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8 Thoughts About Facial Pain And TMD For 2018

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

Date: January 8, 2022


As 2017 wound down I took some time to reflect on strategies that have helped my patients find relief from their facial, persistent tooth, and jaw pain problems.

So, here are some thoughts that you may find very helpful for patients with persistent pain problems.

1. Healing Is A Process

Healing continues to be a process – not an event. Once the right diagnosis is made and treatment started it takes time (weeks, for sure) for persistent symptoms to ease when the origin of the pain is in the supporting structures of muscles and joints. It takes somewhat longer (and the likely use of medications, too) for symptoms to ease when the pain is of nerve origin. It’s important to note that the patient at all times must be compliant and participate if the healing process is to be successful.

2. Anti Depressants Could Be A Culprit

Although it’s not the most common scenario, it appears that in some patients the broad category of anti-depressant drugs, particularly SSRIs such as Paxil, Effexor, Prozac, and Lexapro, can lead to muscle pain in the head, neck, face, and jaw. And particularly, when there are few other clues to explain an intensification of a muscle pain. In these patients, the level of suffering is high while physical findings are not revealing. 

With the involvement of their prescribing physician, a switch to alternative medications and/or dosages has led to profound pain relief.

3. Lowered Pain Thresholds

Many of my patients suffer with acute pain not only because of recognizable tissue injury (associated with spasm and inflammation) but also because their overall pain thresholds have dropped. An overall drop in pain thresholds may be due to lifestyle such as someone who burns the candle at both ends 24/7, which keeps the fight or flight system in a perpetually active state. For this group of patients, Chinese temple exercises or Tai Chi for just 30-45 minutes a day has worked wonders. 

4. Sleep Quality & Quantity

In regard to pain thresholds, an evaluation of a patient’s sleep quality and quantity are important. Determining whether a patient has insomnia or a sleep-related breathing disorder is key. These two specific sleep disorders, which often are interrelated, must be addressed if in fact, a persistent pain problem is to be eased or solved.

5. Night Tooth Clenching & Grinding

When it comes to treating night tooth clenching and grinding, an abundance of theories are circulating. We do know that some patients who grind and clench have normal sleep patterns while others sleep in a disrupted and fragmented way. It’s crucial that this be determined first because the type of treatment and oral appliance will vary based upon the presence or absence of a sleep disorder. 

6. Supplements

Despite industry claims, it remains unclear if supplements are truly effective for pain relief. However, some of my patients have believe that consistent use of Fish Oil (Omega 3 fatty acids) and Magnesium can relieve their muscle pain. Magnesium Glycinate, which is easily absorbed, can be taken at a dose of 300mg/day for women and 400 mg/day for men. A number of patients have also found that Turmeric is helpful for joint pain. Turmeric can be taken at 400-600mg/day – but care must be taken if the patient is on a blood thinner. With all supplements, a physician’s input is always wise.

7. Food As Medicine

At last, the ongoing efforts of biologic research have begun to identify foods that can substantially reduce nerve sensitization and inflammation in the body, both of which are critical parts of pain physiology. Grape seed extract, organic chicken broth, and cocoa (72% dark chocolate) have all been identified as promising foods to complement other treatments designed to diminish pain-prompting risk factors. At the moment there are no standard quantity recommendations for these foods, but incorporation into the diet on a daily basis can be a helpful strategy, even if the benefit is the placebo effect and a change in lifestyle choices. 

8. Breathing 

With chronic pain comes shallow and quick breathing. This rapid breathing causes an excessive expiration of carbon dioxide, which leads to higher levels of muscle tension and nerve excitation in the body. In addition, lower carbon dioxide levels make it harder for the body to use oxygen. As a result, treatment strategies in my office often focus on slow-paced belly (diaphragmatic) breathing. Many patients learn helpful breathing techniques in yoga classes. I also refer them to, a website and app that teaches people how to meditate and live mindfully. Plus, the Buteyko breathing method is often very helpful.


Invariably, when you take the time to discover “who they really are” you have a better the chance of unraveling their pain problem. There is no substitute for understanding the full scope of your patient’s life.

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