Flora Blathwayt used to dread getting over-tired – because she knew that if she yawned, it would unleash sharp pain across her right jaw. Other simple actions such as chewing or brushing her teeth were also agony.
Like an estimated one in 15 Britons, Flora has temporomandibular joint disorder (or TMJ). It’s the same condition, affecting the movement of the jaw, that former Radio 2 presenter Zoe Ball recently revealed she has.
Writing on Instagram, Zoe said: ‘I have TMJ and wake most days with awful headaches from tension and jaw clenching.’
Other symptoms of the condition include clicking or grinding noises when you move the jaw – or difficulty opening your mouth fully.
Since she started experiencing the problem 18 months ago, Flora says she’s ‘forgotten what it’s like to take normal facial movements for granted’.
‘I could be at, say, a networking event as canapes are passed round and even though they’re little items, just trying to eat one would hurt so much, so I don’t,’ says the 38-year-old from London.
‘Routine activities such as cleaning my teeth became difficult. Also, I’d find myself holding my right jaw with my hand just to try and relieve the pain.’ Her jaw would also ‘click’ painfully.
TMD is the name given to a range of conditions affecting the temporomandibular joint – which is located in front of the ears and connects the jawbone to the skull.
Former Radio 2 presenter Zoe Ball recently revealed she has the condition, which affects the movement of the jaw
The condition can also affect the muscles, ligaments (bands of tissue that support joints and connect bone to bone) and surrounding nerves, hence the pain, explains Dr Nyree Whitley, a dentist at Mydentist, a network of NHS and private practices.
The temporomandibular joint works like a hinge, although a complex one. ‘It’s the joint that allows you to move your jaw side to side, up and down and forward and back,’ says Dr Whitley.
TMD occurs when bone, ligaments and muscles in the jaw aren’t moving together as they should, or because of overuse of the muscles and the joint – which can be the result of poor posture, tooth grinding, nail biting, chewing gum or even habitually chewing the top of a pen. All of these can put the jaw under stress.
TMD is common, yet according to Luke Cascarini, a consultant oral and maxillofacial surgeon at the London TMJ Clinic, it’s often overlooked or misunderstood.
He points out that even the terminology is inaccurate. Patients often say they have TMJ – which is the joint – when they actually mean TMD, he says.
In fact, he estimates that 90 per cent of the time, the condition doesn’t come from the joint itself but from overloading the muscles in the jaw. Often, he explains, this is caused by an involuntary ‘suckling’ action of the tongue – similar to that of babies when they feed.
‘The tongue gets thrust forward, which leads to the release of brain chemicals that cause jaw muscles to become overloaded,’ says Mr Cascarini.
‘We tend to call this movement bruxism, which is also confusing because that really just means clenching or grinding of teeth – and it is much more than that.’
Like an estimated one in 15 Britons, Flora has temporomandibular joint disorder, or TMD
Why some adults start doing this suckling motion isn’t completely understood – it’s likely down to changes in the brain, with stress and anxiety playing a role for many too. TMD is also associated with the neurodevelopmental disorder ADHD.
‘Unlike a baby, an adult has teeth and a different shaped jaw joint – so when adults do this, it can cause the shock-absorbing disc of cartilage [between the jaw bone and skull] to become displaced and damaged,’ says Mr Cascarini.
‘Over time, the activity can cause real damage to the joint itself, leading to arthritis and jaw misalignment.
‘It can also fracture teeth or wear them down and inflame the ligaments supporting the teeth, which is very painful – the gums can recede and the jaw bone becomes thickened and lumpy,’ he adds.
‘The jaw muscle pain is extremely unpleasant and can spread to the back of the head and down the neck to the shoulders.’
Other causes of TMD include Alzheimer’s disease, Parkinson’s, brain injury or sleep apnoea (a disorder which causes breathing to repeatedly stop temporarily while you sleep).
Drugs such as antidepressants can also exacerbate the problem of TMD. What links many of these factors is that they disrupt brain activity – and it is this that leads to malfunction of the jaw (and the tongue thrusting action).
Accordingly, TMD can also be brought on by stressful or traumatic events. This is what happened to Flora, who witnessed a cataclysmic and distressing event in June 2023, though does not want to reveal the details.
Zoe Ball shared photos on Instagram before and after her treatment for the painful condition
‘Suffice to say, it was shocking,’ she says. ‘The morning after, my teeth started chattering and I couldn’t seem to stop. It wasn’t the cold, I wasn’t shivering. It was so strange – I’d never had any problems like this before.
‘A doctor friend who came to stay with me soon after said she could hear me clenching and grinding as I slept nearby,’ she adds.
‘I also developed terrible pain when I tried to open my mouth fully. It felt as if my jaw was completely locked.
‘For two weeks I couldn’t chew and just subsisted on yoghurt and fluids. I kept telling myself it was because I was anxious after what had happened and it would go – but it didn’t.’
After a couple of weeks, Flora (who runs Washed Up Cards, a company that makes greetings cards from discarded plastic), saw her GP who thought it was the result of anxiety and suggested counselling.
But as her symptoms were so pronounced, Flora wanted her jaw to be examined by a specialist.
So in August last year she went to see a maxillofacial surgeon privately and had an MRI scan, which revealed an anterior dislocation (on the right hand side) – meaning the jaw bone was moving out of the joint socket. There was also a lot of inflammation.
She was told surgery could correct it, but the specialist advised more conservative therapies first.
These included the Bowen technique – a hands-on therapy that uses gentle pressure to treat the body’s soft tissue and nervous system – and deep breathing exercises.
‘I tried so many things, including pain relief and heat packs on my jaw, and I was prescribed baclofen – a muscle relaxant,’ says Flora. ‘But the pain never fully went away and it was taking a real toll on my mental health.’
Flora stopped going out and even gave up her regular cold-water swimming, ‘as my doctor told me that it could make my condition worse’, she says.
This is because the deep breathing in response to cold-water exposure can aggravate jaw muscles that are already inflamed.
‘In fact, when I read Zoe Ball has also been a lover of cold-water swimming, I thought there might be a link for her too,’ says Flora.
Another option for TMD can be Botox injections, explains Hazim Sadideen, a consultant plastic surgeon at the Cadogan Clinic in London.
‘This is injected into the masseters [the big ‘chewing’ muscles in the cheek] and often the temporalis muscles – which extend up to the skull and which are needed for closing the jaw.
‘This temporarily relaxes these muscles, reducing tension and pain,’ he says. The effects usually last three to six months.
Unable to afford more private treatment, Flora went back to her GP and went on the waiting list to see a surgeon on the NHS.
In September 2024, she had an arthrocentesis – a ten to 30-minute procedure in which small needles are inserted into the joint so sterile fluid can be flushed through to remove debris and reduce inflammation.
However, while this can help with pain and movement in the short term, corrective surgery like this is only part of the answer, explains Mr Cascarini.
‘The key to dealing with TMD is finding out why you have the disorder – i.e. what is happening in the brain to stimulate your jaw muscles.
‘It’s not always possible to just switch it off, but different causes have different treatments. For example, in anxiety-related cases drugs that boost levels of GABA [a chemical messenger in the brain associated with relaxation] seem to be helpful, while if it is linked to ADHD, some psychiatrists have used drugs to block the surge of the stress hormone noradrenaline.’
Above all, says Mr Cascarini, it’s about ‘treating your brain with kindness to stop it getting into distress’.
He recommends improving sleep habits and avoiding alcohol and other stimulants, ‘which can interrupt sleep and so distress the brain’.
Some supplements such as magnesium may also help, he adds. One theory is the mineral boosts GABA levels.
As for Flora, after the successful operation she hopes she’s on the road to full recovery.
‘I still have pain but not like it was before,’ she says. ‘Having a positive attitude can really help. I’m trying hard to imagine myself better, which I hope really will become the case.’
