I’ve been having pain in and around my jaw for several months. My GP can’t find anything wrong but I’ve read that there is a condition called temperomandibular joint disorder which causes jaw pain and is said to be more common in ME. Is this true? And what can I do when I have a GP who doesn’t seem to know anything about how to diagnose or treat this condition?
The two temporomandibular joints connect the jawbones to the skull. So temporomandibular joint disorder (TMJD) affects the ‘chewing’ muscles and joints between the jaw and the base of the skull. Conditions that may increase the risk of people developing this type of fairly common jaw joint problem include various types of arthritis, jaw injury, persisting grinding or clenching of the teeth, and stress. As you say, there is also some evidence that TMJ disorder is more common in people with ME/CFS.
In addition to causing pain or tenderness in the jaw and in the jaw joints, other symptoms can include:
- Clicking, popping, or grating noises when you chew or move your mouth.
- Pain in front of the ear that may spread to the cheek, ear and temple.
- Difficulty opening the mouth – so the jaw may feel tight, as if it is stuck, making eating difficult.
- Headaches or migraines.
- Earache or a ‘buzzing’ or blocked sensation in the ear.
Some people with jaw pain also tend to clench or grind their teeth. However, there are plenty of other people who regularly clench or grind their teeth and never develop TMJ disorders. There are a number of investigations that can help to diagnose the cause of jaw pain. A CT scan can provide detailed images of the bones in the joint. An MRI scan can reveal problems with the joint’s disk. TMJ arthroscopy involves the insertion of a small thin tube (cannula) into the joint space. A small camera (arthroscope) is then inserted to view the area.
Pain and discomfort associated with TMJ disorders may settle down without any specific treatment and can often be relieved with simple self-help measures:
- Resting the joint by eating soft food and avoiding chewing gum.
- Holding a warm or cold flannel to the jaw for 10- 20 minutes, several times a day.
- Doing gentle jaw stretching exercises – which your doctor or dentist can advise on.
- Avoiding opening the joint too wide until the pain settles.
- Avoiding clenching the teeth for long periods of time.
- Massaging the muscles around the joint.
- Relaxation techniques if stress is a factor.
- Mouth guards may be helpful if you grind your teeth.
These are plastic devices that fit over the teeth at night to reduce jaw clenching and teeth grinding. They can be made to measure by your dentist. Painkillers such as paracetamol, ibuprofen, or codeine can help relieve the pain associated with TMJ disorder. If these don’t control the pain, your doctor can prescribe stronger medication such as a muscle relaxant or an antidepressant. Steroid injection into the jaw joint can help reduce pain and swelling in a joint. If the above measures don’t help there are surgical options that could be considered – including what is called a joint wash out (= arthrocentesis). Having outlined all the key facts about TMJ disorders I would suggest that you make an appointment with your dentist – because dentists have far more expertise in diagnosing and treating TMJ disorders than most doctors do!
If you have been diagnosed with ME/ CFS plus a TMJ disorder please let us know which treatments have helped and which treatments have not helped.
Medical Matters is for information purposes only. The answers provided by Dr Shepherd and the ME Association’s other expert advisers should not be construed as medical advice. We recommend that any information you deem relevant is discussed with your GP as soon as possible. It is important to obtain advice from a GP who is in charge of your clinical care, who knows you well, and who can consider other likely causes for symptoms. Seek personalised medical advice whenever a new symptom arises, or an existing symptom worsens. Don't assume that new or worsened symptoms are a result of having ME/CFS.