With TMJ Disorders, Depression & Anxiety Sometimes Come Along for the Ride

We’ve talked before about the relationship between TMJ disorders (TMDs) and obstructive sleep apnea (OSA) – not to mention the links between apnea and systemic health – but OSA is hardly the only condition associated with jaw joint problems.

Anxiety and depression sometimes come along for the ride.

One 2019 study of chronic TMD patients found that over 31% of them also had anxiety, while just over 36% had depression. Those rates are roughly 10 times higher than in the general population.

A more recent study showed that people with TMD symptoms were more likely to experience psychological distress, as well as a weakened sense of feeling psychologically free and able to control their own life. “Anxiety,” noted the research team, “appeared to increase the likelihood of TMD pain and/or TMJ sounds.”

We’ve known about this relationship between TMJ problems and mental health for some time, yet there’s still no consensus as to what drives it. A 2021 review of the science summarized the current knowledge well:

The precise mechanisms linking psyche and TMD are unknown. Potentially, stress may alter the threshold of pain perception in the central nervous system, increase the intensity of parafunctional habits as well as masticatory muscle fatigue and tightness, and initiate the disorder. Or the other way round – pain (especially chronic), through the constant input of painful stimuli, induces central sensitization and causes permanent changes in the central nervous system. Pain and psychological distress seem to create a dynamic vicious circle, in which mental disorders intensify the perceived pain and the perceived pain worsens the course of mental disorders. In many cases, it is hard to distinguish the cause from the effect. The mechanism may also be associated with the dysregulation of the hypothalamic–pituitary–adrenal axis, leading to the production of excessive amounts of stress hormones, such as cortisol and catecholamines. The axis hormones are associated with mental disorders, such as depression, and other somatic illnesses, such as diabetes, hypertension or facial pain. Other studies confirmed that patients diagnosed with TMD presented with statistically significantly higher levels of stress hormones in comparison with healthy controls. [emphasis added]

Naturally, this raises the question of whether treating one condition can help treat the other. A 2022 review by the Cochrane Oral Health Group found only limited evidence that psychological therapies – in most cases, cognitive behavioral therapy (CBT) – can help alleviate TMJ pain. But what about treating the TMD? Could that possibly improve mental health?

That was the focus of a scientific review recently published in Diagnostics. A search of several major databases of medical research led the authors to 10 randomized clinical trials that met their criteria. Nine were included in a narrative analysis. Every single one of them showed “a statistically significant beneficial effect” of TMJ treatment on psychological symptoms.

Although the study authors didn’t find this same effect in their meta-analysis of four of the studies, they still concluded that

[the] current evidence is in favour of the interventions for TMD in improving symptoms of depression and anxiety.

In our office, where we take a holistic and biological approach to mouth/body health, it’s definitely something Dr. Abdulla considers when developing each TMD patient’s customized treatment plan. Treating a TMJ disorder typically involves one or more of the following:

  • Therapy, exercises, and meditation to reduce stress, manage stress triggers, and relax facial and jaw muscles.
  • Ultrasound therapy, which uses high-frequency sound waves to deliver pain-relieving heat to neck and facial muscles.
  • Custom-fitted, non-obtrusive oral devices, or splints, to realign the jaw during sleep.
  • Myofascial trigger point release therapy, which applies external pressure to specific points around the face and neck.
  • Botox injections in the chewing muscles, which have proven effective in cases that have been resistant to other forms of treatment.

Many of our patients find even long-standing TMD symptoms dissipating after their first few appointments. And when they come in to report their progress, it’s hard not to notice the real relief and increased happiness they feel. They’re finally out of pain, after all, able to eat comfortably again or simply open their mouth wide to yawn when tired.

It’s a joy for all of us to see, as well.

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