From the Guidelines
Stress and anxiety are recognized as contributing factors to the development of temporomandibular joint (TMJ) syndrome, as they can lead to behaviors like jaw clenching and teeth grinding that put excessive pressure on the TMJ. Psychological stress often leads to physical behaviors that increase muscle tension in the face and jaw, resulting in pain, inflammation, and dysfunction of the joint 1. According to the BMJ guideline on managing chronic pain associated with temporomandibular disorders, cognitive behavioral therapy (CBT) with or without biofeedback or relaxation therapy is strongly recommended for patients with chronic pain associated with TMD 1.
Some key points to consider in managing TMJ syndrome related to stress and anxiety include:
- Cognitive behavioral therapy (CBT) as a first-line treatment approach
- Relaxation techniques such as deep breathing exercises and progressive muscle relaxation to reduce muscle tension
- Avoiding behaviors that exacerbate TMJ symptoms, such as chewing gum or eating hard foods
- Considering physical interventions like gentle jaw stretches and applying warm compresses for symptom relief
It's essential to address the underlying stress and anxiety to break the cycle of pain and dysfunction in TMJ syndrome. While some interventions like reversible occlusal splints, arthrocentesis, and certain medications may be conditionally recommended against 1, a comprehensive treatment plan should prioritize stress reduction and behavioral modifications to manage TMJ symptoms effectively.
From the Research
Temporomandibular Joint (TMJ) Syndrome and Stress/Anxiety
- Temporomandibular disorders (TMD) are a collective term for a group of musculoskeletal conditions involving pain and/or dysfunction in the masticatory muscles, temporomandibular joints (TMJ), and associated structures 2.
- The etiology of TMD is multifactorial, comprising biological, psychological, and social factors, including stress and anxiety 3, 4.
- Research has shown that psychological factors, such as depression, anxiety, and stress, play a significant role in the development of TMD, influencing the onset, course, and treatment response of the disorder 3, 4.
- Studies have found that patients with TMD may have an upregulated hypothalamic-pituitary-adrenal (HPA) axis, with higher cortisol secretion, and that anxiety, depression, and pain catastrophizing scores are significantly higher in TMD patients 4.
Treatment of TMJ Syndrome
- Treatment options for TMD include noninvasive pharmacologic therapies, minimally invasive muscular and articular injections, and surgery 5.
- Conservative therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants, can be effective in managing mild to moderate TMD 5.
- Adding pharmacologic treatment, such as cyclobenzaprine, to patient education and self-care, can be effective in reducing jaw pain upon awakening 6.
Relationship between Stress/Anxiety and TMJ Syndrome
- There is evidence to suggest that stress and anxiety can contribute to the development and exacerbation of TMD, and that addressing these psychological factors can be an important aspect of treatment 3, 4.
- The biopsychosocial model of health and illness recognizes the significant role of psychological factors in the development of TMD, and highlights the importance of a multidisciplinary approach to treatment 3.