Jaw Pain and Rheumatoid Arthritis
The temporomandibular joint (TMJ) encompassing the jaw is one of the most complex and misunderstood joints in the body.1 There are multiple muscles, bones and soft tissues involved in motions that occur in all directions.
The jaw gets used for many purposes all day long – biting, chewing, swallowing, speaking, showing emotions, yawning, etc. Some people grind their teeth at night, called bruxism, putting more stress on the jaw and teeth.2 The National Institute of Dental and Craniofacial Research provides relevant patient information on the TMJ and associated disorders at their comprehensive website.
Jaw pain associated with the TMJ
The problems associated with the TMJ are called temporomandibular disorders (TMD). Symptoms include radiating pain, jaw stiffness, joint locking, and changes in the way teeth fit together.3 TMD can arise from muscle issues called myofascial pain, misalignment of the joint, arthritis of the joint, trauma, or a combination of the above.
What is the cause of TMD?
While many people believe that clicking of the TMJ is a cause, there is no scientific evidence that clicking alone causes disorders. For reasons unknown and like RA, issues with the TMJ are more common with women.4 While no definitive connection has been made, the trigeminal nerve serving much of the head passes very near the joint and may be involved in symptoms.5
Who experiences TMD symptoms?
Is there a link between jaw pain and rheumatoid arthritis?
Many rheumatoid arthritis patients display TMD. One study showed that upwards of 90% of RA patients showed TMD symptoms.7 The jaw joint can be impacted by rheumatoid arthritis much like it impacts other joints in the body with inflammation, bone erosion, and tissue damage.8 Joint damage in the hands of RA patients was seen as a strong predictor of TMD severity.
Other studies show that bone loss in the jaw was related to disease duration and inflammatory blood marker levels.9 Even juvenile idiopathic arthritis (JIA) patients show TMD problems.10
Treatment options for jaw pain
Unfortunately, there is no officially accepted medical specialty or accepted standards of care for TMD. According the non-profit TMJ Association, treatments may include eating soft foods, ice and heat packs, pain medications, exercises, relaxation, side sleeping, avoiding chewing gum, dental splints, and limited cortisone injections. They highly recommend avoiding treatments that cause permanent changes in the jaw or bite. Surgery is not recommended because of lack of scientific evidence.11
Ineffective treatment for TMJ pain
Because of the lack of officially accepted practices and research-based treatment options, a myriad of ineffective treatment options are proposed. The Internet only exacerbates the promulgation of hoaxes, moneymaking schemes, and “breakthrough treatments that work in only 3 weeks.”
A simple search reveals “FDA” approved devices, videos on how to “permanently cure TMJ”, physical manipulations of the joint, herbal remedies, orthodontic treatments, books galore, and diets for curing TMD. Some people advertise that they can stop TMD headaches forever. Interestedly, many of these untested treatments originate from professional healthcare providers.
What has helped my jaw pain
Personally, I’ve tried just about everything including ice packs, heat packs, relaxation techniques, physical therapy exercises, self-massage, pharmaceutical muscle relaxants, nighttime dental appliances from cheap drug store ones to the professional dentist made models, and botox injections into the associated muscles. All have helped to some extent and the symptoms seem to come and go.
For me, jaw pain worsens during an RA flare
One evident pattern is that symptoms appear to become worse during an RA flare or when an RA treatment combination starts losing effectiveness. But that pattern applies to just about every joint.
More TMJ or jaw pain research is needed
Unfortunately, not much is known about the causes and treatments of TMD and more research is needed. It stands to reason that if overall RA symptoms are being controlled by treatment, that TMJ issues will be less likely. It is important to remember that not all TMD symptoms are caused by RA and not all RA patients will get TMD. If you suspect TMD, speak to your rheumatologist and it may also be wise to bring your dentist into the conversation.
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?