A 50-year-old female patient who has been experiencing chronic stress, tension, and poor sleep quality. She occasionally clenches her teeth due to work-related stress, and over the past year, she has noticed not only significant teeth clenching but also pain when opening her mouth. She even has difficulty eating larger portions, and there are clicking sounds in her temporomandibular joints (TMJ). She experiences pain when sleeping, and her facial and neck muscles are also painful. The patient sought dental care, where she was diagnosed with temporomandibular joint syndrome (TMJ syndrome) and provided with a bite correction appliance. However, her condition did not significantly improve. She later consulted Dr. Zheng Yingzhi, a psychiatrist at China Medical University Hsinchu Hospital.
After diagnosis and treatment, Dr. Zheng Yingzhi determined that the patient's TMJ syndrome was related to long-term work-related stress leading to autonomic nervous system dysfunction. She recommended medication to help stabilize the autonomic nervous system, along with electrical stimulation and relaxation exercises. After about two months of combined medication and non-pharmacological treatment, the patient's teeth clenching intensity significantly decreased, and muscle soreness and tenderness improved.
Dr. Zheng Yingzhi pointed out that common symptoms of TMJ syndrome include pain when opening the mouth or chewing, limited mouth opening, facial or neck muscle soreness, ear pain, tinnitus, jaw deviation, jaw dislocation, and pain radiating to the eyes, face, shoulders, neck, and back. TMJ syndrome is often not as easily detectable as typical joint pain in the limbs. In addition to the typical feeling of tension when opening the mouth, it may also be accompanied by symptoms such as migraines, cheek congestion, and discomfort. TMJ syndrome is most common in individuals aged 20 to 45, with a higher prevalence among women. It is now recognized that many cases of TMJ syndrome are not caused by improper bite alignment but rather result from autonomic nervous system dysfunction due to psychological stress. When a person is under high stress, the muscles around the mouth and neck tend to remain tense even during sleep, leading to long-term tension accumulation in these muscles, resulting in symptoms such as pain when opening the mouth, chewing, and swallowing.
Stress can lead to unconscious teeth grinding, poor sleep quality, nocturnal teeth grinding, and may also be associated with anxiety, panic, fibromyalgia, and insomnia, among other symptoms. Additionally, TMJ syndrome may not only be caused by stress but also by factors such as bite alignment, dentures, muscle, joint injuries, inflammation, tumors, or rheumatoid arthritis.
