TMJ & The Pandemic – The Back Story

If you’ve been seeing an increased number of patients with broken or fractured teeth over the past two years, it comes as no surprise. Along with broken and fractured teeth, the pandemic is responsible for a significant increase in the number of patients presenting with aching jaw muscles, sore TMJ joints, headaches, and neck pain. TMD and orofacial pain problems are complex, but the pandemic has made them even more so.

In my practice, we’re seeing an increase of patients of all generations – from as young as 10-years old to people in their late 80s. For some, the dominant source of their muscle and joint dysfunction and pain is clenching their teeth during the day and grinding them at night. For many others, however, angst and emotions alone have led to a generalized state of fight-or-flight, disrupting their lives and leading to alterations in their breathing, musculoskeletal dysfunction, and pain.

These patients are seeking care not only in my office but with chiropractors, massage therapists, acupuncturists, and clinical psychologists. They’re seeking a way out of something for which there are no simple solutions.

The most significant increase in my office is in elderly patients. Covid has altered their physical and mental stimulation and caused major restrictions on their socialization. This disruption has created emotional angst coupled with long and lonely days. The result, for many, is anxiety and depression, which upsets the brain and creates physical changes leading to musculoskeletal pain. Not only do these patients have face and neck pain (often for the first time in their lives), but many also suffer from headaches.

Because many elderly patients are reluctant to come into the office, we offer Zoom telemedicine consultations. Telemedicine allows us to provide education and insights regarding the origins of their orofacial and jaw-related pain. It enables us to initiate home care strategies such as moist heat/cold applications, massage techniques, exercise videos, and diaphragmatic breathing programs. In this way, many of our elderly patients experience a reduction of symptoms within a short period of time.?And at times, if the pain symptoms sound more ominous, a prompt visit to a physician is encouraged.

From an overall perspective, however, just having a diagnosis and discovering that their symptoms are common and familiar makes patients feel better. It’s also my sense that just having contact with a caring medical professional provides a sense of comfort and optimism that things will get better.

As expected, our typical types of patients – female teenagers, college students, and young adults – still dominate our daily schedule. The pandemic has disrupted and put their lives on hold, too. The resulting depression and anxiety make it hard for some students to focus and concentrate, particularly in highly-challenging academic environments. Many turn to ADD and ADHD medications which activate the sympathetic nervous system. Some are taking antidepressants which are linked to increased sleep bruxism.

There’s another subset of patients that has emerged during the pandemic. These patients have symptoms that are more profound than their physical findings. They have high levels of pain but less physical evidence to support a muscle or joint-based diagnosis. I believe they are likely in trouble as a result of nerve excitation, what we call?sensitization. In these scenarios, pain occurs in the?absence?of noxious stimulation and, for many of these patients, touch prompts pain. It appears that a large group of continuous risk factors including anxiety, depression, insomnia, lack of exercise, poor diet, and excessive work hours may predispose to this neuropathic pain condition.

The bottom line is this: we must take the time to sit down with our patients who are suffering. Broken teeth and jaw pain are just the consequences of uncontrollable changes in people’s lives. These difficult times require a fuller investigation. Get the back story.

After 35 years of practice in the field of orofacial pain and TMD, it’s satisfying to know that we can help most patients, even those who can’t or are reluctant, to come to the office. I continue to be optimistic that ongoing research will continue to assist success in our clinical practice.