Tag: Donald Tanenbaum

working out in the gym on a bike

Indoor Cycling Classes Can Cause Jaw Pain and TMJ

Over the past few years in my practice we have seen an increasingly number of female patients who are committed fans of high intensity indoor cycling workouts (sometimes called “spinning”) such as Soul Cycle. They have been arriving complaining of jaw pain, limited jaw motion, and jaw clicking, all the typical signs of TMJ or Temporomandibular Disorder. What we’ve determined is that these popular high intensity indoor cycling programs may be detrimental over time for some women, particularly as they relate to the upper neck muscles.

Indoor Cycling and TMJ – What’s the Connection?

Many TMJ disorders start in the muscles of the head and neck region. Tight, fatigued, and overused neck muscles can cause changes in head position and consequently changes in the tone of jaw muscles and the position of the lower jaw (even when at rest). Over time these subtle changes can cause jaw pain and tightness. In addition, there are trigger points in the neck muscles that when active can refer pain to the jaw and lead to muscle contracture of the jaw muscles, leading to diminished jaw motion and sometimes changes in how the teeth come together.

By working one’s upper body while pedaling a stationary bicycle, the head and jaw posture is often strained in a way that can lead to extreme muscle fatigue. The head weighs about 18 lbs. and in the midst of an intense cycling class this 18 lb. ball is hanging forward and bouncing around. As a result of this challenge to the biomechanics and physiology of the neck, muscle pain and at times even nerve pain, can emerge in the face and jaw, a condition commonly referred to as TMJ.

Case Study: TMJ and Soul Cycle

Knowledge of how the neck works is important in understanding why TMJ problems can be caused by intense indoor cycling classes. My patient Nancy is a perfect example. She is 27 years old and recently came to see me complaining of severe jaw pain, limited jaw motion, and jaw clicking. A thorough interview revealed that the only change in Nancy’s daily routine was the inclusion of three to four Soul Cycle classes per week. Discussion also revealed that she had been experiencing jaw tension during class that often lingered for hours afterward. What started out as a short-term symptom had evolved into even more troublesome problems. I recommended that she give herself a break from Soul Cycle, engage in a short regimen of physical therapy, and take anti-inflammatory medication for a limited period of time. We’re happy to report that today Nancy’s jaw problems have been resolved.

I recognize that intense indoor cycling fitness programs such as Soul Cycle can have tremendous personal and physical benefits. What should be kept in mind is this: many classes every week over a long period of time may actually put your jaw at risk. And what good is a fit body if you can barely open your mouth?

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 https://www.nytmj.com/about-dr-tanenbaum/.

Tags Donald Tanenbaum, indoor cycling and jaw pain, indoor cycling and tmj, soul cycle and jaw pain, soul cycle and tmj, spinning and tmj, TMJ

Ear Pain Tinnitus TMJ

TMJ and its Relationship to Ear Problems and Sinus Symptoms

Many of my TMJ patients also complain of ear problems and sinus symptoms. Is there a relationship between these painful and uncomfortable conditions and TMJ dysfunction? Let’s start with ears.

Ear Problems & TMJ

The experience of ear symptoms in patients with TMJ is very predictable due to a number of factors. Most importantly during growth and development the structures of the ear, the TM Joint and the jaw muscles originate from similar cells and as a result share nerve pathways that can influence muscle tone and performance. For instance, the muscle that determines the size of the Eustachian tube (influences ear pressure) is directly influenced by the same nerve that serves the jaw muscles and TM Joint. As a result, a TMJ problem can lead to changes in the way the Eustachian tube effects the ear, at times leading to symptoms of ear pressure, fullness, clogging, pain and even ringing.

In addition, the tension across the tympanic membrane and the position of the malleus bone can also be altered in patients with TMJ. As a result, ear symptoms can emerge and linger. In some cases, patients also experience tinnitus. Ringing ears or tinnitus is only occasionally related to TMJ problems. A relationship may exist when the tinnitus changes during jaw movements and or eating. If the tinnitus (pitch and intensity) does not change as a result of jaw function and remains constant on a daily basis it is unlikely that TMJ therapy can help.

For a complete discussion of the TMJ tinnitus connection, visit: https://www.nytmj.com/tinnitus-jaw-connection.

Sinus Symptoms & TMJ

With regard to sinus symptoms it is common for patients with TMJ to complain of pain and pressure in their sinuses, despite the fact that there is no sinus disease, infection, or inflammation. The reason is due to mechanisms of referral, where the site of the symptom is not the origin of the symptom. Jaw muscles in particular can refer pain to the sinus region often making a diagnosis difficult. Muscles that are tight, inflamed, and fatigued due to overuse behaviors and sleep bruxism commonly lead to sinus symptoms. As a result TMJ therapy that reduces muscle problems often leads to the relief of the reported sinus symptoms. Some common treatments include jaw exercises; jaw muscle conditioning, massage, bite plates, and injection/needling therapy that relax tense overworked muscles.

The bottom line is that if a patient seeks care with ear and or sinus symptoms that have no apparent relationship to disease, injury or illness, then there is a good chance that an underlying TMJ problem may be responsible.

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 Donald Tanenbaum, ear pain and tmj, ear pressure and tmj, ringing ears and tmj, tinnitus and tmj, tmj and sinus symptoms

Bruxism Nightguards & Oral Appliances TMJ

Biteplates Need To Be Monitored

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date June 18, 2013
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Thousands of people every year are prescribed biteplates by their dentists. There are two common scenarios that prompt a dentist to make this recommendation.

Scenario 1: Tooth Grinding

You went to your dentist for a routine appointment and you were told that there is evidence that you are grinding your teeth at night (sleep bruxism). Your dentist may in fact show you areas of tooth wear on your teeth. You have no jaw or tooth pain, which is good, but a biteplate is made to protect your teeth at night while you sleep. This biteplates may be made of hard acrylic, dual laminate materials with a soft inside and hard outer shell, or may be totally soft and pliable.

Since you have no symptoms of jaw or tooth pain, there is no need to do anything else. Your dentist should ask you to bring it with you when you go in for a routine tooth cleaning appointment. Overtime it may have to be remade due to wear and tear, or adjusted if new dental restorations have been placed.

Scenario 2: Jaw Pain, Stiffness, and more…

You are experiencing pain/tightness/stiffness in the jaw muscles, pain in the Temporomandibular Joints (TMJ’s), or clicking that is new or getting worse. Your symptoms may be worse in the morning as many people often wake up with symptoms of jaw pain, diminished jaw motion, and even a jaw that feels locked and out of place. Your dentist will in this situation commonly make a biteplate that can be modified over time as your symptoms change. It may have a flat biting surface or inclines to address your specific problem.

These adjustable biteplates need to be monitored as your condition improves, or if it is not helping to reduce symptoms. Just like an orthopedic splint for the knee, problems, modifications, or changes are required overtime as the situation dictates.

If your jaw problem was due to a specific trauma or injury (sports related/eating/accidental) which lead to a joint sprain, muscle strain, or joint inflammation, as healing occurs you will likely wear the appliance less until you don’t need it at all.

However, if your jaw pain, locked jaw, decreased motion, sore teeth, or headaches resulted from persistent and aggressive sleep bruxism , then long term use of the biteplate may be required. Periodic visits to the dentist will be required to determine when, and if the biteplate use can be reduced or eliminated. Regardless of the reasons that you needed a biteplate to begin with, please make sure your dentist monitors its use at least once a year.

Learn more about biteplates and oral appliances.

Tags Biteplates, Bruxism, Donald Tanenbaum, jaw pain, Mouthguard, Oral Appliances, TMJ, Tooth Grinding

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

Tags Donald Tanenbaum, PCOS, PCOS and facial pain, PCOS and toothache, Polycystic Ovary Syndrome, Type 2 Diabetes and facial pain

Jaw Problems

Case Study: Jaw Locking All Day With Tremendous Pain

A patient came to my office four months ago complaining that she woke up every morning with her jaw in a locked position. It was so bad that her morning routine starting by standing in the shower bathing her jaw with hot water until her jaw popped open. Then she could start her day.

Her problem however didn’t stop with this unlocking event. Her jaw would click and then lock numerous times during the day and she had no choice but to manually force it open. Each unlocking effort was accompanied with pain that intensified as the day passed. She also had to support her jaw with her hand in order to chew and she worried that her lockjaw problem would interfere with her ability to talk and fulfill her professional responsibilities as a teacher.

Remarkably her problem seemingly just started one morning. There was no history of trauma, no recent dental visits, and no underlying medical problems that could be responsible for the onset of the jaw clicking and locking. It just started one day and then took over her life.

Treating Locked Jaw

Just like a knee problem, the nature of my patient’s problem was related to compromised cartilage and unstable ligaments in the jaw joint. These problems are “orthopedic” in nature and require treatment that is similar to those used for injured knees and or ankles The treatment planned was designed to stop further injury, stabilize the joint and give the body a chance to heal.

The treatment for this patient had three parts:

• An oral appliance (orthotic) designed to prevent joint locking, relax the jaw muscles, and reduce joint inflammation.

• Exercises and physical therapy to help improve and restore proper jaw mechanics, muscle coordination, and stability of the ligaments

• Daytime behavior modification strategies to ease postural strains on the jaw and neck muscles and jaw joints

The Outcome

After four months of treatment, my patient has responded well with no morning jaw locking, no pain, better eating capacity and optimism that this problem was not going to compromise her ability to hold a teaching job. Though not ‘cured’, her orthopedic problem had stabilized and she was in her own words “better” and not in need of ongoing care in my office. Maintaining a home program would likely be all that she needed to stay comfortable and avoid future problematic situations.

This ability to help patients “get their lives back on track” never gets old and continues to be a source of my daily efforts when patients come seeking advice, guidance and care.

Tags Donald Tanenbaum, Dr. Tanenbaum, jaw locking, Jaw Problems, Locked Jaw, Lockjaw

Case Studies Facial Pain Jaw Problems TMJ

Case Study: High-Powered Executive Wakes Up With A Locked Jaw

Last week a new patient came in for a consultation. She had been having pain in her jaw for quite awhile, but had ignored it. Like many of my new patients, what made her suddenly take it seriously was the terribly frightening experience of waking up with a locked jaw. Eventually her jaw loosened up enough for her to call her dentist and be referred to me. Understandably, she was pretty scared when she walked in the door.

Here’s the backstory:

This patient is a highly successful businesswoman in her early 50’s. She has a high level job as an executive for an international garment manufacturer and manages a large group of employees. She had a lot of responsibility at work, and obligations at home managing the lives of teenage children and watching out for the welfare of her aging parents. As if this was not enough, her daily struggle with a chronic digestion ailment made the challenges of life all the more difficult.

What I was able to uncover in my conversation with this patient was that unbeknownst to her, she had been resting her teeth together and clenching her teeth for a very long time, not just at night, but during the day, as well. From asking the right questions, she realized that she was maintaining a tooth contact position when working on her daily financial reports, when dealing with her bosses, and even when she was on the phone with clients.

Over time, this action of “making a fist in your face” can begin to fatigue the jaw muscles and result in the “locked jaw” and pain that this patient experienced.

You see, the mind-body connection is very strong. When you are under stress for a long period of time, the brain becomes understandably upset. As a result, the brain is unable to maintain control over blood flow, muscle tension, and nerve discharges that are essential for muscle comfort. Loss of this control therefore ultimately leads to an accumulation of irritating chemicals in your muscles like lactic acid, and others that lead to pain and muscle tightening.

In the presence of this irritating chemical environment the nerves that run through your muscles fire excessively and cause pain along with a muscle tightening result. In essence a brain under emotional siege, sets the stage for muscles to falter.

My patient left the office beginning to understand what happened to her jaw. The first thing she has to do is to begin the process of changing the destructive behaviors that had led to her jaw problems. To accomplish this she was provided with strategies designed to relax her jaw, which included a series of breathing exercises that she must do………… but that easily fits into her day.

Beyond treatment therefore, understanding the mind-body connection is the first step to stopping damaging behaviors such as day tooth contact or clenching that often have unpleasant outcomes.

Tags Donald Tanenbaum, Facial Pain, Facial Pan Case Study, Locked Jaw, Lockjaw, TMJ Causes, Tooth Contact, Tooth Pain

Sleep Apnea Snoring

Treatment for Sleep Apnea May Assist in Weight Loss

While on a recent airplane flight to Chicago, I was unfortunately sitting across from a young man around thirty years old who was sleeping fitfully. From his outward appearance he was not overly tall, likely about 5’11” but clearly overweight particularly in the midsection.

With each breath came a snoring (or roaring) sound accompanied occasionally by a gasp for air. It was clear that this young gentleman had the appearance of obstructive sleep apnea and one can only wonder about his future if he did not address this problem with weight loss or medical intervention.

This scenario of young men and women snoring excessively is played out daily across America and the reason most of the time is obesity. Though there are many individuals that snore and develop obstructive sleep apnea, due to large tonsils and small airways due to thin necks and set back lower jaws, the problem is most commonly seen in overweight people.

For these individuals their calorie intake continues to exceed the calories they burn with the end result of fat being deposited in the neck and airway along with their midsections. Once established these patterns of weight gain are hard to reverse taking tremendous self control and discipline.

The end result unfortunately is not only a disturbed bed partner and daytime fatigue but new evidence suggests that a persistent obstructive sleep apnea condition can weaken the body’s immune system and increase the risk for cancer, as the results of a recent study published in the American Journal of Respiratory and Critical Care Management suggests.

What is also interesting is that once an obstructive sleep apnea problem has been established with the associated oxygen deficits while sleeping, there is also a disruption of the delicate hormonal balance that controls appetite and hunger patterns.

As a result it has been shown that moderate to severe obstructive sleep apnea conditions often impair weight loss efforts despite caloric control and increased exercise. As a result of this reality, a great number of patients in our office are using oral appliance therapy while sleeping and as a result are breathing better and losing the weight that they were unable to previously shed. As an end result, their improved airway capacity will most certainly reduce their risk of cancer in the future and help all of us rest peacefully on our next airplane flight.

Tags Donald Tanenbaum, Obstructive Sleep Apnea, Sleep Apnea, Snoring

Sleep Apnea

Sleep Apnea Treatment Improves Heart Function

In a previous blog post, I discussed how CPAP (Continuous Positive Airway Pressure) and custom oral appliances could be used to facilitate night-time airflow into the lungs, preventing snoring and aiding mild to moderate sleep apnea.

Researchers in England have found a new development in sleep apnea treatment. A CPAP breathing machine can improve heart function and may even prevent heart failure.

According to a new study, published by the American Heart Association, researchers at England’s University of Birmingham used echocardiogram exams to study heart structures and function in sleep apnea patients before and after CPAP therapy.

Patients were broken into three groups:

Group One: Patients with High Blood Pressure
Group Two: Patients with Obstructive Sleep Apnea
Group Three: Healthy Control Group

The lead researcher, Gregory Lip, found asymptomatic sleep apnea patients had measurable heart damage. The observable structural and functional changes found in moderate to severe sleep apnea patients were found to be akin to those suffering from high-blood pressure.

All three groups were treated across six months with CPAP. After a second round of echocardiograms, much of the heart damage had been reversed in several major areas:

Reduced thickness of the heart muscle wall
Improvement in cardiac function
Loosening of the cardiac chambers

Given the therapy’s role in improving overall heart health, sleep apnea patients should consider CPAP treatment regardless of cardiac problems. This could translate to a major reduction in stroke and risk for other heart-related diseases.

If you suffer from sleep apnea and are considering CPAP as treatment please do not hesitate to contact me. Learn more about Dr. Tanenbaum here.

Tags CPAP, Donald Tanenbaum, Obstructive Sleep Apnea, Sleep Apnea, Sleep Apnea and Heart, Sleep Problems

BOTOX® Bruxism

BOTOX® and Bruxism

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date April 3, 2012
No Comments on BOTOX® and Bruxism

In previous blog posts on bruxism, I’ve discussed how teeth grinding can lead to worn teeth, fractured teeth, facial or jaw pain, and a host of other maladies. There are many ways to treat bruxism, and one of the most recent and perhaps unexpected is BOTOX®.

BOTOX® was originally used for treating muscle spasticity diseases such as strabismus (eye misalignment), blepharospasm (eyelid spasm), and torticollis (wry neck). BOTOX® works by temporarily decreasing or paralyzing the muscles it is injected into. The logical extension of this would be to apply BOTOX® to a myriad of other medical conditions in which excessive or intense muscle contractions are causing pain or dysfunction.

It turns out that BOTOX® can in some cases, be a sensible medical application to bruxism, as injections of BOTOX® into the masseter and temporalis muscles – the large muscles that close the mouth and bring the teeth together – can reduce the forces of bruxism to a significant extent.

The Procedure: By injecting small doses of BOTOX® (different levels are used for each patient) directly into the masseter and temporalis muscles, the muscles are weakened enough to diminish the forces associated with involuntary grinding of the teeth and clenching of the jaw. As a result damage due to the TMJs and symptoms of jaw pain and headaches should be reduced if not eliminated after 2- 3 injection sessions over several months. Luckily, chewing and facial expressions will not be effected by BOTOX®.

Reasons to Consider BOTOX®:

If you know you are clenching at night but oral appliances are not helping or making your morning symptoms worse.
Positive effects can be felt within 10- 14 days even if you have been suffering for month or years.
If helpful, the need for medication (muscle relaxants) at bedtime and pain medications during the day will be reduced or even eliminated.

The optimal dose of BOTOX® must be determined for each patient as some people have stronger muscles requiring more BOTOX®. The effects last for about three months. After a few rounds of injections, many of our patients require no further injection sessions though we continue to advise the use of an oral appliance while sleeping if tolerated.

If are suffering from bruxism please do not hesitate to contact me so I can assist you in making treatment decisions.

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 Botox, Bruxism, CPAP, Donald Tanenbaum, Facial Pain, Jaw Problems, Obstructive Sleep Apnea, Teeth Grinding

Sleep Apnea Snoring

Is Snoring Causing Your Child’s Behavioral Problems?

In very young children and even in infants, sleep-inhibiting breathing such as sleep apnea, mouth breathing, and even snoring may affect more than just a healthy night’s sleep.

According to a recent New York Times article, a study conducted by Karen Bonuck, PhD., at the Albert Einstein College of Medicine at Yeshiva University found that sleep-inhibiting breathing starting in infancy and early development is causing more than just problems with sleeping and staying awake during the day. This longitudinal study tested 11,000 children (controlling for future behavioral problems caused by events such as maternal smoking and prematurity) found a definitive link between children with sleeping problems during early development and later behavioral problems.

Sleep-inhibiting breathing leads to a poor night’s rest for your child potentially providing their brain with too little oxygen or too much carbon dioxide. This could seriously affect the prefrontal cortex area of the brain which is directly linked to behavioral decision-making.

Parents need to pay attention to their child’s breathing at night, even as early as infancy. A good night’s sleep restores what a developing brain has lost during the day.

If you feel your child is having a problem with snoring, sleep apnea, or mouth breathing, do not hesitate to contact me. Learn more about Dr. Tanenbaum here.

Tags Child Sleep Apnea, Child Snoring, Donald Tanenbaum, Sleep Apnea, Sleep Apnea Behavior, Snoring

Facial Pain

What Causes Facial Pain?

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date January 30, 2012
No Comments on What Causes Facial Pain?

Over the course of 25 years in practice, I have seen thousands of patients who complained of persistent pain in their face, ears, teeth, and/or jaw. These pain complaints have often been accompanied by tightness and soreness in their jaw and facial muscles, limited jaw opening, difficulty chewing due to pain, and at times other symptoms such as burning and tingling in the face and lips. Many of these patients have been told by their doctors that their symptoms are “in their head” as a result of past treatment failures. At other times, patients have felt as if they were being personally blamed for having a problem.

If you are one of those people who have facial pain that has lingered, not only is your pain real, it is not your fault! Facial pain can be understood and effectively treated. Facial pain problems fall into one of five recognizable categories. These are:

Pain of Tooth Origin
Pain of Muscle and Joint Origin
Pain of Nerve Origin
Headache including Migraines
Pain due to Medical Problems

Unfortunately, many facial pain problems are often misunderstood and misdiagnosed because of three key factors:

Referred Pain: This means that the location of the pain being experienced is not where the pain is coming from. The most familiar referred pain is the pain experienced in the left arm just prior to or during a heart attack. The phenomenon of referred pain is common in the face, leading to treatment at the site of the described pain, but not at the true source of the pain. As a result, pain continues.

Misinterpreting Pain Intensity: Often facial pain is so intense that patients assume that something is terribly wrong. Though it is known that the intensity of symptoms often has nothing to do with the seriousness of a problem, doctors are often persuaded to order lots of medical tests leading to anxious moments while patients wait for the results. When nothing of concern is discovered, a short moment of relief is replaced with the question: “I still hurt, what do I do now?”

Emotions and Pain: Since most people are not able to accept the concept that emotions and stress, through their influence on muscles, can cause significant pain, and because the majority of doctors are unwilling to adequately explain how this occurs, the most common source of facial pain, muscles, are often neglected. As a result, pain lingers and becomes more difficult to treat over time.

So, if you are one of those people who are suffering, using pain medications frequently and having trouble at work or in school because of your facial pain, you really can get help. The most important thing is to find a doctor who listens, understands, and takes into consideration all the aspects of your life that could be contributing to your problem.

From there, many treatments options are available, and your doctor should be able to identify the right one for you. To find out more about facial pain, check out the groundbreaking book “Doctor, Why Does My Face Still Ache”.

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 Doctor Why Does My Face Still Ache, Donald Tanenbaum, Facial Pain, Facial Pain Book, Facial Pain Doctor, Help for Facial Pain

Facial Pain Jaw Problems

Creams for Face Pain and Jaw Pain

Are there any topical creams that I can use to decrease my face and jaw pain?

A patient recently came to the office with a cream rub that she had been rubbing into her jaw and facial muscles. Although the cream smelled terrible, she thought it was helping. The question is then, do these creams work?

According to research performed on over-the-counter TOPICAL PAIN RELIEF products, creams designed to relieve muscle pain are generally safe, can provide short-term benefit but do not provide long-term relief. The reason these products have only limited usefulness is likely related to the fact that they do not penetrate deeply enough into the muscles.

The most common types of creams contain these basic ingredients:

• Menthol (a counter-irritant)

• Salicylates (aspirin)

• Capsaicin (a pain reliever found in hot pepper)

Menthol: Common products such as Flexall 454, Icy Hot, and Biofreeze contain menthol, wintergreen, or eucalyptus oil that makes the skin feel hot or cold and provides a distraction from the pain. Patients who come into my office tell me these products either provide temporary relief, or do not help at all. Generally these counter-irritant products are rubbed into the jaw muscles 3-4 times a day. When using these products on the face, care must be exercised to avoid contact with the eyes or lips.

Salicylates: The common ingredient found in aspirin, Salicylates are most effective when taken orally. Research indicates that the effectiveness of salicylates decreases to a significant degree when used as a topical cream. Bengay, Aspercreme, and Sportscreme contain this ingredient and are commonly used by my patients.

Capsaicin: A compound found in chili peppers, capsaicin causes a hot, burning sensation when applied to the skin. This topical rub actually depletes a chemical in nerve cells responsible for sending pain signals to the brain. Common products that use this compound are Capzasin, and Zostrix. These products, however, can be risky when applied to the face, as they can cause intense burning and irritation should they get in the eyes, or on the lips.

As expected, some patients swear by these products despite what the research reports. In my opinion there is likely some placebo effect taking place to account for at least 1/3 of the pain relief experienced by patients using these rubs. Additionally, the physical act of rubbing and massaging the facial muscles when applying these products can also provide relief by increasing blood circulation to the area.

In summary, self-help actions can go a long way toward reducing face and jaw pain. Despite poor scientific evidence, these creams can provide some degree of benefit and are recommended as part of an overall self care plan.

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 Cream for Face Pain, Cream for Jaw Pain, Donald Tanenbaum, Dr. Tanenbaum, Jaw Problems, Ointment for Face Pain, Ointment for Jaw Pain, TMJ

Ear Pain TMJ

Causes of Ear Pain

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date December 27, 2011
No Comments on Causes of Ear Pain

Many patients come into my practice complaining of ear pain, when other physicians have found nothing wrong with their ears. The ear pain complaints heard most often are these:

• My ear feels full

• My ear feels stuffy

• I feel like something is dripping in my ear

• I feel pressure in my ear

• There is ringing in my ears

• I hear a hissing sound

• I hear a buzzing sound

More often than not, patients complaining of ear pain will see their general practitioner, internist, or an ENT (ear, nose, and throat) doctor. But if there is no evidence of an infection, and there is no fluid or inflammation in the ear (or other problems with ear function) the ear pain could be happening because of a malfunction in the muscles of the face, jaw, or TMJ (Temporomandibular Joint).

Because of the way our ears, face, and jaw develop inside the womb, the malfunction of one area can cause pain in the other. To figure out if your persistent ear pain is related to a muscular issue, pay close attention if the ear pain you’re experiencing:

• Increases when you eat

• Increases when you talk

• Increases when you open or close your mouth

• Is constant and intense

If these are the dominating symptoms, chances are the ear pain will not go away unless doctors can address the muscle and joints in the face that are causing it to begin with. Treatment that focuses specifically on the ear will not work if the ear pain is just a symptom of a different problem.

Tags Donald Tanenbaum, Dr. Tanenbaum, Ear Pain, Inner ear, TMJ

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
No Comments on Estrogen, Pain, and TMJ

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.

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

TMJ

What is a TMJ Doctor?

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date November 20, 2011
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Because many common symptoms of TMJ problems often can be the result of other medical conditions, those who represent themselves as “TMJ Doctors” (or “TMJ Specialists”) must be able to not only recognize common TMJ problems, but also must be adequately trained and have sufficient past experience to enable them to accurately diagnose the vast number of other problems that can produce these common TMJ symptoms:

Facial and jaw pain
Diminished jaw motion
Facial and temporal headaches
Jaw muscle spasm and tension

Whether the symptoms you are concerned about are due to a facial migraine, a nerve pain problem, disease in a salivary gland or sinus, a thyroid condition, brain tumor, or strained Temporomandibular joints and jaw muscles, the “TMJ Doctor” you see must be skilled in making what is called a “differential diagnosis.” From a patient’s perspective, that means you need to know with a degree of medical certainty that your ‘TMJ’ problem is truly due to a local muscle and joint problem, and not due, instead, to some underlying medical disease process.

In today’s world, particularly in communities with access to major medical centers, hospitals or universities, you should expect your “TMJ Doctor” to have an academic appointment or faculty position at one of those institutions. He or she should also be involved with teaching, lecturing, and/or publishing, as these positions and efforts are a clear indication that there is a commitment to learning and advancement of knowledge.

Most important, don’t be fooled by the ‘TMJ Doctor” who has high-tech computerized equipment that (allegedly) determines whether your bite is bad or if your jaw is in the wrong position. Though imaging technology (CT scans and MRI’s) is often important in making an accurate diagnosis, the vast majority of all TMJ problems can be diagnosed accurately with a careful history and examination. The adage, “The diagnosis is in the history if the doctor chooses to listen” holds true in just about all these situations.

Lastly, because most TMJ problems respond to treatment over time and with supportive measures to heal the injured TM joints and muscles, treatment most commonly should not require changes to your teeth or bite. If your “TMJ Doctor” recommends ongoing bite adjustments (grinding the tooth surfaces with a drill), crowns to fix your bite, or extensive orthodontics as the primary focus of care, these should be looked at suspiciously, and you should definitely seek a second opinion.

Tags Donald Tanenbaum, Dr. Tanenbaum, TMJ, TMJ Causes, TMJ Dentist, TMJ Doctor

TMJ

The Most Important Equipment in a TMJ Doctor’s Office

Modern technology, such as imaging, has led to wonderful advances in diagnosing medical problems, but for certain patients with TMJ/TMD* complaints, TMJ doctors can better understand individual patients by simply listening and looking. That’s why the most important equipment in the office is the doctor’s ears.

How is that? Simply put, most jaw disorders are rooted in a muscle problem, and the key to resolving the issue is for the TMJ doctor to understand what has compromised the muscle in the first place. With all symptoms of TMD—pain, tightness, restricted motion, sense of bite change, odd sensations in the face—there must be an explanation for why the muscles are fatigued, irritated, or contracted to the point where these symptoms emerge. Electronic diagnostic and treatment equipment is useful for TMJ doctors, but it doesn’t always reveal the ‘why’ of the problem the way simply speaking to the patient can.

Unless there has been an identifiable trauma (accident), recent dental changes, or an underlying medical problem that leads to muscle pain or spasm, the majority of all TMD muscle problems that we see stem from life challenges, conflicts, emotions, and learned behaviors. Some of these emotional or behavior triggers can include:

Gum chewing
Nail biting
Biting on pen caps, straws, or plastic items
Phone cradling
Leaning forward for long periods of time

Information about these common habits can only be gathered by engaging the patient in a conversation. In the words of famous physician Sir William Osler: “The diagnosis is in the history if we choose to listen, but most of us are deaf.”

TMJ doctors’ goal is to listen first, look second, and then integrate the information gathered to treat our patients. I suspect this formula will outlive many of the high tech diagnostic tools that continue to entice the dental practitioner looking to treat the patient with TMD.

*To understand the usage of TMJ and TMD in this article, please click here.

Tags Donald Tanenbaum, Temporomandibular, TMD, TMJ, TMJ Doctor, TMJ Doctor in Long Island, TMJ Doctor in NYC

Headaches TMJ

Causes of Migraine Headaches: TMJ?

Could TMJ be the Cause of a Migraine Headache?

The answer is: No!

People who suffer from chronic debilitating headaches are often misdiagnosed because doctors sometimes mistake tension headaches (which can be cause by TMJ disorders), for migraine headaches. The reason is that it’s not unusual for people who have TMJ to experience headaches that are as intensely painful as migraines. But TMJ does cause of migraines.

How Does TMJ Cause Tension Headaches?

Tension headaches are the most common form of headaches and can be caused by the constant tension held in the muscles in your face, head, and neck when they remain contracted over a long period of time. The tension that can build in your jaw muscles from a TMJ problem can lead to such powerful headaches that they’re often mistaken for a migraine. In addition, when the muscles in your jaw, face, or neck constrict, they reduce blood flow. As a result, less oxygen and nutrients are delivered to the muscles, which predispose them to fatigue and pain. Also, as the nerves running through the muscles become irritated, lactic acid and other irritating chemicals accumulate. The end result is more intense headache pain symptoms, that can be as intense as a migraine.

A dentist with experience in TMJ and neuromuscular disorders of the jaw can properly diagnose the difference between TMJ and migraines. Some symptoms of TMJ headaches include:

Tightness around the head
Band-like pressure around the temples
Persistent aching in the jaw muscles
Discomfort in the facial muscles
Increased pain with jaw use

Once diagnosed, there are a number of relief options for TMJ-related tension headaches. Treatments include:

Jaw and Neck Exercises
Muscular Injections
Physiotherapy
Medications
Oral Appliances
Simple Relaxation and Sleep Strategies

Before you dismiss the possibility of a disorder in the TMJ (Temporomandibular Joint), be aware of the symptomatic similarities between TMJ and migraines. The difference could mean a lifetime of relief from the pain of tension headaches.

Tags Causes of Migraine Headaches, Donald Tanenbaum, Migraine Headaches, Migraines, Tension Headaches

Bruxism Nightguards & Oral Appliances TMJ

Mouthguards & Nightguards: How Long Do They Need to Be Worn?

This is a common question asked by patients in my practice. The answer to this question is based mainly on the reason it was recommended in the first place! So, if you are wondering if you will have to wear your nightguard forever, here are some common scenarios. There’s a good chance that one of them fits your situation exactly:

Scenario 1: You have no teeth grinding symptoms, but your dentist notices that your teeth are worn or chipped or that fillings and caps previously placed look worn.

The dentist then informs you that you have been grinding your teeth at night. You’re shocked! You have no pain in your teeth, no jaw muscle soreness in the morning, and you haven’t noticed any other signs to indicate that you are grinding your teeth. Your dentist recommends that you wear a nightguard while you’re sleeping, warning of the problems that will develop if you don’t wear it.

Now here’s the important thing: If you move ahead and get the nightguard, bring it with you and show it to the dentist when you go in for your twice-a-year dental cleaning. If the nightguard exhibits grooves and notches cut into the acrylic, then you have been grinding and you should continue to use it. If, however, there is no evidence of wear and tear, it’s probably in your best interest to bring this to the attention of the dentist and discontinue using it.

Scenario 2: You make an appointment with your dentist because “out of nowhere” your jaw muscles and teeth are aching in the morning.

You mention to your dentist that stress levels have been high in your life and will likely stay that way for an undetermined period of time. A TMJ nightguard is advised and you wear it for a while and notice that the achiness in the morning has decreased.

What next? This all depends on what is going on in your life: stress, fragile emotions, disrupted sleep, etc. As these factors may drive the night grinding it is probably advisable to stay with the nightguard until things calm down. Once life is calm and if your morning symptoms have gone away, you can begin to reduce the number of days the nightguard is worn during the week.

Over time you will likely find that you no longer need the nightguard. Keep in mind, if life issues arise again, the grinding will likely return and you may need the nightguard again, so don’t throw it away!

Scenario 3: You not only have morning jaw muscle soreness, but your teeth ache and you have persistent facial pain during the day. In addition, you feel that you can’t open your mouth wide and chewing has become a chore because your jaw joints click and/or lock.

This scenario suggests that you may have a more significant jaw problem often called ‘TMJ’. Unlike the first two scenarios, the level of muscle and joint compromise is more significant with TMJ. And beyond the night grind there are likely other factors that have led to and are perpetuating the symptoms. In this situation the use of a nightguard at night will likely be for an extended period of time (maybe forever).

I have many patients who return to my office 3-6 years after they were last seen looking to get their nightguard repaired or replaced. Many of these patients tried to stop wearing it when they felt better, but the symptoms began again. In this situation I ask my patient to visit me at least once a year to help maintain the integrity of the device and make sure it is doing the right thing and not causing harm.

Note: There are many different names for dental nightguards:

Nightguard
Mouthguard
Oral Appliance
Splint

There are many different types as well. The decision to pick one type over another is usually made by your dentist based on your diagnosis.

If you have more questions about TMJ, and you live or work in New York City or on Long Island, schedule a consultation with me here or call 212-265-0110

Thank You!

Tags Bruxism, Donald Tanenbaum, Dr. Tanenbaum, Jaw Problems, Mouthguard, Nightguard, Oral Appliances, Oral Splint, Teeth Grinding, TMJ, TMJ Dentist, Tooth Grinding