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Interviewer: How do I know if my headache is caused by a mouth-jaw issue? That's next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Gary Lowder is a practicing dentist and a professor, both at the University of Utah School of Dentistry. He's got 30 years of TMJ experience and he's seen a lot of cases of people coming in with headaches asking, "Is this a mouth-jaw issue?" Headaches are so common nowadays and can be caused by so many different things, how do you know if it's caused by a mouth-jaw issue? Is there any kind of one-tell that you look for?

Dr. Lowder: Well first of all, in my practice I like to know if a patient has been to their physician or their ENT to find out if there's any underlying infection that might be contributing to the headaches. A lot of patients will say that they have migraines, but in fact they're really just severe muscle tension-type headaches.

So what we do is we will often use a technique called Spray and Stretch, where we use a vapocoolant spray on the muscle areas of the face to see if there is a diminishing of the pain. If we can get headache to respond to that kind of a test, then it usually indicates that it could be related more to muscle irritability, muscle tension, or another term is called Trismus, and that gives me encouragement that this is something that can be treated because it's more of a muscle tension-type headache than a true migraine-type headache.

Interviewer: And we're talking about tense muscles in the jaw and the mouth area?

Dr. Lowder: Yes.

Interviewer: Does that cover the neck area as well what you do, or is that different?

Dr. Lowder: It also covers the neck area. A simple test to know why is if you look up toward the ceiling and tap your teeth together, the bite will feel different that if you look down toward the floor and tap your teeth together. And the neck muscles actually determine head position.

If the head position is altered by tension in those muscles, it can alter your bite, which in term can trigger clenching and/or bruxism, and you can either get headaches toward the end of the day or when awakening in the morning. Often morning headaches are due to the fact that the individual is clenching their teeth throughout the night.

Another sign that could help you understand if you're clenching or grinding is look at your teeth in the mirror and see if you see any signs of wear. The canine teeth or the cuspids just to the sides of the incisors, should have nice points on them. If those points are missing and they're flattened, that means that you have been doing some grinding and abrading of your tooth structure and it can be a factor in headaches.

Again, not all headaches are related to teeth and occlusion, but if it's been ruled out that you have migraines or some other systemic reason for a headache, then we need to suspect that maybe the occlusion is a factor.

Interviewer: So what are some common issues that might be causing my headaches? So TMJ would be one of them, grinding your teeth sounds like another. Are there any other ones?

Dr. Lowder: Well, stress is probably the number one culprit. And stress happens for good reasons and negative reasons. For instance, Christmas can be very stressful to some people, and so can birthdays and weddings. And so a promotion at work, increased responsibilities, can cause us to start grinding or clenching our teeth, and that usually can create tension-type headaches over time.

Interviewer: What can I do about it if I have headaches that are being caused by my muscles and my jaws and my mouth?

Dr. Lowder: I'd like to say, "Just take a deep breath and relax," but that doesn't always work. I think it is good though to evaluate the stress in your life, both physical and emotional stress and determine if there's a more healthy way to deal with them. Stress management counseling is a good idea. Considering your daily activities, is there anything that you're doing that puts more strain on the muscles of your neck and shoulders than the body is able to tolerate?

The position you're in, if you're at a computer all day, can make a difference in how those muscles feel, which can in turn, create muscle tension-type headaches. Physical therapy is beneficial in those cases, ice packs, good quality exercises, routines that can help strengthen those muscles are also beneficial.

If you feel like you're clenching or grinding your teeth and doing it habitually or waking up having these symptoms, some form of protective mouth wear can be beneficial. And those are called dental splints or mouth guard that helps to take the stress off of the teeth and distribute it over the plastic, protecting the teeth and relaxing the muscles associated with your jaw.

Interviewer: That's interesting. So a lot of headaches can start from there but it sounds like there's some hope for people if that's where their headaches are starting.

Dr. Lowder: There definitely is. It's worth investigating because you don't have to suffer with a headache if it's coming from muscle tension in that area. It's also important to know that in some cases of temporal-mandibular disorder, there is clicking and popping that occurs inside the joints just in front of the ear. If it's non-painful we often do not treat that, it's very common. And if it's non-painful or if it doesn't limit your jaw function, then we don't usually treat it. When it becomes painful then the patient should seek help to try and alleviate the problem as soon as possible so that further breakdown in the form of osteoarthritic remodeling isn't occurring.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at the scoperadio.com.

updated: December 19, 2018
originally published: May 27, 2015

Interviewer: Why does my jaw pop, and do I need to do something about that? That's coming up next, on The Scope.

Announcer: Health information from experts, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Gary Lowder is a practicing dentist and a professor at the University of Utah School of Dentistry and has 30 years of TMJ experience to boot. The question that I would imagine you get a lot is: "My jaw pops. Is that something I should worry about?" What's the answer to that?

Dr. Lowder: There are actually two kinds of popping that patients report. One is when they're almost at their widest opening, like when you when you yawn. This type of popping is more of a subluxation where the lower jaw bone passes over a ridge in the upper jaw bone, and that's a normal occurrence caused by just a hyperextended lower jaw.

The other type of popping is the one that's more concerning, and it involves the displacement of the cartilage-like disc which is inside the joint. This type of popping occurs usually quietly when you're closing. The disc will slip forward of the lower jaw bone. Then when you go to open again, there will be a louder pop or crack that happens when the disc repositions itself onto the condyle of the lower jaw.

Interviewer: So, talking or chewing, is that when this happens?

Dr. Lowder: Yes. It can happen

Interviewer: And even just opening your mouth.

Dr. Lowder: It can even be bothersome to other people at the table where you're eating. They can hear it, and they'll wonder what's going on, and that's usually because that disc is dislocating on closure and then reducing back to normal position on opening. If it's painful, it's usually painful because the ligament that controls the disc is being stretched, or the muscles that control the jaw movement are also being affected by that dysfunction.

Interviewer: So, if it's painful, is that something to be concerned about, and if it's not painful, as long as my dinner mates can handle the noise, its okay? Or should I have them both looked at?

Dr. Lowder: I think if it's painful, it should definitely be addressed. One thing that you could try if it's a new episode, and it's never happened before, is just reduce your jaw function. Go to a softer diet. If you catch yourself clenching, try to relax the jaw and maintain a lips together, teeth apart posture.

Interviewer: But what if I like a good steak? Is there any way you can fix it, or am I just going to have to live with this jaw popping then?

Dr. Lowder: Depends on how good the steak is.

Interviewer: Sure.

Dr. Lowder: If you get the tender cuts of meat and cut it in smaller pieces

Interviewer: All right.

Dr. Lowder: ...you'll learn what to tolerate, but you have to go by what your jaw will tolerate. If there's a food that you're eating that causes your jaw to hurt, you need to avoid that food in that form, at least until your jaw's starting to feel more relaxed.

An injury to the jaw can create these popping and clicking episodes, and if it's the first event, I usually tell patients to give it at least two to three weeks to see if it will resolve on its own. And with a softer diet, they may find that things get back to normal again. If that doesn't happen, then you should go in and see your dentist and find out if there's something more that needs to be done.

Interviewer: Could long-term damage be caused if I don't do something about it?

Dr. Lowder: It can, especially if there is pain. It usually signals strain to the muscles or an inflammatory condition which can eventually lead to some arthritic degeneration in the joint, and then that starts to limit function and creates changes in your bite. So it needs to be addressed under those circumstances.

Interviewer: So if I understand correctly, if I start developing a popping in my jaw, and it's painful, back off on what I'm eating, eat some softer foods for a couple of weeks, and if it still continues, that would be the time to see my dentist, or should I go in right away?

Dr. Lowder: I think if it's a first episode that has never happened before, then it's valid to wait two or three weeks just to see if it will go away on its own. If it were to reoccur in another month, then there's something going on that your body's trying to signal to you that the stresses in those areas are exceeding its ability to recover.

Interviewer: And then what will you do to fix that?

Dr. Lowder: What I usually do is to initiate use of an inter-oral appliance that we call a dental splint, and it creates a buffer for the jaw and the teeth to function to. It needs to be adjusted properly so that it is maximum stability, and it doesn't create a new problem for the muscles and joints to deal with. But if it is adjusted properly, it will often relieve the muscle strain and also decompress the joint tissues so that the inflammation has a chance to resolve. I think the real key here is if you have jaw issues that are painful, it is worth going and getting an evaluation by a qualified dentist who can manage TMJ-type issues so they don't cause worse problems later.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: June 1, 2018
originally published: May 20, 2015

Interviewer: TMJ, what causes it, how awful it is, and what you can do about it.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Gary Lowder is a practicing dentist at the University of Utah School of Dentistry and also a professor there as well. And more importantly he has 30 years of TMJ experience. So, Dr. Lowder, tell me about TMJ.