Ask The Experts

Tightness and pain in the jaw

Several treatment options for condition known as nocturnal bruxism

Q I am a woman in my early 50s. I feel tightness on the right side of my jaw and neck and there is pain in the right jaw.

I had some fillings done by the dentist, but the pain remains.

When I saw the dentist again, he said I should be fine after some rest. But despite resting, the tightness and pain have not gone away.

I then saw my osteopath and he said it was temporomandibular joint disorder. He did a little manipulation of my jaw and the tightness eased. But I still feel some pain - from the middle of the chin to the right jaw.

Once, the pain was so unbearable that I took norgesic forte, a muscle relaxant, to ease it.

What is the cause of this pain?

Stress is usually the cause of the grinding and clenching of teeth.

Counselling and stress management therapy can help sufferers facing stressful episodes in life to lead a more balanced lifestyle.

Is there a solution?

A Based on your description, the pain you are experiencing could be a tell-tale sign of temporomandibular joint (TMJ) disorder.

However, it is still important for you to consult a dental specialist so that the condition can be confirmed and treated.

Norgesic forte contains aspirin, caffeine and orphenadrine.

Aspirin is for pain relief, orphenadrine is a muscle relaxant and caffeine is supposed to enhance the effects of aspirin.

However, the medication has been discontinued for a while.

Now Arcoxia, Tramadol and Celebrex are often used to treat jaw pain.

I am not familiar with what an osteopath does, so I cannot comment.

Tightness and pain in the jaw can be related to jaw trauma. Since you did not mention any such episode, I am presuming there was none.

However, we commonly see these symptoms as a result of nocturnal bruxism (grinding or clenching).

Most patients are unaware of this habit until their sleeping partners talk about loud noises coming from the patients - caused by teeth actively grinding, or moving against each other - when they are asleep.

But even more insidious is nocturnal clenching - where teeth are tightly pressed against each other and no sounds are generated.

Often, dentists can highlight to the patient if there is evidence of nocturnal bruxism.

The pressure and force exerted in nocturnal bruxism far exceed those in normal chewing. Habitual bruxism in the long term will lead to the damage and displacement of the cartilage disk in the jaw joints, resulting in inflammation, pain, limitations when opening the mouth, and teeth sensitivity.

Joint conditions like rheumatoid arthritis also contribute to TMJ symptoms.

There are a few treatment options available to prevent TMJ disorder from worsening.

Stress is usually the cause of the grinding and clenching of teeth.

Counselling and stress management therapy can help sufferers facing stressful episodes in life to lead a more balanced lifestyle.

A hard plastic mouthguard can also be used to disperse the force of bruxism, allowing muscles and joints to heal during sleep.

Usually, the use of a mouthguard reduces the symptoms in 80 per cent of the cases.

One should also not open one's jaws too widely. Refrain from singing or playing musical instruments that use the mouth.

Eating softer foods will help to promote the healing process. Avoid chewing on bones, ice and nuts.

Pain medication is often prescribed to handle the pain episodes in the short term.

Clinical Associate

Professor Chua Ee Kiam

Senior consultant in the Prosthodontic Unit, Department of Restorative Dentistry, at the National Dental Centre Singapore

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A version of this article appeared in the print edition of The Straits Times on May 17, 2016, with the headline 'Tightness and pain in the jaw'. Print Edition | Subscribe