Author: Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain

45340186 - woman with a toothpain, isolated on white

BOTOX® For Jaw Problems – Who To Trust

The effectiveness of BOTOX® to erase the signs of aging is well-known. But BOTOX®, as you may have heard, can be used to treat a number of medical conditions, as well. As the popularity of BOTOX® has grown so has the number of people who are willing to inject it. BOTOX® for jaw problems, including symptoms associated with TMJ (temporomandibular joint dysfunction), is no exception.

If you’re reading this article you’re possibly experiencing jaw pain or know someone who is. I’ve been treating patients for jaw problems for over 30 years, and during most of that time, I depended upon oral appliances (also called tooth protectors, night guards, or bite plates) as part of first-line therapy to help my patients. Countless people are a tremendous amount of relief from the devices and some won’t consider sleeping without them.

Unfortunately, a small percentage of people do not get relief from first-line TMJ treatment, and some of them develop even more jaw symptoms when using them. If you’re one of these folks, you may be considering injections of BOTOX® for jaw problems as many others are, too.

However, it’s critical for you to understand that BOTOX®, like the oral appliances that help so many of my patients, will not cure your jaw problem. You must address the reasons your jaw got into trouble in the first place.

For BOTOX® for jaw problems to work effectively, it must be injected into both the masseter and temporalis muscles. And, the injections will likely need to be repeated for a time at three-month intervals. Your jaw is a complex structure and is integral to the quality of your life.

You need to be extremely careful about who you choose to administer BOTOX® injections. In some cases, BOTOX® doesn’t work and may even do more harm than good.

BOTOX® For Jaw Problems Is A Serious Decision

First, it’s critical that you are evaluated by an experienced orofacial pain specialist before you have BOTOX® injected into your delicate jaw muscles. Orofacial pain specialists have a specific focus on jaw problems and they have the experience, education, skill and knowledge to determine if BOTOX® for jaw problems will help you.

Here are five scenarios where BOTOX® for jaw problems can be appropriate:

1. You Overuse Your Jaw Muscles

When jaw muscles become overworked, over-built, and consequently, sore and painful, it can be for a variety of reasons. Most people know that TMJ symptoms can be caused by grinding and clenching your teeth at night. But, there are a lot of other causes of TMJ that happen during the day such as gum chewing, nail or cuticle biting, gnawing on pens or pencils, or even bracing your jaw muscles as you work, especially when you sit for hours at a computer.

I do administer BOTOX® for jaw problems in my practice, but not before I work closely with a patient and help them modify or eliminate the overuse behaviors that caused their problems in the first place. Many strategies including muscle-stretching exercises, breathing exercises, and relaxation techniques are very effective and non-invasive. If the overuse behaviors are not addressed and changed, BOTOX® for jaw problems has little – or no – benefit.

2. Your Jaw Muscles Bulge

BOTOX® for jaw problems is predictably effective when a patient’s jaw muscles are so overbuilt that they bulge even when they’re contracted.

3. You Have Jaw Pain Only On One Side

If your jaw pain is not the same on both sides, before you choose BOTOX® injections, you must be examined by a medical professional who is educated and experienced in the relationships between teeth, bite and jaw postures and how they influence muscle health, overdevelopment and pain. BOTOX® injections must be placed strategically and it’s critical that the correct amount is injected into each muscle site. It’s critical that the person administering the injections has a great deal of expertise.

4. If You Have A Locked Jaw

It requires some deep investigating to determine when and if BOTOX® injections are the right treatment for patients whose jaw locks frequently or has been locked for a while. A locked jaw can be due to a myriad of factors. Figuring out why it’s happening in the first place is critical before you consider BOTOX® for jaw problems. Only an experienced orofacial or TMJ specialist can make the right decision

5. Your Jaw Is Clicking

Constant clicking in the jaw joint is usually due to a problem in the ligaments, bones and/or cartilage. Although a clicking jaw can be caused by overuse behaviors like the ones stated above, BOTOX® for jaw problems won’t help if the clicking has become persistent. In fact, BOTOX® can cause even more jaw clicking. If your jaw is clicking and it’s accompanied by pain, a thorough examination by an orofacial pain specialist is your first step. The last thing you need is more problems.

Conclusion

I have been treating patients with jaw problems for over 35 years and BOTOX® or jaw problems is becoming more and more important. But it’s only one of the ways I help my suffering patients. The instinct I’ve developed from my years in practice combined with my focus on science enables me to determine when, and if, BOTOX® is the correct treatment option in each case, where it should be injected and the correct amount of medicine to use.

If you’re considering BOTOX® for jaw problems related to TMJ, lockjaw, clicking or pain, please let an experienced orofacial pain specialist evaluate you before making the decision. To find an orofacial pain specialist in your area, link here.

I was interviewed on Good Morning America about BOTOX® for jaw problems. Click here to view the interview.

Tags Botox, Bruxism, Jaw Problems, Oral Appliances, Orofacial Pain

Jaw Problems Orofacial Pain TMJ

Dr. Sarno and My Approach to TMD

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date August 4, 2017
1 Comment on Dr. Sarno and My Approach to TMD

On June 23, 2017, Dr. John Sarno passed away at the age of 93. A controversial figure in mind/body medicine as it relates to back pain, Dr. Sarno explored the connection between the mind, emotions and back pain. He was a truly a pioneer. He challenged his medical colleagues to consider the uncomfortable notion that the majority of back pain sufferers were in trouble not because of structural flaws in their backs, but rather a result of muscle tension.

Dr. Sarno felt strongly that back pain results from what he called TMS – Tension Myositis Syndrome – which was a direct result of “internal rage” driven by life’s conflicts, unrealized dreams, childhood traumas, uncontrolled tension stressors, and other factors that could persistently upset the brain. His theory was this: when an upset brain turns on the body’s sympathetic nervous system, the blood flow to muscles and nerves is reduced and causes mild oxygen deprivation. The result is pain in the back muscles.

An obituary in The New York Times states: “Revered by some as a saint and dismissed by others as a quack, Dr. Sarno maintained that most non-traumatic instances of chronic pain – including back pain, gastrointestinal disorders, headaches, and fibromyalgia – are physical manifestations of deep-seated psychological anxieties.”

Despite his detractors, Dr. Sarno had many supporters in the medical community who conducted research in an effort to lend science to his assertions. In a 2007 study led by University of Southern California Professor David Schechter, it was found that chronic pain subjects who underwent mind/body treatment (reading educational materials, journaling about emotions, and in more extreme cases, undergoing psychotherapy) experienced an average pain reduction of 52 percent.

Dr. Sarno and My Approach to TMD

I met Dr. Sarno a number of times and attended many of his lectures, which were open to the public. Many of the principles he embraced resonated with me when I carefully considered the population of TMD sufferers who were coming to my practice seeking pain relief.

Over the years I discovered that when a patient’s jaw and orofacial pain was not due to an identifiable trauma, major structural imbalances, or an underlying medical disorder, the patient’s problem was likely of muscle origin and due to overuse fatigue. With a bit of investigation, overuse fatigue was usually due to daytime acquired behaviors such as nail and cuticle biting, jaw muscle bracing, frequent daytime tooth contact, tooth clenching, raised shoulders, furrowed brows, tense lips, or strained fast paced chest breathing.

In reality, the same life scenarios that Dr. Sarno identified in his back pain patients were often characteristic of my TMD patients. At times these personal conflicts would also be responsible for restless and fragmented sleep and the onset of sleep bruxism activity, further adding to muscle overuse and fatigue.

What is critical to realize, however, is that by the time patients arrive at my practice looking for help, tissue injury has already occurred due to physiologic changes in the jaw and neck muscles – and sometimes the temporomandibular joints. As a result, not only is it critical to make the mind body connections, but the majority of patients we see are engaged in assistive therapies that may include exercises, physical therapy, and or injections for the compromised muscles and or Tm joints.

For unclear reasons, Dr. Sarno rejected all assistive therapies such as massage, physical therapy, acupuncture, and injection techniques. This is where he and I differ in philosophy. In the book “Doctor, Why Does My Face Still Ache?” which I co-authored with my mentor, Seymour Roistacher, DDS, we carefully outline what I think leads to compromises in the temporomandibular system and why, therefore, the use of additive therapies makes sense if healing is to be achieved.

In the process of understanding each TMD sufferer that I treat, I strongly feel that the most important question I ultimately ask is this:

“Who are you?”

It’s only then I can begin to unravel the mysteries of each patient’s persistent orofacial pain and TMJ problems.

Artwork from www.ThankYouDrSarno.org

Click here to read the 2007 University of Southern California study.

Click here for Dr. Sarno’s obituary in The New York Times.

Live or work in New York City or on Long Island? You can schedule a consultation with me here or call 212-265-0110.

Tags Jaw Problems, Orofacial Pain, Temporomandibular

Bruxism Children & TMJ Jaw Problems TMJ

Teeth Grinding in Children, Adolescents, and Teens

Teeth grinding is the first thing that parents think of when they discover signs of wear on their children’s teeth. And while teeth grinding in children, adolescents, and teens is common (which I’ll explain later in this article), it is not always the reason that teeth become worn. In many cases, frequent consumption of highly acidic beverages is what causes tooth wear in young people.

To understand why acidic beverages cause tooth destruction, it’s important to know what pH means.pH is the measure of the acidity and alkalinity of a liquid. The more acidic a liquid, the more damaging it is to your teeth.

Acidic beverages such as soda pop break can down tooth enamel, which is the outer protective coating of your teeth. When tooth enamel breaks down, dentin, the underlying tooth material, is exposed. Because dentin wears down six times faster than enamel, daily exposure to acidic beverages can cause enormous damage to teeth.

Most of the popular beverages in the U.S. are highly acidic, as you can see from the chart below. Sadly, these are also the beverages most preferred by young people. To make matters worse, it’s common for them to vigorously swish beverages from side to side in their mouths before swallowing, making the potential for tooth destruction even more probable.

When parents who are concerned about their children’s worn teeth come to my office, the first thing I look for is signs of highly developed and bulky jaw muscles. That is the hallmark of teeth grinding and clenching. If I don’t see those signs, then frequent acid exposure is most likely to be the cause.

Teeth Grinding in Children, Adolescents, and Teens

Teeth grinding in children, adolescents, and teens causes a different type of destruction. Grinding and clenching produces frictional wear as opposed to the erosion of tooth enamel caused by acid.

Grinding and clenching behavior usually occurs during sleep and, because of that, is called sleep bruxism. Sleep bruxism affects approximately 5%-10% of young people, and the number is growing.

The underlying reasons for teeth grinding in children, adolescents, and teens remains unclear, but we believe it is likely to be related to fragmented sleep accompanied by frequent brain arousals. The cause can include (but is not limited to) insomnia, generalized states of daily anxiety, medications such as those used to treat AHD/ADHD, and obstructed breathing due to large tonsils, and/or small lower jaw profiles.

If you’ve noticed your children’s teeth are showing signs of wear, such as chips (or if they’re beginning to look smaller), it’s important to see your dentist as soon as possible. If acidic beverages are the cause of the problems, until that risk factor is addressed, the potential for excessive tooth destruction will go unchecked – and likely lead to extensive dental in the future.

Remember, the best beverage is water!

Tags Teeth Grinding

Case Studies Facial Pain Jaw Problems TMJ

Can Lyme Disease Cause TMJ? – 3 Case Studies

As a specialist in orofacial pain and TMJ for over 30 years, it’s my conclusion that the impact of Lyme Disease on the peripheral and central nervous systems can produce nerve and muscle pain that mimics the symptoms of TMJ. But can Lyme Disease cause TMJ?

Starting in the early 90’s many patients have visited my office exhibiting the symptoms of TMJ – jaw pain, limited jaw opening, and severe facial pain. But upon evaluation, I did not find the common histories and risk factors that typically cause the muscle strain and inflammation associated with TMJ problems.

Lyme Disease infects over 300,000 people in the United States every year. But making a diagnosis is extremely difficult due to the fact that the only blood tests available are unpredictable. On top of that, only 25-50% of infected people ever develop the telltale rash associated with a deer tick bite (the tick that carries Lyme).

If left untreated, Lyme can cause facial tics (contraction and twitching of muscles), jaw pain, headaches in the temples, neck stiffness, and episodes of pain during talking and smiling. Very similar, if not identical to TMJ.

The three case studies that follow prompted me to ask this question:

Can Lyme Disease Cause TMJ?

3 Case Studies

Case Study #1: John

In 1992 I treated a patient named John. John was a 38-year-old landscape gardener who worked at a golf course on the East End of Long Island. His complaints were acute jaw pain, limited jaw opening, and an inability to bring his teeth together in a consistent way.

At first glance, it seemed that John had the type of jaw problem that I see every day in my office so I prescribed the course of treatment that helps most of my patients. But it didn’t help him. Then I discovered that John had been diagnosed with Lyme Disease.

Case Study #2: Anne

A recent patient named Anne. She is a 52-year old female. She describes her symptoms this way: “I have pain in my face that can be so intense that I have thought about going out on disability.”

Ann’s pain is triggered whenever she talks. And her jaw muscles feel as if they’re “pulling all the time”. At times her teeth ache. And when the frames of her glasses press on her temples, the pain escalates. Anne’s facial and jaw symptoms have been present for seven months and are accompanied by exhaustion, disabling headaches, and what she describes as “bizarre sensations in my body”.

As with John, my evaluation did not suggest the reason for Anne’s suffering was a typical TMJ problem. But evaluations don’t always indicate Lyme, either. Due to the fact that she takes long walks in the Connecticut woods and because she remembers getting bitten by insects (she never had the telltale rash) her infectious disease doctor has considered starting her on antibiotic therapy for Lyme Disease.

Case Study #3: Sue

Another patient named Sue, a 45-year old female, came in with jaw problems, too. She had been diagnosed with Lyme disease seven years earlier. Sue felt sure that her Lyme had been “successfully treated with alternative remedies.” But still, she suffers from tight jaw muscles, intense pain when she lays her face on a pillow, fragile emotions that prompt daily outbursts of crying, and “raging pain in my face and jaw”. She was sure she had TMJ but never imagined that the effects of Lyme Disease cause TMJ symptoms.

Sue also suffers from bouts of intense back pain with a nerve-like character, that comes on suddenly and as quickly passes.

As noted, Sue believes that her Lyme Disease has already been “cured” by alternative remedies. But as in the cases of John and Anne, my evaluation provided no evidence of the typical causes of TMJ symptoms. With her belief in alternative treatments, it is no surprise that Anne is very reluctant to try antibiotic therapy. But she is about ready to move in that direction.

Did Lyme Disease Cause TMJ Symptoms In John, Sue, or Anne?

The outcome of these cases remains to be determined, but they are very similar to many other confirmed cases of Lyme Disease I have encountered since 1992 when I first began to wonder if can Lyme Disease cause TMJ symptoms.

It is my conclusion, therefore, that the impact of Lyme Disease on the peripheral and central nervous systems can produce nerve and muscle pain that mimics the symptoms of TMJ. I am hopeful that better testing, control of the deer tick population, more effective treatments, and even perhaps a vaccine is on the horizon for these suffering patients.

If you would like to add your comments please feel free to do so below.

Live or work in New York City or on Long Island? You can schedule a consultation with me here or call 212-265-0110.

Tags Case Study, Facial Pain, Jaw Problems, TMJ

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Jaw Problems Nightguards & Oral Appliances Orofacial Pain TMJ

TMJ From Scuba Diving Or Snorkeling

During this time of year, it is common for my practice to see many patients who experience symptoms of TMJ from scuba diving or snorkeling. In fact, it has been reported that between 15%-20% of the people who scuba dive or snorkel have some level of jaw problem.

To find out why you first must understand the temporomandibular joints (TM’s) and how they function. Your TMJs are the hinges that connect your upper jaw to your lower jaw. They enable you to open and close your mouth in a smooth, unrestricted way. When functioning properly, your TMJ’s allow you to chew, talk, and yawn in comfort.

But because the TMJ’s are moved by muscles and stabilized by ligaments, any problem with those muscles and ligaments will have a negative effect on the function of your jaw and your comfort. People whose TMJs are overworked may experience pain, limited jaw opening, joint noises, and sometimes even a change in the way their teeth come together. The symptoms are very similar to an overworked knee.

TMJ From Scuba Diving Or Snorkeling Is Very Common. Here’s Why:

Whether you scuba dive or snorkel, your lower jaw must come forward to secure your breathing mouthpiece in place. It’s a very awkward position and when held for a long period of time, it fatigues your muscles and strains your ligaments. The result can be soreness, pain, and limited jaw function.

New divers are at the greatest risk for TMJ from scuba diving or snorkeling. The novice has a tendency to fiercely grip down on the mouthpiece for fear of it slipping out of place. This forceful clenching can set jaw problems into motion. And a poorly fitted mouthpiece is often a culprit, too.

Prevention & Treatment of TMJ from Scuba Diving Or Snorkeling

As an orofacial pain specialist, I have some advice for you if you are a new or inexperienced diver here’s some advice: try to maintain a loose grip on your mouthpiece and always make sure it fits properly. (If you suspect it doesn’t…don’t use it! Trade it in ASAP.) If mild symptoms start to occur, don’t dive for a day or two. Try anti-inflammatory medications such as Advil or Aleve, if tolerated. And ice packs on painful areas for seven minutes several times a day can also help.

If experiencing severe symptoms and just a day or two off from diving doesn’t improve your condition, you should see a dentist who focuses on temporomandibular disorder. TMJ is the result of tired, tight, injured or sore muscles, inflamed tendons, or compromised ligaments, bone and cartilage. As a result, TMJ treatment is similar to what is offered by an orthopedist when managing a knee problem.

Here are some of the ways we treat patients with TMJ from scuba diving or snorkeling at my practice:

Limiting the overuse of the jaw by dietary restrictions
Identifying strategies to reduce daytime habits that may prevent healing such as clenching, nail and cuticle biting, gum chewing
Medications to reduce inflammation and muscle tension
Supporting the injured joints or muscles with an oral appliance
Home jaw exercises and self-massage of jaw muscles
Physical therapy if needed
Trigger point injections for pain and tension in the jaw muscles

It’s best to avoid TMJ from scuba diving or snorkeling by taking precautions such as loosening the grip on your mouthpiece and making sure it fits properly. Stop your diving activities if symptoms start and seek care to assure healing. The vast majority of our patients do heal and happily resume their diving activities after several months.

Live or work in New York City or on Long Island? You can schedule a consultation with me here or call 212-265-0110.

Tags Jaw Problems, Oral Appliances, Orofacial Pain, TMJ

Jaw Problems Tinnitus TMJ

The Connection Between Tinnitus and TMJ

Editor’s Note Updated 2025: This article remains part of our archive. For the most current overview of the TMJ and tinnitus connection, visit: https://www.nytmj.com/tinnitus-jaw-connection/

My dental practice has a unique focus. The majority of our patients come to us suffering from TMJ problems. The TM joint is the hinge connecting your jaw to the temporal bones of your skull, which are located in front of each ear. The healthy function of this joint enables you to chew, talk and yawn. When the joint is inflamed, strained, or unstable it can cause pain, limited jaw movement, and a variety of jaw noises during motion. When the muscles that move the TM joint are compromised, similar symptoms may result, as well.

There is a connection between tinnitus and TMJ problems, too, and we see patients in my practice looking for relief. But before I get into the explanation of how tinnitus and TMJ are linked, I want to be sure you understand the nature and causes of tinnitus itself.

The connection between tinnitus and TMJ is real.

What Is Tinnitus?

Tinnitus Definition: The annoying sensation of hearing a sound when no external sound is present. Patients describe these sounds with words such as ringing, humming, buzzing, roaring, clicking, and hissing. This sensation is constant for some people and intermittent for others, and it can be in one or both ears. For some sufferers, the intensity of the sounds can vary from day to day while for others it is without fluctuation in intensity.

What Causes Tinnitus?

There are many known causes of tinnitus that include identifiable damage to the inner ear hair cells, age-related hearing loss, exposure to loud noises, earwax blockage, and changes in the health of the bones in the middle ear. Less commonly, tinnitus can be associated with Meniere’s disease, trauma to the head and neck region, and/or TMJ disorders. For some people, however, the cause is never discovered.

What Is The Connection Between Tinnitus And TMJ problems?

TMJ problems are essentially orthopedic in nature. The common symptoms of TMJ are many and can include pain in the jaw muscles or specifically in the jaw joints, limited jaw motion, jaw muscle tension and tightness, jaw joint clicking, popping and or locking, headache pain in the temples, and/or a bite that doesn’t feel normal. Tinnitus is a less common symptom. When TMJ problems, however, affect the ear, symptoms can be pain, stuffiness, and/or tinnitus.

The onset of these symptoms may be due to underlying medical disorders, emotional stress which drives muscle tension, disrupted sleep, traumatic events, periods of sustained jaw opening, sleep bruxism, and daily overuse behaviors and or neck postures. All of these factors can result in joint sprains, muscle strains, muscle spasms and /or inflammation. Less common origins include a “bad bite.”

Why TMJ Problems Can Lead To Tinnitus (Or Make It Worse)

1. The nerves that serve the jaw muscles and jaw joint are also responsible for the function and tone of muscles that determine the size of the Eustachian tube and tone of the tympanic membrane. Alterations in the function of these two structures can be responsible for tinnitus.

2. There is one specific ligament connecting a middle ear bone (the malleus) to the jawbone. When a TMJ problem changes the position of the lower jaw the malleus can be altered in its function due to ligamentous traction and that can lead to tinnitus.

3. The main nerve supply from the TM Joint has been shown to have connections to parts of the brain involved with hearing and the interpretation of sound. If TMJ problems alter the function of this nerve, it‘s quite possible that the brain will interpret normal sounds as abnormal and patients report tinnitus.

4. Worth mentioning is that because TMJ problems are often associated with neck problems, evaluations of the neck must be also part of an overall assessment. There is evidence that nerve endings in the neck make connections to the hearing centers of the brain. Ear symptoms, therefore, have been shown to emerge as a result of long-standing neck problems or those created by acute trauma.

Determining If A TMJ Problem Is Driving Tinnitus Symptoms

Try to determine if your tinnitus symptoms are influenced by moving your jaw (chewing, yawning, talking, opening it widely, sticking it forward). If you notice a link, then it’s very possible that TMJ problems are at the root of your tinnitus. The same is true for head and neck movements.

TMJ Neck Treatment To Help Tinnitus

If your tinnitus is related to your jaw or neck, dealing with these problems will be very helpful. There are a host of treatment strategies available including reducing overuse behaviors and or postures (such as teeth grinding, nail-biting, frequent computer work), exercises, home TENS therapy, muscle injections or dry needling techniques, BOTOX®, the use of oral appliances to support your jaw joints and jaw muscles (especially at night), physical therapy, medications, meditation, mindfulness training, and diaphragmatic breathing instruction.

These treatments, if found to be helpful, may require several weeks or months to see maximum results.

Summary

As I mentioned before, tinnitus can be caused by damage to your inner ear, hearing loss, exposure to loud noises, earwax blockage, and more. If your doctor has not found a link between your symptoms to any of the above, it may be time for an assessment of your jaw and neck structures. There may, indeed, be a connection between your tinnitus and TMJ problems.

Here’s a directory of orofacial pain professionals around the world: American Academy of Orofacial Pain.

You can get more information about TMJ and ear problems here: TMJ and its Relationship to Ear Problems and Sinus Symptoms

Live or work in New York City or on Long Island? You can schedule a consultation with me here or call 212-265-0110.

Dr. Donald Tanenbaum is a dentist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat facial pain associated with jaw problems, TMJ, referred pain, nerve pain, and migraines. You can contact the office here.

Tags Jaw Problems, Tinnitus, TMJ

Facial Pain Jaw Problems Orofacial Pain TMJ

BOTOX® Injections For TMJ – 6 Things You Need To Know

During the past few years in my practice as a dentist who focuses primarily on TMJ and orofacial pain problems, I have seen a lot of success using BOTOX® injections for TMJ to treat muscle pain and oral nerve pain.

BOTOX® is not suitable for every patient, however. Care must be taken as to when to use it, how to use it, and who is a good candidate. If you’re considering BOTOX® as part of your treatment for TMJ problems, jaw pain, pain in or around your teeth, or because of a change in the shape of your jaw, please read on:

6 Important Things You Need To Know About BOTOX® Injections For TMJ

BOTOX® is Not a First-Line Treatment for Jaw Muscle Pain
First-line treatment for jaw muscle pain (and spasm or tightness) is dictated by a careful evaluation to identify why you have symptoms in the first place. For example, it may be necessary for you to change some daytime habits, postures and behavioral tendencies that fatigue the jaw and neck muscles. Or if you clench or grind your teeth at night you may need to wear a protective night guard. In addition, you may get relief from medications, home jaw and neck exercises, breathing exercises, meditation, a change in your diet, or all of the above. Muscle injections or dry needling would be next in line along with visits to a physical therapist, chiropractor or osteopath who would work to promote muscle comfort. The bottom line, however, is that you the patient, must participate in the process of getting better and BOTOX® will not produce the desired goals if the underlying reasons for your pain have not been identified and dealt with.
BOTOX® Will Not Ease Certain Types Of Muscle Pain
There are times when muscles hurt even though they have not been overused. When life circumstances, emotions or thoughts cause your muscles to tighten and ultimately ache, then BOTOX® injections for TMJ will not likely help. Instead, counseling, talk therapy, cognitive behavioral therapy, and the like may be the right strategies to pursue.
If You Currently Wear a Night Guard
If you currently wear a night guard and still have morning symptoms of muscle pain or tightness, joint noises, locking, and/or pain, you may be a good candidate for BOTOX®. This is particularly true if you find yourself biting hard on the guard when you wake up in the morning. Keep in mind however, that BOTOX® will be most helpful if you continue to wear your night guard. Two strategies are better than one in this scenario.
If You Can’t Tolerate A Night Guard
If you have simply cannot tolerate a night guard (and have tried various types, with your dentist’s guidance) BOTOX® injections for TMJ may provide meaningful benefit.
If Your Jaw Muscles Are Too Big
If your jaw muscles are just too big and visibly over-built, BOTOX® may be an option. One of the predictable things that BOTOX® does is reduce muscle bulk when used over time. BOTOX® has been shown to be effective in producing a flatter and more natural-looking profile. You will likely need three BOTOX® sessions in three-month intervals to achieve the best results. However, jaw bulk may creep back if the reasons your muscles become larger have not been identified and dealt with.
If You Experience Persistent Oral Nerve Pain
Small quantities of BOTOX® may be helpful if you experience persistent pain in your gum tissue, at the site of a tooth or tooth extraction, or at other sites around your face. Nerve pain inside your mouth or in your face is often due to electrical discharge from the trigeminal nerve. BOTOX® injections for TMJ into the painful sites (often called trigger zones) can provide real benefit, especially if you don’t respond well to oral medications. In spite of being relatively new, this type of treatment is showing promise.

In Conclusion

BOTOX® has become a helpful component in the management of TMJ, jaw muscle pain and oral nerve pain problems. The important thing for you, the patient, is to understand that BOTOX® injections for TMJ are not a cure-all. Careful assessment by an experienced practitioner remains the key to making treatment decisions that will result in a long-term positive outcome. If you choose BOTOX® as first-line therapy without understanding the origins of your pain, you will likely be out of pocket quite a bit of money with nothing to show for it.

Can Braces Cause TMJ?

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date September 20, 2016
No Comments on Can Braces Cause TMJ?

TMJ problems can be a real burden that leads to pain, limitations on eating and embarrassing jaw joint noises. In my practice as a dentist who focuses primarily on TMJ and jaw problems, patients often ask me, “Can braces cause TMJ?” Although there’s no easy answer, I’ll do my best to explain.

Can Braces Cause TMJ? Three Scenarios

If you’re concerned that braces are the cause of your jaw issue, you’ll likely fit into one of the following three scenarios:

Scenario 1: You finished orthodontic treatment less than a year ago and suddenly you have TMJ symptoms.

Let’s give this scenario some thought as there may be some concerns about what we call new bite relationships. Think about this: your teeth have been moved and have had to settle into new positions. That means your jaw muscles, tendons, joint ligaments, cartilage, bones, lubricating systems, and shock-absorbing disc all had to adapt to the new environment. Thankfully, most people experience no problems with this process.

But in some people the end orthodontic result can lead to asymmetric tooth contacts or tooth contact patterns that force the lower jaw into an awkward position when the teeth are brought together. Therefore, the jaw is consistently forced into postural positions while chewing that lead to sprains and strains. If this scenario occurs in a person who has daytime behaviors that prompt tooth contact or who has a history of night clenching or grinding, these awkward bite postures will have a greater impact and can lead to even more severe TMJ symptoms than are caused by the behaviors themselves.

If you fit into Scenario 1, the answer to the question, can braces cause TMJ? is Yes! You should to return to the orthodontist or dentist who moved your teeth. There’s a chance that to “shore up the foundation” a short phase of orthodontics or some dental procedures to provide more tooth contact symmetry can do the trick. If you don’t feel your complaints are being taken seriously, a second opinion is recommended.

In addition, you may need change your daytime over-use behaviors such as teeth grinding or clenching, wear a protective oral appliance at night, and perform jaw exercises. It’s important to identify any other risk factors that could play a role, as well. (See a list at the end of this post.)

Scenario 2: You have braces now and your TMJ problems just began.

Regardless of whether your braces are the traditional or the Invisalign-type removable aligners, if you experience occurrences of pain (beyond what’s expected during orthodontics) or joint noises and/or locking, you must report your symptoms to your orthodontist or the dentist providing your treatment. Your braces might not need to be removed, but instead adjusted to make sure your jaw is no longer stressed.(Also, it is important to be sure that the orthodontic process is not being compromised by outside factors, such as those that are listed at the end of this post.

Scenario 3: You had braces, but they were removed many years before your TMJ problems began.

Can braces cause TMJ if they were removed years ago? It’s unlikely that braces removed years before your jaw symptoms first started could be the primary or exclusive cause of TMJ. In fact, the vast majority of studies conclude that even if one’s bite is “off” for decades (one’s natural bite or an orthodontically-created bite) there is little chance this single factor is the cause of TMJ problems.

If your long-ago removed braces are not the primary reason you have TMJ, then what is? Something clearly has happened, likely over a long period of time that caused fatigue and overworked, sprained, or traumatized your jaw muscles and joints.

If you were my patient, I would conduct a full assessment and start by asking you some very important questions that fall into four distinct groups:

1. Did You Have An Injury?
The TMJs and associated jaw muscles can be injured the same way knee or elbow structures can. Were you injured on the athletic field or in a car accident? Did you have a recent medical procedure that kept your mouth open for a long period of time or in an awkward position? Did you notice sudden jaw pain or popping while eating, yawning, playing a musical instrument, or even singing? Did you recently have dental work performed or a challenging wisdom tooth removal that could have compromised your jaw structures?

2. Do You Over-Stress Your Jaw?
Over-use behaviors and head postures can impact the structure and stability of your jaw muscles and temporomandibular joints (your TMJs). Do you chew gum or bite your nails, cuticles, or pens? Do you hold your eyeglass frames between your teeth? Do you grind or clench your teeth at night and/or during the day? Do you have work-related neck strain? Do you have longstanding neck symptoms that include pain and muscle tightness?

3. Has Your Health Changed?
Changes in the your medical health can also be a source of challenge to your jaw. Are you on a new medication? Have you stopped smoking? Do you have a new neuromuscular, rheumatologic and/or autoimmune disease? Are you profoundly depressed or have anxiety? Have you been diagnosed with a chronic illness? Do you have problematic insomnia, migraines or fatigue? Have you changed your diet to one that requires more consistent chewing of tougher foods? Even merely being concerned about your health is sufficient to initiate jaw muscle tension and pain.

4. Are You Stressed-Out?
A fatigued, conflicted, and unhappy brain is a source of muscle tension and can have a negative impact on your nervous and immune system. That can lead to a lower threshold of pain. Do you have ongoing challenges at home and or at work? Are you caring for a sick child or parent? Is your marriage in trouble? Are there financial worries? The list of critical life matters that can cause changes in the way you sleep, breath and hold muscle tension throughout your body are endless. Any of these changes can cause jaw-related symptoms.

If you answered yes to any of the above, your TMJ symptoms are likely the cause of a number of factors. It is crucially important to discuss these with the orthodontist or dentist who is handling your case.

So, the answer to the question, “Can braces cause TMJ?” is “Yes, sometimes!”

If you are considering braces for yourself or your children, inform the dentist or orthodontist of any jaw problems before you start treatment. A thoughtful practitioner will make a careful assessment of the history and clinical characteristics of every patient before determining how to proceed.

Live or work in New York City or on Long Island? You can schedule a consultation with me here or call 212-265-0110.

For more information on TMJ and jaw pain, link here:
Temporomandibular Disorder
Jaw Problems

Tags Bruxism, Jaw Problems, Teeth Grinding, TMJ

Fibromyalgia TMJ

Is It TMJ or Fibromyalgia?

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date July 21, 2016
No Comments on Is It TMJ or Fibromyalgia?

The majority of patients in my practice arrive complaining of TMJ pain. For many, their pain is over the jaw joints. While others complain of pain only in their jaw muscles. These separate, but related, pain sites represent the components of a true TMJ pain problem. In fact, whether the pain is focused over the joints or in the muscles, it’s almost always the result of very specific factors such as teeth clenching or grinding during the night or day, daytime behaviors such as nail or cuticle biting, poor sleep, strained respiration, and/or chronic stress and challenging life circumstances.

I do see many patients, however, who experience severe pain in the jaw and face, but who display no evidence of common risk factors typical in the patients who have TMJ pain due to a temporomandibular disorder. For these patients, their pain is real but the cause is different. A very large percentage of them have a diagnosis of fibromyalgia in their medical history.

Is it TMJ or Fibromyalgia?

Although a full understanding of fibromyalgia remains unclear, fibromyalgia patients typically have a very low threshold of pain throughout their entire body. The best analogy is to imagine what it feels like to put on a shirt when your back has been burned from multiple days at the beach. That’s what it’s like to have fibromyalgia. All the time.

As a result common activities such as chewing, yawning, talking, or even putting their face on a pillow produces face and or jaw pain. This daily pain may often leads them to brace the jaw muscles and fatigue them. This can result in motion limitation and thus mimics a common TMJ problem.

Treatment strategies for fibromyalgia patients are markedly different than for typical TMJ patients.

When I work with typical TMJ patients I can isolate the factors that caused their problems in the first place and then help to control them. But if you are a fibromyalgia patient, it is much more challenging to manage your face and jaw pain. Treatment must focus on helping you acquire higher pain thresholds.

Through research we’ve discovered that meditation, diaphragmatic breathing, restorative yoga, exercises, a positive outlook on life, and even laughter can all be beneficial for fibromyalgia patients. In addition, certain medications show promise – particularly those designed to enhance your own pain inhibitory systems by helping restore and/or bolster levels of serotonin and endorphins. Injections of BOTOX® coupled with frequent jaw motion exercises also show promise for specific jaw muscle pain in fibromyalgia patients.

In summary, facial pain symptoms are not always the same and require careful assessment before conclusions are reached with regards to diagnosis and treatment strategies. In my practice we see progress with both the common TMJ sufferer and those with jaw pain due to fibromyalgia.

If you’re in pain and are need to know if it is TMJ or fibromyalgia, and you live in the New York City area, please feel free to call my office for a consultation. Outside the area you can find a list of professionals through the American Academy of Orofacial Pain.

Dr. Donald Tanenbaum is a dentist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with facial pain, TMJ and sleep apnea.

Tags fibromyalgia, TMJ

Jaw Problems Orofacial Pain TMJ

What Is An Orofacial Pain Specialist?

If you’ve never heard the term orofacial specialist, I’m not surprised. I’m one of only a few hundred formally trained orofacial pain specialists in the United States. That’s because orofacial pain specialists have not been terribly visible on the health care playing field – until recently. Until very recently the field of orofacial pain was not a recognized specialty by the American Dental Association. This fact made it difficult for patients to get proper treatment. But in March 2020, the American Dental Associations’ National Commission on Specialty Status finally named Orofacial Pain as a new dental specialty,

Orofacial specialists like me treat patients who suffer from pain of muscle origin, joint origin, and nerve origin that is focused in the head, neck, mouth, face and jaw area. For example, we treat people who have chronic toothaches and gum pain – despite having multiple dental evaluations and treatment. The problems we treat involve jaw pain, limited mouth opening capacity, and jaw clicking and locking. In addition, many patients with TMJ issues have problematic headaches, and in many cases, have pain in the nerves that supply the teeth, gums and other facial tissues.

At times we also are called upon to diagnose and or treat patients with complex medical problems that result in facial pain.

Why don’t more people know about orofacial pain specialists?

Because until recently, this specific area of dentistry has not been granted “specialty status” by the American Dental Association. And that’s why orofacial pain specialists can be difficult to find. But now, dental schools that train dentists to become oral surgeons, endodontists (root canal), periodontists (gum therapies) and orthodontists (braces) can also train them to be experts in orofacial pain.

To help our patients, orofacial specialists rely on a wide variety of treatment options including education, medication, therapeutic injections, oral appliances, and muscle and joint rehabilitation therapies. Patient education is crucially important in my field as many of the problems we treat in the jaw muscles and joints are the result of daytime jaw overuse behaviors and sleep-related teeth grinding and clenching. Most orofacial specialists have strong referral relationships with physical therapists, clinical psychologists, pain management physicians, psychopharmacologists, chiropractors and even acupuncturists and leaders of meditation programs. All of these together allow us to successfully care for our patients’ individual needs.

We often validate the fact that your pain is not only real but helpable despite – past treatment failures. Just knowing there’s an answer helps my patients feel better right away.

If you or someone you know has been suffering you can find an orofacial specialist in your area by linking to the American Academy of Orofacial Pain at aaop.org. Look for a specialist with “Diplomate” status. If you’re in the NYC 212-265-0110 or Long Island 631-265-3136 area, feel free to call my office for a consultation.

Relief is here.

Dr. Donald Tanenbaum is a dentist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with facial pain, TMJ and sleep apnea.

Tags Jaw Problems, Orofacial Pain, TMJ

Bruxism Jaw Problems TMJ

BOTOX® For Jaw Reduction: The Real Story

News Flash! Bettheny Frankel Explains Why Her Face Has Changed: “I Get BOTOX® In My Jaw.”

That headline has been winding its way through the web in the past few weeks. I must admit that when I first saw it I had no idea who Ms. Frankel was (I had to ask my wife). But as an orofacial pain specialist, and someone that uses BOTOX® for jaw reduction in my practice, the headline stopped me in my tracks. It’s a topic discussed at lectures and in medical journals, but I have never seen it in mentioned in mass media before.

The article goes on to explain that the reality TV star was encouraged by her dermatologist to consider getting BOTOX® injections in her jaw. The goal was to reduce the size and shape of the jaw. It had become bulky as a result of many years of tooth grinding.

Now, if you are about to jump on the phone to your dermatologist and ask about injections of BOTOX® for jaw reduction you need to know a few facts:

Here’s how your jaw works: The masseter muscles (define your jaw profile) combined with the muscles in your temples and the jaw joints (the “TMJ”s) all work together to enable you to open and close your mouth. They help you to chew and to speak. But…when they are used too much all kinds of problems can occur. These problems can be sore jaw muscles, headaches in the temples, sore teeth, jaw clicking and locking, diminished jaw motion, ear pain that occurs without an ear problem being identified, and more. What’s more, the size and shape of your jawline can change.

That’s what happened to Bettheny Frankel.

While BOTOX® has a prominent place in my arsenal of treatment methods, BOTOX® alone cannot change the behaviors or risk factors that can cause your jaw to change shape. BOTOX® doesn’t cure the source of the problem. In order for that to happen, you must stop overusing your jaw muscles.

For the average person over-use activities are teeth clenching and grinding. This can happen during the day (called Awake Bruxism) or at night (Sleep Bruxism). Or both.

In addition there are many daytime jaw overuse behaviors. Chewing gum, biting your nails or cuticles gnawing on a pencil, or simply clenching your teeth together will engage your muscles. When your teeth come together, you are making a fist in your face. Imagine what can happen after hours of making that fist on a daily basis!

During sleep, teeth clenching and grinding can occur for a multitude of reason, most of which are out of your control.

Here’s the good news: Jaw over-use behaviors during the day can be changed. In addition, we continue to get better at identifying the risk factors that may be driving your sleep bruxism. Experienced TMJ/Orofacial pain dentists, like me, have gained valuable insights into these problems leading to effective treatment strategies.

The treatment options can range from natural supplements, sleep hygiene programs, prescription medications, deep breathing exercises employed during the day and before bedtime, formal meditation training, oral appliance strategies that introduce different appliance designs during the course of the week, jaw and neck exercise programs and injections. These injections can include the use of BOTOX®.

Here’s the bottom line: BOTOX® after several injection sessions can prevent the jaw muscles from contracting forcefully. That leads to more slender and less bulky muscles. BOTOX® injections can return your face to its previous proportions. But, if you want long-term success BOTOX® must be surrounded by other supportive and complementary care. Because…if you don’t stop and/or reduce your daytime jaw muscle overuse and sleep bruxism, your jaw muscles will inevitably bulk up again.

So, go ahead. Talk to your dermatologist about BOTOX® for jaw reduction. But also get a referral to a TMJ/Orofacial pain dentist who will help you maintain your normal jawline for life.

Good luck!

Read about the various methods used to correct jaw over-use behaviors:
TMJ Treatment
Can Bruxism Change The Shape Of Your Face?
Case Study: 10 Years of Teeth Clenching
Can TMJ Patients Get Better?

Tags Bruxism, Jaw Problems, Teeth Grinding, TMJ

Jaw Problems Orofacial Pain Women & Pain

Chronic Orofacial Pain – The 60/40 Rule

Every morning upon my arrival at work I glance at the list of patients due to be seen that day. As a board-certified orofacial pain specialist, my patients are primarily people who seek treatment for their chronic orofacial pain. Some of them will be scheduled for a follow-up assessment and/or treatment. Others are first-time patients who seek answers to a problem that has recently emerged. And some are looking for answers to a chronic problem that has lingered despite self-directed care and/or prior interventions by other medical, dental, and health care providers.

With the knowledge that many of these patients suffer from headaches, muscle- and joint-related jaw disorders, persistent and stubborn toothaches, and/or nerve pain disorders, you would be right to assume that the treatment options for each would be very different. In some ways that thinking is accurate. To care for each of these problems the treatment choices and sequencing will vary to a considerable extent.

However, if success is to be realized there is one crucial element that must be considered. I call it the 60/40 Rule in the treatment of chronic orofacial Pain.

The 60/40 Rule In The Treatment Of Chronic Orofacial Pain Explained

The 60/40 Rule is this: the patient and the provider must share the responsibility of implementing the care plan. Sometimes the patient will do 60% of the work and the provider will do 40%. Sometimes that will be reversed. It all depends upon the nature of the patient’s problem.

I allude to this concept in my book Doctor, Why Does My Face Still Ache?. Many of my colleagues who devote their energies to treating TMJ and chronic orofacial pain patients also embrace this concept. However, recently at a conference sponsored by the American Academy of Orofacial Pain it was asserted by one of the keynote speakers that an 80/20 Rule in regard to the treatment of chronic orofacial pain is the correct ratio. In his mind the patient should be responsible for 80% of the work and the provider for 20%. Though this an understandable goal, clinical research, which has consistently concluded that only 25% of chronic pain patients will only do 50% of what is required to make progress this 80/20 Split appears to be an unlikely reality

In my practice, the 60/40 Rule has been most helpful when treating patients with facial and jaw pain of muscle/ joint origin, often called TMD problems. The origin of their problems is related to persistent tightness and fatigue of the jaw and neck muscles combined with overuse-driven instability of the temporomandibular joints.

A multitude of risk factors is most often associated with these problems which include life circumstances, tension, emotions, acquired behaviors, food selections that overwork the muscles and TM joints, habitual and work-related postures, poor breathing dynamics, and loss of sleep quantity and quality. Taken all together you can readily see how the 60/40 Rule of shared responsibility makes sense.

Thankfully, I have an arsenal of treatment options at my disposal to help patients get relief from chronic orofacial pain.

Here are some of them:

Postural retraining
Daily home exercises
Home muscle massage
Elimination of destructive daily behaviors and habits
Diaphragmatic breathing strategies
Formal meditation training
Movement therapies such as Feldenkrais or The Alexander Technique
Improvement in sleep quantity and quality
Medication
Oral appliances that support and rest muscle and joint injuries

This collaborative approach between the patient and the provider is essential for success. When the responsibility is shared, patients own their successes and in addition, are more open to share their disappointment if treatment fails.

The 60/40 Rule in chronic orofacial pain treatment ensures that patients are fully engaged in their own treatment and this sets providers free from an expectation that they are fully responsible to fix or cure a chronic problem that may not have an easy solution. The 60/40 Rule must be explained at the outset of treatment when both patient and practitioner are the most focused on the challenges that lie ahead. This is particularly true if the patient has experienced treatment failure in the past.

As new knowledge indicates that chronic pain problems are best treated with interventions that confront the nervous system, the immune system and the emotional brain, a collaborative approach to care is now even more critical. Patients and providers that embrace The 60/40 Rule will be the beneficiaries of treatment that is both successful and lasting.

Dr. Donald Tanenbaum is a dentist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with facial pain, TMJ and sleep apnea. To find an orofacial pain expert in your area, link to the American Academy of Orofacial Pain here: http://www.aaop.org/

Tags CHRONIC OROFACIAL PAIN, Jaw Problems, Orofacial Pain, Women & Pain

Facial Pain Jaw Problems TMJ

TMJ Problems During Invisalign Treatment

Modern technology has changed nearly every aspect of dentistry during the past ten years. The world of orthodontics, in particular, has seen incredible advances that allow teeth to be moved in a revolutionary way. Because of software technology dentists can now simulate the tooth movement steps that are necessary to go from starting point to end point before treatment has even begun. This remarkable technology is known to most of us as Invisalign.

Invisalign has not only changed the way teeth are moved, it enables many more dentists than before to offer tooth movement services. This is a huge shift in the way orthodontic treatment is delivered. And for millions of people, Invisalign is more desirable than traditional braces. However, despite the wonderful outcomes, many patients experience TMJ problems during Invisalign

How To Prevent TMJ Problems During Invisalign Treatment

The best way to prevent TMJ problems during Invisalign treatment is to ask your dentist some very specific questions before you make the decision to go ahead. Here are some sample questions:

YOU’VE HAD TMJ PROBLEMS IN THE PAST: “I have had jaw problems in the past. Is Invisalign the best choice for me?”
YOU DON’T KNOW IF YOU CLENCH OR GRIND YOUR TEETH: “I don’t know if I clench or grind my teeth during the night. Can you check for signs before I decide to start Invisalign?”
YOU’RE ENTERING INTO A STRESSFUL PERIOD IN YOUR LIFE, such as moving or a divorce: “I’m going to be under a lot of stress in the near future. Should I wait until life is calmer to begin the Invisalign treatment?”
YOU’RE ON A MEDICATION THAT COULD CAUSE MUSCLE TENSION such as Adderall. “I am currently taking Adderall. Could that impact my treatment?”

You may have your heart set on Invisalign, but it’s best to know for sure that it’s right for you before starting. If you are in the midst of treatment I recommend that you make great efforts to be as mindful as you can to keep your trays apart during the day. Report your concerns about night clenching to your dentist immediately if you suspect you are doing it. TMJ problems during Invisalign treatment can negatively affect the outcome.

More than anything else: choose a dentist that you trust and who listens to you and addresses your concerns. It’s better to be safe than sorry.

If you or someone you know is experiencing persistent or acute pain in the face or jaw, we invite you to set up a consultation with one of our Orofacial Pain specialists in the NYC metropolitan area. Our office locations and contact information are below.

Tags Facial Pain, Jaw Problems, Teeth Grinding, TMJ

Sleep Apnea

5 Options For Sleep Apnea Treatment

In the United States, it is estimated that 50-70 million adults experience insufficient sleep on a regular basis, with sleep apnea being one important cause. Depending on whom you ask (sleep physician, dentist, respiratory therapist, ENT surgeon, oral surgeon, dietician) you’ll get a wide variety of opinions on the best sleep apnea treatment options.

Regardless of which treatment is chosen to address apnea, attention to nasal breathing is the key. The oxygen that passes through your nose is filtered, warmed, humidified and combined with nitric acid, all of which increase the percentage of oxygen absorbed in your lungs. In my practice, we work hard to combine the best of multiple treatment strategies to result in outcomes that speak for themselves. We consistently hear commentary that indicates that the treatment strategies employed are truly working. It is not uncommon for my patients to tell me how much better they sleep.

“For the first time in ten years I wake up refreshed and I no longer fall asleep at my desk at three in the afternoon.”

With a focus on individual attention and quick responsiveness to a patient’s needs we, often treat these problems with multiple therapies; sometimes during the same night and/or week. The successful outcomes of this approach have become the foundation of our care. These are the five sleep apnea treatment options that my office relies upon.

5 Options For Sleep Apnea Treatment

1. CPAP (Continuous Positive Airway Pressure)

CPAP continues to be first line therapy for most severe and some moderate apnea patients. The problem is that more than 50% of those who choose CPAP discontinue using it within 6-12 months. In most of these cases, it is because they can’t tolerate the facemask (or even partial mask) due to feelings of claustrophobia, the noise of the machine, or its interference with comfortable sleep positions.

For others, the airflow can be cold and feel dehydrating, which prompts them to remove the mask in the middle of the night. Although quieter machines with built-in humidifiers and heaters are now available, leakage of the masks often produces distressing drafts across the face and less than adequate efficiency.

For young patients, the CPAP sleep apnea treatment option often does not sit well, especially when dating and establishing new relationships. As a result, compliance suffers.

2. Oral Appliances

[Oral appliances] (or MRDs) are mouthpieces that move the jaw forward and subsequently move the tongue base forward. This is designed to keep the airway open. These devices are most effective when custom-made, adjusted, titrated and watched over by a dentist with expertise.

This sleep apnea treatment option has been shown to be extremely effective in patients with mild and moderate apnea and less problematic sleep-related breathing disorders, which are often associated with social snoring.

Approximately 25% of my patients who use an oral appliance will alternate with CPAP. Sometimes switching randomly during the week. It is also commonplace for some of my patients to go to sleep with CPAP then switch to the oral appliance in the early morning hours. This way they get the best of both worlds. In many cases, a patient will use an oral appliance when traveling instead of transporting his or her CPAP machine.

These strategies help minimize the complications of a full-time oral appliance which can include jaw discomfort, bite changes and moving teeth.

Note: It is essential that people who use oral appliances be monitored by their dentist. Monitoring by home pulse oximetry and home sleep studies ensure the effectiveness.

3. Nasal Plugs

Some of my patients have had success with nasal plug therapy called Provent. Nasal plugs make it easy to breathe in, but hard to breathe out. This leaves some air chambered (like the air in a balloon) and supports the soft nasal tissues which can collapse and cause apnea.

When tolerated, nasal plugs are a worthwhile option but require clear nasal pathways to work. In a patient who has nasal obstructions due to a deviated septum and/or enlarged turbinates (the shelves on the inside of the nose) the complaint “I was suffocating with the plugs in place” is not uncommon.

Recently a patient developed jaw soreness wearing a night oral appliance, switched to this option with success, and is now splitting the week between these two options.

4. Positional Apnea Aids

Many people experience breathing interruptions only when they are sleeping on their backs. To keep a patient from sleeping on his or her back, I recommend sewing two tennis balls into a tube sock and attaching it to the back of pajamas. The discomfort of the tennis balls forces the patient to stay on his or her side.

In one study, 38% of people who tested this method were still using it six months later.

Body positioners are also available and can be purchased online. This effort to promote side sleeping is essential and when used with oral appliances, can reduce the amount of jaw positioning required. This is what we strive to achieve.

5. Weight Loss

A big risk factor in the development of obstructive apnea is obesity. Since stress often promotes overeating, I have begun to put into place programs that address stress-related behaviors. The challenge here is to build and maintain collaborative relationships with other health care providers, as well.

Summary

Sleep apnea treatments used in combinations seem to be the best way to address the problem at this juncture. The key to more successful outcomes in the future will require the integration of medical, dental and other health related practitioners. This still remains to be achieved, but we are getting closer.

In the meantime, I will continue to bring together the latest ideas and technologies available and will share them with you here.

Note: The Centers For Disease Control and Prevention has designated insufficient sleep as one of our most serious public health problems. To find out more: [http://www.cdc.gov/features/dssleep]

Dr. Donald Tanenbaum is a dentist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with facial pain, TMJ and sleep apnea

Tags Sleep Apnea Treatment

Jaw Problems TMJ Women & Pain

Postpartum TMJ Pain – What Causes It & How To Get Relief

As a board-certified orofacial pain specialist, my practice focused on treating patients who suffer from the impact of TMJ problems, I am confronted with new challenges every day. One particularly challenging group of patients is women who suffer from postpartum TMJ pain. Here are some of my thoughts on why this population of patients is so commonly seen in my office.

The 3 Big Causes of Postpartum TMJ Pain

1- Sleep Disruption

Everyone knows that the presence of a newborn is incredibly disruptive to sleep. A fragmented, diminished and unpredictable sleep schedule leads to poor quality sleep. When sleep deprivation continues over many months or even years, pain symptoms can develop throughout the body as endorphin levels drop. Joint and muscle symptoms are common throughout the body including the jaw muscles and TM joints.

If headaches in the temples are a common morning symptom suspicion of sleep bruxism must be considered. In addition, if the new mom does not quickly shed her pregnancy weight, she may be predisposed to airway problems, which further fragment sleep quality. Sometimes lingering postpartum TMJ pain is so severe that new moms seek many medical evaluations, most of them unnecessary other than for piece of mind.

2- Neck & Shoulder Strain & Fatigue

Next is the act of carrying around small babies. It seems easy at first but gets more and more difficult as a child’s weight increases. Carrying around the baby can be a challenge for anyone, particularly for small women. A 20-pound baby can cause neck strain and fatigue, which can result in pain. These neck problems very often initiate jaw problems. And thus the cycle begins.

Carrying a baby isn’t the only cause of neck and shoulder strain. Car seat challenges, pushing and folding heavy strollers (especially while holding the child in one arm), talking on the phone or cooking while holding the baby, and time spent sitting on the floor all add up to the potential for muscle problems to arise.

3- Emotional Issues

Last, but not least, the emotional issues than often arise following childbirth can be a significant cause of postpartum TMJ pain. Yes, having a baby is one of the most cherished events in life. But life as we know it is forever changed. For women whose independence started with high school graduation, college, grad school, and then career, the sudden loss of control that the new baby brings can cause tremendous emotional upheaval.

Plus, it’s no easy chore to be on call 24/7, even for the hardiest. For working moms the stress is two-fold. The hours away from her baby can create anxiety and the feeling of “being out of control.” Many new moms also sense a tremendous amount of guilt for being away from the baby every day.

Attending to poor sleepers, colicky babies, picky eaters and constant crying requires skills that must be learned, and there’s no manual.

As the challenges of motherhood continue, the limbic system (the part of the brain where emotions are formed) ultimately stimulates the fight or flight response and that gives rise to increased muscle tone, shallow and fast breathing, and daytime behaviors such as raised shoulders, furrowed brows, lip tension and clenched teeth, just to name a few. The end result, of course, can be the emergence of jaw pain, jaw stiffness, and/or headaches.

Help Is Available

There are no easy solutions for all of these challenges. However, when a new mom arrives at my practice suffering from TMJ problems, I have an arsenal of ways to help her get relief. They include:

Diaphragmatic breathing techniques
Jaw and neck exercises
Help to improve sleep hygiene
Strategies to address awake and sleep bruxism
Meditation recommendations (TM is extremely helpful)
Referrals to Alexander and/or Feldenkrais specialists

I also encourage new moms to ask for help from their parents, siblings or even their friends. Taking some breaks from the daily obligations of caring for a newborn can go a long way to feeling better.

If you have a new baby and are suffering from postpartum TMJ, help is available. To find a dentist in your area that focuses on these types of problems, visit The American Academy of Orofacial Pain at http://www.aaop.org/.

Good luck!

(This is a follow-up to a previous post 3 Reasons Why TMJ Problems Get Worse During Pregnancy

Dr. Donald Tanenbaum is a dentist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with facial pain, TMJ and sleep apnea.

Live or work in New York City or on Long Island? You can schedule a consultation with me here or call 212-265-0110

Tags Jaw Problems, TMJ, Women and pain

Jaw Problems Nightguards & Oral Appliances TMJ

3 Reasons Why TMJ Problems Get Worse During Pregnancy

As a board-certified orofacial pain specialist, the majority of people who pass through my door have TMJ problems, and 80% of them are women. The reasons that women are more prone to TMJ problems are very complex (a subject that I cover elsewhere on my website). Happily, I can report that after a treatment period of approximately three to four months, most of my female patients experience diminished and sometimes even the complete elimination of their symptoms. It is not unusual, however, for some women that were symptom-free for a long period of time to find their way back to my office when they’re expecting a baby. That’s because TMJ problems get worse during pregnancy.

Why do TMJ problems get worse during pregnancy? There are 3 main reasons:

Sleep Disruption

Most women discover pretty early on in pregnancy that their favorite position is no longer comfortable. In many cases, she can’t even find one sleep position that’s comfortable. Add to being uncomfortable, the frequent need to get up to urinate during the night and you have a situation that wreaks havoc on the sleep cycle. Disrupted sleep and brain arousals during the night seem to increase the likelihood of tooth grinding and clenching. Therefore, the pregnant woman that experienced jaw problems in the past is certainly now at risk again. The result is the typical list of TMJ problems: pain, jaw stiffness, morning headaches and jaw clicking and/or locking.
Morning Sickness
For many women, unrelenting nausea and frequent vomiting characterize the early stages of pregnancy. Vomiting itself puts extreme pressure on the shoulder and neck muscles and causes the jaw to be violently thrust forward. Frequent vomiting can cause the jaw ligaments to be sprained and the jaw muscles to be strained. A traumatized jaw joint can be painful, stiff, and mechanically challenged. Although morning sickness usually lasts only a short time, that can be just long enough for TMJ problems to start or to reoccur.
The Relaxin Hormone
Relaxin is a very helpful hormone. It helps ligaments in the pelvis stretchier to accommodate the delivery of a baby. The ligaments become more “lax”. During the later stages of pregnancy, relaxin becomes more and more elevated in the bloodstream. While relaxin’s main job is to prepare the pelvis, it also can make the ligaments in other parts of the body more elastic, including the jaw. Here’s a frightening scenario that is experienced by many pregnant women: A visit to the dentist for a routine cleaning becomes a nightmare when her jaw gets stuck in the open position. Hello, relaxin! Relaxin has made the jaw ligaments unstable and allowed the joint to open wider than normal. Sometimes assistance is even needed to get the jaw closed and that can result in pain and soreness for days, or even weeks. The fear of this scary event happening again is very stressful. (In these cases I teach some simple exercises that are very helpful.)

If you’re pregnant, have had TMJ problems in the past, and suspect that they are beginning to resurface, see your dentist before it gets worse. A custom-fitted nightguard, a routine of jaw exercises, and some general relaxation techniques may just be what you need to relieve the symptoms and allow you to enjoy the rest of your pregnancy.

If you are experiencing postpartum TMJ problems, please link to Postpartum TMJ Pain – What Causes It & How To Get Relief.

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Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with TMJ, jaw problems, bruxism, and more.

Live or work in New York City or on Long Island? You can schedule a consultation with me here or call 212-265-0110

Tags Jaw Problems, Pregnancy, TMJ

Bruxism Nightguards & Oral Appliances TMJ

Why It’s A Bad Idea To Use Whitening Trays For Bruxism

I recently came across an online press release with this compelling title:
Teeth Whitening Trays From ProDental Functions As A Night Guard Against Teeth Grinding.

The press release goes on to state:
“These teeth whitening trays help to stop the condition of teeth grinding which happens drastically at night when persons sleep.”

In my 30+ years as an orofacial pain specialist, I’ve treated thousands of people who suffer from the effects of teeth grinding and I will tell you right now: it is a very bad idea to use whitening trays for bruxism.

Teeth grinding and clenching (clinically known as sleep bruxism) are caused by brain arousal during sleep. What causes the brain to become aroused? There is no easy answer. It could be any number of things: daily stress, a crying baby, chronic pain, breathing problems, too much light, a snoring bed partner…and the list goes on.

Medical practitioners face a big challenge when attempting to identify the exact cause of nighttime brain arousal. In my practice, the goal is to reduce, or even stop, nightly grinding. But that can happen only once the exact cause has been identified. This takes time and determination.

In the interim, most of my patients wear custom-fitted bruxism devices (also called oral appliances) at night. These bruxism devices protect teeth from the destructive impact of constant grinding and clenching. They diminish the loading forces placed on the jaw joints and diminish the contracture force of the jaw muscles.

However, bruxism appliances must be custom-fitted to do their job!

If you’re considering the use of whitening trays to treat your teeth grinding, as the above press release suggests, please beware. You may actually make your condition worse. Here’s why:

3 Reasons Why It’s A Bad Idea To Use Whitening Trays For Bruxism

1. Whitening Trays Are Too Loose

Whitening trays will rarely fit your teeth perfectly. In fact, they are designed to fit somewhat loose and because of that fact, they flop around in your mouth. You must clench your teeth to keep them in place. And the last thing you need is more teeth clenching.

2. Whitening Trays Are Too Short

Whitening trays that are designed for mass utilization will never extend all the way back to your rear teeth. As a result, when you clench or grind your teeth with one of these trays in place, all the force is shifted forward. Though it sounds like a good idea to prevent the back teeth from being engaged when clenching and grinding, this pattern of contact actually puts more pressure on your TM joints. Over time this can cause additional jaw stiffness, pain and even joint clicking and locking (which may not have been present before starting to wear the trays). And not only that; trays which do not cover rear teeth may cause your bite to change over time, adding another difficult problem to fix.

3. Whitening Trays Are Too Soft

Whitening trays are made of a soft, pliable material which encourages more grinding and clenching. Patients call them “chew toys” when describing how they feel. In addition, because these soft trays don’t hold your teeth in place they can cause spaces to develop in between your back teeth. If this happens to you, you’ll forever be fishing food out from between your teeth with your tongue, further aggravating your jaw.

The Takeaway:

If you wake up in the morning with jaw pain, muscle stiffness, jaw clicking or locking, or sore teeth, you likely have sleep bruxism. You may be tempted to try the teeth whitening tray solution. After all, it seems to be adequate and inexpensive. But that decision will most likely lead to more problems with your teeth and jaw.

Please, take my advice: don’t be the victim of a phony pitch that can come back to bite you with a hefty dental bill later. Seek help from an experienced practitioner.

To find a dentist in your area that concentrates on sleep bruxism problems, visit The American Academy of Orofacial Pain at http://www.aaop.org/.

Live or work in New York City or on Long Island? You can schedule a consultation with me here or call 212-265-0110

Tags Bruxism, Oral Appliances, Teeth Grinding

Jaw Problems Orofacial Pain TMJ

When Is TMJ Surgery Needed? What You Need To Know

TMJ surgery has received some negative press over the years. You may have read horror stories on the Internet about TMJ surgery gone bad. The reality is countless patients would still be living with acute jaw pain and limited jaw motion if they had not had surgery as an option.

I’ve spent the past 40 years focused almost exclusively on treating patients with TMJ and facial pain problems. I’m often asked how I determine when TMJ surgery is needed.

Non-Surgical Treatments Are Always Tried Before Surgery Is Ever Considered

It’s important to understand that TM joint problems are orthopedic problems – just like tennis elbow or a rotator cuff injury, for example. Sometimes, tissue injury in the TM joints is severe and involves compromised ligaments, stubborn inflammation, displaced cartilage, and/or arthritic and erosive problems affecting the bones.

If your TM joint pain is due to inflammation, and after we’ve tried all non-evasive therapies, our one last non-surgical effort is steroid injections into the “hot” joint.

The success of steroid treatment depends upon how long you’ve experienced pain, the origin of your problem, the condition of your underlying bone, ligaments and cartilage, and your ability to avoid new injury to the joint. If progress is made after the first injection, a second is usually administered in about three months.

However, when no relief is experienced after the first injection, the steroid method is put aside.

When Steroid Injections Don’t Work – The Next Option Is Arthrocentesis

If steroid injections are unsuccessful, the next option is usually arthrocentesis. Arthrocentesis is a procedure whereby your injured TM joint is, in essence, washed-out to remove the irritating chemicals that accumulate when you have tissue injury.

In addition, your injured TM joints may not move easily due to sticky adhesions. So, the second goal of arthrocentesis is to break down these adhesions, which allows your joint to move more easily. When movement is easier, so are your prospects of healing. (Arthrocentesis is usually performed under local anesthetic and light sedation.)

As with steroid injections, supportive therapies are put in place afterward such as oral appliances, home treatments and exercises, dietary caution, oral medications, and physical therapy.

When Arthrocentesis Doesn’t Work, Is TMJ Surgery Next?

Like any orthopedic problem, there are times when all non-surgical treatments fail.

The procedure of choice in this instance is arthroscopic surgery. Arthroscopic surgery allows your doctor to visualize the damage in your TM joint and effectively remove any adhesions, smooth any irregular bone, and inject steroids right into areas that are inflamed. We often take tissue biopsies at the same time.

When performed by experienced hands, arthroscopic surgery is extremely effective in starting the process of natural healing, which for most patients, results in profound pain reduction and increased ease of jaw motion. Although usually performed under general anesthesia, arthroscopic surgery is an outpatient procedure.

(Home exercises and/or physical therapy are always required after arthroscopic surgery.)

When All Else Fails

If the MRI and CT scans reveal extreme tissue damage, extensive bone erosions, and/or degenerative arthritis, then we may need to surgically open the joint. Opening the joint enables extensive repairs to be made, but it requires special surgical skills and experience. Like all the procedures outlined in this article, long-term rehabilitation is put in place and is required.

A full regimen of non-surgical care must always be attempted before TMJ surgery is ever considered. TMJ surgery can repair injured tissues, relieve (or even eliminate) pain, and improve your jaw function. But it should be always considered as the last resort.

The Takeaway: If you do need surgery, ongoing collaboration between your dentist, a board-certified orofacial pain specialist, your surgeon, and your physical therapist must exist in order for you to heal and experience long-lasting results.

To find a board-certified orofacial pain specialist in your area, visit The American Academy of Orofacial Pain and look for a doctor with Diplomate status.

Tags Jaw Problems, Orofacial Pain, TMJ

BOTOX® For Jaw Problems Is A Serious Decision

Conclusion

Dr. Sarno and My Approach to TMD

Teeth Grinding in Children, Adolescents, and Teens

Can Lyme Disease Cause TMJ?

3 Case Studies

Did Lyme Disease Cause TMJ Symptoms In John, Sue, or Anne?

TMJ From Scuba Diving Or Snorkeling Is Very Common. Here’s Why:

Prevention & Treatment of TMJ from Scuba Diving Or Snorkeling

The connection between tinnitus and TMJ is real.

What Is Tinnitus?

What Causes Tinnitus?

What Is The Connection Between Tinnitus And TMJ problems?

Why TMJ Problems Can Lead To Tinnitus (Or Make It Worse)

Determining If A TMJ Problem Is Driving Tinnitus Symptoms

TMJ Neck Treatment To Help Tinnitus

Summary

6 Important Things You Need To Know About BOTOX® Injections For TMJ

In Conclusion

Can Braces Cause TMJ? Three Scenarios

Is it TMJ or Fibromyalgia?

Why don’t more people know about orofacial pain specialists?

News Flash! Bettheny Frankel Explains Why Her Face Has Changed: “I Get BOTOX® In My Jaw.”

Now, if you are about to jump on the phone to your dermatologist and ask about injections of BOTOX® for jaw reduction you need to know a few facts:

The 60/40 Rule In The Treatment Of Chronic Orofacial Pain Explained

Thankfully, I have an arsenal of treatment options at my disposal to help patients get relief from chronic orofacial pain.

More Patients Experiencing TMJ Problems During Invisalign Treatment

How To Prevent TMJ Problems During Invisalign Treatment

5 Options For Sleep Apnea Treatment

Summary

The 3 Big Causes of Postpartum TMJ Pain

Why do TMJ problems get worse during pregnancy? There are 3 main reasons:

3 Reasons Why It’s A Bad Idea To Use Whitening Trays For Bruxism

Non-Surgical Treatments Are Always Tried Before Surgery Is Ever Considered

When Steroid Injections Don’t Work – The Next Option Is Arthrocentesis

When Arthrocentesis Doesn’t Work, Is TMJ Surgery Next?

When All Else Fails