Magazine article Clinical Psychiatry News

Stress-Related Temporomandibular Dysfunction

Magazine article Clinical Psychiatry News

Stress-Related Temporomandibular Dysfunction

Article excerpt

Since ancient times, the connection between psychological and physical states has been known to medicine.

Thus, it should not be surprising that the psychiatrist's understanding of mental illness and stress can be brought to bear to help patients with a variety of physical maladies, including temporomandibular joint disorder (TMJ).

Of course, traditionally, these conditions have been under the purview of either dentists or physicians specializing in pain medicine. For dentists and pain specialists, solving TMJ problems has been challenging and frustrating. TMJ, known today as temporomandibular dysfunction (TMD), has been responsible for severe facial pain and discomfort for centuries.

According to Donald Marks, D.D.S., who has many years of experience with the New York University College of Dentistry and the Manhattan Veterans Affairs Medical Center, TMD has three basic causes: malocculsions or improper wisdom tooth alignment; anatomical problems may exist and the joint itself could be misaligned; or stress may lead to muscle spasm and grinding, causing the internal and external pterygoid and masseter muscles to go into spasm-causing pain.

The first two causes, when diagnosed and treated properly, can solve the dysfunction and should be the main approach. It is also possible that stress-related problems may coexist with the physiological or anatomical problems, said Dr. Marks.

When stress and anxiety issues are present, an examination of vocational, familial, and social stressors is important. These forces may be playing on the patient's psyche, leading to jaw muscle spasms--not unlike other stress-related life situations that affect different organ systems.

Over the years, when patients were referred to me for assistance in relieving some of the pain of TMD, they already had seen a dentist and non-stress-related causes were either treated concurrently or ruled out. The first thing I would do is to talk with them to identify stressors that might have been missed in the psychological dental evaluation.

At times, I simply identified a set of stressors and described how they could be translated to a specific system in the body and lead to nighttime teeth grinding and muscle spasms during sleep. I also used the Franz Alexander or Helen Flanders Dunbar models to help the patient's understanding. Some patients who gained insight into a particular situation and a different perspective on the stress and pain pattern were able to find relief through these insights.

The effectiveness of these approaches is not only supported by my own experiences but with data. In one study, researchers at Virginia Commonwealth University showed that "promising behavioral interventions are available for TMD patients in whom psychological factors appear to be playing a significant role" (J. Oral Maxillofac. Surg. 2001;59:628-33).

But if behavioral interventions do not work, I use my modification of the Jacobson relaxation techniques developed in the 1920s. This technique, as developed by Dr. Edmund Jacobson, was lengthy and cumbersome. He proposed contracting specific muscle groups, creating a tension in them, and then relaxing them to first identify these groups and then gain a measure of control over these muscles. …

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