Jaw pain in severely anxious patient

T

Theblurredface

Member
Joined
May 15, 2020
Messages
33
Hi, I'm hoping to get some advice from a real dentist but please go easy and sugarcoat it because I'm utterly terrified of the worst case scenario here. Thank you in advance for any responses.
Some quick background: I'm extremely phobic to the point of being unable to go to the dentist at all and having tried everything for it already, I have at least one untreated cavity that was detected the last time I managed to go to the dentist 6 years ago and I haven't managed to go back since. Recently I've had pain in that area off and on but it's been manageable. I am fully aware that I should be dealing with it, I'm a health sciences student, I'm not dumb, I'm just incapable of doing so psychologically and very mentally ill. Please don't lecture me.

However recently what I'm more concerned about is pain in my lower jaw and stiffness over the last couple of days (the cavity is not in the lower teeth) I hope that it's all just in my head, and taking anxiety medication seems to help but I don't know if that's because it's easing my mind or relaxing the muscles. It might be relevant that I started taking a new medication that in rare cases can cause paresis and a lot of movement disorders. I guess I'm looking for affirmation that this should be because of anxiety or medication and not because something is really seriously wrong with half of my face.
Thanks for responding
 
Niall Neeson

Niall Neeson

Well-known member
Verified dentist
Joined
Apr 18, 2019
Messages
169
Hi Theblurredface,

We’re not into lectures here. We understand how big a deal a visit to the dentist can be for many people. I hope a lot of the excellent content on this website will offer you support and maybe even begin to carve out a pathway back towards being able to help maintain the health of your mouth.

In relation to the pain in the lower jaw and stiffness, although it’s impossible to confirm a diagnosis over a forum, it’s very possible that it could be from tension in the masseter muscle.


Are you ever aware of clenching or grinding your teeth? One potential explanation is that a source of stress (possibly concern about the cavity), could increase the extent and impact of clenching and grinding. This can lead to an increase in tension and discomfort in the muscles.

As you mentioned, the anti-anxiety medication could then work by reducing the impact of the stress and also helping the muscles to relax, leading to an improvement.

Does this sound like a possibility to you?

Clenching or grinding the teeth is actually very common. The challenge is, most of the troublesome habits happen at night time so it’s common that people aren’t aware of it (and it’s not always the noisy type of grinding).

If you think this could be the source then a physiotherapist with interest in TMJ may be able to help. Also sensible to reduce the workload of the jaw during the day- eg soft diet, avoid gum, avoid hard or chewy foods, avoid opening wide, put your hand under your chin when yawning to keep it from opening excessively. Applying a hot water bottle and massaging the area may help too.

Let us know your thoughts.

Niall
 
T

Theblurredface

Member
Joined
May 15, 2020
Messages
33
Hi Theblurredface,

We’re not into lectures here. We understand how big a deal a visit to the dentist can be for many people. I hope a lot of the excellent content on this website will offer you support and maybe even begin to carve out a pathway back towards being able to help maintain the health of your mouth.

In relation to the pain in the lower jaw and stiffness, although it’s impossible to confirm a diagnosis over a forum, it’s very possible that it could be from tension in the masseter muscle.


Are you ever aware of clenching or grinding your teeth? One potential explanation is that a source of stress (possibly concern about the cavity), could increase the extent and impact of clenching and grinding. This can lead to an increase in tension and discomfort in the muscles.

As you mentioned, the anti-anxiety medication could then work by reducing the impact of the stress and also helping the muscles to relax, leading to an improvement.

Does this sound like a possibility to you?

Clenching or grinding the teeth is actually very common. The challenge is, most of the troublesome habits happen at night time so it’s common that people aren’t aware of it (and it’s not always the noisy type of grinding).

If you think this could be the source then a physiotherapist with interest in TMJ may be able to help. Also sensible to reduce the workload of the jaw during the day- eg soft diet, avoid gum, avoid hard or chewy foods, avoid opening wide, put your hand under your chin when yawning to keep it from opening excessively. Applying a hot water bottle and massaging the area may help too.

Let us know your thoughts.

Niall

Thank you for getting back to me so quickly. Some stuff I forgot to mention is that ever since I found out I had a cavity 6 years ago I have favoured chewing on one side on the other side. My jaw isn't actually straight anymore visibly (ever so slightly) although I can move my facial muscles symmetrically, my jaw seems to be slightly off to one side and my teeth don't line up well anymore. I think I hold a lot of tension in my jaw as I can't very comfortably close it all the way because it doesn't line up. My pain is actually best in the morning, by resting the side of my face on a pillow I think I release some of that tension of holding my jaw in an exact position.

I am trying to make eating as easy as possible, also because of the cavity, it's tough because I don't want people around me to know what's going on and overreact. I can do that for myself.

I appreciate the advice of seeing a physio but I wouldn't be comfortable with anyone getting that close to my mouth when I know there's embarrassing unpleasant stuff wrong with it. I can't even let a doctor see my throat.

Yes, the benzodiazepines seem to make the biggest difference to the pain, more so than actual pain killers and also stop me feeling so panicked about it for a while.
 
Niall Neeson

Niall Neeson

Well-known member
Verified dentist
Joined
Apr 18, 2019
Messages
169
I understand how you may feel this way about the condition of your mouth but a couple of things to consider.

Firstly, a physio won’t really give a toss about the condition of your teeth or your mouth. And they’re certainly not going to judge you for it.

Secondly, it’s clear to see that you are stuck in this vicious spiral of being ashamed of what’s going on and avoiding attending appointments that may be helpful. I’m sure you can appreciate yourself that you’re avoiding attending the very people who can help you (though I also appreciate that phobia can easily over-ride logic). Now, it’s helpful to know that there are definitely dental and health professionals out there who will not judge you but actually applaud you for attending to do something about it.

If, in your current situation, you simple can not bear to attend even a physio or a doctor then in my opinion the only way forward is some additional psychological support. This may be a psychologist or Cognitive Behavioural Therapist to help untangle the excessive thoughts and emotions you are experiencing.

You have to find a way to break this cycle.

And it’s ok to ask for help to do it.
 
T

Theblurredface

Member
Joined
May 15, 2020
Messages
33
I understand how you may feel this way about the condition of your mouth but a couple of things to consider.

Firstly, a physio won’t really give a toss about the condition of your teeth or your mouth. And they’re certainly not going to judge you for it.

Secondly, it’s clear to see that you are stuck in this vicious spiral of being ashamed of what’s going on and avoiding attending appointments that may be helpful. I’m sure you can appreciate yourself that you’re avoiding attending the very people who can help you (though I also appreciate that phobia can easily over-ride logic). Now, it’s helpful to know that there are definitely dental and health professionals out there who will not judge you but actually applaud you for attending to do something about it.

If, in your current situation, you simple can not bear to attend even a physio or a doctor then in my opinion the only way forward is some additional psychological support. This may be a psychologist or Cognitive Behavioural Therapist to help untangle the excessive thoughts and emotions you are experiencing.

You have to find a way to break this cycle.

And it’s ok to ask for help to do it.
I did try 6 years ago with counselling, and a hypnotherapist with a good track record for phobias, and benzos from the dentist and from the GP... None of it worked, maybe CBT would, I just feel like there would be a lot to unpack in my head with there being so many comorbid mental illnesses going on in there.
I am trying to find a local dentist who thinks they can handle my case with extreme patience because I'm in a lot of pain from this and the cavity. I don't know if I'd be able to go, I don't know what it a stronger motivator at this point, fear, or pain. At the moment my messages may have put off both the dentists I reached out to anyway as they haven't answered but I'll wait and see if they do and what they're like. They both said they worked with phobic and special needs patients on their sites.
Thank you for answering me and being non judgemental
 
Niall Neeson

Niall Neeson

Well-known member
Verified dentist
Joined
Apr 18, 2019
Messages
169
Yeah you’re right, comorbidity is really common with phobia and its does make it more of a challenge to treat effectively. That’s exactly why the additional psychological support comes in as being so valuable.

In the context of dental phobia with comorbidity, CBT has been shown to be effective and is a recommended approach in such cases. Certainly worth looking into. It can sometimes be easier to begin your dental journey being nowhere near an actual dentist.
 
T

Theblurredface

Member
Joined
May 15, 2020
Messages
33
Yeah you’re right, comorbidity is really common with phobia and its does make it more of a challenge to treat effectively. That’s exactly why the additional psychological support comes in as being so valuable.

In the context of dental phobia with comorbidity, CBT has been shown to be effective and is a recommended approach in such cases. Certainly worth looking into. It can sometimes be easier to begin your dental journey being nowhere near an actual dentist.

Thank you for that advice, I will definitely keep CBT in mind, I'm just worried about time frames due to the fact I'm already living with a lot of pain, but then again it's not like I'm progressing or advancing in any way now.
 
Niall Neeson

Niall Neeson

Well-known member
Verified dentist
Joined
Apr 18, 2019
Messages
169
I know what you mean. Better to have options than no options though 👍
 
Top