I was canceled giant bag of Cool Ranch Doritos. I was twenty-three, and, as was typical in those years, I had not eaten anything all day. When I arrived at the downtown hotel room where my friend was hosting a birthday party, the spicy chips beckoned. I crunched a handful of them. But by the time I emptied the bag, I felt something was terribly wrong. It wasn't just my cheeks that wrinkled from the harshness. My jaw tensed. My ears began to ring. Something like an electric current ran through my face and neck.
I spent the rest of the night locked in the bathroom, ashamed of having eaten so many chips that I couldn't move my mouth or speak. A few days later, when I reported the incident to my family doctor, she did not examine my jaw or perform any tests. “You have TMJ,” she said. I asked her what it was; she told me to google and quickly left the exam room.
After scrolling through WebMD, I learned about Temporomandibular Disorders, or TMJ. (TMJ is an abbreviation for the joint itself, and TMJ refers to a disorder.) The term covers a number of conditions that cause pain or loss of function in the jaw joints and muscles. At a later appointment, I told my dentist that I was still experiencing persistent pain in my face. He stated that I must be grinding my teeth at night; I had no reason to doubt his diagnosis.
The clinic ordered a nighttime device, a custom-made plastic shell that cost about $400 and didn't prevent grinding but protected my tooth enamel while I slept. The first night I tried it out, I stared at the ceiling for an hour, feeling the hard plastic poking my gums. After the second hour, I put the slimy device back in its case and put it in a drawer, never to be seen again.
Tphrase “gnashing of teeth” appears seven times in the New Testament, usually describing the fate of those who have fallen out of favor with God. In the parable of the weeds, Jesus describes how he separated the wheat from the weeds and threw the latter into hell, “where there will be weeping and gnashing of teeth.” For many people, teeth grinding can lead to a whole host of hellish consequences: broken teeth, eroded enamel, ear pain, headaches, difficulty chewing food, or locking your jaw in an open or closed position (like the Dorito incident).
Some studies suggest that about 30 percent of adults have TMD. A study conducted in June of this year Journal of Clinical Medicine this number was predicted to rise to 44 percent by 2050, although it is not entirely clear why. Sydney Lisser, a chiropractor and lead jaw specialist at the Jaw and Facial Pain Center in Toronto, says more people are experiencing pain from grinding, but research is divided on whether bruxism and pain are correlated. He is adamant that TMD should not be confused with grinding: not all grinding results in TMD; Not all TMJs are caused by grinding; and not all rubbing is painful or requires treatment.
Anecdotally, Lisser has noticed a significant increase in the number of visits to his clinic since 2016. But he also recognizes that “TMJ” and “bruxism,” the medical term for teeth grinding or clenching, are increasingly buzzwords for doctors and patients alike. Then there was the stress of the pandemic, with one dentist calling 2021 “the year of the broken tooth” in an interview with the Australian Broadcasting Corporation. Social media is littered with stress-relieving techniques, facial yoga, and various products claiming to solve the problem, including “temporomandibular joint cushions,” a vibrating massage pen, and a plastic “jaw stretcher” that sells for more than $100.
The proliferation of these treatments points to a number of problems, one of which I suspect is patient frustration. Dentists often resort to using a night guard as a primary solution to jaw pain. But what if it doesn't work? What if the patient cannot comply with this form of treatment for any reason? What if they grind their teeth while they're awake? And isn’t it even worth finding out why the patient is doing this?
None of my doctors seemed interested in these issues. Left to my own devices, I found myself Googling “Tmj relief??” and came across the dubious suggestion that regular “meowing”—actively pressing the tongue against the roof of the mouth with the lips closed—could provide some pain relief as well as an improvement in the jawline. (I'll take the pillow, thanks.) I suspect that doctors and patients may be spending too much time thinking about the cure instead of thinking about where the pain is coming from.
WITHoh doctors have suggested three possible reasons for the grinding. Stress is perhaps the most obvious cause of conscious bruxism. There's been a lot to gnash our teeth about lately. Lisser suggests that constant access to our devices increases this anxiety. It so happened that on the morning we scheduled the interview, my baby wasn’t sick for the first time in days, and I was falling behind on almost every task related to work and home. I later learn that many of those who seek treatment for TMJ are women.
There are also less simple reasons. The 2024 report found that more than 16 per cent of Canadians received antidepressants from community pharmacies in the past year. One class of these antidepressants are selective serotonin reuptake inhibitors (SSRIs), which maintain the availability of serotonin in the brain. Instead of the nerve cells reabsorbing serotonin as they normally do, the medication blocks this reabsorption and keeps the neurotransmitter active longer, resulting in improved mood. These medications can be critical for people who take them to get to work, perform daily tasks, and take care of themselves and their families. But recent research suggests that these antidepressants may also increase jaw clenching or grinding. This may be because serotonin influences how we regulate our movements. Dentists warn that this is not a reason to stop taking an SSRI, but it is at least worth talking to the doctor who prescribed it.
Finally, there are sleep disorders. Researchers have found that many sleep apnea patients also grind their teeth at night. People with sleep apnea often wake up—briefly and usually without even realizing it—as their breathing stops and starts during the night. One hypothesis suggests that the mouth muscles may try to reopen airways narrowed due to sleep apnea, and this may lead to bruxism. It's a compelling theory, especially considering that more and more people are being diagnosed with sleep disorders in the United States and Canada. But many doctors are skeptical of this explanation, and research is still inconclusive. In fact, a 2019 review of seven scientific articles said there is still no conclusive evidence to support a link between the two conditions. For now, the connection remains what one study called a “medical mystery.”
Of course, these aren't the only reasons why someone might grind their teeth or end up being treated for TMJ. In fact, the University of Toronto has a two-day course dedicated to diagnosing and treating this disorder. Lisser is one of the instructors, and he believes part of the diagnostic process involves eliminating other causes. For example, when a patient comes to him complaining of jaw pain, he first checks for warning signs, such as recent trauma or oral lesions. Once more serious conditions have been ruled out, Lisser takes the patient's history and performs a physical examination to determine if there is any damage to the muscles, joints or other structures of the jaw. Rehabilitation may include monitoring normal jaw movements. For example, you might observe a patient eating a bagel while the doctor evaluates his chewing pattern (my jaw hurts just thinking about it).
The U of T course is also taught by Bruce Freeman, an orthodontist and co-director of the facial pain clinic at Mount Sinai Hospital, and Jacopo Cioffi, an orthodontist, pain researcher and assistant professor in the U of T School of Dentistry. When I spoke with Freeman and Cioffi, they told me something about the night guards, which I've suspected for a while. “There have been studies that have shown that night guards are no more effective than physical therapists; they are no more effective than placebos,” Cioffi says. He emphasizes that they can be part of a pain management toolkit, but are not a stand-alone solution for treating TMD. He compares this condition to a cavity. Dentists usually find the cavity, fix it with a filling, and assume that the pain has gone away. He believes the field needs to look at TMD differently, rather than as something that can be fixed with a night watchman: “We need to treat it the same way we deal with other chronic pain.”
This may look like a combination of approaches: manual therapy (including physical therapy), massage, relaxation techniques, pain medications, and even psychotherapy. For example, cognitive behavioral therapy has been found to help people defocus their pain. Freeman told me that some of his patients say they feel better after simply talking to him about their experiences. This doesn't mean their symptoms weren't real or serious, but maybe they just needed to feel heard.
Wthen I decided to write this part, I thought it would be quick and easy. The night guards are bad! We're all stressed! The reality turned out to be a little more complicated. I think I was actually looking for an opportunity to talk. The more I discussed this article, the more I met friends, colleagues, sources, and experts who were dealing with similar frustrations. This frees up the ability to talk about your pain without being immediately interrupted by your healthcare provider.
Like everyone I know, I try to manage my stress. I've always been an anxious person, but the Doritos debacle was probably the first physical manifestation of this tendency. When I spoke with Lisser, he noted that he encourages his patients to make lifestyle changes. There's nothing special about it: less screen time, better sleep hygiene, good nutrition. I've seen some of this in action. At twenty-three, I had a hard time with my body. I smoked ten to fifteen cigarettes a day, skipped meals, and juggled between multiple jobs. I didn't believe in psychotherapy or a good night's sleep. When I turned thirty, I mellowed. I'll probably never be as lean and competitive as I used to be, but at least I can unclench my jaw.
I've also come to rely on what some professionals probably consider band-aids: doing the occasional face stretch found on a physical therapist's YouTube, slicing apples instead of biting them whole, exercising as much restraint as possible on crunchy snacks, and memorizing the correct jaw position (at least according to Google) while I type at my desk: teeth spread and tongue resting lightly on the roof of my mouth, the tip of which is just behind the tip of my mouth. incisors.
A few months ago, I took things a step further by booking a special jaw massage at a small but luxurious spa in downtown Toronto. The therapist started with the usual suspects for tension: the shoulders, the base of the neck, and even the scalp. She ran the oily gua sha tool across my cheeks and pinched the skin with a tiny suction cup. Then it's time to work on the inside of the mouth. With her latex-gloved hands, she pressed the pressure points on my gums. She stretched my lips in all directions to touch sore spots I didn't even know existed. I wasn't sure whether to feel deeply embarrassed or sublimely relaxed.
At the end of the meeting, she told me that she could tell that I had an office job. I wondered how she could track my sedentary lifestyle from just one interaction, but as I walked home from the subway station, I noticed something else—something I knew would be temporary. For the first time in my entire life, I didn't feel any tension on my face. At least now my jaw felt weightless.
Julieta Caballero is an illustrator at The Walrus.
