TMJ and Gender
In doing some research for an upcoming article, I found an astounding statistic: an estimated 90 percent of those affected by TMJ pain are women in their childbearing years. What contributes to so many more women suffering? Is it hormones? Is it lifestyle?
I spoke with Terrie Cowley, president and co-founder of The TMJ Association, to help answer some of these questions.
HealthCentral: I have read that women are at a much higher risk for TMJ than men. Why?
Terrie Cowley: First a clarification: That figure of 90% refers to those TMJ patients that have the most severe and chronic form of TMJ. Epidemiological studies show that women are twice as likely as men to report pain and jaw dysfunction. This could be either because they aren't bothered by the symptoms or they are mild and come and go while responding to simple remedies. The female-to-male ratio increases to 3 or more to 1 when jaw pain and dysfunction drives people to seek care, and reaches 9 to 1 in the most severe cases. No matter how severe, the age range for women who develop TMJ disorders is the childbearing years. Research is in its infancy and we really do not have all of the reasons that women are at a much higher risk than men at this time.
HealthCentral: Do hormones play a role in TMJ pain?
Terrie Cowley: Considering the fact that TMJ disorders predominately affect females, researchers began looking at the role female hormones play in TMJ disorders. Sex and gender studies in pain are one of the hottest areas of research. What we know is that there are estrogen receptors in jaw tissue and also in the brain, where the hormone can affect pain perception and interact with the brain's own systems of pain control. Some of this control reflects how opioid receptors act and we know that females and males respond differently to various types of types of opioid receptors. Studies have shown that high levels of estrogen seem to improve pain control, while other studies show that women who take estrogen supplements - say, to treat menopausal symptoms - are at an increased risk for TMJ Disorders. Just as with your question about why more women suffer than men, I'd have to say future research, particularly in the area of genetics-gene expression, etc. will add to our knowledge base on not just on hormonal roles in TMJ but social, cultural and behavioral factors involved in each individual's experience of pain.
HealthCentral: How is TMJ diagnosed?
Terrie Cowley: Diagnostics remain a challenge. Currently there isn't a simple scientifically validated test to diagnose TMJ Disorders. At this time a TMJ diagnosis is based upon the patient's description of pain and jaw dysfunction, history and examination of the head, neck, face and jaw. What the TMJ Association recommends to anybody who thinks they have a TMJ problem (or is told they have a TMJ problem) is to first consult with a medical doctor to rule out any other disease that may be causing your symptoms. If your physician diagnoses a TMJ problem and refers you to a dentist, we recommend obtaining multiple independent opinions to confirm your diagnosis.
HealthCentral: What treatment options exist for a TMJ sufferer?
Terrie Cowley: It is important to remember that most TMJ symptoms will abate over time with or without treatment. If someone is experiencing symptoms, a number of self-help remedies are useful, such as moist heat, ice, soft diet, over-the-counter analgesics and so forth. In a survey that we conducted several years ago, we listed 45 treatments that are being recommended to TMJ patients and we asked them to tell us which were helpful. The number one most effective treatment reported was a hot pack or heating pad.
The National Institute of Dental and Craniofacial Research recommends that until we have scientific validation that treatments offered to patients today actually help and do no harm, patients should choose reversible treatments. These are treatments that don't cause permanent changes in the position of the jaw and or teeth. Among treatments that do cause changes in the jaw and teeth are orthodontics, grinding teeth down, surgery and the use of splints that move the jaw to a different position.
Even when symptoms persist, aggressive types of treatment may not be the answer. Patients who experience long-term severe pain are more likely to be helped by finding an empathetic primary-care physician, internist, or neurologist, someone who believes TMJ pain is real and is willing to work with the patient on finding medications that help that individual.
HealthCentral: What symptoms should people - especially women - be on the lookout for with regards to TMJ?
Terrie Cowley: The most typical TMJ symptoms are a dull, nagging, aching pain in the jaw area of the face, which can also extend to the neck and shoulders. Jaw muscles can feel tight. It may be difficult to open the jaw wide or even to close it completely. Many patients also seem to have headaches, ear pain and a feeling fullness or water in the ear.
I think that it is important to note that we have found that a number of patients with TMJ disorders also experience other pain conditions that predominantly or exclusively affect women. Some of these conditions are fibromyalgia, chronic fatigue syndrome, endometriosis, irritable bowel syndrome - and there are others. A study just out from the University of North Carolina Chapel Hill Vulvodynia clinic found an astonishing 79.9% of the vulvodynia patients also had TMJ symptoms. Just as we are seeing an explosion in research on male-female differences in pain perception and control, we're seeing growing interest in why it is that some pain patients are prone to develop multiple pain conditions.
For more information on TMJ and The TMJ Association's on-going campaign for awareness, please visit www.TMJ.org.