May 24, 2023 – Dental pain is the worst. It can come seemingly out of nowhere and interfere with eating, drinking, and everyday activities. But what happens when the pain is not necessarily in your teeth but, rather, around your face, jaw, and neck?
Shane G., a 40-year-old finance manager based in Austin, TX, is painfully aware of the distinction. After sitting in what he explained was an extremely stressful meeting at his office one day, he decided to take his laptop to a bar and finish his work over a basketball game and a beer.
“I took a sip of beer, and it was like the corners of my mouth were on fire,” he said. “It was sharp, sharp pain with heat attached to it; there was clearly something wrong.”
The type of pain Shane was feeling is more commonly known as orofacial pain and includes over 30 types of temporomandibular disorders (TMDs) – conditions that affect the two joints that connect the jaw to the skull (temporomandibular joint), as well as the jaw muscles and tissues.
About 5% to 12% of the U.S. population has TMDs. Because they are difficult to diagnose and can overlap with other conditions, patients often embark on what may seem like an endless 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 set up an emergency appointment with a knowledgeable dentist who suspected that the issue was his jaw muscles. After taking X-rays and measuring for a night guard to address possible grinding and clenching, Shane was referred to a massage therapist. Not only did she identify the root of his pain, but he was able to find some degree of relief after one session.
Not everyone is as fortunate.
There are “practitioners who’re just unfamiliar with the diagnosis and a little too quick on the trigger to provide irreversible treatment,” said Clifford Chow, DDS, an orofacial pain specialist at 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, the conditions can change and things can get worse and more difficult to treat,” he said.
Even though they aren't rare, orofacial pain disorders are often missed or mistaken for other conditions by dentists and doctors. And TMDs frequently come along with other conditions, such as fibromyalgia and migraines, making diagnosis even more difficult.
“In dentistry, we have this saying: If you hear hoofbeats, think horses, not zebras,” said Lisa Crafton, DDS, a dentist in private practice in Columbia, MD.
For “the majority of people who come in with facial pain, most of it is muscular,” she explained. “And I feel that most people have it after an episode of stress. Or for some, it could be 2 weeks after a stressful incident and then all of a sudden, their jaw is killing them.”
“If you think of a skull, the lower jaw is held in by muscles,” Crafton said. “So, I always start by thinking, OK, let’s try muscular release.”
Katie Pudhorodsky, an Austin, Texas-based licensed massage therapist with a focus in head, neck, and jaw work, has treated Shane and countless others with TMD pain. Pudhorodsky has become a go-to for many dentists who, like Crafton, recognize the muscle component in certain TMDs right away.
Massage can often help address the pain linked to two of the most common TMDs: myofascial pain (discomfort or pain in the connective tissue and muscles controlling 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 shows up in a variety of ways and is often referred, meaning that it hurts in areas other than the exact location of the jaw muscles, joints, and tissues. Symptoms include headaches, neck pain or stiffness, tooth pain, sinus pain, a feeling of fullness in the ears, ringing in the ear (tinnitus), numbness, and/or tingling.
The universal experience is that most of the patients Pudhorodsky sees in her practice are looking for relief.
“They’ve brought this conversation up with their dentist or their medical provider that they have pain, and they get the runaround. They get moved around from specialist to specialist until someone says, ‘Hey these muscles are tight; maybe that’s a piece of the puzzle,'” she said.
Nataly S., a 32 year-old researcher from Austin, said that she landed in Pudhorodsky’s office after she had sudden jaw pain and what she described as “jaw clicking.”
“I was going through a particularly emotionally stressful time,” she said, as she reflected 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 said that I would benefit from TMJ-specific massage.”
Nataly got relief after one session with Pudhorodsky and continued to do her exercises twice daily.
“By the end of the week, the pain was gone,” Nataly said.
Four Pillars of Relief
Pudhorodsky sees patients in person but also offers detailed education and exercises online. Most of her work is geared toward helping people achieve and maintain muscular relief and is based on four pillars:
- “Pillar one is to relax the muscles and reduce trigger points. And that’s done through massage and stretching,” she explained. “This can be done by a professional or by yourself at home.
- Pillar two is to retrain the muscles that weren't engaging; these exercises are also used to stabilize the bite.
- Pillar three is to maintain proper oral resting posture. “That’s looking at proper oral resting posture. We want our tongue up onto the roof of our mouth, lips together and teeth slightly apart,” Pudhorodsky said.
- And “pillar four is to address bad habits of use; this is when you start to stop making those bad patterns from continuing on.”
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 releasing tight muscles and retraining the joints to move in a more balanced way, massage can help fix part of the problem, ease 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 that they have a TMD, that’s not a diagnosis; it’s a broad term of disorders, and they’re often the ones that could miss something," he said. "They have to be more specific in the diagnosis and more specific in the treatment.”