Doc: Painful jaw clenching may be TMJ disorder
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?
Dear J.S.B.: 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?
Dear S.F.: 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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