David Ângelo: “most myalgia is associated with stress and anxiety, and subsequent static and/or dynamic contraction”
About Stress Awareness Day, celebrated today November 2, read the opinion piece by David Ângelo, Temporomandibular Joint Surgeon, Clinical Director of the Portuguese Facial Institute and Department Coordinator temporomandibular disorders, on temporomandibular joint disorders (TMD). Associated with multifactorial causes, some of these being factors such as stress, anxiety, and past traumatic events, TMDs are currently considered the most common cause of orofacial pain of non-dental origin, resulting in pain and inability.
Although I have been dedicated to treating patients with orofacial pain and temporomandibular disorder (TMD) for over 10 years and have written extensively on the subject, I still struggle to simplify something extremely complex. I will, however, make a humble attempt, this time with a different approach.
I will need the cooperation of those who read us. To start, I’m going to ask you to place your index fingers in front of your ears (to be more precise, about 1 cm in front of the tragus). Now I ask you to open your mouth ten times, as wide as you can. What you felt moving was your temporomandibular joint (TMJ). In fact, he has just experienced a complicated movement of rotation and translation, through a joint with two synovial compartments separated by fibrocartilage.
The good news is that if you have had no pain, no discomfort, no “disengagement” (a term often used by my patients in consultation), if you have had no restriction or gaps in the opening of mouth, it is very unlikely that you have a dysfunction of this joint. . The bad news is that around 34% of people will experience some of the aforementioned changes. Now that I have captured your attention, or at least 34% of the readership, it is important to list what temporomandibular disorders are.
TMD, or temporomandibular disorders, is a very broad diagnosis for characterizing patients with pathology of the TMJs and/or adjoining structures (most often pathology of the masticatory muscles). To simplify, let’s separate the two problems into: articular and muscular.
Joint problems relate to the joint you just palpated in the previous exercise. The main problems of this joint are: (1) synovitis: inflammation of the joint which can cause pain – the explanations can be different: trauma, infection, overload, ligament rupture; (2) disc displacement: articular meniscus out of its normal position which can cause clicks, deviations, limited opening of the mouth or pain, for several reasons: trauma, infection, joint overload, reduction in joint lubrication, ligament rupture ; (3) joint osteoarthritis: joint wear which is normally associated with changes in the position of the joint meniscus and which may be linked to autoimmune pathology and situations of joint instability.
The problems of the facial and cervical muscles are related to the entire stomatognathic system. They can be different, but in more than 80% of patients there is myalgia. When we delve deeper into these cases, we realize that most myalgias are associated with stress and anxiety, and the resulting static (tightening) and/or dynamic (nocturnal and/or diurnal bruxism) contraction.
Often, muscle pathology is associated with intra-articular changes. In a study by the Portuguese Facial Institute, the presence of myalgia was verified in 80% of cases of intra-articular pathology. Furthermore, it has also been observed that the success of a surgical treatment in the resolution of joint pain is correlated with the reduction of muscle tension.
At this point I also ask you to palpate your masticatory muscles (master and temporalis) – apply some pressure and notice if there is any discomfort and/or built up tension in these muscles. If so, it is likely that during the day, in stressful situations, you grit your teeth. This constant tightening leads to chronic myalgia that is often difficult to treat. In addition, little by little, this muscle tension will contribute to starting to have joint problems, as explained above.
The good news is that if you are at an early stage, you can reverse the situation and prevent the progression of the pathology. As? Avoid clenching your teeth during the day – upper and lower teeth should only touch when chewing. Adopt healthy sleeping habits and you will definitely get better.
In a recent study performed at the Instituto Português da Face, signs and symptoms were studied in 595 patients. There was a female predominance in 80% of cases. The top three complaints were: joint cracking (13.26%); joint pain (12.49%) and tension in the masticatory muscles (12.15%). Risk factors such as twitching and bruxism were detected in 60% and 30%, respectively. Among the other pathologies detected in the patients studied, anxiety was the most widespread (20% of cases). These data reinforce the relevance of avoiding risky behaviors, such as tension and bruxism, as well as alerting to the importance of adopting behaviors that reduce stress and anxiety on a daily basis, such as the practice of meditation, mindfulness and physical exercise.