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Categories
Jaw Problems TMJ

Effective At-Home Treatments for TMJ & Painful Jaw Muscles

 

Do you suffer from TMJ symptoms, jaw pain, or both? As a board-certified orofacial pain specialist or TMJ doctor, I have many tools at my disposal for patients who suffer from tight, painful jaw muscles. Over the years I’ve recommended (and developed) a number of relaxation techniques and massages for TMJ and jaw muscle pain. If you notice yourself opening and closing your mouth all day long to stretch out your jaw muscles, you probably have a TMJ problem. Try some of these at-home treatments for TMJ and painful jaw muscles.

2 TMJ Relaxation Techniques and Breathing Exercises

Most people with ongoing jaw pain and tightness tend to breathe with shallow chest movements during the day. As a matter of fact, if you suffer from any kind of muscle pain you’re probably already breathing too fast. When you breathe too fast, you create an imbalance of oxygen and carbon dioxide in your body. This sets you up for more even muscle pain and fatigue.

The following techniques will help you slow your breathing and help your muscles relax:

1. With your lips lightly touching, place your tongue gently on the roof of your mouth behind your front teeth, or gently against the back of your lower front teeth. Then, bring air in through your nose and extend your belly outward. Hold this for 3 seconds then exhale through your mouth while parting your lips slightly. Repeat 6 times. (You can do this once every hour.)

2. With your lips lightly touching, gently place your tongue gently against your lower front teeth, upper front teeth, or just float it in no particular position. Breathe in through your nose for 4 seconds filling your belly. Then, exhale through your lips or nose for 4 seconds. Pause for 2 seconds. Repeat 6 times over a 1-minute period. This will help you train yourself to slow down your breathing. Perform once every hour whenever you need it.

2 Massages for TMJ and Sore Jaw Muscles

A sore jaw indicates that your jaw muscle health has been compromised and is likely due to the accumulation of an irritating substance that forms in response to muscle overuse, such as lactic acid. The key here is to increase the blood flow to your sore muscles which in turn brings fresh oxygen and nutrients to the affected areas. The Temporalis and the Masseter are the two most important muscles for you to focus on.

massage for TMJ, temporalis and masseter

1. Perform this massage with your mouth hanging slightly open, and your head relaxed: with your index and your middle finger, massage the sore areas in your temporalis and masseter muscles in a circular motion for 6 seconds on the right side, and 6 seconds on the left. If you can, do both sides at the same time. Press firmly, but not so hard that tears come to your eyes. After massaging your muscles, open your mouth to its fullest non-painful position and then close it slowly. Repeat 6 times.

2. I find this one is best done in the shower. Open your mouth halfway and place the pad of your index finger on the most rear upper tooth on one side. Then slide your index finger off that tooth and move it toward your cheek in an upward direction. You should run into a wall of bone. That is where your jaw muscle attaches and it is likely to be very tender. Once you’ve found the tender region, push your index finger inward and hold for at least 30 seconds before releasing. Then switch to the other side and repeat. Massage each side 2 times. (You can also move your index finger in a circular pattern instead of maintaining constant pressure.)

3 Exercises for Sore Jaws

1. This exercise is designed to release tension in the muscles that enable you to open and close your jaw. Place your tongue as far back as possible on the roof of your mouth. Now, try to open your mouth, keeping your tongue in this position (the range of motion will be very limited). While your tongue remains in place, position your thumb under your chin and attempt to open your mouth against the resistance of your thumb. Maintain this resistance for 3 seconds before releasing. Repeat this 6 times. This exercise can be performed up to 6 times per day.

2. Here’s another technique that many of my patients find helpful: blow air into your cheek on one side and hold it for 6 seconds. Then switch to the other side and do the same thing. This can be done 6 times per day.

3. You can also do some tongue exercises to loosen your tight jaw muscles. With your lips sealed, move your tongue in a complete circle 6 times to the right and then 6 times to the left. Then take 6 cleansing belly breaths as described above and repeat the tongue movements 2 more times.

If At-Home Treatments For TMJ Don’t Work…

Tight jaw muscles can produce serious pain. If you are suffering, and the above at-home treatments for TMJ don’t work after doing them for over a week, please contact your dentist or an orofacial pain specialist in your area. You can find a provider in your area by going to the American Academy of Orofacial Pain.

Good Luck!

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

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

gender bias in chronic pain, chronic pain
Categories
Facial Pain

Gender Bias In Chronic Pain Treatment

A common theme in many of the scientific conferences I’ve recently attended is that chronic pain, when left untreated, can actually cause permanent changes to the brain and nervous system. That knowledge makes it all the more important for physicians to address pain soon after a patient’s struggles begin. In my practice I treat a majority of female patients who are dealing with severe jaw and facial pain. From their stories, I know first-hand that gender bias in chronic pain treatment is real.

There seems to be a common attitude among many health care providers that

women who complain about pain are exaggerating their suffering.

According to references in the book “A Nation in Painby Judy Foreman, studies have shown that doctors are more likely to request tests for male patients who complain of pain. Men“s symptoms are often treated as physical and neurological conditions while similar symptoms in women are considered due to psychological or psychosocial issues. In addition, there is evidence that physicians frequently dismiss women who report chronic pain or write them off as experiencing emotional hysteria, unlike their male counterparts.

This evidence, combined with the well-known
biologic factors that predispose women to jaw and facial pain, makes it easy for me to understand why women with longstanding pain problems ultimately seek care in my office. The problems I see are broad in nature and typically caused by disorders of muscle, joint, or nerve tissue. My patients’ stories about misdiagnosis and/or delays in proper pain therapy (as a result of the attitude that the pain is all in her head) are certainly unnerving.

In addition, many of my female headache patients have been told to “tough it out” or take anti-anxiety medications for pain problems. These treatment recommendations again put the emphasis on blaming the patient as opposed to identifying a potential biological cause and directing treatment at specific pain receptors and pathways. 

Clearly these kind of gender-biased misconceptions need to be addressed if women are to get the timely pain care they deserve, especially before changes occur in the brain and along nerve pathways. As a result of research in the often-maligned diagnoses of Chronic Fatigue Syndrome and Fibromyalgia, these disorders have been redefined (Chronic Regional Pain and Systemic Exertion Intolerance Disorder) revealing that biases can be changed. As scientific investigations are today beginning to shed light on gender-specific pain problems, hopefully the same kind of change in attitude will prevail.

For the time being women suffering from chronic pain will have to seek help where they can find it. Many chronic pain support groups have sprung up (I often share their posts often on my Facebook page) which can help these patients feel less alone.

My office will continue to assess the physical and cognitive emotional components of all pain complaints that pass through our door, regardless of gender. With a female patient population approaching 82%, I know that not only do these patients have real problems I know that most of them can be helped.

Have you experienced gender bias in your quest for treatment for chronic pain? Please share:

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 facial pain, TMJ, headaches and sleep apnea.

teeth grinding, bruxism, grinding of the teeth
Categories
Bruxism TMJ

Good News About Teeth Grinding

“Doctor, why do I grind my teeth so fiercely every night?”

As a professional who works with TMJ and bruxism problems in my practice I hear that question almost daily. The fact is, we don’t yet know all the reasons that so many people grind their teeth at night. If you are a grinder, I have some good news for you! We are getting closer every day to a more science-based understanding of what is at the root of your problem; and that knowledge is helping to choose the best treatment for you.

Is It Your Bite?

Amongst my colleagues there is general agreement that teeth grinding and clenching are not related to the way your teeth fit together (your bite). Therefore, if you were offered treatment that promises to reduce your grinding by giving you a better bite, you would be best served by walking away from this option.

Is It Stress?

Surprisingly, stress appears to be only part of the problem. Studies have suggested that short-term stress has less to do with your nighttime teeth grinding and clenching than does long-term, unresolved stressors and life circumstances. When stress is indeed the culprit, medications can be used for a short period of time to get you through difficult patches relating to home, work, school and medical challenges. Over the long-term, medications (if continued) should be coupled with an oral appliance and routine practicing of pre–sleep jaw exercises and relaxation and breathing techniques. However, long-term medication use is discouraged and often ineffective over time.

The Good News

Researchers are finally gaining a much better understanding of the mechanisms that cause teeth grinding and clenching. In fact, grinding of the teeth is now considered to be a movement disorder (just like restless leg syndrome). Some studies suggest that teeth grinding is much more common when the brain is aroused and sleep is restless. Brain arousals (which lead to unrefreshing and restless sleep) may be due to a multitude of factors including a noisy sleep environment (a snoring bed partner), a crying baby, a chronic pain problem, airway struggles due to conditions such as asthma or sleep apnea, late evening consumption of caffeine or eating, and general anxiety (to name just a few possibilities).

Imagine this scenario, which is not uncommon in my practice: During sleep you struggle to breath because you are either not getting adequate oxygen or because of other factors such as recent weight gain, a large tongue that falls back into your airway, or tonsils that are so large that they compromise airflow. As a result your brain is frequently aroused and that causes you to wake up, take a few breaths of air, and then attempt to fall asleep again.

A severe form of this syndrome is called RERA (Respiratory Effort-Related Arousal). With RERA breathing is so labored (due a small airway) that you never get the quality sleep you need and as a result you are always tired the next day. Interestingly, people with this problem also tend to grind their teeth. If this happens to be why you grind so aggressively, treatment can be designed to address the source of your problem

Treatment For Teeth Grinding

With my patients, I look at all the risk factors that could be driving the brain arousals and are initiating grinding and clenching. Once identified, I work to create a customized treatment plan which can include:

    • Quieting The Sleep Environment: Can you imagine how peacefully you would sleep if your bed partner stopped snoring?
    • Changing Dietary Patterns In The Evening: Try to have your biggest meal at lunch and avoid caffeine (including chocolate) after 3pm. If an evening snack is important, frozen bananas can satisfy any sweet tooth!
    • Managing Chronic Pain: Providing proper treatment for your chronic pain problems, especially if your pain is in your neck and/or back.
    • Meditation: Meditating in the evening (but not necessarily right before bedtime) is helpful for many people, especially if you are prone to anxiety or if you have a very stressful life.
    • Jaw Exercises: Performing stretching exercises before you go to sleep can reduce the morning symptoms associated with clenching and grinding.
    • Losing Weight: When you lose weight you may also find that your airway will allow more efficient airflow while sleeping, and therefore less chance of brain arousal and fragmented sleep.
    • Tonsils Removal: If labored breathing during sleep is your problem, sometimes removing the tonsils or reducing their size allows easier breathing particularly in children and adolescents.
    • Sleep Positioning: Sleeping on your side instead of on your back can also increase airflow.
    • Oral Appliances: Oral appliances are very commonly chosen to address teeth grinding. However, the benefits of using oral appliances is only achieved if the design is the right one for you and addresses the specific reasons for your teeth grinding in the first place.

The Takeaway:

If you are a grinder or a clencher, don’t despair. We have more answers now than ever before and we have more treatments that can address not only the symptoms associated with your problem, but the reasons that they occur in the first place.

Have questions or comments? Go my Facebook page: http://on.fb.me/17w20sg 

photo attribution: By Aweisenfels (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

sleep apnea appliance, oral appliance, TAP appliance
Categories
Case Studies Sleep Apnea Snoring

Is Your Sleep Apnea Appliance Working?

Snoring and obstructive sleep apnea are not only disruptive to your bed partner; they may also be the cause of many other illnesses. And as we have seen in the news recently, can result in deadly vehicle accidents. If you have opted to wear an oral appliance at night for snoring and/or sleep apnea (as opposed to using a CPAP machine) you may have noticed that it’s not working as well as it did when it was first fitted by your dentist. So, how do you know if your sleep apnea appliance is working?

John: A Case Study

My patient John is a 45-year old who had chosen to wear a sleep appliance to spare his wife from the disrupted sleep she was experiencing as “he snored like a jackhammer.” However, after a period of time his snoring (and consequently his wife’s nighttime annoyance) had reappeared.

John came to my office and we sat down to talk. He confessed that he had gained a whopping 15 pounds over nine months, so it wasn’t surprising that the appliance was no longer effective. I subsequently corrected the fit of his appliance (basically moving it slightly forward), which took care of his nightly jackhammer snoring (and probably saved his marriage!). But, another problem developed.

John began experiencing morning jaw tension and an awkward bite, which lasted for about an hour. Another visit to the office and a bit more adjustment took care of the issue. Now John is sleeping peacefully and not worried about a TMJ problem. So, if you use an oral appliance to manage sleep apnea/snoring, and your weight varies you should be going back to your dentist to reset the appliance

How To Determine If Your Oral Appliance Is Working

For those snoring without sleep apnea, your bed partner feedback will certainly alert you as to when the appliance is not working, but how do you know if you live alone? If you sleep alone and are wearing an appliance to protect the tissues in the back of your throat from the consequences of snoring over time, monitoring is key.

How To Monitor Snoring and Apnea With Technology

There are a number of mobile apps that can monitor your snoring at night. The best ones are SnoreLab and SnoringU.

For those with obstructive sleep apnea (with or without a bed partner) the absolute best way to know if your appliance is working properly is to use a pulse oximeter on two consecutive nights. A pulse oximeter will measure your blood oxygen levels while you are sleeping. If there is less than optimal oxygen your blood, then your appliance needs to be adjusted. The pulse oximeter can be purchased online or provided by your dentist.

Even more information can be obtained through using a HST (home sleep test), which is often covered under insurance plans and obtained through a sleep clinic or your dentist.

Important: technologies such as FitBit and JawBone cannot be used for monitoring oral appliances and Basis Peak and Microsoft Band, though sensing body motion and monitoring heart rate, also come up short.

The message is clear…don’t assume that once fitted, your oral appliance will always maintain its effectiveness. It’s necessary to have it monitored at least once, preferably twice, every year.

 

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 facial pain, TMJ, headaches and sleep apnea.

timj pain
Young female is crying near window with jalousie
Categories
TMJ

FDA Looking At Conditions That Impact Quality Of Life

 

There are hopes that TMD will be included.

I’m happy to announce some great news. The FDA (The Food & Drug Administration) is taking a closer look at medical conditions that can have a significant impact on your quality of life. Starting in 2016 the FDA will hold public meetings with the goal of determining the impact on daily life of 20 chosen diseases, and to look at the scope of services that are available to treat these conditions.

The TMJ Association is making huge efforts to have TMD (Temporomandibular Disorder) chosen as one of the diseases that will be focused on. That TMJ problems affect your quality of life is not news if you are one of estimated 35 million Americans who suffer from it every day.

Chronic pain problems, like TMD, rarely occur alone. It is estimated that 85% of TMD patients have other chronic pain conditions such as headaches, endometriosis, fibromyalgia, interstitial cystitis, irritable bowel syndrome, chronic fatigue syndrome, sleep disorders, or vulvodynia. In many cases these conditions are so complicated that patients don’t know where to turn to for care. As a matter of fact, I see many patients every week who have been told that they will never get better and that their problem is in “the head.”

If chosen as one of the conditions to be studied by the FDA, more information will be made readily available to you, the public, as to the nature of TMD and the treatments that are available.

Here are some facts about TMD that more people need to know:

  • TMD problems are orthopedic in nature.
  • TMD problems may be the result of (or aggravated by) rheumatologic, autoimmune or neurologic conditions.
  • Women are the largest group with TMJ symptoms as a result of specific biologic predispositions, some of which are hormone-driven.
  • Common TMJ problems may be the result of an accident, overusing the jaws, bad posture, teeth grinding (bruxism), or muscle tension caused by by emotions and life’s challenges.
  • Treatment for TMJ disorders should not focus merely on the teeth; the ultimate goal should be tissue healing and change of habits.
  • Getting better typically will lead to less pain, less medication, better function and increased optimism in people who before had anticipated a lifetime of suffering.

The same as with other orthopedic problems, after treatment patients may still have some pain, but it is likely that it will be at a much more tolerable level.

For all of you TMD/TMJ sufferers out there, the fact that the FDA has recognized that it’s time for this type of condition to be validated is welcome news. The result will be more access to information and thus, more access to treatment.

 

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 facial pain, TMJ, and headaches.

6 foods that can break your jaw donald tanenbaum
Categories
Jaw Problems

6 Foods That Can Break Your Jaw

Just this week I treated two patients who unfortunately chose to eat foods that not only are known to often cause fractured teeth but also can at the same time create significant jaw injuries. Now, a particular food can’t actually “break” your jaw, but an injury in the jaw joint (TMJ) can certainly feel like it.

To start the conversation, picture this: the jaw joints (or “hinges”) and the attached ligaments allow you to open and close your mouth. The attached muscles and tendons provide the power for this movement. So, if you think about the jaw as an orthopedic system (just like the knee) it is subject to sprains, strains, ligament stretch, slipped cartilage and inflammation that at times can be severe. When you bite into or munch repetitively on hard or large food substances, you can cause significant painful damage to your delicate jaw joints.

Here are the top offenders:

1. Bagels
In New York City the unquestionable leading offender is the bagel. But it’s not the hot steamy variety that has just come out of the oven or the fake-out options in the grocery store such as Lender’s Bagels. The problems come from the overly-toasted, crisp beauties that are consumed daily with cream cheese or stacked high with tomatoes, onions and favorite delicacies and eaten like a sandwich.

The most treacherous situation occurs when a college student has no choice but to grab a 3-day old, shiny bagel wrapped in cellophane and then tries to eat it as he or she runs between classes. Inevitably, I find myself providing care to students returning for the Thanksgiving or Christmas break. And this week is no exception.

2. Biscotti
Next in line are those irresistible biscotti cookies that land on your table after overindulging at your favorite Italian restaurant. The coffee or tea is on the table for dunking, but what are the chances that you will dunk the biscotti before sinking your teeth into one of those “jaw crackers?” You first encounter firmness but that doesn’t deter you from trying to break off a piece with your front teeth. With each successive effort to win the battle, you are one step closer to traumatized and sprained TMJs.

For those who have been on the cusp of this occurrence you know exactly what I am talking about. For those of you have met your match and subsequently suffered with jaw pain, limited jaw motion or joint noise, I suspect you have since become dunkers.

3. Sourdough Pretzels
Not far behind biscotti is a snacking favorite, the infamous Sourdough Pretzel. While it’s OK to eat just one or two, something compels most of us to finish the entire bag even though our jaws begin to rebel after 10 minutes. The end results are tired jaw muscles, a headache in the temples, or a painful TMJ that prevents you from eating a normal diet for a few weeks.

4. Chocolate
Chocolate delicacies are also on the Jaw Breakers list. How many of you have bitten into a piece of chocolate that you anticipated would be soft? Unfortunately by the time your brain realizes that you are up against a piece of concrete your jaw muscles have contracted with such force that your TMJs are pushed beyond their limit. The end result has been reported as “I heard an explosion in my jaw joint and since then I can’t open my mouth or bring my teeth together properly!”

And don’t forget about the frozen Snickers and Milky Way bars that have been left in the freezer for a few months. One wrong decision here may become a midnight snack you would like to forget.

5. Sandwiches
Last but not least is that oversized burger on a bun or Panini sandwich. Though soft in consistency, the need to open your mouth like an alligator is all it may take to end up reaching for Advil to ease the sharp pain radiating into your ear or in severe cases, spending the next few hours in the emergency room with your jaw stuck in an open position.

6. Candy-Covered Apples
These ruby colored beauties on a stick are particularly dangerous because they look so delicious. Almost impossible to easily bit into, they have caused jaw problems for years, particularly around Halloween.

In Conclusion

Try to exercise some good judgment and restraint when contemplating your next bite. This is particularly true for women whose joint ligaments are more vulnerable to stretch and whose muscles are more prone to fatigue. If you sense you are pushing your luck, you are probably right!

Seek care if you have suffered the consequence of an overzealous bite, particularly if several weeks have passed and you’re still suffering.

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

toothache arthritis, tanenbaum
tooth X-ray in famale hand
Categories
Persistent Toothache

A Toothache Can Be Caused By Arthritis

 

Though it seems strange, a toothache can be caused by arthritis. This was what happened to one of my patients this past year. It all started when John began to experience acute pain in an upper right molar. His dentist could not find a reason for the pain, since upon evaluation there was no decay or other problem apparent. So John was sent home with instructions to use Advil or Tylenol and hope for the best.

But John’s tooth pain persisted. He returned to his dentist’s office where more x-rays were taken and a root canal procedure was scheduled, albeit reluctantly. But even after the root canal, John’s tooth still ached and at times a neighboring tooth seemed to hurt, as well. John’s complaints ultimately led to the extraction of the offending right molar.

Then John started to experience pain in the extraction site and the teeth surrounding it. To make matters even worse, the same scenario began to unfold on his left side. And still, his dental team (comprised now of a number of specialists) found nothing on x-rays or during examination to explain it.

John’s suffering grew to the degree that the quality of his life was completely compromised. In desperation, he agreed to yet another root canal and subsequent tooth extraction. No change.

By this time there was no doubt that the source of John’s wicked tooth pain had to be of non-tooth origin. His persistence in seeking care and his unwavering belief that “there must be something wrong with my tooth” led him finally to me.

We found the answer to John’s suffering and was buried in his medical history. About one year before his tooth problems began, he had sought care for multiple joint pain throughout his body. The diagnosis was a (systemic) inflammatory condition called Spondyloarthropathy, which causes pain similar to what is associated with arthritis. A rheumatologist prescribed a few months on Enbrel, a medication used to treat inflammatory autoimmune conditions, and John’s body pain symptoms went into remission.

Let’s discuss arthritis for a brief moment: Arthritis essentially means “inflammation within a joint.” This same type of inflammation can occur in tendons and ligaments, the attachment sites in muscles and joints that keep us moving and functioning. Ligaments are also what attach your teeth to their bony sockets. They are called periodontal ligaments. Therefore, unexplained tooth pain can be due to an irritable periodontal ligament.

John’s medical history was the key to finally figuring out why he experienced acute tooth (and tooth site) pain that did not respond to conventional dental treatment. His tooth pain was the result of irritated periodontal ligaments. It took only three weeks back on Enbrel for John’s tooth site pain to go away. If his arthritis condition flares-up again, his tooth pain may reemerge. But, for now John is pain-free and able to enjoy his life again.

Here’s the moral of the story: As a patient you must share your medical history with any doctor who is having difficulty with a diagnosis. And as medical professionals, we must remember to ask all the right questions, request records and collaborate with other doctors on behalf of our patients.

Pain is real and no stone should be left unturned to find the source.

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

sleep apnea driving, metro north sleep apnea
Categories
Sleep Apnea

Communter Train Operators To Be Treated For Sleep Apnea

[NOTE: This post was previously published on October 15, 2014. In light of the recent announcement that Metro-North railroad will be starting a pilot project in January 2015 to test drivers for sleep apnea, I thought I’d post it again.

“The railroad’s 410 train operators and 20 more in training will be screened for the sleep disorder by a Metro-North health department,” according to the New York Post. “Those recommended for additional screening after the initial evaluation will be referred to a company that specializes in sleep disorders, according to the MTA.”

This is truly good news for anyone who uses the railroad every day to commute to and from work. Yes, the public is becoming more aware of the dangers of sleep disorders, but unfortunately, it sometimes takes a horrific accident such as this one to get things moving.

On the morning of December 1, 2013 a Metro North derailment in the Bronx cost four passengers their lives and injured 59 more, many seriously. Although the National Transportation Safety Board has not determined the exact cause of the accident, the agency has stated that the driver suffers from a condition called Obstructive Sleep Apnea, also known as OSA.

OSA is characterized by excessive daytime sleepiness, which is a result of night after night of poor quality sleep. When you have OSA your airway is partially blocked and your breathing repeatedly stops and starts multiple times during the night. Your blood oxygen level drops causing your brain to be aroused – essentially waking you up.

The airway obstruction and thus the drop in blood oxygen levels can be caused by a number of risk factors of which you may have one or more:

  • Excessive weight
  • Large tongue
  • Big tonsils
  • Small lower jaws that fall backwards while sleeping
  • Long and floppy soft palates and uvulas.

If you snore, stop breathing, and toss and turn all night, it’s likely that you have OSA. Certainly if you are awakened frequently throughout the night, you will be exhausted when you get up and more exhausted as the day wears on.

Obstructive Sleep Apnea Treatment

Medical care for OSA is focused on encouraging patients to lose weight, a change in sleeping position, and even surgery in some cases. Tonsils, the uvula, and even the size of the tongue can be adjusted. But, the most common therapy is called C-PAP (continuous positive airway pressure) which involves the nightly use of a mask which is connected to a small machine that sits next to your bed.

As an alternative, or in addition to C-PAP, are oral appliances, which bring the jaw forward and move the tongue away from the airway. Ongoing research has shown that these appliances not only work well, but compared to C-PAP may be easier for patients to deal with night after night. Happily, there are now ways to test whether an oral appliance would be a good option for you (ahead of time while in your own bed!).

My Opinion About OSA Related Accidents

Let’s get back to last year’s Metro North accident. The driver reported that he had gone into a “daze” as the train careened many miles above the speed limit toward the curve. Before the accident, doctors had diagnosed him as obese and having hypothyroidism, high cholesterol, low testosterone, vitamin D deficiencies, B12 deficiencies, and mild high-frequency hearing loss.

But the driver had never been screened or examined for Obstructive Sleep Apnea until after the accident!

It’s impossible to ascertain how many deadly vehicle accidents are related to undiagnosed or poorly treated OSA. We will likely never know.

I believe that it should be mandatory for all drivers of public transportation vehicles (and all truck drivers who spend long hours on the road) to be tested and treated for OSA. Imagine…oral appliances could find their way into the overnight supplies carried by truck drivers who park at rest stops, pilots who sleep at airports, and train conductors who similarly catch a few hours of sleep during the course of their work schedules.

We have the tools, now is the time to become more effective educators and providers of care and keep the public safe from these mostly avoidable deadly disasters.

Read more about the Metro North accident here: http://www.huffingtonpost.com/2014/04/07/metro-north-driver_n_5107612.html

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 Obstructive Sleep Apnea. 

TM, transcendental meditation
Categories
Headaches TMJ

Transcendental Meditation Can Ease TMJ Symptoms and Headaches

In my practice I work with patients who suffer from facial pain, tight jaws, headaches (of a muscle or migraine variety), neck pain, or a combination of two or three symptoms. Some of my patients are poor sleepers and many of them grind and clench their teeth at night, resulting in problems with the TMJ (temporomandibular joint). But what most of these patients have in common is an extraordinarily high level of stress due to tension at work, overwhelming financial burdens, caring for aging parents, and more.

Sound familiar to you? Read on:

The logical way to reduce stress would be to make some big changes in your life, right? But that’s no simple task, if it’s possible at all. Unfortunately, when you live with stress over a long period of time your brain can become either fatigued, upset, or both. In this state you are more likely to develop physical ailments associated with the muscles of the head, neck and jaw. This perpetual state of mind-body imbalance can result in unhappy muscles resulting in facial pain, stiffness, spasms, limited head or jaw motion, and/or frequent muscle or migraine headaches.

The question then becomes “Are there treatment strategies that deal with the source of unhappy muscles instead of merely dealing with the end result?” This is where Transcendental Meditation (TM) comes in. Though it is far from being the only technique that addresses brain fatigue and upset, there is increasing scientific evidence that suggests that TM can help achieve mind-body balance.

How does TM work to ease TMJ symptoms and headaches?

The practice of TM promotes restful alertness of the mind. When you are in a restful alertness state there is improvement in the coordinated functioning of all parts of your brain (called EEG Coherence). EEG Coherence means that brain is operating in its most efficient way. In this state there is synchronization of the many types of brain waves communicating with your organ systems, and your organs are communicating in synchronization with your brain. When these communication pathways work well, muscles and joints are under a lower level of strain, they fatigue less, and they function more smoothly and easily.

Over time, people who practice TM report less pain, decreased strain, and more comfort in their face, jaw, neck and head.

As a doctor whose specialty is treating pain I will always have patients who need prescriptions, muscle or joint injections, oral appliances, exercises, rehabilitation and other relaxation strategies. But I now strongly advise all my patients to consider making Transcendental Meditation a part of their daily routine. So far, the feedback from my patients who practice TM is very encouraging.

After a consultation in my office I can refer you to one of the TM centers that I work with; sometimes even enabling you to receive a lowered fee to be trained.

Do you practice TM? Please feel free to share your experience here:

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 facial pain, TMJ, and headaches.

lockjaw what to do when you can't open your mouth
Categories
Jaw Problems

Lockjaw – What To Do When You Can’t Open Your Mouth

The clinical term “lockjaw” refers to a specific problem that can be the sign of a serious bacterial infection called Tetanus. Happily, due of the widespread use of the vaccine, it is extremely rare today for anyone in the U.S to develop it. But the expression “Lockjaw” lives on and is today what most people use to describe the scary feeling of waking up in the morning unable being unable to open your mouth without extreme pain.

In most cases, the causes of this kind of lockjaw are not because of a disease, but are usually related to overuse of the jaw muscle, which work much like a hinge. But that fact doesn’t mean that the average person doesn’t get very panicky when his or her mouth just won’t open without extreme pain.

If you were vaccinated for Tetanus as a child and you haven’t experienced any trauma or injury to your jaw, it’s likely that you can’t open your mouth because your jaw muscles are in spasm. Here are a few tips that should help ease the pain, help you open your mouth, and get you on your way:

Lockjaw: What To Do When You Can’t Open Your Mouth

First Thing In The Morning
If you wake up with jaw muscles which are in spasm and you can’t open your mouth or can only open it slightly, it’s a sign that you have either been overusing your jaw muscles during the day or you have been aggressively grinding or clenching your teeth during of the night. Unfortunately, grinding (also called bruxing) and clenching are common in today’s high-paced world especially for people who spend most of their working hours at a computer. Here’s what to do:

Lockjaw in the Morning
Use Moist Heat: Get into a hot shower and while the water is running on your face, gently massage your temples and your jaw. Do this for five minutes. Take a break and then do it for five more minutes. This simple method should ease the muscle spasms enough for you to gently ease your mouth open without pain.

What To Do During the Day To Avoid Lockjaw
Start to pay attention to behaviors or habits that overwork your jaw muscles and work to change them. These are commonly

  • Nail biting
  • Cuticle gnawing
  • Chewing on pens or pencils
  • Biting your lips or cheeks
  • Clenching or grinding your teeth (especially while you are working at your computer)

When To See Your Dentist
If you are experiencing a locked jaw most mornings, and if you feel or hear “clicking” in the joint your jaw joint is probably “slipping.” This is a more serious problem that needs medical attention right away.

Aside from being really frightening most cases of lockjaw are not serious. Try to change some of your habits and you will probably experience a reduction in the occurrence of this painful problem.

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat facial pain associated with jaw problems, and TMJ. Find out more at www.nytmj.com

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

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tooth X-ray in famale hand
Categories
Persistent Toothache Referred Pain

Lingering Toothache After Root Canal

When the recommendation has been made for wisdom teeth removal, and the patient has (or has experienced TMJ problems), some very important factors must be considered because TMJ problems and wisdom teeth removal sometimes don’t play nice with each other. The trauma to the jaw during surgery can make TMJ problems flare and potentially cause longer-term problems including pain, additional joint noises and more challenging joint locking problems.

Consider the following case: An 18-year old female is preparing to go off to college in the fall. Although she is experiencing no pain symptoms associated with her wisdom teeth, her dentist and consulting oral surgeon have made a recommendation to have all four removed, in order to avoid potential problems while she’s away at college.

The patient and her parents are concerned that her recently stabilized TMJ problem (clicking, pain and sporadic morning locking) will flare up as a result of the extraction process. Is this a legitimate concern, or excessive worry?

Since TMJ problems are orthopedic in nature it is logical to assume that a difficult extraction event can cause a managed TMJ problem to resurface. This is particularly relevant if the patient mainly had joint problems that required care. Females more than males are at risk due to the fact that their TMJ structures are biologically more susceptible sprain and strain.

The following is my recommended list of questions that should be discussed before the patient goes ahead with the wisdom teeth extraction.

1. Should the teeth be left in place for a year or two to ensure further healing of the TMJ problem?

2. Should two teeth be taken out initially, instead of all four? (A lengthy surgery could therefore be avoided.)

3. Should a local anesthetic alone be used so that the patient could communicate with the surgeon if in fact she felt that the jaw was being stressed, or should sedation/general anesthetics be used to relax the patient’s muscles and diminish muscle tension due to fear.

4. Should an intravenous steroid be routinely used to minimize any potential muscle/ joint inflammation, which would lead to post-extraction pain, and excessive/prolonged limited jaw motion.

Clearly there are no easy answers to these questions. The important message is that if your son or daughter is in this position, please be proactive and ask the difficult questions.

Some more questions to consider:

  • Is the jaw clicking and/or locking due to instability of the joint ligaments or movement of the shock-absorbing disc?
  • Are the wisdom teeth impacted in bone, are they fully or partially erupted, and if impacted, are they lying on their sides? (If they are lying on their sides, it will likely require more time and more bone removal to be extracted).
  • Is there inflammation of the gum tissues surrounding or overlying the wisdom teeth? Or is the plan to remove them designed to prevent possible acute periods of pain while the patient is at school or traveling overseas for an extended period of time?
  • Is there concern that the erupting wisdom teeth may cause undesirable tooth movement after orthodontics has been completed?
  • Does the patient’s gender and age make a difference in the outcome?

Patients with TMJ histories must be handled thoughtfully, and with an open mind. Remember, the removal of wisdom teeth is most often an elective procedure. Delaying their extraction may carry with it additional risks, but a patient with a history of TMJ problems, (particularly a young female) is always at risk during the extraction process.

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Categories
TMJ

TMJ Problems and Wisdom Tooth Removal – Is There a Right Time?

When the recommendation has been made for wisdom teeth removal, and the patient has (or has experienced TMJ problems), some very important factors must be considered because TMJ problems and wisdom teeth removal sometimes don’t play nice with each other. The trauma to the jaw during surgery can make TMJ problems flare and potentially cause longer-term problems including pain, additional joint noises and more challenging joint locking problems.

Consider the following case: An 18-year old female is preparing to go off to college in the fall. Although she is experiencing no pain symptoms associated with her wisdom teeth, her dentist and consulting oral surgeon have made a recommendation to have all four removed, in order to avoid potential problems while she’s away at college.

The patient and her parents are concerned that her recently stabilized TMJ problem (clicking, pain and sporadic morning locking) will flare up as a result of the extraction process. Is this a legitimate concern, or excessive worry?

Since TMJ problems are orthopedic in nature it is logical to assume that a difficult extraction event can cause a managed TMJ problem to resurface. This is particularly relevant if the patient mainly had joint problems that required care. Females more than males are at risk due to the fact that their TMJ structures are biologically more susceptible sprain and strain.

The following is my recommended list of questions that should be discussed before the patient goes ahead with the wisdom teeth extraction.

1. Should the teeth be left in place for a year or two to ensure further healing of the TMJ problem?

2. Should two teeth be taken out initially, instead of all four? (A lengthy surgery could therefore be avoided.)

3. Should a local anesthetic alone be used so that the patient could communicate with the surgeon if in fact she felt that the jaw was being stressed, or should sedation/general anesthetics be used to relax the patient’s muscles and diminish muscle tension due to fear.

4. Should an intravenous steroid be routinely used to minimize any potential muscle/ joint inflammation, which would lead to post-extraction pain, and excessive/prolonged limited jaw motion.

Clearly there are no easy answers to these questions. The important message is that if your son or daughter is in this position, please be proactive and ask the difficult questions.

Some more questions to consider:

    • Is the jaw clicking and/or locking due to instability of the joint ligaments or movement of the shock-absorbing disc?
    • Are the wisdom teeth impacted in bone, are they fully or partially erupted, and if impacted, are they lying on their sides? (If they are lying on their sides, it will likely require more time and more bone removal to be extracted).
    • Is there inflammation of the gum tissues surrounding or overlying the wisdom teeth? Or is the plan to remove them designed to prevent possible acute periods of pain while the patient is at school or traveling overseas for an extended period of time?
    • Is there concern that the erupting wisdom teeth may cause undesirable tooth movement after orthodontics has been completed?
    • Does the patient’s gender and age make a difference in the outcome?

Patients with TMJ histories must be handled thoughtfully, and with an open mind. Remember, the removal of wisdom teeth is most often an elective procedure. Delaying their extraction may carry with it additional risks, but a patient with a history of TMJ problems, (particularly a young female) is always at risk during the extraction process.

Categories
Bruxism TMJ

5 Long-Term Effects of Bruxism

Millions of people suffer the effects of bruxism, which is the involuntary grinding and or clenching of the teeth at night. There are many reasons why you may brux your teeth. Getting to the bottom of the causes and designing a course of treatment for bruxism sufferers is a large part of what I do daily in my practice.

Since it happens at night, you may not be aware that you are grinding! However, if you consistently wake up with an aching jaw or a morning headache, there’s a good chance that you are bruxing in your sleep.

So, why is this a problem?

Because the long-term effects of bruxism can be serious:

1. A Change In Your Profile: If you are noticing that your jaw is becoming more “square” it may be a result of bruxism. As you grind, your masseter muscles can get more and more bulky. This may not bother a man, but for women, it is very concerning.

2. Sore and Worn Teeth: Bruxism can destroy your teeth! Not only can it wear them down, some people rip right through the enamel. Once enamel is compromised, the underlying dentin wears at a rate 6x faster than enamel. This affects your bite, your appearance, and even your health.

3. Jaw Pain: Some people experience jaw pain and soreness, especially in the morning. However, this pain can also linger through the day and even keep you from opening and closing your mouth without discomfort. Many individuals have daily ongoing pain in their face and jaw as a result of the nightly grind.

4. TMJ noises: Other consequences of bruxism may be the onset of jaw joint clicking as a result of strained ligaments and a dry joint environment that results from compression of the TMJs. Clenching, in particular, can squeeze all the moisture out of these joints leading to noisy, painful situations, and sometimes even locakjaw.

5. Headaches: Morning headaches in the temples are common in people who brux. As the temporal muscles fatigue during bruxism, lactic acid builds up which irritates the nerves in the muscle and the result can be a headache. In patients who suffer from migraines, this is a particularly troublesome situation, as it can trigger a more severe situation.

If you are experiencing any of the above, there’s a good chance you are bruxing. The long-term effects of bruxism can impact your life. See your dentist for advice. If you have been treated by a dentist, and are still suffering, now’s the time to seek out the help of a dentist with extensive training in this field.

Dr. Donald Tanenbaum is a specialist 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. Find out more at www.nytmj.com.

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Categories
Bruxism TMJ

5 Reasons You May Be Grinding Your Teeth

Tooth grinding (also called bruxism) is a real problem for thousands of people. It can wear down teeth, loosen teeth, and even cause severe jaw muscle and TMJ pain. At times clicking and locking of the TMJs (Temporomandibular Joint) can result from long-term bruxism. If you think you have this problem you have probably asked yourself “Why do I grind my teeth at night?”

Research suggests that tooth grinding is likely to occur if the brain becomes aroused during sleep. There are two stages of sleep during which Bruxism is most likely to take place. These include Stage 2 Sleep, which is one of the first and lighter stages of sleep and lasts approximately 20 minutes and REM (Rapid Eye Movement Sleep). Most dreaming occurs during REM.

Here are some of the suspected reasons for brain arousal (and therefore teeth grinding) during sleep:

    1. Insomnia – Individuals who have a hard time getting to sleep or staying asleep seemingly experience bruxism more often than those who don’t.

 

    1. Sleep Apnea and Snoring – There is some evidence that in people who have obstructive sleep apnea (breathing stops while sleeping due to airway obstruction, prompting the brain to be aroused) that tooth grinding frequency increases.

 

    1. New Motherhood – Being frequently awakened by a crying baby or anticipating a baby’s needs disrupts sleep and new moms report higher or new teeth grinding activity.

 

    1. Medications – The use of antidepressants such as Paxil and Effexor have been shown in some people to induce tooth grinding.

 

  1. High Achievers and Daytime Stress – People who operate at a high mental pace during the day tend to clench and grind more at night.

The Good News! There is treatment for teeth grinding regardless of the cause of the brain arousal. If you have insomnia, talk to your doctor. Medication or therapy or both can really help. Also, sleep apnea is very easy to detect (if your partner hasn’t already told you!) by a sleep study at home or at a clinic. If you are diagnosed with sleep apnea, there are a myriad of ways to treat it, from oral appliances to CPAP machines.

If the stresses of everyday life are causing your grinding, a custom made oral appliance (night guard) can work wonders. It won’t prevent you from grinding but it will ensure that your teeth aren’t damaged and that your jaw muscles and TMJs are not overworked.

For severe bruxism, you may need to see a TMJ specialist who can provide a variety of treatment options to address the origins and consequences of your bruxism.

Dr. Donald Tanenbaum is a specialist 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. Find out more at www.nytmj.com.

Categories
Persistent Toothache

Lingering Toothache – Is It A Sprained Ligament?

Fortunately for those of us who have experienced a lingering toothache, relief typically follows a visit to the dentist. Whether a filling, a crown (cap) or root canal therapy was necessary, pain reduction is common within 24-48 hours. But when a toothache won’t go away in spite of the fact that the tooth pulp is healthy based on examination and x- ray investigation, believe it or not, it may be due to a sprained ligament.

To understand how a toothache can be the result of a sprained ligament, a quick review off the anatomy of a tooth is essential:

Every tooth in the mouth is anchored to the bone in which it sits by a structure called the periodontal ligament or PDL. This ligament is no different than any other ligament in the body, and when healthy, is responsible for maintaining the tooth in a stable position. This ligament, which is mainly composed of water, also acts as a shock absorber. The PDL is teeming with nerve endings, which gives it a great capacity to guide our chewing movements and tell the brain how much force to exert based upon the consistency of food in the mouth.

In addition, the PDL is the “GPS system” of the oral cavity and is so fine-tuned in its functioning that it can find a small fish bone in the midst of a mouthful of food. This capability helps protect the teeth and the surrounding soft tissues from injury that could otherwise occur during normal function.

  • Tooth pain is typically the first symptom of a PDL sprain. Common ways that sprains happen are:
  • Biting on food that is harder than anticipated
  • Impact from an expanding airbag
  • Chin trauma that forced the teeth together
  • An accidental collision with a baby’s head
  • Dental or oral surgery
  • Daytime overuse such as nail biting or pencil chewing
  • Nighttime clenching or tooth grinding (bruxism)

Once sprained, these ligaments may take some time to heal simply because it is difficult, if not impossible, to avoid using the tooth or teeth involved during chewing, speaking, and even at times, swallowing. Over time if the PDL is continually insulted, the tiny nerve endings in the ligament will become sensitized (similar to being sunburned) and as a result pain levels will increase and often spread to the surrounding gum tissue and neighboring teeth. And, if daytime overuse behaviors continue and/or sleep bruxism persists, the pain will likely continue.

Because this problem is not in the tooth pulp, or due to compromise of hard tooth structure, any dental efforts to fix the problem will likely lead to even more exacerbation of the pain. Like all ligaments if a sprain occurs, rest and support are often needed in order for healing to occur.

The key therefore is to identify why the sprain occurred before treatment is planned. If due to a single and identifiable event, time is the best therapy as healing will usually occur. Taking an anti-inflammatory medication like Advil or Aleve for five to seven days can also help along with avoidance of chewing on the painful tooth. If you suspect that night clenching or grinding of the teeth is the cause, then the use of an oral appliance  while sleeping may be the best remedy.

At times trauma to a tooth may cause ligament pain that lingers and becomes chronic due to nerve endings that begin to fire spontaneously even when provoked by normal daily activities like speaking, swallowing and eating even soft foods. These situations may  require medications that work to quiet irritable nerve endings. The most important thing to remember is that these problems are not solved by root canal therapy and this direction of care should be avoided.

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

Categories
BOTOX® Bruxism Jaw Problems

Case Study: 10 Years of Teeth Clenching

Last week a 44-year old woman came in to see me concerned with the fact that the her face had become more and more “square-shaped” over the past ten years. She openly revealed that working full time and raising three kids had been no easy task for her and that she often went through the entire day with her teeth clenched. I explained to her that those ten years of teeth clenching had essentially been causing her to make a “fist in her face” for all those years. With that kind of daily stress on the muscles, it’s no wonder that her face had changed!

The end result of her clenching behavior was that she had “buffed” her jaw muscles. They bulged outwardly just like your biceps would as a result of lifting weights every day over a prolonged period of time. Remarkably, my patient never experienced any pain in her face or her jaws, which probably would have caused her to seek help sooner. The issue for her now, however, was the change in her appearance.

My examination (not surprisingly) revealed that she had bulky and powerful jaw muscles (masseter) that bulged outwardly when her teeth were clenched together. Even the muscles in her temples bulged! Over the decade this patient had actually increased the size and number of muscle fibers giving her a ‘Clint Eastwood’ look.

The first hurdle in treatment was to get the patient to actually change her acquired behavior and learn to live in the world with her teeth apart during the day. The clenching tendency that she had developed was likely the result of trying to cope with her daily stresses, some of which were not under her control. Relaxation and breathing techniques were reviewed, and she began to use an oral appliance during the day to create awareness. This was the first part of the plan. As experience has taught me, just stopping new muscle building does not effectively reduce the bulk of jaw muscles in a predictable fashion. Once built, these muscles tend to stay large as a result of normal daily activities. So what next?

BOTOX® Injections:
In order to actually decrease the size of her well-built muscles, we needed to reduce the ability of these muscles to contract forcefully on a day-to-day basis. This is where BOTOX® can really help. We administered three BOTOX® injections into the patient’s masseter muscles; each injection session approximately three months apart. With time, the BOTOX® led to muscle atrophy (size reduction and less strength) without compromise of eating or talking along the way. The result was a return to a more normal jaw profile.

To assure a lasting result my patient has to continue participating. This means teeth apart during the day and wearing the bite plate appliance at night (to diminish the impact of her night clenching). Some simple jaw stretching exercises are also required to keep the jaw muscles supple.

Although it took almost one full year from start to finish, this cosmetic makeover has truly made a difference in slimming my patients’ facial profile that was the end result of years of muscle building. This is probably the only time that reducing muscle bulk actually can make someone look better!

BOTOX® for teeth grinding is in the news! I was recently interviewed on ABC’s Good Morning America on the topic, Can BOTOX® be used to treat teeth grinding?  Click the link to watch the segment.

4 Medications for TMJ Problems Donald Tanenbaum
Categories
Jaw Problems TMJ

4 Medications For TMJ Problems

As a TMJ specialist, there are times when medications are an important part of the treatment strategy. Though side effects must be kept in mind, there are medications that are often extremely helpful for short periods of time. So, for many TMJ sufferers, I have found that there are some medications that work rather well to address pain, muscle tension, and jaw motion restrictions.

However, it’s the way that these medications are used that differentiates their effectiveness. The following information should be very helpful to those considering (or currently) taking medications for a TMJ problem.

1. Advil (Ibuprophen) and Aleve (Naproxen): For pain, particularly when inflammation is present. Very important! Advil and Aleve are not muscle relaxants, in spite of what many people believe. They are classified as non-steroidal anti-inflammatory drugs and designed to reduce inflammation in joints and muscles. Most important: For individuals who have had jaw problems for an extended period of time, these medications must be taken for 2-4 weeks in order to be maximally beneficial. At the same time, the factors that caused the inflammation must be addressed or the medications will have limited benefit.

For some inflammatory problems associated with the temporomandibular joints specifically, these medications may be necessary for 8-12 weeks just like they would be required for this duration for inflamed and painful knees. Because Advil and Aleve can upset the stomach and kidneys, care must be taken when extended use is prescribed. Alleve has been recently recommended to be the anti-inflammatory of choice for those at risk for a heart attack or have a history of heart problems .

2. Tylenol (Acetaminophen): For pain when inflammation is not present. Acetaminophen is a different class of drug than Advil and Aleve and is not an anti-inflammatory medication. It is an analgesic that is effective to relieve pain when inflammation is not present. Your doctor must monitor long-term use of Acetaminophen as it can induce headaches and can compromise liver function (particularly in individuals that consume alcohol daily).

3. Muscle Relaxants: Commonly known muscle relaxants are Flexeril, Soma, Skelaxin, Zanaflex and Robaxin. This class of drug can only be obtained with a prescription. Muscle relaxants can be used both during the day and at night before going to bed. Because some people experience fatigue when using them particularly during the day, we often need to try several types to get the right one.

Muscle relaxants can also be used while taking other products such as Aleve, Advil and other prescription anti-inflammatory options. The time frame over which these medications are taken is variable but can be used for many months (particularly when taken only at bedtime).

An added bonus for patients taking muscle relaxants is that they promote restful sleep and can often reduce the intensity of nighttime grinding and clenching of the teeth.

4. Anti-Anxiety Medication: When anxiety and worry are driving muscle tension and pain in the face and jaw it is not uncommon to prescribe small doses of anti-anxiety medications for a short period of time to be taken during the day, at bedtime, or both. These medications work in the brain and help reduce the ability of muscles to “brace” as a consequence of life events, thoughts, and or emotions.

The commonly known medications in this category are Valium, Xanax, Klonopin, and Ativan. These are controlled substances, available by prescription only, and registered in a national data bank to help prevent overuse and abuse.

When taken at bedtime they are very effective (in short term periods) in reducing tooth grinding and clenching and the consequent symptoms of pain and muscle tension in the morning. My patients often report that anti-anxiety medication “takes the edge of my pain and muscle tension.”

So, for TMJ sufferers, medications have proven to be very helpful in breaking the “pain cycle” and allowing other therapies to begin to work for long-term relief. The key is using the right one, careful monitoring, and short-term use.

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

obstructive sleep apnea, sleep apnea, implants for sleep apnea, dr tanenbaum, tanenbaum tmj, tmj
Categories
Sleep Apnea Snoring

An Implant for Obstructive Sleep Apnea?

There has been a lot in the news lately about implants as a way to treat sleep apnea. As a dentist involved in helping patients with their snoring and obstructive sleep apnea, my biggest challenge has been figuring out strategies to keep the tongue from falling back into the oropharyngeal region. Once this happens, airflow is compromised, leading to diminished levels of oxygen in the blood and frequent arousals while sleeping.

As a result, these patients never feel rested, experience daytime sleepiness, and often underperform at school or in the workplace. Others develop significant heart-related problems or even fall asleep behind the wheel with tragic outcomes. Moreover, for patients who have small lower jaw, large tonsils, fat uvulas, and long sloping and floppy soft palates: nighttime airway compromise is a big problem (even if tongue size is normal!). For obese patients with large necks, fat tongues, and weak tongue muscle strength, the problem is further compounded.

Treatment over the years has included weight loss, airway surgery, CPAP (essentially blowing air through the obstruction), and oral oral devices to prevent the tongue from falling backwards while sleeping (tongue retaining devices) or designed to actively keep the jaw forward, carrying the tongue in the process (mandibular positioning devices). Tongue retaining devices that pull the tongue forward past the lips have also been used with variable levels of success.

On the horizon, however, is a new kind of implant that may be an alternative treatment option for those with obstructive sleep apnea. As reported in the January 9th issue of the New England Journal of Medicine this implant will serve as a pacemaker of sorts, delivering electrical impulses to the nerve that is responsible for maintaining tone in the muscles that keep the tongue in a forward posture.

Tests conducted to date found that “these impulses reduced nightly sleep apnea events by about 68 percent, according to the results of the one year clinical trial. The technology also decreased by 70 percent the number of times that a person’s blood oxygen level dropped due to sleep apnea. Not surprisingly, patients reported a 40 percent improvement in their ability to stay awake during the day.”

According to new reports that reference the Journal article “the device operates by having an electrode run from the pacemaker to the hypoglossal nerve located under the tongue. Another lead wire runs down to the muscles between the ribs of the chest and keeps track of the person’s breathing. As the patient breathes in and out, the pacemaker sends electrical impulses to the nerve, which causes the person’s tongue to move slightly forward and their upper airway to contract open. Both movements keep the airway from collapsing.”

“It’s a unique and promising new treatment,” said study co-author Dr. Ryan Soose, director of the division of sleep surgery of Pittsburg Medical Center. The surgery is minimally invasive, and patients typically were back to regular activity within in a day or two.”

Though more research is needed, this new option will be a welcome addition to the treatment options that are currently available.

Dr. Donald Tanenbaum is a specialist 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. Find out more at www.nytmj.com.