Painful jaw clench­ing may be TMJ dis­or­der

Manteca Bulletin - - Perspective - TO YOUR GOOD HEALTH By Keith Roach, M.D.

DEAR DR. ROACH: I have de­vel­oped the habit of un­con­sciously clench­ing my jaw dur­ing the day. I tend to worry about things and have trou­ble turn­ing off enough to re­lax. I ac­tu­ally don’t mind clench­ing my jaw, since it of­fers some re­lief. But now my jaw hurts on one side when I chew food, and some­times I have trou­ble open­ing my mouth wide enough to take a bite of food. Some­times my jaw clicks, and I worry that if can some­how open my mouth wide enough, it will get stuck there. I also have de­vel­oped a mild earache that comes and goes on the side where the pain is. I’m wor­ried that I have caused dam­age to my jaw. Can you help me? -- J.S.B.

AN­SWER: Jaw clench­ing dur­ing the day is some­thing many do, and if you watch peo­ple care­fully, you will ob­serve it in peo­ple you know. It can be a re­ac­tion to stress or anx­i­ety, or it may sim­ply be a habit peo­ple have dur­ing con­cen­tra­tion. It can, in some cases, be a man­i­fes­ta­tion of a med­i­cal con­di­tion, such as Parkinson’s dis­ease, or re­lated to med­i­ca­tions, es­pe­cially ones used for psy­chi­atric con­di­tions. Tooth clench­ing, or grind­ing, goes by the med­i­cal name of brux­ism, and while it com­monly hap­pens dur­ing sleep, some peo­ple, like you, have awake brux­ism.

It’s pretty clear from your de­scrip­tion that you have tem­poro­mandibu­lar joint dis­or­der, a group of con­di­tions that all man­i­fest with prob­lems in the joint where your lower jaw at­taches to your skull, just in front of and be­low the ear.

Given your clear as­so­ci­a­tion of the jaw clench­ing with wor­ry­ing and be­ing un­able to re­lax, it would be best to treat those first. There are be­hav­ioral treat­ments and other types of non-phar­ma­co­logic treat­ments, like work­ing with a li­censed ther­a­pist or coun­selor. You also should have a reg­u­lar visit with your den­tist, if you haven’t re­cently. In the short term, an anti-in­flam­ma­tory med­i­ca­tion, like ibupro­fen or naproxen, may pro­vide re­lief.

DEAR DR. ROACH: Do phy­toe­stro­gens work the same as an­i­mal es­tro­gens when treat­ing menopausal is­sues? -- S.F.

AN­SWER: Plant es­tro­gens, es­pe­cially those found in soy pro­teins, called isoflavones, have some char­ac­ter­is­tics of an­i­mal es­tro­gens (like estra­diol, the ma­jor hu­man es­tro­gen, avail­able as a bioiden­ti­cal phar­ma­ceu­ti­cal). Plant es­tro­gens are much weaker than estra­diol, so they are less likely to be ef­fec­tive in treat­ing hot flashes, for ex­am­ple. Many women take them with the ex­pec­ta­tion that since they are plant-de­rived, they will pose less risk. How­ever, the risks from es­tro­gens, in­clud­ing blood clots and breast cancer, are not well-stud­ied in plant es­tro­gens. Be­cause of this, the same level of cau­tion should be used with us­ing plant es­tro­gens as with estra­diol or other pre­scrip­tion es­tro­gens: Use the small­est amount that is ef­fec­tive, and only for a lim­ited pe­riod of time, gen­er­ally not more than five years. Plant es­tro­gens are not rec­om­mended for women with a his­tory of block­ages in heart ar­ter­ies or stroke, a his­tory of breast cancer or any kind of abnormal blood clot.

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