Flora Blathwayt was always afraid of becoming overtired because she knew that if she yawned it would cause a sharp pain in her right jaw. Other simple actions such as chewing or brushing teeth were also painful.
Like an estimated one in fifteen Britons, Flora has temporomandibular joint disorder (or TMJ). It’s the same condition, which affects the movement of the jaw, that former Radio 2 presenter Zoe Ball recently revealed she has.
Zoe wrote on Instagram: ‘I have TMJ and wake up most days with a terrible headache from tension and jaw clenching.’
Other symptoms of the condition include clicking or grinding sounds when you move the jaw, or difficulty opening your mouth fully.
Since she started experiencing the problem a year and a half ago, Flora says she has “forgotten what it’s like to take normal facial movements for granted.”
“For example, I could be at a networking event where canapés are being passed around and even though they’re small things, it would hurt so much to eat one, so I don’t,” says the 38-year-old from London.
‘Routine activities such as brushing my teeth became difficult. Additionally, I found myself holding my right jaw with my hand just to relieve the pain.” Her jaw also ‘clicked’ painfully.
TMD is the name given to a series of conditions that affect 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, even though it is complex. “It’s the joint that allows you to move your jaw back and forth, up and down, forward and back,” says Dr. Whitley.
TMD occurs when bones, ligaments and muscles in the jaw do not move together as they should, or due to overuse of the muscles and joint – which can be the result of poor posture, teeth grinding, nail biting, chewing gum or even habitually chewing the top of a pen. All this can put pressure on the jaw.
TMD is common, but according to Luke Cascarini, an oral and maxillofacial surgeon at the London TMJ Clinic, it is often overlooked or misunderstood.
He points out that even the terminology is imprecise. Patients often say they have TMJ – the joint – when what they really mean is TMD, he says.
He estimates that in 90 percent of cases the condition is not caused by the joint itself, but by overload of the jaw muscles. Often, he explains, this is caused by an involuntary ‘sucking’ action of the tongue, similar to that of babies when they feed.
“The tongue is pushed forward, leading to the release of brain chemicals that cause the jaw muscles to become overloaded,” says Mr Cascarini.
‘We tend to call this movement bruxism, which is also confusing because that really just means grinding your teeth – and it’s much more than that.’
Like an estimated one in fifteen Britons, Flora has a temporomandibular joint disorder, or TMD
Why some adults begin to make this sucking motion is not fully understood. It probably has to do with changes in the brain, with stress and anxiety also playing a role in many. TMD is also associated with the neurodevelopmental disorder ADHD.
‘Unlike a baby, an adult has teeth and a jaw joint of a different shape. “When adults do this, it can cause the shock-absorbing disc of cartilage (between the jawbone and skull) to shift and become 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 break or wear down teeth and inflame the ligaments that support the teeth, which is very painful – the gums can recede and the jawbone becomes thicker and lumpy,’ he adds.
‘The jaw muscle pain is extremely unpleasant and can spread to the back of the head and through the neck to the shoulders.’
Other causes of TMD include Alzheimer’s disease, Parkinson’s disease, brain injury, or sleep apnea (a condition in which breathing repeatedly stops temporarily while you sleep).
Drugs such as antidepressants can also worsen the problem of TMD. What ties many of these factors together is that they disrupt brain activity – and this is what leads to poor jaw (and tongue thrust) function.
Accordingly, TMD can also be caused by stressful or traumatic events. This is what happened to Flora, who witnessed a cataclysmic and disturbing event in June 2023, but does not want to reveal the details.
Zoe Ball shared photos on Instagram before and after her treatment for the painful condition
“Suffice it to say, it was shocking,” she says. ‘The morning after my teeth started chattering and I couldn’t stop. It wasn’t the cold, I wasn’t shivering. It was so strange; I had never had this kind of problem before.
“A doctor friend who came to stay with me shortly afterwards said she could hear me clenching and grinding as I slept nearby,” she adds.
‘I also had terrible pain when I tried to open my mouth fully. It felt like my jaw was completely locked.
‘For two weeks I couldn’t chew and I only lived on yoghurt and liquid. I kept telling myself it was because I was scared after what happened and that it would go away, but it didn’t.’
After a few weeks, Flora (who runs Washed Up Cards, a company that makes greeting cards from discarded plastic) saw her GP, who thought this was due to anxiety, and suggested counselling.
But because her symptoms were so pronounced, Flora wanted her jaw examined by a specialist.
So in August last year she went privately to a maxillofacial surgeon and had an MRI scan, which revealed an anterior dislocation (on the right side) – meaning the jawbone moved out of the socket. There was also a lot of inflammation.
She was told that surgery could correct this, but the specialist recommended more conservative therapies first.
These include 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 completely went away and it took a huge toll on my mental health.’
Flora stopped going out and even stopped swimming regularly in cold water, “because my doctor told me this could worsen my condition,” she says.
This is because the deep breathing in response to cold water exposure can aggravate jaw muscles that are already inflamed.
“When I read that Zoe Ball also loves swimming in cold water, I thought there might be a connection for her too,” says Flora.
Another option for TMD may be Botox injections, explains Hazim Sadideen, a plastic surgeon at the Cadogan Clinic in London.
‘This is injected into the masticatory muscles (the large ‘chewing’ muscles in the cheek) and often into the temporalis muscles, which reach up to the skull and are necessary for closing the jaw.
“This temporarily relaxes these muscles, reducing tension and pain,” he says. The effects usually last three to six months.
No longer able to afford private treatment, Flora went back to her GP and went on the waiting list for an NHS surgeon.
In September 2024, she underwent an arthrocentesis – a ten- to thirty-minute procedure in which small needles are inserted into the joint so that sterile fluid can be flushed through it to remove debris and reduce inflammation.
While this may help with pain and movement in the short term, corrective surgery like this is only part of the answer, Mr. Cascarini explains.
‘The key to managing TMD is figuring out why you have the condition, i.e. what happens in the brain to stimulate your jaw muscles.
‘It is not always possible to simply turn it off, but different causes have different treatments. For example, in anxiety-related cases, medications that increase levels of GABA (a chemical messenger in the brain associated with relaxation) appear to be helpful, while, if it is related to ADHD, some psychiatrists have used medications to block the wave of stress . hormone noradrenaline.’
Above all, Mr. Cascarini says, it’s about “treating your brain kindly so it doesn’t go into distress.”
He recommends improving sleep habits and avoiding alcohol and other stimulants, “which can interrupt sleep and thus tax the brain.”
Some supplements such as magnesium can also help, he adds. One theory is that the mineral increases GABA levels.
As for Flora, after the successful surgery, she hopes she is on the road to a full recovery.
“I still have pain, but not like before,” she says. ‘A positive attitude can really help. I’m doing my best to portray myself better, and I hope that will be the case.’