and ask whoever is treating them what their diagnosis is.
“If they just say they have a TMD, that’s not a diagnosis; it’s a broad term of disorders, and they’re often the ones that might miss something,” she said. “They have to be more specific in diagnosis and more specific in treatment.”
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