Temporomandibular dysfunction (TMD) has a prevalence reported to be as high as 25%, making it a common clinical feature, arising from dysfunction of the temporomandibular joint (TMJ) and the associated jaw and facial muscles.[i] Whilst it is common, it has often been seen as a simple mechanical joint dysfunction, rather than the complex chronic pain disorder it now appears to be. As such, past research has focussed on physical interventions, and has discarded the psychological and socials impacts.[ii]
As with many conditions, there is an increased prevalence in one gender when compared to another. It’s important that professionals recognise this, and take it into account when assessing patients and forming a diagnosis. TMD affects more women (15-26%) than men (8-15%).[iii] Clinicians should explore the reasons why this may be, and offer specific advice to help women manage their condition, in a way which is tailored to their specific needs.
With this in mind, it’s important to understand why women may be more likely to experience TMD, and suffer disproportionately both in terms of frequency and severity.[iv] In doing so, clinicians will be able to more effectively assist their patients with their specific needs and concerns, and offer the most appropriate advice. Factors that may make women more susceptible to TMD include:
Stress
TMD and stress are directly linked, causing the muscles to tense, jaw to clench, and teeth to grind, including during sleep. Generally, women report higher levels of stress and anxiety compared to men, and women are more likely to be deficient in magnesium, the mineral which helps to regulate stress.[v]
Jaw structure
Men and women’s jaw structures can be different. Women’s jaw muscles can be more prone to injury and inflammation, leading to reduced blood and oxygen reaching the face, including the jaw. This is in addition to the increased levels of lactic acid, leading to cramping and pain, as well as headaches.[vi]
Hormones
Some research suggests that a misaligned jaw may interfere with oestrogen receptors in the jaw, making the symptoms of TMD more painful. Further, an imbalance of progesterone could negatively impact bone, collagen, and cartilage, and hormone fluctuations during each month can mean that the way women experience pain can change at any point in time, with oestrogen generally relieving pain. Because of the potential role that hormone imbalances can have on pain, some women may benefit from talking to their doctor, particularly if they are taking hormonal contraceptives.[vii]
TMD can lead to a number of complications, each of which can drastically impact patients’ quality of life. These include chronic pain, limited chewing function, and bruxism wear and tear on the teeth. Its symptoms include jaw and facial pain, shoulder or neck pain, jaw stiffness, difficulty opening the mouth, jaw popping or clicking, headaches, migraines, earaches, toothaches, and tinnitus.[viii]
Management of TMD can vary from patient to patient. However, as it can result in trismus in the long-term, having significant impacts on patients’ quality of life, it’s important to recommend management techniques which nourish the jaw and facial muscles, and expand the mouth opening.
The Royal College of Surgeons makes a number of lifestyle recommendations for patients experiencing TMD, these are:
Jaw exercises are a great way to help patients expand their mouth opening, by repeatedly and gradually stretching the facial muscles. [x] To help with this, recommend the use of the OraStretch® Press Rehab System. When it is used as recommended for a patient’s specific situation, it can increase the mouth opening by an average of 26mm. The use of this jaw exercise rehab device helps to improve patients’ quality of life, by strengthening and stretching the jaw muscles to enable more normal function and reduced pain and stiffness.
In order to make the most appropriate recommendations to patients, it is important to understand their condition well, and why they may be predisposed to the symptoms they are experiencing. As with many conditions, one gender often statistically experiences it more than another. As such, when examining women, in particular, consider TMD as a possible diagnosis, and start preventative therapy where appropriate.
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[i] Camfield, D., Wilson, C. & Loescher, A. Sociodemographic trends in a UK temporomandibular joint disorder clinic. Br Dent J (2022). https://doi.org/10.1038/s41415-022-3932-4
[ii] Camfield, D., Wilson, C. & Loescher, A. Sociodemographic trends in a UK temporomandibular joint disorder clinic. Br Dent J (2022). https://doi.org/10.1038/s41415-022-3932-4
[iii] Yakkaphan P, Smith JG, Chana P, Renton T, Lambru G. Temporomandibular disorder and headache prevalence: A systematic review and meta-analysis. Cephalalgia Reports. 2022;5. doi:10.1177/25158163221097352
[iv] Camfield, D., Wilson, C. & Loescher, A. Sociodemographic trends in a UK temporomandibular joint disorder clinic. Br Dent J (2022). https://doi.org/10.1038/s41415-022-3932-4
[v] https://www.tmjplus.com/why-women-experience-tmj-more-than-men/
[vii] https://www.tmjplus.com/why-women-experience-tmj-more-than-men/
[viii] https://my.clevelandclinic.org/health/diseases/15066-temporomandibular-disorders-tmd-overview
[ix] https://www.rcseng.ac.uk/-/media/FDS/TMD-Patient-support-document-March-2024.pdf
[x] https://www.rcseng.ac.uk/-/media/FDS/TMD-Patient-support-document-March-2024.pdf