TMJ and PTSD

TMJ and PTSD have been shown to have a strong link between each other. The TMJ joint can become and remain overactive due to the effects of PTSD on the human body.

Temporomandibular Joint (TMJ)

Your temporomandibular joint (TMJ) is a hinge joint. It connects your jaw to the temporal bones of your skull in front of each ear.

The TMJ lets you move your jaw up and down and side to side, allowing you to chew, yawn, and talk.

This joint is often affected by Temporomandibular Disorders (TMD). These disorders cause severe pain and discomfort and entail problems with the jaw and muscles in your face that control it.

While no direct cause that has been documented, there are some theories. Dentists and other credentialed professionals who treat these disorders state that it could be due to problems with the muscles around the joint (temporalis muscle and masseters) or issues with the TMJ. Physical injury to the TMJ, your jaw, head, or muscles of the head and neck could be contributing factors. An example would be taking a heavy blow or whiplash. Stress and PTSD symptomology have also been correlated with disorders of the TMJ.

Symptoms include:

• Problems when trying to open your mouth wide
• Tenderness or pain in your neck, shoulders, face, jaw/joint area, and in and around the ear when speaking, chewing, or opening your mouth wide
• Lockjaw (when your jaw gets “stuck” or “locks’ in the open– or closed-mouth position
• Face feeling tired
• Popping, grating, and/or clicking sounds in the TMJ when opening or closing your mouth or while chewing, sometimes this can be painful
• Difficulty chewing
• Onset of a sudden uncomfortable bite
• Swelling on the side of your face
• One or both sides of the TMJ can be affected by these symptoms

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) can be developed because of experiencing scary, dangerous, or shocking events.

According to the National Center for PTSD, approximately 11-20% of veterans who served in Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) have been diagnosed with PTSD. About 12% of the veterans who served in the Gulf War (Desert Storm) have been diagnosed with PTSD, and approximately 15% of veterans who served in the Vietnam War have been diagnosed with PTSD.

PTSD Symptoms include:

• Re-experiencing symptoms

• • Bad dreams
  • Scary or frightening thoughts
  • Reliving the event
  • Flashbacks (this is where you relive the trauma repeatedly and includes physical symptoms such are sweating and elevated heart rate)

• Reactivity and arousal symptoms

• • Angry outbursts
  • Easily startled
  • Difficulty sleeping
  • Feeling tense or being “edgy”

• Avoidance symptoms

• • Avoiding things that remind you of the event
  • Avoiding feelings or thoughts related to the traumatic event
  • Staying away from objects, events, and places that remind you of the traumatic experience

• Mood and cognition symptoms

• • Feelings such as guilt or blame
  • Loss of interest in pleasurable activities
  • Developing negative thoughts about yourself or the world
  • Difficulty remembering the main details of the traumatic event
  • Having more negative thoughts and feelings than before

The Relationship Between TMJ and PTSD

There is a strong link between TMJ disorder and PTSD.

As a result of experiencing trauma, the body will go into “fight or flight mode.” In this mode, the sympathetic nervous system is activated. Hormones such as norepinephrine and epinephrine are released, which creates physiological changes in your body so that it can protect itself from potential harm. It increases your heart rate, blood pressure, breathing rate, and mental alertness. It also activates your muscles, preparing them to fight or run away from danger, hence the saying “fight or flight.”

Since your sympathetic system is activated in “fight or flight mode,” your parasympathetic system, which is in charge of “rest and digest” functions, is put on pause until your body feels safe or you are in a physically safe place. Typically, once the danger or traumatic experience ends, your body will return to parasympathetic functioning and recover physiologically. However, in cases where there is repeated exposure to a traumatic event, or the traumatic event has significantly impacted you, your body may not be able to return to its “rest and digest” state. Under this PTSD condition, your TMJ may continue to overwork or experience dysfunction.

One of the physiological changes that occur in “fight or flight mode” could be clenching of the jaw for extended periods and/or bracing of the jaw muscles. This is because when the parasympathetic system activates the muscles, you may unconsciously clench your jaw or grind your teeth. This, in turn, creates inflammation of your jaw muscles, and it can create the TMJ symptoms mentioned. It can also damage the soft cushioning inside your jaw, causing it to slip out of place or erode.

VA Evaluation of TMJ disorder

The Veteran’s Affairs (VA) evaluates veterans with TMJ disorder under 38 CFR 4.150 Schedule of Ratings: Dental and Oral Conditions, Diagnostic Code 9905. The VA disability ratings for TMJ disorder vary based on the severity of your condition. It uses the painful motion principle to evaluate applications for disability benefits.

0% rating: No pain or discomfort in the TMJ, no loss of range of motion (ROM), and no loss of functioning.

10% rating: Pain in the movement of a joint, whether there is no functional loss of range of motion with the pain.

A key item the VA measures is your maximum unassisted vertical openings of the mouth (how far you can open it). A normal human jaw has a maximum unassisted range of vertical opening from 35-50mm. You will receive a higher rating if your jaw has a maximum unassisted range of vertical opening that is less than this range:

30% rating: 30-44 mm maximum assisted range of vertical opening

40% rating: 11-29mm maximum assisted range of vertical opening

Up to 50% rating: 0-10 mm maximum assisted range of vertical opening

100% rating: If you have dietary restrictions whereby you need to eat soft foods, semi-solid foods, or full pureed and liquid foods, this will result in the highest disability rating for a particular range of motion category.

If you are a veteran who believes your TMJ is related to PTSD, contact a veterans benefits attorney.