The Gnashing of Teeth, The Painful Face of Fibromyalgia

It is rather common for patients to complain of suffering chronic fatigue along with all the pain of fibromyalgia, but it seems to me that too often perhaps doctor and patient neglect to discuss the pain of Temporomandibular Joint Disorder (TMJD), which is also seen commonly in fibromyalgia patients. Perhaps this is because the patient and doctor think it is a dental problem, better left to a dentist. Unfortunately, many dentists think TMJD is at least in part a muscular problem, better left to the patient’s medical doctor.The reality is that the many patients suffering from fibromyalgia unfairly end up facing the facial pain of TMJD alone.

TMJD can cause a patient to experience nausea, headache, dizziness, and difficulty chewing due to jaw pain. By some estimates, 90% of fibromyalgia patients experience facial and jaw pain; many of these same patients are thought to suffer from TMJD. You can see how it might be difficult to make a diagnosis.

TMJD affects the functioning of the jaw, but it can also result in muscle pain throughout the head and neck. A person suffering from TMJD can suffer a range of problems, from headaches to a “locked” jaw. When coupled with the problems seen in fibromyalgia, TMJD can be almost disabling. This is all the more concerning, when data shows that over 75% of people with fibromyalgia also suffer from TMJD.

There is a school of thought that divides TMJD into two types:

1. Joint TMJD, caused by damage to the cartilage or ligaments of the temporomandibular joint. This can in turn be the result of prior injury, dental problems, or grinding of the teeth. This can present as popping or clicking of the jaw joint, the inability to open the mouth very wide, TMJ pain, and headaches.

2. Muscular TMJD, which more commonly affects the fibromyalgia patient. This affects the muscles used to chew and move the face, neck and shoulders. Muscular TMJD can be caused by a lack of sleep, muscular trauma, and stress. It can present as headaches, and difficulty with opening and closing the mouth.

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Stress has a major impact on both fibromyalgia and TMJD. Stress can cause some to clench or grind their teeth, causing continued stress on the muscles and the TMJ, making both joint and muscular TMJD worse. Stress must be brought under control: life styles may need to be changed, and medications may be necessary to relax the facial muscles, lessen the pain, and relieve the sleeplessness. Massage can certainly be of great value in such cases. Dental intervention is needed for those with missing teeth; and an orthotic occlusal plate can help to stabilize the bite and bring balance to the muscles of the jaw and head and neck areas. As with so many illnesses, a multi-disciplinary approach is best-and often most appreciated by the patient.

Unfortunately, as with so many things in medicine, the economics of properly caring for the TMJD patient becomes a barrier for so many patients. This is not surprising, in light of the two types of TMJD discussed above.

Insurance companies often do not cover the cost of treating TMJD claims for the following reasons:

1. They see the two types of TMJD as representing a controversy about both the causes and treatments of TMJD.

2. There is not a large amount of scientific validation of TMJD therapies.

3. The perceived conflict regarding whether TMJD is a medical or a dental problem results in a tug-of-war between medical and dental insurance companies, resulting in a situation where neither insurance group feels it is their responsibility to pay.

Talk to your insurance company and your doctor regarding the best treatment. For those with concomitant fibromyalgia, the treatments for fibromyalgia will offer at least partial relief. And I cannot stress enough the importance of getting stress under control when it comes to refractory TMJD. Work with your doctor, your therapist, your self.