According to research, TMJ should be better and not worse during pregnancy because of elevated hormone levels of relaxin. The TMJ (temporomandibular joint) is the jaw joint which controls the opening and closing of your jaw.
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TMJ disorder should improve during pregnancy
TMJ worsening during pregnancy is actually a common misconception because it is not true at all. If you look at the research more closely, it has in fact demonstrated that pregnancy improves your TMD.
The misconception of pregnancy making your TMD worse
One of the most cited sources for how being pregnant can make your TMD worse comes from a study out of Russia. They make two claims with the first one being true while the second one being false.
Alleged claims:
Pregnancy elevates the hormone levels of Estrogen and Relaxin.
The relaxin hormone makes the joints more "lax" in order to accommodate child birthing and consequently it also makes your TMJ more "lax" which makes it worse.
The first claim is true because various other studies have shown that relaxin is being produced during pregnancy. We couldn't find any research which refutes this point. All of the pregnancy and TMJ studies all seem to concur that relaxin plays a role.
The second claim that the hormone relaxin makes your temporomandibular joint more "lax" results in TMJ pain is partially false. The Russian study alleges that due to the joint becoming lax, it can result in jaw clicking and also potentially having a locked jaw (when you open and can't close your mouth).
Your TMJ can certainly "click" more if the ligaments become more lax but that is usually not a painful symptom for sufferers of TMD. Also having the joint become more lax can potentially lead to your jaw becoming locked open if it slides too far out.
However, that is an incredibly rare occurrence. How many pregnant women do you know that had their jaws locked? Not very many I presume.
Usually when the public refers to TMJ disorders, what they're talking about is generalized jaw pain or joint pain. The two situations above don't necessarily contribute to pain in that sense.
Most TMJ patients typically complain about pain when they wake up in the morning or discomfort from chewing hard foods. Those symptoms are caused by joint degradation from overuse or from teeth grinding and clenching in the middle of the night.
Explanation for symptoms:
Joint degradation is a result of chronic overuse and it wouldn't happen from just being pregant.
The tiredness from chewing or pain from waking up in the morning is from muscle overuse. Usually as a result of parafunctional habits at night where you're constantly using the muscles.
When the muscles become tired from overuse, they can develop muscle knots in the chewing muscles. These knots can spasm and cause you sporadic pain. Basically your chewing muscles start to become very tight and tender.
The treatment for tight muscles is usually to make them more relaxed. Your dentist may send you to physical therapy for myofascial release or they may even prescribe you a muscle relaxant. All of which are purposefully trying to get your muscles to become more "lax" by deactivating the TMJ trigger points.
Do you see where we are going here? During pregnancy, the hormone relaxin becomes elevated which makes your joint more "lax", which is precisely the treatment outcome that your doctor is looking for when you are having TMJ problems!
Is that not contradictory to the alleged claims from the Russian study? Thus, all claims saying that your TMJ will worsen during pregnancy due to relaxin must be false.
Pregnancy improves TMJ symptoms
Hopefully you're pleasantly surprised to now know that pregnancy can actually improve your TMD. For instance, if you had pre-existing TMJ problems it should technically get better throughout the course of your pregnancy and it is all due to the effects of the hormone relaxin.
This study actually demonstrated that patients had an improvement in musculoskeletal and orofacial pain symptoms over the course of pregnancy. They concluded that the improvements were due to a dramatic change in hormones which resulted in joint laxity. In other words, the elevated levels of relaxin contributed to an improvement in TMJ symptoms.
In case you weren't convinced, there was a study that was done on rats which demonstrated that there was a decrease in orofacial pain in pregnant rats as opposed to non-pregnant ones. Although they stated that it was due to an elevated level of estrogen. Nonetheless, both estrogen and relaxin levels are elevated during pregnancy.
Therefore we must say that over the course of pregnancy your TMJ symptoms should improve. Just be aware that the hormones don't ramp up to max levels immediately. They tend to slowly increase as you move through the trimesters and should peak right about the time you're due to give birth.
Prevalence of TMJD while pregnant
According to the NIH the prevalence of TMD is about 5-12% of the general population.
It is twice as prevalent in women when compared to men.
However, we've also come across other studies saying that TMJ problems can affect up to 40% of the population and that it can affect women up to 5x as much vs men.
We will have to conservatively go with the NIH study's estimates but even within the listed tables, it does show some % going up beyond the 30% mark. Nonetheless, what seems to be agreed upon is that it does seem to affect women more than men.
Therefore we will have to say that TMJ problems are certainly not uncommon since it already affects a sizable portion of the population. Since women make up roughly half of the population, we would expect that the same percentage of women should be affected if they happen to be pregnant.
TMD prevalence in pregnant vs non-pregnant women
Despite temporomandibular joint disorders being more prevalent in women vs men, there is actually no difference between women who are pregnant and those who are not.
This study from Turkey found that there was no statistical difference between the two groups. They were measuring the changes in systemic joint hypermobility vs TMD. Apparently there wasn't an increase in the temporomandibular joint just from being pregnant.
A second study verified the results, which basically came to the same conclusion. There was no difference in joint hypermobility for the TMJ despite being pregnant.
Therefore with a good amount of certainty, we would have to say that pregnant women do not necessarily have more problems with their temporomandibular joint.
How to manage TMJ pain while pregnant
Despite the fact that the hormone relaxin during pregnancy should improve your TMD, it does not mean that you become immune to TMJ pain. It may lessen the symptoms by making the joint more lax so that your muscles don't become as tight but it won't get rid of the problem completely.
It'll be a lot more clear if you understand the cause for temporomandibular joint disorders. If it is due to joint degradation, you most likely can't do anything about it unless you get a joint replacement.
However if your TMJ pain is coming from overworked muscles, it is most likely due to teeth grinding and clenching in the middle of the night. Both are usually the result of stress. When you're stressed out, you may subconsciously take it out on your mouth by grinding or clenching your teeth.
It is certainly no walk in the park being pregnant and it can be extremely stressful. Due to that reason alone it is totally plausible that women who never grinded their teeth nor experienced TMD may all of a sudden come down with jaw pain. It is because they are stressed from being pregnant and thus have developed parafunctional habits at night which resulted in a sore jaw.
If you're experiencing jaw pain or jaw soreness, you should definitely seek professional help such as from your dentist. They will guide you to what you need to do and how to treat it.
What helps TMJ pain during pregnancy
The first thing you should do is get an evaluation by your dentist. If you are indeed grinding your teeth all of a sudden, it would be prudent to have a night guard made, which is an acrylic appliance which you wear to protect your teeth.
It will prevent your teeth from being worn down. It may also improve some of the grinding symptoms by getting your jaw to relax a bit sometimes.
The second thing you should do is to try to destress. We know it may not be possible sometimes but certainly there are things in your life which you can alter that can at least decrease some of the stress that you are experiencing. As an example, maybe get your husband to take over more of the house work!
The third thing that you can do is to actually get a facial massage or myofascial release. You can do this with either a physical therapist or a massage therapist. They can help you release some of those tight TMJ muscles. If you can get the muscle to be less tight and less tense, you should experience some pain relief.
The tight muscles with big muscle knots are usually the culprit for whenever you have a TMJ flare up. When the tight muscles have a spasm, it can cause you excruciating pain that may seem spontaneous and appear out of nowhere. Of course we all know that it wasn't out of nowhere because those tense muscles have been getting more tense over time.
Alternative treatments:
Dry needling. When needles are inserted into the muscle in order to break up the knots.
Botox. Freeze the muscles so that they aren't as active at night time.
Muscle relaxants. A medication that will just get you to relax when you sleep.
Overall, you should try your best to avoid things that make it worse such as if eating hard foods tire out your joint. If that is the case, you should avoid the hard foods or choose foods that are softer.
Even after you give birth, you should still implement these treatment protocols. It may potentially make your symptoms go away after giving birth.
The Verdict
We would have to say that pregnancy should technically improve your TMJ pain and not make it worse. The hormone relaxin is elevated during pregnancy and the function of that is to make your joints become more lax. A more lax temporomandibular joint should be a less painful one.
However, that is not to say that you can't develop TMJ issues while you're pregnant if you never had it before. A lot of the TMJ symptoms can be a result of teeth grinding or clenching which stems from stress. Since pregnancy is a stressful period, some women may develop the condition during the process.
It may be a little confusing since we put it that way since pregnancy should improve the symptoms but at the same time you can still develop TMD. You must understand that it will lessen the symptoms but it does not prevent it from occurring.
Basically what you should expect is that, your TMJ pain may feel worse initially during the beginning of pregnancy such as the first trimester. However as you progress through the second and third trimester where your hormones become even more elevated, you should notice an improvement in the symptoms.
We suppose since it may be worse in the beginning rather than the end, it could technically be classified as an early sign of pregnancy. However, it is still not a reliable sign nor is it as early as a missed period.
