Category: Women & Pain

Why Women Experience TMJ Symptoms More Frequently Than Men

TMJ disorders affect women far more often than men.
This is not a coincidence. Differences in joint structure, hormones, and pain processing can make symptoms more likely to develop and harder to resolve.
Understanding why is often the first step toward real, lasting relief.

If you’re a woman dealing with TMJ symptoms such as jaw pain, clicking, locking, tightness, frequent headaches, or facial pain, this is for you.

I’m a board-certified orofacial pain specialist and have been treating people with TMJ symptoms for over 40 years. The majority of patients who come to our NYC practice are women. In fact, close to 70% of people seeking treatment for TMJ disorders are women.

There are biological reasons for this huge disparity, and understanding them can be essential if you are struggling to feel better.

Helping Patients Better Understand Their Persistent Symptoms

Many women come to us looking for a reason why their jaw continues to hurt, though they have used a nightguard, taken anti – inflammatory medications, and followed a soft diet for months.

TMJ (the clinical term is temporomandibular joint disorder, or TMD) involves the interaction between your joints, your muscles, and your nervous system. According to the National Institute of Dental and Craniofacial Research, these disorders are among the most common causes of facial pain.

TMJ symptoms are not something you’re imagining. They are what your body is expressing.

Why This Happens in Women

1. The ligaments in your temporomandibular joint are more flexible and less stable

In women, the ligaments in the temporomandibular joint tend to be more flexible and less structurally stable than in men.

There is a reason for this! The temporomandibular joint in women contains an abundance of estrogen receptors, making its tissues directly responsive to hormonal fluctuation. In fact, estrogen promotes elastin production, producing ligaments that are more flexible and less structurally organized than those in men. The result is greater joint laxity and reduced load-bearing capacity. In women, this means that the temporomandibular joint is more susceptible to compromise with everyday function, and certainly when under excessive loading during daytime jaw overuse behaviors and sleep grinding and clenching of the teeth.

More stable joint ligaments tolerate these stresses longer. More flexible ligaments reach their limits sooner.

That is why symptoms can emerge more commonly in the temporomandibular joints in women over time.

2. The female brain processes pain differently

Pain is not just about what is happening in a body part. It is also about how your brain processes pain signals.

Men generally have stronger central nervous system modulating elements for dampening pain signals. Women, on average, have less of that built-in inhibition due to the lack of Androgens, including testosterone and related hormones. In practical terms, male hormones strengthen the brain’s capacity to send dampening signals down to pain receptors throughout the body. Women, carrying lower androgen levels, lack this same degree of biological protection

This means that the same level of inflammation and tissue injury generated pain can be experienced very differently.

What might feel like temporary soreness in a man can become persistent pain in a woman.

This is not about tolerance or resilience. It reflects real biological differences in how the nervous system regulates pain.

3. Stress has a greater physical impact on a woman’s jaw

Stress affects everyone, but it often shows up differently in women than it does in men, again for biological reasons.

Under prolonged stress, the human body can remain in an activated state, often with accompanying muscle tension. This is called sympathetic activation. Over time, this activation can deplete the neurotransmitters that support descending pain modulation, the very system that blunts pain experiences on a daily basis. With research suggesting that women have less robust pain blunting systems than men, the pain that results from ongoing muscle tension can be more profound in women and recovery even in the presence of care taking longer.

In the jaw specifically, muscle pain and fatigue as a result of stress-driven daytime clenching and night grinding can be impactful and persistent

Men can experience this as well, but women tend to develop more sustained symptoms, which increases the overall load on the system.

The Emergence of TMJ Symptoms

In our NYC metropolitan area practices, we commonly see TMJ symptoms develop as a result of a specific traumatic event, a mind-body disorder that drives persistent muscle tension, or an underlying medical condition that reduces tissue resiliency in the jaw muscles and temporomandibular joints.

Sometimes multiple factors are responsible, and symptoms develop gradually.

First, the body adapts. Then it begins to struggle. In women, as a result of the biological factors mentioned, the likelihood of a TMJ problem emerging and hanging around increases. At times, TMJ symptoms such as jaw pain, clicking, locking, tightness, frequent headaches, or facial pain no longer resolve on their own but require explanation and formal treatment.

A More Complete Understanding for Women

Biological vulnerability is real, but it does not mean that tissue healing and feeling better are not achievable. With the right evaluation, the causes and risk factors can be addressed comprehensively with education and a wide variety of supportive treatments that lead to meaningful and sustainable improvement.

Are You a Woman Experiencing TMJ Symptoms in the NYC Metropolitan Area?

If you are dealing with persistent jaw pain, clicking, locking, tightness, frequent headaches, or facial pain, there is a reason why.

At New York TMJ & Orofacial Pain, we specialize in diagnosing and treating TMJ disorders and orofacial pain. We take the time to understand what is actually driving your symptoms and build a treatment plan around it.

Our team of orofacial pain specialists provides evidence-based, individualized care at our locations in the NYC metropolitan area. We work closely with each patient and often other healthcare providers to restore comfort and function.

If your symptoms have persisted despite reassurance or prior treatment, a more specialized evaluation can make all the difference.

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Tags Facial Pain, Orofacial Pain, TMJ/TMD

TMJ Women & Pain

TMJ Problems: 3 Reasons Women Are More Affected Than Men

In the intricate workings of the human body, few conditions are more intertwined with biology, psychology, and neurology quite like TMJ (temporomandibular joint) disorders. As someone deeply entrenched in the study and treatment of TMJ disorders for over 4 decades, I’ve seen firsthand the disproportionate impact these conditions have on women.

At our practice, New York TMJ & Orofacial Pain, 77% of our patients are women. This figure intriguingly spikes to almost 90% among those opting for BOTOX® injections to combat severe jaw muscle pain.

Not Mere Statistics

These numbers are more than mere statistics; they help Orofacial Pain specialists like us understand gender-specific vulnerabilities and design targeted, effective treatments for our female patients. The research that’s been done into this gender bias has primarily focused on three areas:

The Influence of Estrogen
Psychological Factors
Neurological Factors

Estrogen’s Critical Role

Estrogen has a critical role in reproductive health, but it also wields significant influence over TMJ symptoms. Fluctuations in estrogen levels punctuate women’s life events from menstruation to pregnancy to menopause. However, most people don’t know that these fluctuations can have a significant impact on the severity of TMJ symptoms.

This hormonally fueled modulation of pain perception and inflammation, coupled with its impact on ligament elasticity, intricately ties a woman’s hormonal rhythms to the functionality of their jaw joints.

Menstruation, Menopause, & Hormone Therapy

Estrogen levels fluctuate during menstruation, menopause and for those using hormone replacements or birth control pills, potentially making pain more pronounced. Many patients tell us that during the week leading up to menstruation and during menopause, they experience increased TMJ pain and dysfunction. Estrogen also reduces the strength of ligaments, making the ligaments in the jaw structure more flexible, which can cause injury to the TMJs. Jaw overuse behaviors such as awake or sleep bruxism, chewing gum, nail-biting, cuticle biting, and the like cause more TMJ dysfunction in women than in men.

Pregnancy’s Unique TMJ Challenge

During pregnancy, a woman’s body releases Relaxin, a hormone that prepares the body for childbirth (a good thing) but can intensify or trigger TMJ problems. This underscores the need for nuanced, compassionate care strategies that resonate with the body’s unique hormonal landscape during pregnancy.

The Mechanics of Muscle Fatigue

Jaw muscles respond to stress and strain in a unique way. Overuse behaviors can quickly fatigue them, producing lactic acid that causes pain and spasms. Moreover, the flexibility of the muscles, a trait more pronounced in women, may also be linked to jaw hypermobility – a common precursor to TMJ problems.

The Neurological Perspective

Finally, groundbreaking research has revealed that men and women process pain differently. Brain imaging techniques show differing patterns of brain activation in response to pain between women and men. Women have significantly lower pain thresholds than men and, therefore, typically seek care for TMJ-related symptoms more quickly. This spotlights the critical need for gender-aware TMJ specialists.

The Road Forward

It’s obvious why TMJ disorders disproportionately affect women. This knowledge enriches our practice’s understanding and cements our commitment to fostering hope and healing for women and everyone.

If you or someone you know is suffering, look for care at a practice that appreciates the gender-specific nuances of the experience.

Conclusion

At New York TMJ & Orofacial Pain, we provide compassionate, empathetic, and personalized care for people suffering from the often devastating effects of TMJ problems. Here, you’re not just a statistic but a participant in a shared quest for understanding, relief, and recovery.

We have four locations in the New York City metropolitan area staffed by experienced and caring board-certified Orofacial Pain specialists who will correctly diagnose your condition and create a treatment plan to help you feel better. Please call us to schedule a consultation at your nearest location (see below). If you live outside the NYC area, the American Academy of Orofacial Pain’s directory will help you find an Orofacial Pain specialist in your area.

You may also be interested in the following articles:
How To Evaluate Yourself For TMJ
Facial Pain – Is It Bruxism or Is It Bulimia?
Is Your TMJ Pain Actually A Migraine?

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

29976177 - illustration of an irritated wife covering her ears while her husband snores

Sleep Apnea Snoring Women & Pain

Snoring Is Not Funny

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date August 8, 2018
No Comments on Snoring Is Not Funny

For years snoring has prompted humorous cartoon depictions of bed partners sorting out their different views of the problem and hilarious videos revealing what the non-snoring bed partner will resort to in order to get a good night’s sleep.

The problem with snoring, however, is that both parties – the snorer and snoree (what I call the person who is forced to listen to the noise) are ultimately impacted. Sometimes severely.

Let’s start with the snorer. Although snoring was once regarded as merely an annoyance, research now shows that it is actually the result of airway turbulence, often accompanied by obstructive sleep apnea or upper airway resistance syndrome. Both conditions cause sleep arousals and lead to less than refreshing sleep and excessive daytime drowsiness.

Snoring Is Much More Than An Annoyance

People who have obstructive sleep apnea experience episodes (sometimes lots of them) when their breathing completely stops while they’re asleep. Breathing only resumes when a drop in blood oxygen wakes up the brain and causes them to take a breath. This repetitive cycle of stopping breathing and loss of oxygen to the brain often leads to injury and inflammation in the lining of the blood vessels and cardiac tissue, which makes snorers more susceptible to heart attacks and strokes.

And if that’s not enough, snorers with obstructive sleep apnea airway problems are more likely to have gastrointestinal reflux (heartburn) and experience brain matter degeneration, which is one of the causes of Alzheimer’s disease.

Sadly, the majority of snorers do not realize that their snoring is more than just an annoyance and, therefore, never even think to seek care. The link between snoring and cardiac problems, reflux, and brain degeneration is proof that it’s much more than a social annoyance. Plus, even if the snorer does not have an airway problem, research shows that the vibrational trauma created by snoring will eventually lead to tissue floppiness in the pharynx, which leads to more snoring noise, combined with injury to the nerves that help maintain airway health.

It’s obvious that snoring carries serious health risks for the snorer. But what about the poor snoree?

The Majority Of Snorees Are Women

The majority of snorers are men and, therefore, women are the majority of snorees. Countless women suffer a considerable toll due to the disrupted sleep caused every night by their snoring bed partner. And it’s loud. A snorer’s roar can reach the decibel levels of a construction jackhammer. Imagine trying to sleep with a jackhammer being operated in your bedroom.

For the snoree, constant sleep arousals can lead to chronic muscle and joint pain (TMJ problems included), headaches, daytime sleepiness, and cognitive impairment – to name just a few. In addition, we have evidence that fragmented sleep with multiple arousals can also be responsible for tooth grinding when sleeping.

CPAP Is Not The Only Option

Putting this all together makes a real case for snorers to realize that by not seeking care they’re going way beyond simply being insensitive to their bed partners. Happily, medical professionals now have many ways to treat snoring including oral appliances, which are an extremely helpful therapy for snoring and obstructive apnea. CPAP is not the only option!

So, if you’re a snorer it’s time to get help. Not only is it a smart decision for your health, it’s a smart decision for your relationship, too.

Chronic Orofacial Pain – The 60/40 Rule

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

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

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

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

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

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

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

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

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

Here are some of them:

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

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

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

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

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

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

Jaw Problems TMJ Women & Pain

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

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

The 3 Big Causes of Postpartum TMJ Pain

1- Sleep Disruption

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

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

2- Neck & Shoulder Strain & Fatigue

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

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

3- Emotional Issues

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

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

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

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

Help Is Available

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

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

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

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

Good luck!

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

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

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

Tags Jaw Problems, TMJ, Women and pain

Women & Pain

Women, Sleep, & Pain

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date February 27, 2013
No Comments on Women, Sleep, & Pain

In my practice, it has been a given that over the course of any, day, week, month, or year, the number of female patients seeking care significantly outnumbers male patients coming through the door. In fact, recent statistics have revealed that 77-82% of the patients we see with muscle pain, migraines, nerve pain, or TMJ problems are women.

As a result of this on-going theme in practices all over the world, researchers have focused on isolating the reasons why this gender dominance occurs when it comes to facial pain problems. Though absolute answers have not been agreed upon, there seems to be a general consensus that women seek care more than men for facial pain problems for three specific reasons.

Why Women Seek Care For Facial Pain More Than Men Do

The origin of many Facial Pain problems appears to be related to biologic factors. The most important likely relates to the hormone estrogen and it’s influence on inflammation, tissue injury, and the way the brain perceives pain.
Women have fewer ways to express anger than their male counterparts, and as a result their autonomic nervous system (involved in the “fight or flight” response) fires excessively.
Women look for answers to symptoms and medical concerns to a much greater extent than men and as a result women visit physicians more than men.

Other Gender Concerns?

Now there also appears to be gender concerns when it comes to the condition obstructive sleep apnea, which puts patients at risk for multiple medical problems including daytime sleepiness, cardiovascular disease and brain injury as a result of oxygen deprivation while sleeping. A small percentage of our facial pain patients have been diagnosed with this problem and many of them wake up with morning headaches and commonly report grinding and clenching of their teeth when they sleep. What is most interesting, however, is that according to a recent study at the University of California, Los Angeles, women who have sleep apnea may experience more damage to their brain cells as a result of the condition than men with obstructive sleep apnea.

In this study of 80 participants, researchers analyzed brain nerve fibers to find differences in brain cell damage between those with sleep apnea and those without, as well as between men and women with the obstructive sleep apnea. In addition to finding a higher severity of brain cell damage in the women with sleep apnea, they also found that the women with this sleep condition had more symptoms of depression and anxiety than the men. The researchers caution that additional studies are needed to fully understand these results.

Why is this important?

Knowing that between 2 to 4 percent of middle-aged women experience obstructive sleep apnea, and that upwards of 90 percent of them will never be diagnosed, there are millions of women who may be at considerable risk from the consequences of impaired breathing while they sleep.

As a result of these concerns, all my patients, regardless of gender, are screened for sleep-related breathing disorders including snoring and obstructive sleep apnea as a matter of course. As the stereotyped sleep apnea patient has always been an overweight male with a large middle section many of my female patients are rather surprised when testing reveals that they have an airway problem when sleeping. With this knowledge in hand my ability to help my patients is greatly enhanced.

Tags Dr. Tanenbaum, women and facial pain, women and sleep apena, women and snoring, women sleep and pain

Case Studies Women & Pain

PCOS, Toothache, and Facial Pain – The Connection

Case Study: Regina, Female, Age 45

In this case study, I discuss the connection between PCOS (Polycystic Ovary Syndrome), Toothache, and Facial Pain.

For over two years Regina had suffered with toothache pains, which persisted despite several root canal procedures and ultimately the extraction of several teeth. Even with these efforts and consultations with a number of dentists and dental specialists, she continued to suffer.

Evaluations by an internist and a neurologist led to further upset as she was told that “there is nothing wrong” and that she should return to her dentist.

Regina did not know where to turn.

Like many other patients that I see, Regina did in fact have tooth pain but the origin was not in her teeth. Her pain was due to a type of neuropathy (damage to the nervous system) that was likely related to a medical condition called PCOS and it’s association with Type 2 Diabetes.

PCOS, the common abbreviation for Polycystic Ovary Syndrome, is a condition in which a woman has an imbalance of female sex hormones. This may lead to menstrual cycle changes, trouble getting pregnant, and other health issues. Most important, however, the disorder shares a key factor with Type 2 Diabetes; namely the imbalance of blood glucose and insulin called Insulin Resistance.

Simply stated, Insulin Resistance is a malfunction of the body’s blood sugar control system (insulin system) is frequent in women with PCOS, who often have elevated blood insulin levels. Researchers believe that these abnormalities may be related to the development of PCOS.

In individuals where diabetes is not well controlled there are often constant high levels of blood sugar. Over time this can cause damage to both blood vessels and nerves throughout the body, including these structures in the face. The nerves can become physically damaged or inflamed causing pain, numbness and weakness.

According to the National Diabetes Information Clearinghouse, when this affects the nerves of the face, it is called a Focal Neuropathy. In fact, Diabetes is the biggest risk factor for neuropathy today!

How Was Regina Helped?

With the knowledge that Regina’s tooth pains were unrelated to her teeth but rather to her underlying PCOS and Diabetes, the focus of her treatment completely changed. All dental efforts (which had previously done nothing but make her pain worse or spread to adjacent teeth) were suspended and she was put into the hands of a group of medical specialists, of which I was one, who focused on her blood glucose levels and her weight gain, which had made her anxious and constantly upset.

I prescribed medications to diminish Regina’s nerve excitability and taught her strategies to ease jaw muscle tension, spasm and pain, which had developed secondary to her tooth pain suffering, which had persisted without answers. An oral appliance was also prescribed while sleeping as her variable blood glucose levels has impacted the quality of her sleep and led to increased levels of night clenching. My interventions helped ease her suffering considerably while her other physicians addressed the blood sugar issues.

Regina Today

For the most part Regina is pain-free except the when her blood glucose levels fluctuate excessively during times of high stress or sleep deprivation. When she does come to my office once in a while complaining of tooth pain and sensitivity in teeth that are structurally sound, I provide reassurance that her pain is real, but just not in the teeth.

This validation and getting Regina back on track with regard to sleep, stress, glucose levels, and weight remain critical to her long-term comfort.

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

Dr. Donald Tanenbaum is a 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 Donald Tanenbaum, PCOS, PCOS and facial pain, PCOS and toothache, Polycystic Ovary Syndrome, Type 2 Diabetes and facial pain

Woman with severe Migraine Headache holding hands to head

Case Studies Facial Pain Headaches Women & Pain

Headaches & Facial Pain Caused by Emotional Distress

Caring for the Caregiver

Case Study: Joan

Joan was referred to my office due to her daily headaches and facial pain that had continued to get worse despite taking over-the-counter medication on a daily basis and treating herself to a few massage sessions. She had seen her family doctor who had assured her that there was nothing terribly wrong, that the headaches and facial pain were a result of stress, and that she should start exercising more frequently and try to get more sleep.

Joan came to me when she could no longer tolerate the pain. After careful listening and a full examination, it was clear to me that her pain likely had a muscle origin. For Joan, along with countless other people in America and across the globe, her aching facial, jaw, and neck muscles were undoubtedly the result of an ongoing burden that had begun to dominate her life. Joan’s particular burden was that six months prior, her husband had suffered a debilitating stroke and she had become his sole caregiver.

Joan’s world had changed overnight. She was now a full time, worrier, cook, chauffeur, appointment maker, and sole provider of her husband’s physical and emotional needs. Although she took on these responsibilities with love and commitment, it was clear that she had been unprepared for the enormous challenges she faced. As the weeks and months passed, friends and family retreated to their own worlds, and she was left to fill the voids in her husband’s life, knowing that this job came with an unknown future.

As a result of her daily caregiver obligations, Joan’s sleep suffered, her independence all but disappeared and her ability to exercise and stay healthy dwindled to almost nothing. Suddenly her neck ached, headaches emerged, and she found herself gritting her teeth during the day as she tried to maintain patience and deal with the physical effort it required to get her husband showered, dressed, and fed.

Joan’s headaches and facial pain were clearly the result of muscles that were in crisis as a result of a ‘brain under siege’ and muscle fatiguing behaviors (clenching/raised shoulders…) that were prompted by the realization that she was alone and unprepared for an unknown future. The more Joan and I talked, the more I realized that not only was she suffering with pain, but she was lonely and depressed as well.

To help address Joan’s sore and painful jaw, face and neck muscles, I set her up with number of common therapies. These included “physical self regulation techniques” which help patients identify and change the behaviors that they have developed as a result of ongoing life challenges and stressors.

Just becoming aware of when the brows are furrowed, the lips are tense, the shoulders are raised, the jaw muscles are braced, or the teeth are clenched is the first step. I then taught her a number of exercises and breathing techniques that reduce muscle tension and can lead to significant pain relief over time. To complement these self-care efforts, we added medications, muscle injections, oral appliances, and physical therapy.

Though as a result of these efforts Joan felt somewhat better (in spite of the fact that nothing had actually changed in her life), there clearly was more that had to be done to help Joan not fall back into her acute pain state once formal treatment in my office stopped. That is when I introduced her to the Caregivers Survival Network, founded by Adrienne Gruberg.

By joining The Caregiver Survival Network (CSN), she became part of a community of other caregivers eager to interact, share stories and be a source of support. She found a lot of free services geared exclusively to a caregiver’s needs and links to other organizations and websites for caregivers, as well. As a result of taking advantages of the ideas and services shared on the CSN, her feelings of being alone started to dissipate and I feel that Joan is on the mend both physically and emotionally.

If you are in a similar situation, or know someone who is, please direct him or her to http://www.caregiversurvivalnetwork.com/

Tags Caregiver Survival Network, Dr. Tanenbaum, Facial Pain, Headaches, Referred Pain, TMJ Case Study, Women & Pain

Jaw Problems TMJ Women & Pain

Estrogen, Pain, and TMJ

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date November 29, 2011
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Why is TMJ Disorder So Prevalent Among Women?

Not only is there a clear dominance of TMJ in women, but also the severity of the problem is often at a level virtually never seen in men. This scenario is frequently seen in the case of teenage girls, suggesting that the problems we are confronted with could be hormonal. Some research has unveiled a link between TMJ and estrogen, which could shed light on the dominance of TMJ in women.

Take the example of Mary, a 17-year-old female who came to my practice. Mary’s problems started when she was 12 years old with the onset of non-painful TM joint noises that did not interfere with eating or jaw function. Over time, pain emerged and her bite began to change, altering her profile and appearance. Before long her pain was so debilitating and her bite so altered, that there was no choice but to seek surgical treatment. Both TM joints had “dissolved away” and her jaw profile and bite had to be reestablished.

How could this happen with no history of trauma and no apparent underlying medical disease? The role of hormones, estrogen in particular, has been identified. Research has shown that Estrogen:

Impacts the body’s natural pain fighters (endorphins)
Increases inflammation in the Temporomandibular Joints
Compromises the strength and adaptive ability of all ligaments

These factors, coupled with lower endurance capacity in female jaw muscles, are all that is likely needed for difficult problems to arise. Additionally, research suggests there may be specific genetic predispositions that lead to unprovoked TMJ in women.

Though the treatment that Mary had received has restored function, jaw stability, and reduced her pain, there is still much to learn about gender specific jaw problems.

Dr. Donald Tanenbaum has been practicing in New York City and Long Island for over 20 years. He is uniquely qualified to diagnose and treat bruxism, TMJ and TMD problems, Sleep Apnea, facial pain, muscle pain disorders, nerve pain disorders, tension headaches, and snoring. Learn more about Dr. Tanenbaum here.

Tags Donald Tanenbaum, Dr. Tanenbaum, Estrogen and Pain, TMJ, TMJ Causes, TMJ Dentist, TMJ Doctor