Some of the most commonly prescribed medications used in treatment plans for pain and for depression – as well as some other conditions encountered in many medical/dental practices – especially medications primarily used for depression, have a pain-relieving effect, because of the result of excess serotonin.
As a result, a patient may have a condition, which has not fully, clinically blossomed in terms of the symptoms presented. For example, if a patient is on an antidepressant that also decreases the amount of pain, it would be quite common for them to have a dysfunction of his/her Temporomandibular joint (TMJ), which is the jaw joint, with only minimal symptoms. The symptoms would be greater, if the patients were not on that medication.
As a result, a Temporomandibular joint (TMJ) dysfunction may not be identified and properly treated.
The check-off list of the symptoms of TMJ (jaw joint) Temporomandibular joint dysfunction includes:
____ craniofacial pain
____ jaw locking, popping
____ ear pain/stuffiness
____ headaches: cluster, migraines
____ facial drooping from a stroke
____ facial numbness
____ internal derangement of the TMJ discs
____ airbag injury
____ reflex sympathetic dystrophy of the face
____ trigeminal nerve contusions
____ ear pain from air travel
____ cervicogenic headaches (from disc herniations)
____ other related conditions
A number of Serotonin Reuptake inhibitor medications are associated with clenching, yawning and grinding of teeth (as cited in the Journal of the American Dental Association, Vol. 132, No. 5, pages 629-638, 2001). These are commonly used antidepressant medications, which contribute to the mental wellbeing of our patients. They may mask the symptoms of TM joint dysfunction and, additionally, they may cause bruxism and clenching. They include:
• Prozac (Fluoxetine) • Paxil (Paroxetine) • Zoloft (Setraline) • Celexa (Citalopram) • Wellbutrin (Bupropion) • Effexor (Venlafaxine)
“Patients receiving SSRIs or Atypical Antidepressants may develop movement disorders that include clenching and grinding of the teeth, also known as bruxism. This may occur because these medications increase the extrapyramidal levels of serotonin; thereby, inhibiting dopaminergic pathways that control movements.” JADA, Vol. 132, No 5, pg 629-638, 2001.
Similarly, in addition to the use of these medications, which can cause bruxism and then, subsequently, lead to TMJ conditions, which can be painful, further complicating and even compromising the patient’s progress; a number of other conditions can also contribute to these TMJ (jaw joint) problems. Specifically, other causes of bruxism and clenching include:
• medical amphetamines for ADD
• overall stress
• ineffective coping strategies
• irregular work shifts
• high blood levels of alcohol
• disturbed sleep patterns
Utilizing my training and expertise as both a physician and a dentist, I have been treating patients with atypical facial pain and Temporomandibular joint disorders from around the world for over 20 years now. I have been able to correct the painful and debilitating symptoms of TMJ conditions by a number of different medical approaches including fabricating a special customized intraoral appliance to maintain the jaw in its proper position. Because the jaw is not static, grinding and clenching can do a great deal of harm to the nerve structures, the teeth and the articular disc (cartilage) of the Temporomandibular joint.
The articular disc (meniscus) of the Temporomandibular joint is not in a fixed position. It is attached to the muscles that can pull it out of alignment in the process. As a result, it can become fragmented and frankly degenerate. The fibro cartilage of the Temporomandibular joint has no capacity to repair and needs to be preserved for good jaw tracking. The jaw joint system cannot be put to rest. Its position must be functionally stabilized while in motion. Malaligned hyperactive jaws impinge on the trigeminal nerve causing headaches, both tension and migraine headaches.
Hence, if a patient is being kept on one of these medications long-term for the significant therapeutic benefits that they provide in the overall treatment plan of his or her doctor, please know that in these cases, an appropriate appliance can be fabricated to mitigate their condition.
In these cases, I, generally, recommend that they be treated with a specialized customized intraoral appliance that will buffer the forces of occlusion and realign the jaw. The forces of occlusion can be up to 200 pounds in the molar area (Ref. answers.com). This customized appliance can protect the integrity of the Temporomandibular joint structures, which includes the delicate network of nerves and blood vessels that can be compromised when the jaw joint is out of alignment.
Copyright 2011 by Patricia A. Richard, M.D., D.M.D. All rights reserved Dr. Pat Richard can be reached at (203) 254–8080. Her offices are located 1735 Post Road – Unit 6, Fairfield, CT 06824. She is a Diplomate, American Academy of Pain Management, Diplomate, International Academy of Medical Acupuncture, Diplomate, American Board of Forensic Medicine, Specializing in: • Interventional Pain Management, • Temporomandibular Joint Disorders, • Jaw Trauma, • Migraines, • Cluster Headaches and • Facial Pain