RA and the jaw
RA can affect the size of the jaw and patients can experience problems with the jaw joint (known as the temporomandibular joint or TMJ) which are similar to other joint difficulties with RA. It is estimated that in more than 17% of patients with RA or juvenile idiopathic arthritis (JIA), the jaw joint is affected; commonly resulting in pain, swelling and limited movement of the joint.
The jaw joints (TMJs) are located in front of each ear, as shown in the diagram. When you have a problem with the jaw joint, it is known as temporomandibular joint dysfunction or temporomandibular disorder (TMD).Discomfort in the jaw can include:
- Difficulty eating hard, chewy foods
- Scraping noise
- Dislocation of the jaw
“The pain was just so horrible to have in the jaw, it’s really not nice; and you don’t want to eat.”
Juvenile Idiopathic Arthritis (JIA), which affects children and adolescents, under the age of 16 years can also affect the jaw joint. It may speed up or slow down the natural growth process of the bones on either side of the affected joint.
If the lower jaw does not develop normally it can lead to a smaller mouth which in turn can limit the opening. This can affect eating, brushing habit and the length of time that patients can keep their mouth open.
What can I do if I have jaw problems?
Please inform your dentist, dental therapist or hygienist if you are experiencing any of these problems:
- Pain on opening wide
- Limited opening
- Difficulty accessing the back of your mouth when brushing
If there is limited opening or discomfort, this will need to be managed with shorter dental appointments or rest during particular treatments.
There are a number of self-help measures that can help improve TMD, including:
- Resting the joint by eating soft food and avoiding chewing gum.
- Holding a warm or cold flannel to the jaw after doing a few gentle jaw-stretching exercises.
- Avoiding opening the joint too wide.
- Massaging the muscles around the joint.
- Relaxation exercises to relieve stress (people tend to clench their jaw when stressed).
- Not resting your chin on your hand.
There are two main exercises which may be useful (DO NOT do these if the joint is inflamed i.e. swollen and painful). Your dentist can explain which will be of most help to you. It is important to warm up your facial muscles for a few minutes with a warm compress before starting your exercises.
- Open your mouth slowly.
- Curl your tongue upwards so that the tip of your tongue is touching the back part of the roof of your mouth.
- Close your mouth slowly, keeping your tongue in the above position. Repeat this sequence 10 times, 2 – 3 times daily.
- Sit upright facing a mirror.
- Open your mouth slowly ensuring your lower jaw does not swing to one side; this may require you applying gentle guiding pressure with your hand against your jaw.
- Repeat this sequence 10 times, 2 – 3 times daily.
The Melbourne TMJ Centre website has some good pictorial examples of these and other TMD exercises.
If you continue to experience TMJ problems, please see your dentist for further advice and treatment options. A referral to a hospital specialist may be necessary.