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What is an involuntary jaw movement in the elderly? Causes, symptoms, and treatment options

5 min read

According to the Dystonia Medical Research Foundation, oromandibular dystonia—a cause of involuntary jaw movements—is most common in women and typically begins between the ages of 40 and 70. But what is an involuntary jaw movement in the elderly, and what are its causes, symptoms, and treatment options? These involuntary movements can range from subtle chewing motions to more severe clenching or spasming, significantly impacting quality of life for seniors.

Quick Summary

This article explains the various causes of involuntary jaw movement in the elderly, including neurological conditions, medication side effects, and dental issues. It details associated symptoms, provides a comparison of common movement disorders, and outlines treatment strategies to manage these challenging conditions.

Key Points

  • Tardive Dyskinesia is a Common Cause: Involuntary jaw movement is often a side effect of long-term use of antipsychotic or anti-nausea medications, a condition known as tardive dyskinesia.

  • Oromandibular Dystonia is Another Key Diagnosis: This neurological disorder causes repetitive, forceful contractions of the jaw and face muscles, which can interfere with speaking, eating, and jaw function.

  • Medications are a Leading Factor in Elderly Patients: Aging and medication usage, particularly dopamine-blocking agents, significantly increase the risk of developing these movement disorders in seniors.

  • Symptoms Can Mimic Other Conditions: Early-stage symptoms can be subtle and are sometimes misdiagnosed as dental problems like TMJ issues or simple tooth grinding (bruxism).

  • Treatment Depends on the Underlying Cause: Management may involve adjusting medications, administering botulinum toxin injections, using oral medications, or performing deep brain stimulation (DBS) for severe, resistant cases.

  • Holistic Care is Essential: Besides medical intervention, stress management, speech therapy, and addressing dental health can help seniors cope with the physical and social challenges of involuntary jaw movements.

In This Article

An involuntary jaw movement in the elderly is an abnormal, repetitive motion of the jaw, tongue, or facial muscles that occurs without conscious control. While sometimes a temporary side effect, it can also signal a more significant underlying neurological condition. The causes are diverse, and accurate diagnosis is crucial for effective management.

Causes of involuntary jaw movements in the elderly

Identifying the root cause is the first step toward finding relief. Several conditions and factors can contribute to these movements, each with distinct characteristics.

Tardive Dyskinesia (TD)

Tardive dyskinesia is a neurological disorder caused by the long-term use of dopamine-receptor-blocking drugs, such as certain antipsychotics and anti-nausea medications. Older adults, especially post-menopausal women, are at a higher risk of developing TD.

  • Symptoms: Repetitive, involuntary movements such as lip-smacking, puckering, grimacing, tongue protrusion, and chewing motions.
  • Onset: Symptoms often develop months or years after starting the medication.
  • Treatment: Management typically involves gradually discontinuing or adjusting the causative medication, or using specific FDA-approved medications (VMAT2 inhibitors) to reduce symptom severity.

Oromandibular Dystonia (OMD)

Oromandibular dystonia is a focal neurological disorder that causes involuntary, sustained, or repetitive muscle contractions of the jaw, tongue, and face. It can result in the jaw opening involuntarily, clenching shut, or shifting side to side.

  • Symptoms: These include jaw clenching, involuntary mouth opening, tongue protrusion, chewing difficulty, and slurred speech. Stress can worsen symptoms, while sleep often provides temporary relief.
  • Causes: The exact cause is unknown but is believed to involve abnormal signals from the basal ganglia in the brain. It can also be drug-induced.
  • Treatment: Treatment plans are highly personalized and may include botulinum toxin injections, oral medications, and speech therapy.

Parkinson's Disease

Parkinson's disease is a progressive neurological disorder that can cause a characteristic resting tremor, which may affect the jaw, chin, and tongue.

  • Symptoms: A slow, rhythmic tremor of the jaw that disappears with voluntary movement, such as chewing.
  • Other signs: Other symptoms include slowness of movement (bradykinesia), rigidity, and postural instability.
  • Treatment: Medication used to manage overall Parkinson's symptoms can help with the tremor.

Other possible causes

  • Dental Issues: Poorly fitting dentures or tooth loss can lead to involuntary chewing motions as a subconscious effort to maintain muscle tone or stimulate saliva.
  • Dry Mouth: Xerostomia, or dry mouth, often caused by medication side effects or dehydration, can also trigger involuntary movements as the person attempts to stimulate saliva.
  • Dementia: In some cases, involuntary chewing or lip-smacking can be a form of perseveration, a repetitive behavior seen in some forms of dementia, such as Alzheimer's or Lewy body dementia.
  • Malnutrition/Dehydration: Low levels of certain vitamins (e.g., B1, B12) or severe dehydration can lead to movement disorders and muscle spasms.

Symptoms and diagnostic considerations

The symptoms accompanying involuntary jaw movement provide critical clues for a neurologist. They often vary depending on the underlying cause. For example, a slow jaw tremor at rest suggests Parkinson's disease, while sustained, forceful contractions may point to oromandibular dystonia. The onset of symptoms, presence of other neurological signs, and medication history are all key to a correct diagnosis. Imaging tests like SPECT or PET scans can help differentiate drug-induced parkinsonism from idiopathic Parkinson's disease.

Comparison of involuntary jaw movement disorders

Feature Tardive Dyskinesia Oromandibular Dystonia Parkinson's Disease Jaw Tremor
Cause Long-term use of dopamine-blocking drugs Neurological disorder (often idiopathic or drug-induced) Degeneration of dopamine-producing neurons
Movement Type Repetitive, stereotyped movements (smacking, chewing, tongue thrusting) Sustained or repetitive muscle contractions (clenching, opening, deviation) Slow, rhythmic tremor at rest
Body Distribution Primarily orofacial (mouth, face, tongue); can spread Focal to oromandibular area, but can be segmental Jaw, chin, mouth, tongue, and limbs
Timing Delayed onset, after months or years of medication use Can be worsened by voluntary action, improves with sleep Occurs at rest, disappears with voluntary movement like chewing
Key Triggers Medications (antipsychotics, antiemetics) Stress, specific actions (e.g., speaking) None specifically, related to progression of disease
Treatment Focus Medication adjustment, VMAT2 inhibitors Botulinum toxin injections, oral medications, sensory tricks Dopaminergic medications, deep brain stimulation (DBS) for severe cases

Treatment and management

Treatment for involuntary jaw movements depends heavily on the underlying cause. A movement disorder specialist, often a neurologist, is best equipped to create a personalized treatment plan.

Medication management

  • For Tardive Dyskinesia: The first step is to review the patient's medication list with a healthcare provider. Stopping the offending medication may resolve symptoms, though not always permanently. FDA-approved VMAT2 inhibitors can help manage persistent TD symptoms.
  • For Oromandibular Dystonia: Oral medications like clonazepam or baclofen may provide some relief for mild symptoms. For more severe cases, botulinum toxin injections into the affected muscles are often the most effective treatment.
  • For Parkinson's Disease: Standard Parkinson's medications that regulate dopamine levels, such as levodopa, can help control tremors.

Non-pharmacological therapies

  • Botulinum Toxin Injections: Used for oromandibular dystonia and severe cases of tardive dyskinesia, these injections temporarily weaken the hyperactive muscles. The effects last for several months and the injections must be repeated.
  • Sensory Tricks (Geste Antagoniste): Some individuals with dystonia can temporarily suppress movements by touching the affected area, such as the chin or lips. Chewing gum can also provide temporary relief.
  • Dental Appliances: For movements exacerbated by dental issues, custom-made mouth guards or adjustments to dentures can help manage symptoms.
  • DBS Surgery: In severe, medication-resistant cases of dystonia or Parkinson's, Deep Brain Stimulation (DBS) surgery is an option. Electrodes are implanted in the brain to block the abnormal signals causing the movements.

Lifestyle and supportive care

  • Stress Management: Stress is a common trigger that can worsen involuntary movements. Techniques such as mindfulness, yoga, and meditation can help.
  • Speech and Swallowing Therapy: For those whose movements impact speech or eating, a therapist can provide strategies to improve function and strengthen unaffected muscles.
  • Nutritional Support: Addressing any underlying malnutrition or dehydration is important for overall health and can sometimes alleviate muscle-related issues.

Conclusion

Involuntary jaw movement in the elderly is a challenging condition with a variety of potential causes, including medication side effects, underlying neurological disorders, and dental problems. The most common causes are tardive dyskinesia and oromandibular dystonia. A comprehensive evaluation by a movement disorder specialist is crucial for an accurate diagnosis and an effective, individualized treatment plan. While there is no single cure, treatments such as medication adjustments, botulinum toxin injections, and supportive therapies can significantly improve a senior's quality of life.

Dystonia Medical Research Foundation

Frequently Asked Questions

Yes, dental issues like ill-fitting dentures, significant tooth loss, or oral pain can lead to or exacerbate involuntary chewing motions or other oral dyskinesias. A dental professional can assess and address these factors.

Not necessarily. While some forms of dementia, such as Alzheimer's or Lewy body dementia, can involve repetitive motions (perseveration), including jaw movements, many other conditions can cause this symptom. Medication side effects and other neurological disorders are more common causes.

A neurologist who specializes in movement disorders is the most appropriate specialist to diagnose and treat involuntary jaw movements. They can differentiate between various causes and recommend the best course of action.

Yes, many medications, most notably older and newer antipsychotic drugs (neuroleptics) and certain anti-nausea drugs, can cause tardive dyskinesia. Other drugs like antidepressants and lithium have also been linked.

Yes, botulinum toxin injections can be very effective for treating oromandibular dystonia. The toxin temporarily paralyzes the overactive muscles, reducing the involuntary contractions for several months at a time.

A sensory trick, or geste antagoniste, is a simple action that temporarily reduces involuntary movements in dystonia. For jaw dystonia, this might include gently touching the chin or lips, chewing gum, or biting on a toothpick.

Early symptoms of tardive dyskinesia can be subtle, such as mild, repetitive lip-smacking, tongue movements, or minor facial grimacing. They tend to progress slowly and may be unnoticed at first.

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.