Category: Bruxism

3 Tips To Reduce Jaw Problems From Aligners

Over the last 10-15 years, the use of clear aligners has found a place, favored by many patients, amidst other traditional orthodontic techniques. When directed by an orthodontist or a trained dentist, tooth movement accomplished by the use of aligners can lead to better dental hygiene and periodontal health, create more stable bite relationships, and boost self-confidence as a result of improved smile esthetics. All of these are positive outcomes.

As a TMJ specialist, however, I see many patients who are in the midst of aligner therapy to straighten their teeth experiencing a variety of jaw symptoms. Some are receiving their care from a trained orthodontist or dentist, and some have opted for self-directed care using mail-order aligners. Either way, their complaints are typically the same: after wearing their aligners for several weeks or months, they have difficulty opening their mouths, their jaw joints are clicking and popping, and most often, they have jaw pain. If this sounds like you, I’d like to offer you some tips on how to reduce jaw problems from aligners.

But first, it’s essential to understand that aligner therapy is a form of orthodontic treatment, the same as old-fashioned metal braces. In fact, anything designed to move teeth is a form of orthodontic treatment. Over the past few years, I’ve identified some reasons why some people experience jaw problems from aligners, whether they’re under professional care or are wearing mail-order aligners. It all has to do with the posture and position of your jaw while your aligners are in place…

Jaw Problems – During The Day

When you wear your aligners during the majority of the daytime hours, there’s a pretty good chance that the aligners are in contact with each other. This may seem ok, but in reality, once the aligners are in contact the jaw is no longer at rest. In fact, the normal rest position of your jaw is hanging in a loose way with the lips relaxed and teeth apart. So, when your aligners are in contact, your jaw is not at rest but is in a braced and tense muscle posture.

As a result of the top and bottom aligners being in contact for hours on end, your jaw muscles can fatigue and the jaw joints are put in a braced position. As a result of being overworked, injury can occur, in a fashion common to all joints in your body. Injury leads to symptoms of soreness and pain in the muscles and the onset of joint clicking and popping. At times jaw motion can become restricted as a result of the joint and muscle injuries. This is often called lockjaw.

Unfortunately, there are times when a new aligner tray doesn’t seat fully on the teeth when first used. At these times, patients are often provided what are called ‘chewies’ and instructed to bite on them to help engage the trays fully onto the teeth, so that the planned tooth movement can occur. Though this may be an important step, it can’t possibly be good for the jaw joints and muscles!!

Jaw Problems – While You’re Asleep

Since aligners are always used during the sleeping hours, some patients notice that they are clenching their teeth (often for the first time in their lives). Others who recognized that they were always night clenchers without morning symptoms prior to the aligners being used, now experience jaw soreness and pain as the result of the aligners and wonder why. One reason may be that the top of the aligners are not commonly adjusted to make sure that when they do come together, the right and left sides hit evenly. For some patients, this imbalance is all that is needed to start an injury process. This imbalance can be overlooked even if you’re under the professional supervision of an orthodontist or dentist. So, if you’ve opted for mail-order aligners, this concern will definitely be overlooked. The bottom line, however, is that contact of the trays in any way for a sustained period of time increases the risk for jaw muscle and joint injuries to occur.

So, if you’re in the midst of treatment or are considering it, here are some tips I’ve put together that can reduce the risk of a jaw problem developing

3 Tips To Help Reduce Jaw Problems From Aligners

During the day, try to keep your upper and lower aligners separated. Your lower jaw should hang like a hammock in the breeze. If you find this difficult, try some breathing exercises to help you relax. My patients get great results from Buteyko breathing and techniques like those found online on Headspace, Calm, and Buddhify (links below).

If you’re under the care of an orthodontist or dentist and suspect that you have been clenching while you’re asleep, make an appointment to have your aligners adjusted. If you are indeed clenching, at least you’ll be clenching evenly on the right and the left sides. For those of you who’ve chosen self-directed mail-order aligner therapy, this is one of the risks.

If you suspect jaw problems from aligners are developing as a result of what is happening during your sleeping hours, speak to whoever is guiding your care and consider giving your jaw a rest, and don’t wear them for a week or so. Or, wear only one aligner at a time at night for a short period of time as long as contact against the teeth on the other arch is even.

Conclusion

Clear aligners are here to stay and clearly, patients will benefit on many levels from pursuing this innovative form of tooth movement. However, if you’re having jaw problems since starting with aligners, and are under the care of an orthodontist or dentist, make an appointment right to address your concerns, If you’ve opted to “fly on your own” with mail-order aligners and have noticed jaw pain, that your jaw is clicking or popping, or if you’re having trouble opening your mouth all the way, I strongly advise you to discontinue treatment and seek professional advice.

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Tags Bruxism, Jaw Problems, Orofacial Pain

Bruxism Children & TMJ TMJ

Your Child Is Grinding His Teeth – What Should You Do?

Is this familiar?

You think your child is fast asleep, then suddenly, a screeching sound is coming out of his/her bedroom. What could be causing it? The most likely explanation is your child is grinding his teeth – an activity clinically known as sleep bruxism.

Sleep bruxism, which is often associated with jaw pain (TMJ), is the most common problem seen in my practice for the past 30 years. As a result, I know first-hand that a little information goes a long way to help parents understand what is happening and what can be done about it.

When A Child Grinds His Teeth, What’s Happening?

The first thing to understand is that a certain level of jaw movement during sleep is normal for most people. It’s called Rhythmic Masticatory Muscle Activity, or RMMA. Some people who grind their teeth experience higher levels of RMMA, which can result in tooth damage and jaw pain problems.

Much research has been done in the past few years on teeth grinding and sleep bruxism. One significant finding is that in many people who grind during sleep, their brain is becoming aroused and causing sleep to be fragmented. The result is the body’s fight-or-flight system becomes activated. In tandem, jaw motion (RMMA) increases and teeth grinding is often the result.

Teeth Grinding in Children Under 10-Years Old

If your child is under ten-years-old and grinding his teeth, it’s likely during the time when his baby teeth are being lost. If you hear the telltale screeching sound that indicates your child is grinding his teeth, look for evidence of tooth wear. If you see it, a visit to your child’s dentist is highly recommended. Also, ask your child if he is experiencing jaw symptoms such as joint popping, cracking, locking, or pain. If the answer is yes, it’s time to see the dentist.

Teeth Grinding In Adolescents & Teens

We have many clues about why adolescents and teens grind their teeth during sleep. Current theories include:

1. Large tonsils, a big tongue that clogs the airway, a small lower jaw, blocked nasal passages, or a long floppy soft palate can cause breathing problems during sleep, and, in turn, causes a drop in blood oxygen. The brain awakens and activates the body’s fight-or-flight system increasing the likelihood of sleep bruxism.

2. Adrenaline – During times of stress and anxiety, the level of adrenaline (catecholamines) in the bloodstream increases. For adolescents and teens who experience long-term anxiety, high adrenaline levels have been shown to induce sleep bruxism.

3. Chronic Pain – Migraines, gastrointestinal disorders, and back and neck pain set up ideal conditions for sleep disturbances and can lead to teeth grinding.

4. ADD/ADHD Medications – Medications such as Adderall, Concerta, and Strattera stimulate the fight or flight part of a child’s nervous system and result in sleep disturbances.

5. Caffeine – Many adolescents and teens drink coffee and high caffeine beverages during the day and into the evening. Caffeine has been proven to be a contributing factor to disturbed sleep patterns.

6. Nicotine – Nicotine is a stimulant. It’s widely known to contribute to sleep problems. The use of e-cigarettes, which are very high in nicotine, is particularly prevalent among adolescents and teens and can be a direct cause of sleep problems.

7. Not Enough Sleep – With the obligations of school and extracurricular activities, many young people are under a tremendous amount of pressure. They put in long hours and don’t get enough sleep. Others simply stay up late playing video games or communicating on social networks. Sleep quality is ultimately impacted, leading to restless nights of tossing and turning and the emergence of sleep bruxism.

What You Should Do:

By now, you can understand if your child is grinding his teeth, there are multiple risk factors. The good news is that teeth grinding is treatable and can be managed. There is a wide array of options at our disposal to help manage the problems caused by sleep bruxism for children who grind their teeth including oral appliances, jaw exercises, meditation, acupuncture, medication, and even BOTOX®.

But here’s the key – managing your child’s sleep bruxism will not cure it. It will, however, help him get through some tough periods. Meanwhile, the medical community continues to pursue a better understanding of the underlying causes of nighttime brain arousals.

If your child is grinding his teeth and you’re concerned, his dentist or orthodontist should be able to help. If the situation is dire, you can find someone in your area who focuses on Sleep Bruxism, such as a member of the American Academy of Orofacial Pain – AAOP. Choose a professional designated Diplomate.

Tags Bruxism, children & tmj, Teeth Grinding

Bruxism Case Studies Orofacial Pain TMJ

The Connection Between PTSD & TMJ

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date July 26, 2019
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Identifying the origin of a patient’s chronic orofacial and TMJ pain is what makes my work both challenging and rewarding. Sometimes the answers are readily apparent while at other times uncovering important clues is more difficult. In all cases, there is no substitute for obtaining a careful history as the insights gained often help point to the mechanism of pain that is driving a patient’s suffering.

With this thought in mind, I’ve treated numerous patients whose chronic orofacial and TMJ pain is the result of unresolved trauma to the nervous system. A careful history, however, reveals that this trauma is not because of a physical event such as a documented injury or ongoing activities such as nighttime bruxing, but instead, it is the result of personal anguish.

I’ve treated many patients whose problems are not caused by classic scenarios, but instead, are caused by unresolved trauma to their nervous systems. They feel they have no control over their lives, that there is no resolution to their grim situation, or are unable to escape a potentially dangerous environment.

These scenarios are commonly associated with individuals diagnosed as having Post Traumatic Stress Disorder, or PTSD.

These patients are not unlike our servicemen and women who return from overseas carrying the trauma of what they experienced. Although in my practice, military service is not the most common source of patient problems, these patients need just as much understanding and support as our soldiers.

PTSD Affects The Nervous System In A Specific Way

When dealing with a highly traumatic event or many persistent traumatic events over time, the body’s sympathetic nervous system goes survival mode. In medicine, it’s called the hyperactive state.

When the nervous system is in the hyperactive state for an extended length of time, tissue injury often occurs. It can be accompanied by pain, restricted motion in the joints, muscle cramping, and muscle fatigue. The body also releases stress hormones (primarily cortisol), which can cause biologic changes that prevent healthy healing and can lead to chronic pain. This particularly affects muscles that are already overworked or tense.

When a patient previously suffered from issues such as migraines, neck pain, or back pain – they invariably get worse. When the pain becomes persistent, that’s when feelings of anxiety, hopelessness, and depression can emerge.

A patient in this condition has trouble reacting to stressful situations in a healthy way, which creates even more life challenges.

PTSD & TMJ – A Case Study

“Jill” is a 39-year-old woman who arrived at my practice with the classic symptoms of TMJ: ongoing jaw pain, jaw tension, and limited jaw motion. Not unlike hundreds of other patients, her symptoms were the result of jaw muscle and joint tissue compromise.

However, upon examination, I did not detect the telltale signs of nighttime bruxism, nor any of the most common origins of chronic orofacial pain.

The next step was to sit down with Jill and see if I could get her to talk candidly about her life, which she did. It turns out that Jill is a single mom. She works full time, and her job is stressful and demanding. On top of that, Jill has another, even more, extreme stressor in her life. Her child was born with a severe medical condition, of which there is no cure, that requires constant care and monitoring.

Faced with the overwhelming pressure of raising a medically-compromised child, working at a stressful job, and constantly worrying about the future, Jill had been living in a continuous flight-or-fight mode for years.

As a result, Jill’s natural state was shoulders raised, quick, shallow breathing, and a tendency to brace her jaw muscles or clench her teeth for minutes, even hours, at a time.

Can A Combination Of PTSD & TMJ Be Treated?

So the question was, can someone like Jill, who problems are caused by the stress in her life that she can’t change, actually get better?

The road is not easy, but when a patient participates in TMJ treatment, there is hope. Meditation, Cognitive Behavior Therapy (CBT), psychotherapy, physical therapy, Tai Chi, breathing exercises, or other techniques, are useful. Being aware of and working to change daytime behaviors such as jaw bracing, tooth contact, breath-holding, and shoulder raising can also help.

Conclusion

It was not fast or easy, but by employing a number of these strategies, Jill continues to be “much better than the day I met her.” She takes fewer over-the-counter pain medications, sleeps more soundly, and most importantly, she believes that a better day is coming for her.

While it’s often impossible for someone suffering from PTSD to change her environment, she can make changes to how she exists within that environment. This can lead the way to unravel the complexities of PTSD and its associated symptoms.

Tags Bruxism, case studies, Orofacial Pain, Teeth Grinding, TMJ

BOTOX® Bruxism Case Studies Facial Pain Jaw Problems Orofacial Pain TMJ Women & Pain

Facial Pain – Is It Bruxism or Is It Bulimia?

TMJ /Facial Pain Symptoms & Eating Disorders – The Connection

As a TMJ doctor, every year I see a number of patients who are suffering from an extraordinarily high level of face and jaw pain. At first glance, the level of suffering they report is much greater than what I commonly see. One such group are people with a history of one particular eating disorder – bulimia nervosa. In these patients, the typical characteristics I see in people with TMJ are not present. Although their symptoms may lead them to believe that their pain is driven by stress-related jaw tension and bruxism (teeth grinding and clenching), the telltale signs are simply not there. That’s when I ask myself, is it bruxism or is it bulimia?

Is It Bruxism or Bulimia? A Case Study

Marci was 26 when she arrived at my office some three years ago. For several years she’d been dealing with debilitating jaw and face pain almost daily. The pain was centered at the angles of her jaw on both sides and it had become, as she described it, “unmanageable.”

Pain was ruining her life.

Many doctors and therapists had tried to help Marci find relief. She’d been prescribed pain medications and muscle relaxers. She’d been treated by physical therapists. She had acupuncture and trigger point injections. She even tried wearing an oral appliance to bed, thinking her problems were the result of bruxism.

Frustrated and discouraged, Marci was still suffering – with no resolution in sight.

4 Clues That Bruxism Was Not The Culprit

At first, Marci didn’t share her entire medical history with me. Possibly because she was embarrassed or simply didn’t think there was a connection. However, even without knowing her full history, several clues pointed to the fact that Marci’s pain was not caused by bruxism, but instead was a result of bulimia:

No signs of the kind of tooth wear characteristic of bruxism were detected.
Her masseter (jaw) muscles were not rock hard and well-built, typically a sign of bruxism.
The biting surfaces of her lower molars showed a complete loss of enamel.
Her face was extremely puffy.

So, Why Did I Ask If It Was Bruxism Or Bulimia?

In order to answer the question, is it bruxism or is it bulimia, each clue pointed to the answer. You see, bulimia can wreak havoc in the mouth because frequent vomiting exposes the teeth to acid, which can dissolve their protective enamel. This is seen on the back of the upper front teeth and in the center of the lower back teeth where regurgitated acid can pool. And, over time, frequent vomiting can cause the parotid gland (the largest salivary gland) to become inflamed and enlarged, resulting in acute nerve pain in the overlying jaw muscles and prompting facial puffiness.

Facial & Jaw Pain Caused by Bulimia – Treatment

Probing deeper into Marci’s medical history, I concluded that it was indeed bulimia, not bruxism that was the cause of Marci’s pain. Now it was time to offer a plan of treatment. I prescribed the medication nortriptyline (a once-popular antidepressant) that, when used in small doses has been shown to be effective in reducing pain in muscles by quieting nerve excitation. It is thought to work over time by increasing the activity of serotonin in the brain, according to the Mayo Clinic.

Marci also had a series of BOTOX® injections in her masseter muscles at my office, designed to not only reduce muscle tension but to also diminish the release of nerve-irritating chemicals. (See BOTOX® Injections For TMJ – 6 Things You Need To Know)

She was also given a custom-made topical salve containing a mixture of anesthetic, nerve membrane stabilizers, and anti-inflammatory medications to rub over the sore areas of her jaw three times a day.

A Much Happier Existence

Four weeks into treatment, Marci reported that her pain was more than 40% reduced. A second series of BOTOX® injections months later provided even better results. With her pain reduced, she was more motivated than ever to continue talk therapy, which she had started in an attempt to get a handle on her bulimia.

Today, Marci comes into my office every 4-6 months for a refill of her nortriptyline prescription and occasional BOTOX® injections. She’s nearly pain-free, almost bulimia free, and she leads a much happier existence.

Do You Know Someone Who Has Bulimia?

If you or someone you care about has bulimia and is suffering from facial and /or jaw pain, it is quite possible that a relationship exists. It’s very important to answer the question, is it bruxism or is it bulimia, so the right treatment can be put into place.

Although strategies like those used in Marci’s case won’t provide a cure, they can go a long way towards improving the quality of a suffering person’s life.

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 Botox, Facial Pain, Jaw Problems, Orofacial Pain, TMJ, woman and pain

Bruxism Case Studies Persistent Toothache TMJ

Pain And The Brain – They’re Inseparable

As an orofacial pain specialist, I treat patients who suffer from facial pain and the pain symptoms associated with Temporomandibular Disorders (commonly referred to as TMJ), I think about pain, a lot.

A great deal of new scientific knowledge has been gained in my field in the past several years. Being familiar with this knowledge is an essential part of how I make difficult decisions about my patients’ pain problems. However, taking advantage of this knowledge is only part of it. My years of experience and knowledge of the right questions to ask are what enable me to figure out the “why” of a patient’s pain problem.

Case Study – Robin

Robin, a 43-year old woman, came to my office because she was experiencing tooth and jaw pain that seemed to have come from nowhere. She had always taken good care of her teeth at home and visited her dentist twice a year for routine cleanings and monitoring.

Robin was experiencing pain – and it was getting worse. She had already been to her dentist. Her dentist sent her to see a root canal specialist. Neither professional was able to detect anything to explain her pain, and, as a result, no treatment was rendered. Yet, her pain was getting worse.

When I first met her, Robin was using over-the-counter pain medication and avoided chewing on the painful side of her mouth. Her jaw felt stiff and tight. At times it felt like her jaw muscles were cramping. The simple acts of smiling and talking prompted her pain to flare. She was not yet miserable but was clearly heading in that direction.

Sometimes Robin’s pain would vanish for hours but then return with a vengeance. There was no discernible pattern.

Before I proceed, it’s essential for you to understand a few facts about pain. Contrary to what you may think…

Pain can occur without tissue damage.
The intensity of pain can have little to do with the seriousness of the problem.
Every pain experience starts in the brain, regardless of its origin or severity.
The intensity of pain is ultimately the opinion of your brain (and your brain is not always your friend).

Back To Robin

After an examination, it was clear to me (despite Robin’s high level of suffering) that no clear-cut physical findings existed to tie her pain to a specific tooth or jaw joint/muscle compromise. Sore jaw and neck muscles were the only recognizable finding.

Robin’s level of suffering appeared to be more profound than were my physical findings.

Pain & The Brain – The Right Questions To Ask

At his point, I asked Robin some very specific questions designed to identify the presence of any risk factors that could potentially be impacting her pain thresholds, and causing her jaw and neck muscle discomfort.

As I gathered her medical history, I was not surprised to find out that Robin experienced long-standing sleep deprivation and chronic, painful gastrointestinal problems. And that she was taking care of her aging mother and had a job, which required her attention 24/7.

When I put it all together, it was clear that Robin lived in a state of emotional distress. Essentially, she was ready for battle on an ongoing basis. Next, I looked at her for other clues and found them: raised shoulders, crossed arms, shallow quick breathing, and an acquired behavior of keeping her jaw muscles braced, usually with her teeth clenched, as well.

I concluded that Robin’s tendencies and behaviors had fatigued her jaw and neck muscles to the point where she experienced pain. And the tooth pain she experienced was actually “referred pain”, originating in her jaw and neck.

Essentially the parts of her nervous system that are responsible for maintaining normal pain thresholds and allowing the brain to interpret incoming nerve transmissions correctly were failing. This led to what is called a state of sensitization. In this state, normal life activities, such as opening your mouth, eating, smiling, and talking can lead to pain – even in the absence of apparent tissue injury.

Pain Is In Your Head

I carefully explained to Robin why her pain had developed at the same time validated that the pain was real. Many people in Robin’s situation have been told, “your pain is all in your head.”

But not the way they mean it.

I then outlined what I refer to as the “60/40 rule of care”. I was going to direct 40% of her treatment, which included physical therapy, muscle injections, and medication. She was going to be responsible for the other 60%. She was to do 20 minutes of physical exercise every other day, make an effort to get more sleep, and begin to pay attention to her diet to avoid heightened gastric distress.

Robin also agreed to address issues at her job, and most importantly, to pay attention to changing her stressful breathing patterns and postures driven and shaped by her challenging life.

Pain & The Brain – How Is Robin Now?

Although Robin cannot escape all of the risk factors of her life, she is now able to change the way her body and her breathing react to them.

Like many patients with her type of pain scenario, she has responded well to the strategies we put into place. She acknowledges that her participation in the process has been critical.

Today, when flare-ups occur, Robin now understands in those moments her brain is not her friend. And she is learning how to change her brain’s opinion – quickly.

Pain issues and sleep challenges do not have to be lifetime afflictions. You need someone who listens and possesses the knowledge and compassion to get your pain and sleep problems under control.

I am that someone – and you’re in the right place.
Dr. Donald Tanenbaum, DDS MPH

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Tags Bruxism, Case Study, TMJ, Toothache

close up portrait of a man smoking an e-cigarette

Bruxism Jaw Problems

4 Surprising Reasons You Grind Your Teeth

In my practice, I often evaluate and treat patients who suffer from the effects of Sleep Bruxism. Bruxism is the clinical term for the act of clenching and/or grinding your teeth while you’re asleep.

Sleep Bruxism can cause all kinds of problems for people of any age. Most of the patients who end up in my office complain of some, or all, of the following issues, particularly in the mornings:

Jaw soreness or pain
Limited or stiff jaw motion
Headaches or earaches
Sensitive teeth
Jaw noises of all types
Locked jaw
Neck pain
Foggy brain
A bite that feels off-balance

Although millions of people grind and clench at night, not everyone ends up with these problems. For those who do, the need for care is critical because the potential long-term consequences of untreated Sleep Bruxism can be profound. They include, but are not limited to, a change in your facial profile, worn-down or fractured teeth, persistent jaw pain, headaches focused in your temples, jaw clicking and popping, and a locked jaw.

For many years, those of us in the field have felt that the primary fuel powering Sleep Bruxism is stress. As more research is performed and as practitioners like myself identify common risk factors, that thinking is changing. Life’s stresses cause adrenaline to be dumped into your bloodstream, which that can keep you from getting a good night’s sleep – and cause you to grind and clench your teeth.

However, there are other risk factors out there that can awaken your brain at night and fragment your sleep. Here are a few:

4 Surprising Reasons You Grind Your Teeth

1. ADHD Medication

More and more teens, college students and adults are turning to ADHD drugs to address daily focus issues. These medications, such as Strattera, Vyvanse, and Adderall, may be prompting new and/or higher levels of tooth grinding and clenching at night because they work to activate the body’s fight-or-flight mechanism.

For example, I’ve seen patients who were previously treated for Sleep Bruxism, had it under control but began experiencing symptoms again when they started taking ADHD medication. In the absence of other new risk factors, if you are on these medications, consider them when searching for the cause of your Bruxism.

2. Anti-Depressants

Certain SSRI antidepressants (such as Effexor and Paxil) can initiate Sleep Bruxism activity, too. Up to fifteen percent of people who are on SSRIs experience it, and many new studies have begun in this area.

If you’re on SSRIs and are clenching and grinding your teeth at night, consider trying a different drug.

3. Obstructive Sleep Apnea/Upper Airway Resistance

According to the American Sleep Apnea Organization, over 22 million Americans have an upper airway problem. The telltale signs are snoring and multiple awakenings during the night as the body attempts to get more oxygen. The lack of oxygen and subsequent constant brain arousals activate the sympathetic nervous symptom and may be another potential initiator of Sleep Bruxism. Though there is not a one to one correlation between Apnea and Bruxism, additional investigation and collaborations with sleep physicians may be warranted.

If you suspect you have an airway problem (if you don’t know, ask your significant other) it’s essential to have a sleep study performed – mainly because it allows your dentist to choose the correct an oral appliance for you.

4. Vaping

If you’ve kept your eyes open, you’ve noticed many people walking around using vape pens, some of which contain high amounts of nicotine, a powerful stimulant. Although the impact of nicotine on muscles, the nervous system, and sleep varies from person to person, it is indisputable that stimulants can and do influence jaw muscle pain and tension and can also disrupt sleep. For many people, nicotine adds to their already troublesome Sleep Bruxism and its resulting symptoms.

If you are using high nicotine vapes, please let your dentist or doctor know as you work through finding a solution for grinding and clenching.

In conclusion, if you’ve been waking up in the morning with a stiff, painful or locked jaw or if you experience morning headaches, sensitive teeth, earaches, a bite that feels off-balance, or your jaw clicks – there’s a good chance you have Sleep Bruxism.

See your dentist and discuss the risks factors that you can identify, especially those above. There are many effective avenues of treatment available to you.

You deserve a good night’s sleep!

For more on the long-term effects of Sleep Bruxism, link here.

Tags Bruxism, Jaw Problems

Bruxism Persistent Toothache TMJ

8 Surprising Reasons Your Teeth Are Sensitive

One of the most common questions about dentistry that people ask on Google is this: “Why are my teeth so sensitive?”.

Unfortunately, there’s no simple answer to this question. There could be any number of reasons why your teeth are sensitive, some of which may surprise you. In the following article, I list 8 reasons your teeth are sensitive and a brief explanation of each. Does one apply to you?

8 Reasons Your Teeth Are Sensitive

1. Your Toothpaste Is Too Abrasive

In order for toothpaste manufacturers to gain approval from the FDA they must measure and report the abrasiveness of their products. However, they are not required to report the information to consumers. To help you find out how your favorite toothpaste stacks up, refer to the chart below. Your teeth are sensitive perhaps because of the toothpaste you’ve been using.

2. You’ve Been Using Whitening Toothpaste

Whitening toothpastes often contain chemicals that help to remove surface stains and therefore, make your teeth much whiter. However, these chemicals can damage the surface of your teeth. Several whitening toothpastes have received the American Dental Associations’ (ADA) Seal of Acceptance. However, it is recommended that you consult your dentist before using whitening toothpaste to avoid damage. So, if you’ve been brushing with whitening toothpaste and your teeth are sensitive, whitening toothpaste may be the culprit.

3. There’s Too Much Acid In Your Diet

Citric acid, such as what’s found in lemons, oranges, and grapefruits, can be very damaging to your tooth enamel. It’s not hard to understand how too much citric acid could cause erosion of your teeth enamel and therefore, sensitive teeth.

On the other hand, most people don’t realize that many popular beverages, many of which don’t seem to be acidic, are very acidic. My colleague, New York dentist Michael Sinkin, warns: “…many vitamin waters, energy drinks, and sports drinks are highly acidic and if consumed in large quantities can cause your teeth’s structure to break down.”

So, how can you find out if your favorite beverage contains enough acid to be the reason your teeth are sensitive? Check the pH! pH is the measure of acidity on a scale of 1-14. The lower the number the higher the acidity; tooth enamel begins to dissolve at pH 5.3.

The chart below shows the pH of some popular beverages. If you’ve been gulping Gatorade at the gym or if you slug down a Red Bull every afternoon to fight tiredness, those beverages may be the cause of your sensitive teeth.

Source:
http://michaelsinkindds.com/is-your-favorite-beverage-eroding-your-tooth-enamel/

4. You’re A Swisher!

The next time you drink a soda, juice, or a glass of wine, take note if you swish it around in your mouth before you swallow. Many people swish their beverages without realizing it, which can create a loss of tooth enamel and sensitize the teeth’s dentin and cementin. Wine connoisseurs in particular, who swish in order to better experience the nuances of vintages, are at especially at risk. It’s OK to swish a little, but try keeping it to a minimum.

5. Your Teeth Need A Cleaning

Even people with the means to go to their dentist two or three times a year often avoid it because of dental fear. You can floss and brush twice a day, every day, but it’s nearly impossible to remove all the tartar and plaque that will build up on your teeth naturally. When plaque builds up around and under your gums, it will cause inflammation, and therefore, sensitive teeth.

If you haven’t been to the dentist for a while you could be surprised to discover that most practices now are hyper-aware of how anxious some patients can be, even when they come in just for a simple cleaning. Dental fear is nothing to be ashamed of, so discuss it with your dentist and get those teeth cleaned!

6. You Breathe Through Your Mouth

Chronic sinusitis from allergies or a deviated septum can cause you to continually breathe through your mouth instead of through your nose. An article in RDH, The National Magazine For Dental Hygiene Professionals, states: “Mouth breathing affects the pH of the entire body… meaning the saliva.”

In other words, breathing through your mouth over a long period of time can actually make your saliva more acidic and could be the reason your teeth are sensitive. The best advice is to see an ENT (an Ear, Nose and Throat doctor) as soon as possible.

7. Your Jaw Muscles Are Being Overused

I’ve been treating patients who have tooth and jaw problems that stem from overworked jaw muscles for over 35 years. If you hold tension in your face and keep your teeth clenched together during the day, your jaw muscles are being overworked. Overworked jaw muscles can cause headaches, facial pain, persistent toothache, and sensitive teeth. Try to relax your jaw, especially when you’re working at your desk. For more help, read Problems of the Jaw.

8. You Grind Your Teeth While You’re Sleeping

Nighttime teeth grinding, also called Bruxism, is a common phenomenon that causes your jaw muscles to over-contract. In fact, some people grind their teeth so ferociously that they actually sprain their jaw ligaments, which is why their teeth are sensitive.

My practice is full of people who suffer from bruxism and just want to feel better. Our first step is to figure out what’s causing the grinding. Only once the underlying reasons are discovered can we put in place a treatment plan to eliminate the grinding and therefore, its damaging efforts.

Did you figure out why your teeth are sensitive? Whatever the cause, keep in mind that your sensitive teeth are a sign that something is going on. Don’t ignore it.

(Note: If the cause of your tooth sensitivity is related to overuse behaviors or nighttime teeth grinding and you live in the NYC metro area, please feel free to (212)-265-0110 for a consultation. If you’re outside my area, you can go to www.aaop.org and find a Diplomate in your area.)

Tags Bruxism, TMJ, Toothache

45340186 - woman with a toothpain, isolated on white

BOTOX® Bruxism Jaw Problems Nightguards & Oral Appliances Orofacial Pain

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

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

Bruxism Jaw Problems TMJ

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

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

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

BOTOX® Bruxism Jaw Problems TMJ

Bruxism Can Change The Shape Of Your Face

As an orofacial pain specialist, I’m often asked if bruxism can change the shape of your face.

Here’s a story about a young woman named Sarah who came into my office a couple of weeks ago with her mother. Sarah is a 17-year old, college-bound, high achiever who was convinced that the shape of her face had undergone a dramatic change during the past few years. She was particularly concerned about her jawline. She felt that her jaw muscles looked bigger and more pronounced than before.

When I work with a new patient the first thing we do is sit down, relax, and have a conversation. I usually learn more during this conversation than I do from the physical examination. During my conversation with Sarah I asked her a lot of questions about her life and carefully listened to her answers. It didn’t take long for me to begin to see where her problems started. The physical examination reinforced my hypothesis.

In order to understand what happened to Sarah’s face we must take a look at the master muscles; they are the muscles that control the movement of the jaw. Masseters are like all other skeletal muscles in your body in that they will maintain a baseline shape and size when used normally. And, like all other skeletal muscles in your body, they will change in size and shape when over-used. It’s the same as when you workout your biceps in order to change the size and shape of your arms.

Each time you close your jaw or even swallow, you are using your masseters. Normal chewing and swallowing will not cause them to change in shape or size. What makes masseter muscles change, is when they are contracted over and above what is considered normal, over a long period of time. Since the masseters define the shape of your jaw, over-use behavior can actually change the shape of your face.

By chewing gum, biting your nails, biting your cuticles, chewing on pens, or even holding your glasses between your teeth, you are using your masseter muscles way beyond what they were designed for. Some people hold and clench their upper and lower teeth together during the day without realizing it and over a period of time this causes their masseter muscles to bulk-up.

Also of concern is sleep bruxism. Hundreds of thousands of people grind or clench their teeth while they’re sleeping. This excessive teeth grinding, jaw movement side to side-to-side, and/or clenching in a static, braced position plays a huge factor in the enlargement of the masseters and consequently, the shape of the jaw. So, the answer is:

Yes, Bruxism Can Change The Shape Of Your Face

To reduce the impact of bruxism on the masseter muscles, I normally provide my patients with a custom-fitted oral appliance (also referred to as a night guard). The oral appliance is a very effective tool in reducing the impact of grinding and clenching. But an oral appliance will not stop over-use behavior.

Although Sarah wasn’t complaining about pain, soreness and stiffness are also common effects of bruxism. Imagine how sore your hand would be if you kept it in a fist for most of the day and night. Jaw over-use is just like making a fist in your face, and it can create excruciating pain for many people.

Let’s go back to Sarah. Through our conversation I was able to identify the main reasons that her jawline had changed so dramatically. It turns out that she is a long-time gum chewer, a nail biter, and a nighttime clencher. Sarah has literally been working-out her masseter muscles every day and night for years.

An oral appliance strategy as been put into place that will reduce the impact of Sarah’s sleep bruxism. Next, The next step is for her to change her daytime over-use behaviors. Today, Sarah is wearing the oral appliance at night and working hard to correct her daytime over-use behaviors.

An additional approach that could work for Sarah is BOTOX®. BOTOX® is a popular cosmetic therapy that has the potential to diminish the forces of nighttime bruxism. It works by diminishing the capacity of the masseters to contract, with the result often being a reduction in the bulk of the over-used muscles.

Today, Sarah is wearing the oral appliance at night and working hard to correct her daytime over-use behaviors. But before I will go forward with BOTOX® for Sarah, she must convince me that she understands that if she does not correct the daytime over-use behaviors, BOTOX® is not an option.

Here’s The Takeaway: If you have noticed changes in the shape of your face or your jawline, it’s probably not your imagination. Find a dentist that has special training in bruxism as soon as possible.

I invite you to follow me on Facebook, Twitter or LinkedIn to keep up with all the new research and case studies in this field (and with Sarah’s progress).

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.

Tags Bruxism, Jaw Problems, Teeth Grinding

Bruxism Jaw Problems TMJ

Does The TMJNext Generation Device Work?

Every now and then a new product will hit the market that’s designed to assist in the management of the chronic pain problems that impact the lives of millions of people every year. And when it comes to pain caused by TMJ/TMD problems, one such product is The TMJNext Generation™ Device. Having been sold in Europe for the past few years, this device is now available in the U.S. It is being aggressively marketed not only to dentists but to other healthcare practitioners, as well. As a result, many physical therapists, chiropractors, physicians and wellness clinics are advertising that they provide the device. As a board-certified orofacial pain specialist, I’m often asked, “Does the TMJNext Generation work?

Does The TMJNext Generation Device Work?

The TMJNext Generation™ Device is an ear insert which has been designed to create awareness in the patient of his or her jaw position. Here’s how it works:

First, impressions of your ear canals must be made. Although your dentist may have recommended the TMJNext Generation™, you may be referred to an audiologist (or another type of health care professional) that is willing to assume the liability of making the impressions, which may be outside of the scope of practice.

The impressions are made while your jaw is in a relaxed posture with your teeth apart. In this posture, your ear canal will assume certain dimensions in volume and shape. These dimensions get smaller when you bring your teeth together or clench them.

The ear canal impressions will be used to create custom ear inserts for you. The inserts feel comfortable when your jaw is in a resting posture, but when you bring your teeth together you feel an unpleasant pressure on the devices. The theory is that the uncomfortable feeling will get your attention and you will immediately relax your jaw. It’s like having a pebble in your shoe that makes it uncomfortable to walk.

For some people, the devices might serve as a sort of reminder to keep their jaw muscles loose. In this way, TMJNext Generation™ is essentially a biofeedback device. Anything that can help you keep your jaw loose during the day can be part of overall TMJ/TMD therapy.

Here’s the rub: Countless people who suffer from TMJ/TMD problems have NO NEED for daytime awareness because their jaw is always in a restful position during the day. It is at night while they are asleep that their grinding and clenching happens. For them, these devices could represent an unjustified expense. If physicians, chiropractors, physical therapists, and dentists who have limited expertise in the management of jaw problems are making decisions about the use of The TMJNext Generation™ Device, I’m afraid that overutilization is a real concern. So, does the TMJNext Generation device work?

As of today I have not found scientific articles that provide an understanding as to how these devices could stop or diminish the impact of sleep-related teeth grinding and clenching (bruxism) which is the way many patients get in trouble. Since the devices can apply unpleasant pressure on the jaw joints during a grind or clench, one would have to assume that the irritation would merely wake the wearer up, as opposed to helping him or her stop the activity altogether. I don’t think that would have a favorable long-term outcome.

My limited distribution of these devices at the present time precludes an endorsement or negative commentary. As always, I believe that a careful assessment must be done to adequately understand the type of jaw problem of each patient and what the initiating and perpetuating factors appear to be.

Only with that information can the treating professional guide the patient with sound advice.

Photo credit: http://tmjnextgen.com/

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 sleep apnea.

Tags Bruxism, Jaw Problems, Teeth Grinding, TMJ

Bruxism TMJ

Clenching your teeth at night? So what’s the big deal?

As an orofacial pain specialist for over three decades, I’ve treated thousands of patients that come to me with all kinds of problems caused by sleep bruxism, which is grinding or clenching your teeth at night while you’re asleep. These activities are often linked to neck pain, jaw pain, ear pain, headaches, and toothaches that don’t respond to traditional dental treatment. Millions of Americans are clenching their teeth at night, so it shouldn’t come as too much of a surprise that the consequences can be extremely varied. Here is the story of a good friend of mine:

To protect his teeth while sleeping he has worn a night guard for many years.

Every now and then he would wake up and notice that his lower teeth were pressing against the top night guard very fiercely. He would do some relaxation breathing that I taught him and that usually was all he needed to get back to sleep. He, however, never had jaw stiffness, headaches, or tooth pain due to his clenching.

That all changed last week.

It was a Friday night and he apparently tossed and turned for hours before finally getting into a deep sleep around 2 am. The cause of his edginess was likely a combination of a large dinner with wine at an hour later than what’s normal for him and then watching a late movie. On top of that, his ears were straining to hear his daughter arrive home from a party (I’m sure all parents can relate to that!). It added up to a very restless night.

So, finally, he fell asleep but two hours later was suddenly awakened by an extreme soreness in his lower left second molar that was braced into his night guard. After taking out the night guard he fell asleep but a couple of hours later woke up to a screaming molar (that’s the only way he could describe it!). To make matters worse, his ear throbbed and his jaw ached. Even the gums around this tooth were apparently in crisis.

As it was Saturday he went to play a round of golf but by the second hole was rummaging through his bag for some Aleve. Not only was his mouth freaking out, but also his entire body had begun to tighten up as a result of that aching molar.

The Aleve did work after an hour or so and the pain, stiffness and body tightness began to ease. He was able to finish the full eighteen holes but apparently, it was a forgettable round.

So how does something like this happen? Here’s the blow-by-blow:

The force of my friend’s clenching was so great that it traumatized the ligament that binds the molar to the supporting bone.
Then the tooth’s nerve fibers started to react and the area “lit up”.
Pain spread from the tooth site to his jaw, ear, and the gum tissues adjacent to the traumatized molar (all these areas receive the same nerve supply as the tooth).
Finally, the side of his neck and left shoulder started to tighten and lock up (this is called referred pain).

In actuality, my friend had sprained the tooth ligament by so fiercely clenching his teeth, initiating the pain scenario he described! Treatment was put into place to address this ligament sprain and I’m happy to report that since he came to my office there has been significant improvement in his condition. My friend has also made it his business to go to bed at a decent hour, avoid computer work just prior to going to bed and limit daily caffeine and late-night alcohol (known risk factors that can drive teeth clenching and grinding while sleeping).

So…if you are a clencher, even if you use a night guard this could happen to you! If so here’s my advice:

After seeing your dentist to assess the damage, stop and take a good look at your lifestyle. Are you getting enough sleep? Too many glasses of wine at late-night dinners? Evening hours doing paperwork or at the computer? Stress at a high level? Dwindling exercise and relaxation time? If so, make some changes and see how you feel. You may find that the aggressive clenching will ease reducing the potential for this scenario to be a common part of your life.

And here’s something you probably don’t know: nightguards lose their effectiveness over time and can only do so much to protect your teeth and jaws; so injuries can still occur. Keep an eye on your daily world and do your best.

Tags Bruxism, Teeth Grinding, TMJ

Bruxism Facial Pain Jaw Problems TMJ

BOTOX® Is Effective For Facial Pain Treatment

As an orofacial pain specialist for over 30 years, I have had many opportunities to think about why people develop facial pain problems and what I can do to get them out of trouble. The majority of patients who come my way suffer from pain that is muscle-based and in turn is caused by any number of factors. I have found that BOTOX® is effective for facial pain treatment, especially when other strategies have failed.

In order to determine who is a good candidate for BOTOX® therapy, I must first investigate the cause of the muscle stress in the first place. Usually, I discover that my patient is experiencing one (or more) of the following:

Poor sleep quantity and quality.
Repetitive work postures fatiguing the neck and shoulder region.
Behaviors repeated throughout the day which tightens the jaw, neck and shoulder muscles.
Emotional upset and challenging life circumstances.
Shallow and fast chest breathing patterns.
Excessive consumption of stimulants in beverages and food.
Stimulant-based medications.
Poor breathing at night while sleeping.
Autoimmune problems, which lower pain thresholds.
Physical exercise choices that continually stress the neck muscles such as spinning classes.

When BOTOX® Is Effective For Facial Pain Treatment

BOTOX® is proving to be another way to break the cycle of chronic pain. A series of injections are administered into the jaw muscles, upper neck muscles and across the forehead. The goal is to reduce or eliminate the pain, which in turn often imparts a new sense of optimism to my patients who have suffered for years, many believing that there was no solution.

In addition to relieving pain, BOTOX® is helpful for patients who experience nighttime teeth clenching and grinding. After treatment, there is a period of time when the muscles simply cannot contract as aggressively. And although the cause of the bruxing isn’t eliminated, many people discover that the achy, tight jaw that they normally wake up with is gone.

BOTOX® is not a miracle drug but it is becoming an increasingly important part of my toolbox to help my patients get better. Do you have questions about BOTOX® therapy? Please use the comment box below.

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 sleep apnea.

Tags Botox, Facial Pain, Jaw Problems, TMJ

Bruxism TMJ

Good News About Teeth Grinding

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date February 16, 2015
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“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

Tags Bruxism, Teeth Grinding

Bruxism TMJ

5 Long-Term Effects of Bruxism

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date June 24, 2014
No Comments on 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.

Tags Bruxism, Teeth Grinding, TMJ

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Pain issues and sleep challenges do not have to be lifetime afflictions. You need someone who listens and possesses the knowledge and compassion to get your pain and sleep problems under control.

I am that someone – and you’re in the right place. Dr. Donald Tanenbaum, DDS MPH

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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:

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Yes, Bruxism Can Change The Shape Of Your Face

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Treatment For Teeth Grinding

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

I am that someone – and you’re in the right place.
Dr. Donald Tanenbaum, DDS MPH