A self-help guide for chronic orofacial pain including temporomandibular disorder

Patients suffering from chronic pain in the face, mouth or jaw can now download a self-help guide proven to benefit them in managing their condition.

This pain is often caused by a condition called temporomandibular disorder (TMD) which affects 7% of the U.K. population. TMD can have many causes, including tooth grinding and clenching, which is experienced by up to 30% of people in the U.K.

The guide, Self-Management of Chronic Orofacial Pain Including TMD, can be downloaded for free. It was co-designed by a team of experts and patients with TMD and is led by Dr. Vishal Aggarwal, Clinical Associate Professor in Acute Dental Care and Chronic Pain.

It was developed from Dr. Aggarwal’s research findings, which showed that psychosocial risk factors like health anxiety lead to the development of TMD and chronic orofacial pain. The guide targets these underlying factors as well as providing techniques to alleviate physical symptoms.

Symptoms, including wearing down or fracture of small bits of teeth, can go unnoticed. It is triggered by stress and can flare up during stressful times in a patient’s life.

Dr. Aggarwal said, “Patients may become anxious because of the pain it causes. That in turn makes their experience worse. The guide helps patients to break the vicious cycle of clenching, grinding and anxiety. And if they experience flare-ups during times of stress, they can go back to the guide and refresh their memory of the techniques.

“We have had some fantastic feedback from patients, and we are very keen that as many people as possible are able to access the guide, should they need it, which is why we are offering it for free.”

What is TMD?

TMD is a condition affecting the movement of the jaw and causing chronic pain. Symptoms include:

• pain around the jaw, ear and temple
• clicking, popping or grinding noises when moving the jaw
• a headache around the temples
• difficulty opening the mouth fully
• the jaw locking when the mouth is opened.

How is TMD treated?

Standard treatment includes painkillers, mouth guards and even botox, but Dr. Aggarwal said these approaches are either not suitable for long term use or are not scientifically proven to help.

Dr. Aggarwal said, “These biomedical approaches are directed towards finding and treating an organic pathology for symptoms. This imposes a huge burden on patients and already stretched health care resources.

“Patients frequently attend multiple specialties in medical and dental settings, where they undergo numerous ineffective and invasive tests and treatments that can be harmful and increase costs to already stretched health care services.”

Dr. Aggarwal’s guide takes a holistic approach, helping patients manage their feelings about their pain, as well as managing stress, diet, sleep and exercise, and treating the symptoms by breaking habits with simple techniques, including:

Facial massage

• Back sleeping rather than side or front sleeping
• Using ice packs or heat packs to soothe the pain
• Holding the teeth apart (except when eating)
• Avoiding resting the chin on the hand
• Avoiding chewing gum or chewing pen lids

These techniques, and the guide, can be used by anyone experiencing TMD, and also pain caused by clenching and grinding.

Effective help

Dr. Aggarwal holds a weekly phone clinic with patients to discuss their progress with the self-help guide. Evaluation of the clinic has shown that the guide is effective in helping patients manage their pain and overcome their condition.

Clinical trials have shown that similar guides are effective in helping patients manage chronic whole-body pain.

Patients are referred to Dr. Aggarwal’s pain clinic via their NHS dentist, and he works with them on the guide, although some patients have found the guide useful as a self-help tool.