Saturday, November 6, 2010

TMJ/TMD and Bruxism – Perpetuators of FM Pain and their role in the new proposed diagnostic criteria for fibromyalgia.

The presence of jaw pain is now being considered in the widespread pain index (WPI) for the new proposed diagnostic criteria for fibromyalgia. Temporomandibular dysfunction (TMD) most popularly known as TMJ, and bruxism (teeth grinding) are two common sources of jaw pain, and both can be perpetuators of headaches, which is part of the symptoms severity score in the proposed criteria. Both can be attributed to the presence of myofascial trigger points.

Temporomandibular dysfunction (TMD/TMJ), occurs when your chewing muscles are uncoordinated. This puts apposing muscles under undue stress and increases the occurrence of myofascial TrPs. Paradoxically the presence of myofascial trigger points (MTrPs) shorten and cause dysfunction of the muscle involved which can pull the jaw out of proper alignment causing TMJ. Temporomandibular dysfunction is often associated with chronic muscular headaches, craniofacial pain and the pain can extend to the ears, neck, and shoulders. Some people experience clicking and grinding noises during movement of the jaw. Limitations caused by the presence of MTrPs are related to untreated or undertreated myofascial trigger points which occur anywhere there is muscle, including inside the mouth. (Cooper & Miller, 2010, pages 40, 74, 78, 110, 193 and 378)

Bruxism is a fancy term for grinding teeth. This condition can aggravate facial trigger points, interfere with restorative sleep, cause teeth erosion, and, among other things, contribute to headaches and migraines. If you catch yourself grinding your teeth during the day, you most likely grind at night too. According to my dentist, and the following study, bruxism in sleep is much more forceful.

*Untreated trigger points in the mouth can also lead to neuralgia inducting cavitational necrosis.

Book Excerpt: Neuralgia-Inducing Cavitational Necrosis ©

Neuralgia-inducing cavitational necrosis is caused by cavities in the jawbone leading to destruction. It occurs after tooth extraction and is often missed on X-rays until significant damage is done. It is the result of a lack of blood supply to the area usually as a result of trauma or from an untreated trigger point inside the mouth. (Starlanyl and Copeland, 2001, pg 46). There can also be other causes, such as tissue being left behind with extraction or surgical removal, a weakened immune system, a poorly functioning thyroid, poor nutrition, or smoking. Chronic osteoporosis can also impede healing. Use cautionary measures to prevent necrosis after having a tooth extracted. The treatment, if necrosis occurs, is surgical removal of the bone and tissue involved. (Cooper and Miller, 2010, pg. 102)

Treatment Options

If you find yourself clenching/grinding during the day, place your tongue to the top of your mouth. You will be amazed at how much tension you were carrying physically even if you are not stressed mentally. This tip was from Lauren in a discussion group and IT WORKS!

Follow this link provided by the National Association of Myofascial Trigger Point Therapists, NAMTPT, referenced in our book on page 224 and 373. They are specially trained in Travell and Simons work and this is one of the most comprehensive treatment recommendations for treatment of TrPs (trigger points) associated with TMJ and Bruxism.

Besides addressing myofascial trigger points you should address this problem with your dentist, as it can cause serious tooth erosion. Mouth guards are now available over the counter at a reasonable cost.

Starlanyl and Copeland, Fibromyalgia & Chronic Myofascial Pain Syndrome: A Survival Manual. New Harbinger Oakland, Calif.: 2001.

Cooper, C and Miller, J. Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection. Healing Arts Press: Vermont, 2010 (links available at

1 comment:

Anonymous said...

I remember that fateful day when I had blinding pain explode along the side of my face. None of the doctors knew what was going on. My doctor told me it was impossible for pain to jump from my ankle (original injury site) to my face. I even had one doctor tell me I was just depressed!! I continue to deal with severe jaw pain, especially when I'm tired. Every time a doctor has said they don't know what my symptoms are from, I find them clearly explained either under FM or CFS, and often both!

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