Jaw Pain Pregnancy Third Trimester
In my practice over the years I have treated countless pregnant women and have documented the symptoms and dysfunctions associated with TMD before, during and after pregnancy. One patient in particular that I remember had multiple pain symptoms, but went through 3 pregnancies, during which time the pain subsided. It was not until after her 3rd pregnancy that she started treatment because all of her initial pain returned. This relationship between TMD and pregnancy has been exemplified multiple times and is an interesting part of TMD issues in women.
Studies have shown that the prevalence of TMD in pregnant women is three times less than non-pregnant women. The pain threshold is much higher during pregnancy. Symptoms seem to disappear with the onset of pregnancy and reappear post-partum. This cycle is reflective of the sudden withdrawal of additional estrogen.
The Science Behind TMD and Pregnancy
TMJ tissues contain cells with estrogen receptors – particularly the condyle, disc and joint capsule – as well as muscles of mastication. Estrogen has a great influence on the cartilage and also causes antiresorption on the bones. Additionally, estrogen reduces pain, or at least the perception of pain, during pregnancy due to an increase of collagen (type 3). Collagen type 3 is associated with Ehlers-Danlos syndrome (prevalent in some TMD patients), which can make joints overly flexible. As a result, orofacial pain and musculoskeletal symptoms “go away” during pregnancy.
Chart borrowed from:
Landi N, Lombardi I, Manfredini D, Casarosa E, Biondi K, Gabbanini M, Bosco M. Sexual hormone serum levels and temporomandibular disorders. A preliminary study. Gynecol Endocrinol 2005;20:99-103.
The biggest changes/increases in estrogen levels occur during the 2nd quarter of pregnancy (week 12). Pain has diminished by the start of the 2nd quarter.
Another factor that changes during pregnancy is range of motion (ROM). Studies have shown that mandibular intraoral opening increases during pregnancy and sometimes remains higher postpartum. Orofacial pain improves due to increased joint laxity allowing the ROM increase to occur.
Aside from pain, there are other side effects of TMD that can subside during a pregnancy, but sneak up on you postpartum. Maybe your insomnia goes away for a few months, or maybe your undiagnosed OSA (obstructive sleep apnea) is less noticeable to your husband. Remember to talk to your healthcare specialist about any symptoms you encounter, as insomnia and OSA during pregnancy can be linked to pre-term birth.
The odds of early preterm birth before 34 weeks was more than double for women with sleep apnea, and almost double for those with insomnia – according to a study published in the September issue of Obstetrics & Gynecology.
Dr. Klein takes a conservative approach to treating TMD and OSA. Some of the treatments offered at Michigan Head & Neck Institute include wearing a corrective orthotic (mouthpiece) which can be adjusted as needed for each patient, physical therapy which can include tens unit usage, physical massaging of the area around the TMJ’s, heat applications, and pain-relieving injections. For more information please call us at 586-573-0438 or visit our website at www.michiganheadandneck.com.
Mayoral VA, Espinosa IA, Montiel AJ. Association between signs and symptoms of temporomandibular disorders and pregnancy (case control study). Acta Odontol Latinoam. 2013;26(1):3-7.
LeResche L, Sherman JJ, Huggins K, Saunders K, Mancl LA, Lentz G, Dworkin SF. Musculoskeletal orofacial pain and other signs and symptoms of temporomandibular disorders during pregnancy: a prospective study. J Orofac Pain 2005;19:193-201.
Warren PM, Fried LJ. Temporomandibular disorders and hormones in women. Cells Tissues Organs 2001;169:187- 192.
Macfarlane TV, Blinkhorn AS, Davies RM, et al. Association between female hormonal factors and orofacial pain: study in the community. Pain. 2002;97(1-2):5-10.
Silveira EB, Rocabado M, Russo AK, et al. Incidence of systemic joint hypermobility and temporomandibular joint hypermobility in pregnancy. Cranio. 2005;23(2):138-43.
Galal & El-Beialy, Waleed & Deyama, Yoshiaki & Yoshimura, Yoshitaka & Yoshikawa, Tetsuya & Suzuki, Kuniaki & Totsuka, Yasunori. (2008). Effect of estrogen on bone resorption and inflammation in the temporomandibular joint cellular elements. International Journal of Molecular Medicine. 21;785-90.