By Jack Challem
Copyright 2000 by Jack Challem, The Nutrition Reporter™
All rights reserved. This article originally appeared in Let's Live magazine.
If you hear popping or clicking sounds in the jaw, find that your jaw occasionally "locks," or suffer regular headaches and ear pain, you maybe have temporomandibular joint (TMJ) disease.
If you do, you're hardly alone. The American Dental Association estimates that 10 million Americans suffer from the condition, whose symptoms may range from mild to debilitating.
The epicenters of TMJ disease are the body's two temporomandibular joints, located just in front of the ears. The joints connect the temporal bone of the skull and the lower jaw, also known as the mandible.
Dentists regard the temporomandibular joints as the most complex in the body. They enable the jaw to move in multiple directions, opening and closing like a hinge and gliding back and forth like a sliding door. Healthy joints are extraordinarily flexibility and strong enough to withstand the enormous pressure and wear and tear of chewing food.
TMJ disease, which is considered a form of arthritis, can develop when the joints move out of alignment. The most common cause is a "malocclusion," or bad bite. When teeth are crooked or don't mesh, they cannot grind food smoothly. This misalignment puts extra pressure on the joints and, not surprisingly, many people with TMJ disease have difficulty eating or feel pain when chewing. The pain often radiates outward and can cause toothaches, tightness of the facial muscles, and neck and shoulder discomfort.
Free Radicals and TMJ
What is the underlying cause TMJ disease?
According to Stephen B. Milam, D.D.S., Ph.D., an associate professor at the University of Texas Health Sciences Center, San Antonio, it may be free radicals-the same hazardous molecules implicated in heart disease and cancer.
Free radicals are unbalanced molecules missing one electron out of a pair. The are found in pollutants, such as cigarette smoke and smog, and are also produced as a consequence of normal food burning in the body.
To restore the missing electron, free radicals steal electrons from other molecules. When these molecules happen to be biologically important-such as the deoxyribonucleic acid (DNA) that forms genes-cells become damaged. Antioxidant nutrients, such as vitamins E and C and others, readily donate electrons to quench free radicals, preventing or limiting their damage.
"TMJ disease can result from free radicals that are excessively produced," says Milam. "Free radicals can also be produced at a normal levels, but a person's free radical scavenging potential may be diminished because of any number of reasons, such as poor diet or exposure to pollutants.
According to Milam, free radicals can be generated in TMJ in several ways.
First, free radicals can be created by the mechanical stress of tissue injury, Milam says. Shearing action, such as cutting fingernails and breaking bones, has been documented to generate free radicals. The mechanical stress of a bad bite also appears to produce free radicals.
Second, free radicals form during "hypoxia-reperfusion" injuries-that is, when tissues are briefly deprived of oxygenated blood and blood flow resumes. According to Milam, the unbalanced joint pressure characteristic of TMJ disease can cause oxygen starvation in TMJ tissues. When blood and oxygen are restored, cells may temporarily increase free radical production.
Third, hemoglobin (the iron-containing protein in the blood) is also a potent source of free radicals. Joint damage encourages microbleeding from tiny blood vessels, and as hemoglobin breaks down, it releases iron. This iron promotes the creation of dangerous hydroxyl free radicals, which in turn can break down collagen, elastin, and other proteins forming the body's connective tissue, according to Milam.
Fourth, an inflammatory response can also generate large numbers of free radicals. For example, in people with TMJ disease, the breakdown of arachidonic acid (an essential fatty acid) generates free radicals and proinflammatory hormones called cytokines. Both cytokines and free radicals can promote chronic inflammation, leading to more tissue damage and pain.
Milam believes that free radicals may not cause TMJ disease as long as the body's own (endogenous) antioxidant enzymes and dietary antioxidants are sufficient. However, if these antioxidants are overwhelmed by free radicals-a situation known as oxidative stress-the disease process may get out of hand.
Antioxidants May Help
In general, few dentists routinely use antioxidants to treat TMJ disease and other dental disorders, and relatively few reports on vitamins are published in professional dental publications. However, antioxidants have a strong scientific foundation as free radical scavengers and antiinflammatory compounds.
In fact, two recent studies have found free radical levels to be elevated in patients with TMJ disease and facial pain. , In an article in the Journal of Oral and Maxillofacial Therapy, Milam suggested that antioxidants would likely be of benefit.
Another study used injections of superoxide dismutase (SOD) to treat 29 patients with TMJ disease. SOD is an antioxidant enzyme produced by the body and also sold as a dietary supplement. SOD eased TMJ pain in 83 percent of the patients.
Milam admits that there isn't a lot of "empirical evidence" demonstrating that antioxidants can help patients with TMJ. A lot of the support for antioxidant supplementation is derivative, coming from general research on their properties and from findings in people with arthritis. "For my patients, I do recommend vitamin E and green tea, which is high in polyphenol antioxidants," he says. "Both are very good and safe."
· Vitamin E, the body's principal fat-soluble antioxidant, has a subtle but systemic antiinflammatory effect. In a British study, researchers found that vitamin E supplements helped the eased pain in a group of 20 arthritics. Recommended dose: 400-800 IU daily.
· Vitamin C is the body's principal water-soluble dietary antioxidant. It quenches the dangerous hydroxyl free radical. Combining vitamin C and flavonoids enhances its antioxidant effects. Recommended dose: 500-1,000 mg daily.
· Flavonoids are a large group of antioxidant nutrients found in fruits and vegetables. Pycnogenol®, a complex of flavonoids from French maritime pine bark, can prevent breakdown of connective tissue from inflammation. Another study found that Pycnogenol® reduced inflammation in laboratory animals. Quercetin, another flavonoid, can inhibit the action of "adhesion molecules," which promote inflammatory reactions. Drinking a couple cups of green tea or taking green tea polyphenol supplements might also help Recommended dose: 25-50 mg Pycnogenol®, 250 mg quercetin, or 300 mg green tea polyphenols daily.
· B vitamins have an analgesic (pain-relieving) effect. A study in the German journal Schmerz reported that vitamins B1, B6, and B12 can help reduce musculoskeletal pain, and that the vitamins worked best in combination. A study of American veterans found that generalized body pain was associated with vitamin B12 deficiency. Recommended dose: B-complex supplement containing 25-50 mg of vitamin B1.
· Omega-3 essential fatty acids are the building blocks of antiinflammatory prostaglandins and cytokines. Taking them in supplemental form, or eating salmon twice weekly, can counter the proinflammatory effects of vegetable oils (e.g. corn oil). Recommended dose: 3 grams daily.
· Gamma linolenic acid (GLA) is an antiinflammatory omega-6 essential fatty acid found in primrose and borage seed oils. A number of studies have found GLA to ease arthritic symptoms. Recommended dose: 2-3 grams daily.
Milam acknowledges that dietary supplements may be helpful to people with TMJ, partly because many such patients have difficulty eating and getting optimal nutrition. Although antioxidants, B vitamins, and fatty acids have antiinflammatory or pain-relieving properties, they have not been "proved" beyond a doubt to be beneficial in controlling TMJ disease. Also, says Milam, very high doses of antioxidants may interfere with beneficial free radical reactions in the body. Try taking one or two supplements to start and gauge whether symptoms improve.
More on the Diet/Dental Connection
When it comes to nutrition, the traditional dental advice is simple: eat calcium-rich foods to build strong teeth, and stay away from cavity-causing sugar. However, many other nutrients play profoundly important roles in dental health. A sampling:
· Gum disease. Severe periodontal disease is associated with low blood levels of vitamin C. In addition, deep "pockets" surrounding teeth, a sign of periodontal disease, is also associated with low levels of vitamin C. Several studies have reported that the topical application of coenzyme Q10, a vitamin-like nutrient, can improve the health of periodontal tissues. CoQ10 plays a crucial role in energy production, and researchers believe that inadequate CoQ10 may contribute to the weakness and injury of periodontal tissues.
· Cavities. The polyphenols in unsweetened cranberry juice can prevent cavity-causing bacteria from clumping together. Such bacterial adhesion is an early step in the formation of cavities, according to a report in the December 1998 Journal of the American Dental Association.
· Teeth. It's true that calcium is needed for healthy teeth. Teeth are a form of bone, and strong bones require adequate dietary calcium. Don't overlook other nutrients that also play key roles in bone development. Among them are magnesium, and vitamins B12 and K.
· Oral infections. Periodontal disease has been linked to an increased risk of heart disease. The bacteria infecting the gums appear to stimulate a heightened immune response, and immune cells generate large numbers of free radicals (to destroy bacteria). Antioxidants can fine tune the immune response, enhancing the activity of immune cells and quenching excess free radicals.
The information provided by Jack Challem and The Nutrition Reporter™ newsletter is strictly educational and not intended as medical advice. For diagnosis and treatment, consult your physician.