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Can Cannabis Help Temporomandibular (TMJ) Disorder?

by Philip Ghezelbash

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Temporomandibular Joint (TMJ) disorder is an often severe pain disorder that the endocannabinoid system may regulate. Pain and inflammation — two key symptoms of TMJ disorder — are closely related to the endocannabinoid system and cannabis. Since cannabis influences the endocannabinoid system, it may be medically viable for treating pain caused by TMJ disorder.

There is some research showing cannabis helps reduce pain and inflammation in the temporomandibular joint, as well as pain in other conditions including migraines, osteoarthritis, rheumatoid arthritis, tension headaches, and chronic pain in general. 

Cannabis is safe and well-tolerated for treating chronic pain and is therefore safe to use for TMJ and potentially effective for treating symptoms. More research is needed to understand exactly how effective it may be.

How cannabis works on TMJ disorder

The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. Because the entire system was only discovered in the past 30 years, scientists still have much to learn about the myriad ways cannabis affects the human body.

The ECS consists of two primary receptors, CB1 and CB2. These cannabinoid receptors are important for pain processing. CB1 receptors are concentrated in regions of the brain that regulate pain processing, while CB2 receptors are concentrated on immune cells that regulate inflammatory processes. CB2 receptors are also expressed on neural cells involving pain processing.

Research has shown that low doses of cannabinoids modulate pain-relieving actions of receptors in TMJ pain. In one study, cannabinoid  receptors were shown to contribute to the pain-relieving and anti-inflammatory effects of electroacupuncture on arthritis of TMJ joints in rats.

The findings suggest pain and inflammation in the temporomandibular joint is modulated through CB1 and CB2 receptors. Therefore, the administration of cannabis-based medicine could help to reduce inflammation and pain associated with TMJ disorder through interacting with cannabinoid receptors.

Medical studies on TMJ and cannabis

Cannabis is a well-established pain-relieving and anti-inflammatory agent with potential to help TMJ disorder. While clinical evidence on cannabis and TMJ disorder is scarce, there are studies showing cannabis can help reduce pain in conditions that affect the temporomandibular joint.

  • A review of 28 studies on chronic pain concluded that there is moderate-quality evidence supporting cannabinoid treatments for chronic pain.
  • In one study, cannabinoids were found to induce pain-relieving effects on inflammatory TMJ pain. 
  • One 2006 study examined the effects of cannabis-based medicine Sativex (1:1 THC:CBD). The results showed that the Sativex administration significantly reduced pain caused by rheumatoid arthritis. Rheumatoid arthritis is known to cause inflammation in the TMJ joint in some cases.
  • A 2016 study showed that cannabis was effective for chronic pain in people resistant to conventional opioid pain medications. 
  • One 2016 study showed that cannabis helps reduce pain from migraine headaches. Over 85% of patients in the study reported experiencing an average decrease of 10.4 to 4.6 migraines per month. Headaches are a very common condition associated with TMJ disorder.

 

Cannabis helps reduce pain in conditions that cause pain in the temporomandibular joint, such as rheumatoid arthritis and migraines. Taking into account the totality of positive evidence on cannabis and chronic pain, it’s reasonable to assume that cannabis may help resolve symptoms of TMJ disorder for some people.

CBD for TMJ

CBD has been shown to help reduce pain and inflammation in multiple conditions, including conditions affecting joints and potentially TMJ disorder too.

  • In one randomized controlled trial, researchers looked at the muscle relaxant effects of transdermal CBD application in patients with TMD. Sixty patients were divided into two groups. Group one received CBD whereas group two received a placebo topical formula. Masseter muscle activity was measured on days 0 and 14. The application of CBD formulation was found to improve myofascial pain.
  • One 2018 review looked at how CBD affects chronic pain. The studies examined between 1975 and 2018 showed that cannabis is effective for reducing cancer pain, neuropathic pain, and fibromyalgia.
  • One 2017 study showed that topical CBD can help reduce pain in rats with osteoarthritis. CBD was able to decrease joint pain in a dose-dependent manner and helped to prevent future nerve damage and pain in arthritic joints. 

 

There are also some anecdotes supporting the benefits of CBD for TMJ disorder, such as this statement posted by “EatenbyCats” on Reddit.

“I have TMJ and have found relief with CBD. I’ve tried vaping CBD eliquid but that was no good. I now use CBD oil in capsules, vape isolate crystals, and have recently found flower that also works after trying a few kinds that didn’t”.

Overall, clinical evidence supports the use of CBD for pain. Research also shows that CBD can successfully help reduce myofascial pain associated with TMJ disorder, at least when administered transdermally. That said, more research is needed, specifically for other methods of CBD administration such as ingestion and inhalation.

Side effects

Cannabis Side Effects

In studies on people with chronic pain being treated with cannabis, side effects are mild and short-term. 

Short term side effects include changes to mood, perception, appetite, energy levels, and general impairment which can affect work and other daily activities. The level of impairment is generally contingent on the amount of THC consumed. 

CBD is safe and well-tolerated for pain-relief, even more so than cannabis containing THC, as it is non-intoxicating. 

Long-term side effects from cannabis use are possible, such as dependency and cognitive impairment. These adverse effects are more common for chronic users that begin using cannabis during adolescence or for those who have underlying predispositions to addiction or mental illness.

Disclaimer

The Cannigma content is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with an experienced medical professional with a background in cannabis before beginning treatment.

About TMJ Disorder

Overview

Your temporomandibular joint, or TMJ, is the hinge that connects your lower jawbone to your skull. You have one joint on each side of your jawbone. Temporomandibular joint disorders, or TMD, is when you have problems with the muscles that control the joint, or the bones and connective tissue of the joint itself. 

TMJ disorders can cause significant pain and discomfort, but they are not usually serious and generally get better on their own. There are many possible causes of TMJ disorders and TMJ pain, including arthritis, clenching or grinding your teeth or an injury. 

It’s not clear how many people experience TMJ pain because not everyone goes to the doctor about it, but it’s thought that it affects 10 million Americans, and 5-12% of people worldwide. Women are at least twice as likely to get TMD than men are, and it tends to appear much more often among younger people. 

Symptoms

The main symptom of TMJ disorder is a pain in the area around your temporomandibular joint, in your jaw, ear or temple. You can feel TMJ pain on one or both sides of your face, and sometimes it can spread across your head, neck, and shoulders. 

Other symptoms of TMJ disorder include:

  • Headache and facial pain
  • Feeling like your jaw is “stuck” either open or closed
  • Difficulty opening your mouth very wide
  • Pain or discomfort when chewing
  • Clicking, popping, or grinding noises when you chew, open your mouth, or move your jaw
  • Swelling on one or both sides of your face

TMJ disorder can cause toothaches, headaches, neck pain, and earaches, and it can also provoke dizziness, hearing problems, and tinnitus (ringing in the ears). Sometimes you might only feel your jaw clicking or grating when you move it, but not feel any pain. In these situations, it’s not normally necessary to see your doctor or dentist. 

Diagnosis

If you feel pain or tenderness in your jaw that doesn’t go away on its own after a few weeks, or you can’t open or close your mouth completely, you should go to your doctor or dentist. They’ll usually diagnose TMJ disorder by asking about your medical history and examining the area of your TMJ. 

You can expect your doctor to:

  • Check your temporomandibular joints for pain and tenderness
  • Ask you to move your jaw so he/she can listen for pops, clicks, or grating sounds
  • Ask you to open and close your mouth
  • Test your bite
  • Check your facial muscles are all working properly

You might also be referred for x-rays, MRIs or CT scans to reveal images of the bones and soft tissue in the joint. You may be sent to consult a maxillofacial surgeon, also called an oral surgeon, for an expert opinion. 

Occasionally, the doctor will use TMJ arthroscopy, which involves inserting a small, thin tube with a camera on the end into the joint space to view what is going on. 

Causes

The “hinges” of the temporomandibular joint are covered with cartilage to keep the action smooth, and separated by a disk of tough tissue. You’ll feel pain in your TMJ when something happens to stop the joint from sliding open and closed, like:

  • Arthritis eroding the smooth cartilage
  • The disk getting damaged by wear and tear or moving out of alignment with the joint
  • The hinges of the joint  becoming damaged by impact

Here are some of the most common causes of damage to the smooth movement of the TMJ:

  • Chronic grinding or clenching of your teeth
  • Being in a car crash, a fight, or trauma to your face for any reason.
  • Stress
  • An uneven bite
  • Diseases that affect connective tissue in the body

Treatment 

Most of the time, TMJ disorders get better on their own. To help relieve the pain and discomfort of TMJ disorders and to try to prevent them from returning, you can:

  • Take over-the-counter painkillers like ibuprofen or naproxen
  • Apply ice packs, followed by a warm washcloth, to the side of your face where you feel pain
  • Eat soft foods, like soups, omelettes, and yoghurts
  • Avoid hard, crunchy foods, foods that force you to open your mouth wide, and chewing gum
  • Avoid opening your mouth extremely wide
  • Massage and gently stretch the area around your joints
  • Don’t bite your nails, or rest your chin on your hand
  • Try to stop yourself from grinding or clenching your teeth
  • Learn relaxation techniques to ease the stress in your jaw

If you find that the pain is getting worse, or not going away, your doctor might prescribe medication, therapies and other procedures. 

 

Medication 

  • Pain relievers and anti-inflammatories
  • Tricyclic antidepressants in low doses, to reduce pain and stop you grinding your teeth
  • Muscle relaxants
  • Anti-anxiety medication to relieve stress and reduce pain

 

Therapies 

  • Oral splints and night guards are soft, firm devices that fit over your teeth and reduce the pressure from grinding or clenching your jaw, as well as keeping your teeth aligned correctly.
  • Physical therapy includes stretches and exercises to strengthen your jaw muscles and loosen your temporomandibular joint.
  • Counseling to help you understand when and why you carry out behaviors that provoke TMJ pain, like nail-biting, grinding your teeth, or clenching your jaw.  

 

Other procedures

These procedures are only carried out if your TMJ disorder persists for many months or years, causes significant pain, and is seriously affecting your quality of life, and if other treatments haven’t had any success. 

  • Arthrocentesis is a minimally invasive procedure. Small needles are inserted into the TMJ, and then fluid is inserted to wash out debris and pus.
  • Corticosteroid injections, and occasionally botulinum toxin injections, can help relieve the pain. 
  • Botulinum Toxin – Botox is sometimes injected into the muscles around the TMJ joint and can sometimes lead to significant pain relief.
  • TMJ arthroscopy is a type of minimally invasive surgery on the joint.
  • Modified condylotomy is surgery on the mandible rather than the joint itself, to ease joint locking.
  • Open-joint surgery is the most invasive procedure. It’s carried out if there seems to be a structural problem with your joint. 

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