Jaw - diet advice

Image shows bowl of Greek yoghurt with small amount of fruit on top.

Information is taken from a leaflet produced by the The TMJ Association.

Background

Scientists now agree that Temporomandibular Disorders (TMD) are a complex and poorly understood set of conditions characterized by pain in the jaw joint and/or surrounding tissues and limitation in jaw movements. These problems can affect your ability to chew and swallow foods and limit how wide you can open your mouth.

There are genetic, hormonal, environmental and behavioural factors that may increase your risk for TMD. The immediate causes include a variety of conditions such as injury to the jaw, arthritis, muscle problems, autoimmune and connective tissue disease, developmental conditions, or movement disorders affecting the jaw.

TMD also may occur following head and neck treatments for other conditions including tumours. In individuals who have had prior surgery, altered function may be due to scarring and alteration in remaining bone anatomy.

In some cases, numbness and pain may persist if nerve damage has occurred.

Many patients diagnosed with TMD may also suffer one or more systemic conditions, often also characterized by pain, which include chronic fatigue syndrome, chronic headache, endometriosis, fibromyalgia, interstitial cystitis, irritable bowel syndrome, low back pain, sleep disorders, and vulvodynia.

Having more than one painful condition can further diminish one's appetite and affect food choices.

Whatever your situation may be, it is clear that TMD alone can impact your quality of life and lead to poor nutrition if the jaw pain and oral disability seriously affects your diet.

In addition, TMD patients may experience dry mouth as a side effect of chronic pain medications and other drugs. The lack of saliva to bathe the oral tissues increases the risk for dental cavities, yeast infections, and broken teeth, and adds to the difficulties in chewing and swallowing.

The mouth may also become more sensitive to pain and temperature and affect taste. To avoid these problems and manage your TMD symptoms you should:

Brush and floss teeth after meals.
Get regular dental check-ups and use dentist-prescribed fluoride for dental maintenance.
High-risk patients, where jaw opening is restricted, may be prescribed oral antibacterial mouth rinses that reduce cavity-causing bacteria.
Treat TMD symptoms of pain and limited jaw opening following principles of physical and rehabilitative medicine. Manage chronic pain by reducing inflammation and muscle-based pain whenever possible.
Seek prescription salivary stimulants (sialogogues) if dry mouth is present.
Consume small meals and non-sugar-based snacks. (Limit high sugar products between meals.

How to manage your diet

Many TMD patients struggle to determine what to eat to maintain proper weight and ensure adequate protein, vitamin and mineral status.

Your food choices vary depending on the amount of pain you’re experiencing and your ability to open your mouth, chew and swallow.

For those who are able to adequately open their mouths and have minimal pain, a soft or easy-chew diet will work well. A soft diet is defined as foods that require minimal chewing.

Here is a list of foods to include as well as to avoid in a soft-food diet that requires minimal chewing

Foods to include and foods to avoid in a soft-food diet that requires minimal chewing.
	Soft diet foods to include	Soft diet foods to avoid
Dairy/Dairy alternatives	Smooth yogurt, soft cheeses (feta cheese, ricotta cheese, cottage cheese), milk, custard, puddings, buttermilk, soymilk, almond milk, kefir, cheese sauce	Sliced hard cheese, yogurt containing chunks of fruit or seeds, coconut and nuts
Grains	Soft bread (no seeds, nuts or whole grain pieces), corn bread, muffins without seeds or nuts, soft tortillas, pancakes, stuffing/dressing, matzo balls, couscous, quinoa, pasta, dumplings, gnocchi, rice, mashed potatoes, polenta, grits, hot cereals, cold cereals (crisp rice, corn flakes)	Breads with seeds or nuts, pancakes and French toast without syrup, rice (Some may be able to tolerate well cooked rice, especially with gravy.)
Fruits	Canned fruits, (applesauce, peaches, pears, fruit cocktail), bananas, ripe melon, baked apples, fruit juice, fruit nectars and fruit smoothies	Fresh fruit with skins or seeds, whole grapes
Vegetables	Cooked carrots, squash, zucchini, spinach, kale or other greens, avocados, legumes, green beans, peas, vegetable soufflé, creamed corn, asparagus tips, beets, vegetable juice, cooked pumpkin	Lettuce, chopped tomatoes, fresh vegetables, such as carrots and celery
Protein foods	Soft-cooked chicken or turkey with gravy, meatloaf, fish, deli meats, meatballs, slow cooked meats, tuna, chicken/tuna/egg/seafood salad (made without onion and celery), lox, eggs, tofu, fish sticks (battered, not crunchy), legumes, refried beans, baked beans, hummus, meat and pasta containing casseroles, quiche, refried beans, liverwurst, smooth nut butters	Fried eggs, fried meats with breading, hard-boiled eggs, nuts, and seeds
Soups	Cream-based soups, tomato soup, broth-based soups (Avoid stringy vegetables such as celery.)	Soup that contains celery, undercooked carrots, or rice (Some people can handle rice.)
Desserts	Soft cakes, cobblers and pies (without the crust), soft cookies without nuts or chunks dunked in milk to soften, ice cream (without nuts or chunks), frozen yogurt, sherbet, sorbet, gelato, milkshakes, cheesecake, puddings, custard, gelatin, nutritional drinks	Cakes, cookies, pies, and brownies that are hard and dry making them difficult to chew (Avoid baked goods that contains nuts, seeds, coconut, or pineapple.)

For those unable to tolerate a soft diet, here is a list of pureed foods to include and avoid

A list of pureed foods to include and avoid.
	Pureed diet foods to include	Pureed diet foods to avoid
Dairy/Dairy alternatives	Smooth yogurt, soft cheeses (feta cheese, ricotta cheese, cottage cheese), milk, custard, puddings, buttermilk, soymilk, almond milk, kefir, cheese sauce	Sliced hard cheese, yogurt containing chunks of fruit or seeds, coconut or nuts, cottage cheese (unless pureed), feta cheese
Grains	Bread (without nuts or seeds) that has been soaked into a dissolvable consistency, pureed pasta, pureed pancakes, hot cereals, grits, soft polenta, mashed potatoes (thinned as needed)	Breads with or without nuts that have not been soaked, corn bread, stuffing/dressing, dry cereals, regular pasta/noodles, rice
Fruits	Applesauce, mashed ripe bananas, fruit juice, fruit nectar, seedless jam/jelly, pureed fruits (strained as necessary)	Canned fruit that has not been pureed, fresh fruits with skins and seeds, whole grapes
Vegetables	Mashed white or sweet potatoes, pureed carrots, beets, beans, peas, creamed corn, hummus, legume pastes, vegetable juice	Canned or fresh vegetables that have not been cooked or pureed into a pudding-like consistency
Protein foods	Pureed meats, pureed/scrambled eggs, crustless quiche, egg custards, liverwurst, smooth patés, smooth soufflés, pureed nuts and seeds, yogurt-based smoothies	Fried meats, hard-boiled eggs, quiches and soufflés that contain crusts
Soups	Soups that are smooth (like tomato) or that have been put through the blender	Soups with chunks of meat, stringy vegetables, or contain rice or pasta that has not been pureed or strained
Desserts	Puddings, custards, dessert soups, gelatine, cakes moistened with sauce or milk, fondue, cookies dunked in milk to soften	Cakes, cookies, pies, and brownies that are hard and dry making them difficult to chew (Avoid baked goods that contain nuts, seeds, coconut, or pineapple.)

Tips for adding calories

Preventing weight loss is difficult if you are having trouble eating regular meals. Pain with chewing may reduce your overall calorie intake and food choices, which may result in weight loss.

Wise food choices can maximise caloric intake. Here are some tips to help prevent weight loss: Aim to eat six small meals throughout the day. Each meal should consist of a minimum of 300 to 500 calories.

Add healthy fats to increase your calories. One tablespoon of oil, butter, margarine, or nut butter contains about 100 calories.
Add cheese to meals and consider using full fat dairy products during this time to promote weight gain. Choose whole milk, regular or Greek yogurt, full fat cottage cheese and cream cheese instead of their low-fat counterparts.
Add gravy, broth, or cream soup to meats to increase calories.
Choose high calorie drinks. Look for full fat milk, regular juices, and shakes or smoothies.
Select diet drinks or calorie free beverages less often.
Add cheese sauces, cream sauces, or oils to vegetables.
Look for canned or frozen fruits in heavy syrup.
Eat starchy vegetables such as regular potatoes, sweet potatoes, corn, and carrots instead of non-starchy vegetables (green beans, cucumbers, peppers, zucchini, and spinach).
Eat avocados! Avocados are rich in healthy fats, protein, vitamins and minerals. Add to meals, soups and dips.
Add eggs and eat more egg-based foods such as custard, quiche, and omelettes.
Try mayonnaise-based foods such as ham, chicken, tuna or egg salad. You can eat these types of protein-rich foods with or without bread depending on your tolerance to chewing.

Other helpful tips

When dealing with jaw pain no matter the severity, keep these tips in mind:

Practice good oral hygiene. Brush your teeth after every meal and rinse your mouth out with water. This is especially important to reduce plaque formation after eating starchy foods such as cereals, bananas, dried fruits, and any sugary foods.
Try to maintain a balanced diet. Include all major food groups from grains, vegetables, fruits, milk and protein foods.
Maintain pain management if pain is significant. Seek help from your GP and/or a pain specialist.
Eat fibre-rich foods with every meal to avoid constipation. Choose brown rice or wholegrain pasta, bran-based cereals, fruits, vegetables, nut butters, and legumes daily for your meals.
Hydrate well. An easy way to figure out if you are getting enough liquid each day is to take your weight in pounds and divide it by two. This number is the amount of hydration needed per day in ounces. If you are currently losing weight, then use your usual body weight to do this calculation. Remember that all decaffeinated liquids count towards your hydration needs.
Monitor your weight every few days. If you are losing weight despite increasing your calories or because you are unable to eat enough during the day due to pain, then supplement with liquid calorie nutritional beverages. Speak to your doctor or a dietician.