That's where Vanessa Miller's pains came from. For years, she would wake up in the mornings with headaches. She could also hear a clicking sound in her jaw.
"I would clench my teeth, or grind my teeth, in my sleep," Miller said.
Up to 40 percent of people in the United States have TMJD, or temporo mandibular joint dysfunction -- a combination of problems that affect the jaw and surrounding tissue. It often goes misdiagnosed, and only a small percentage of people ever seek treatment.
TMJD can be caused by an injury to the jaw or by a bad bite that forces the jaw to open and close improperly. And it can also be caused by teeth grinding or clenching.
If not treated, it can also lead to neck and shoulder pain. Women have the problem three times more than men.
Diagnosis begins with a physical and dental exam, along with a patient's complete medical history.
Dr. Pei Feng Lim, who specializes in oral and facial pain at the University of North Carolina at Chapel Hill School of Dentistry, examined Miller by getting her to move her jaw into different positions and putting pressure on it to find the points of pain.
"The pain in her face seems to radiate to certain other areas causing pain like headaches," Lim said.
Conservative treatment can include medication that reduces inflammation and relaxes muscles. Stress can trigger the pain. So can depression, anxiety and mood disorders.
More severe cases of TMJD may require surgery, but moderate treatment can include behavioral changes, such as avoiding hard sticky foods, fast chewing and fingernail biting.
"In the daytime, we teach them to stop clenching/grinding habits, but in the nighttime, that's not really within their control," Lim said.
So, Miller, for example, has a splint molded to her own teeth that she wears at night.
"And it really prevents me from being able to bite down," she said.
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