Asian Scientist Magazine (Nov. 30, 2022) — One morning in early 2018, 38-year-old Namrata, who lives in Mumbai, noticed that the area around her jaws and ears was swollen. It was mildly painful in the beginning. But very quickly, it started to hurt so much that she could barely talk, chew, or even open her mouth. The pain had reached her skull, and she could hardly function. The painkillers Namrata took, didn’t help.
Namrata met a dentist almost immediately. When the dentist pressed the point near her ear, where her jaw met the skull, she screamed in pain. The dentist later told Namrata that she had temporomandibular disorder (TMD)—a malfunction of temporomandibular joints, which connect the jawbone to the skull. These joints are composed of two bones—the mandible and the temporal—separated by a small shock-absorbing disk which keeps the joint’s movement smooth.
In addition to severe pain, people living with TMD may also hear a popping sound or feel a grating sensation while opening their mouth or chewing. Namrata spent many nights crying as she couldn’t sleep because of the pain. Her ear lobes were so swollen that she couldn’t wear earrings, and for months she was on a diet of soups, and mashed fruits and potatoes.
One of the main causes of TMD is the habit of grinding teeth, which displaces the joint backwards, leading to pain, says Jalandhar-based periodontist Gurpreet Saini. TMJ disorder can also be caused by osteoarthritis, injury and trauma. When people are stressed, they tend to clench their jaw and grind their teeth, a condition known as bruxism.
For Namrata, it was emotional trauma. “Coming from a dysfunctional family and having been a survivor of child sexual abuse, trauma was something I lived with,” she says. On particularly stressful days, Namrata has to consciously unclench her jaw.
Several studies have shown that stress, psychosocial impairment and a history of trauma are among the factors that contribute to TMD. A study by the International College of Dentistry, Walailak University in Thailand, has found that COVID-19 and the ensuing self-isolation, social distancing, and quarantine have led to mental health issues in people. These issues, the study concluded, may be correlated with TMDs.
Another study conducted on Israeli and Polish populations found that the pandemic adversely impacted the psycho-emotional status of people in the countries, intensifying their bruxism and TMD symptoms.
A research collaboration between the National University of Singapore, and the School of Health and Social Sciences, Nanyang Polytechnic, Singapore, has found that TMD symptoms are common among Southeast Asian youth who may be psychologically distressed. Of the 400 youth surveyed in the study, those who reported higher levels of stress experienced severe symptoms of TMD.
Despite these links, the awareness about TMD seems to be poor in the medical community in some Asian countries, leading to delayed and incorrect diagnosis, says Saini.
According to Saini, at first, conservative methods are used to alleviate TMJ pain. “If the patient is under too much stress, they may be prescribed anti-stress medicine, muscle relaxant, or a nightguard (a dental appliance worn while sleeping to prevent teeth grinding) to relieve the stress,” she says. Saini also recommends therapy to some patients.
Delhi-based restorative dentist Kamala Kakumanu advises patients to wear custom-fitted night guards and splints while doing strenuous work such as exercise, and if the patient is a bruxer, they must wear the guards for as long as they can. Surgery is required in very rare cases.
Because of the increasing cases of TMD, the market of TMD medications is also rising. In 2020, the worldwide market value for medications used to treat TMD was USD 227 million which is projected to reach USD 303 million by 2027.
Namrata started having slight pain in her TMJ area since 2016. But when she visited a local physician at that time, the doctor brushed it aside and told her not to worry about it. She was lucky to find the right doctor later. Her condition is much better now and she has also managed to reduce her anxiety.
But sometimes she wonders, “if I had been diagnosed early on, would I have suffered so much?”
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Source: Walailak University, National University of Singapore, Nanyang Polytechnic ; Images: Shutterstock
