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Tag: Facial Pain

Case Study: High-Powered Executive Wakes Up With A Locked Jaw donald tanenbaum dds
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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.

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.

How To Get To The Source of Your Facial Pain
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Facial Pain TMJ

Get to the Source of Your Facial Pain

Quite often patients come to our office stating that they have been diagnosed with a TMJ problem due to the location of their facial pain and jaw pain complaints. Though statistically other than toothache pain, the most common facial pain problem is due to the jaw muscles (part of the TMJ system), there are a number of other pain problems that we see routinely. These problems are in fact distinguishable from TMJ problems in a number of ways.

Remembering that a TMJ problem is an orthopedic problem, similar to those in the knees, elbows or ankles, the complaints and findings should be familiar and predictable. For instance if you have a knee problem, there is a good chance that going for a jog or using the knee repetitively during exercise would increase the pain, noise in the knee, or the experience of joint instability. The same should happen in the TM Joint during chewing or keeping the mouth open such as during frequent yawning or sitting in the dental chair.

If a patient says that she* can open and close her mouth, chew whatever she wants, and maintains jaw opening without predictably increasing pain and or making it worse, it is likely that she does not have a TMJ problem. In addition, the pain of a TMJ problem is like that in an elbow that has been overused or strained overtime. The pain has an aching quality that typically is not gone completely during some hours of a day and miserable during other hours for no apparent reason. So, if it’s not a TMJ problem, what can it be?

3 types of Facial Pain that are NOT related to TMJ:

  1. Facial Pain referred from the neck and shoulders
  2. Facial Pain of nerve origin
  3. Facial Pain due to migraines

Pain From The Neck And Shoulders: These problems are related typically to muscles in the neck and shoulders that are in a state of tension. These tense muscles have the ability to refer pain to the face (pain location is frequently not the same place as the pain origin). The pain is often felt in the lowest part of the jaw and does not typically increase with chewing…even with bagels!!!! Examination of these muscles reveals tenderness and often can reproduce the pain in the face. These muscles often refer pain to the ear and teeth prompting medical and dental investigations.

Pain Of Nerve Origin: Though often labeled Trigeminal Neuralgia (which may be the diagnosis), there are a number of variations. The most important thing to remember is that these pains can often be present for seconds or minutes and then totally go away for no apparent reason or time frame. The pain is often sharp and described as excruciating (which, in contrast, is a word never used by a TMJ sufferer). The onset of the pain is often unprovoked but in the words of many patients, “it just comes out of nowhere.” Other nerve pain problems that may be more constant often having a burning quality.

Pain Due To Migraines: Facial pain, including toothache complaints, can be due to migraine problems. This pain often has an odd character, which may include a sense of numbness in the face, and again often do not relate to jaw use. The pain may be preceded by light and noise sensitivity and or a headache across the forehead or in the mid-face region. At times a sense of nausea may accompany these symptoms. Typically these pain complaints are not accompanied by limited jaw motion, jaw noises, or eating challenges.

*Note: facial pain can affect anyone, but the majority of sufferers are female

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.

BOTOX for TMJ
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BOTOX® Bruxism

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.

Doctor, Why Does My Face Still Ache, Donald R Tanenbaum, tmj book
Categories
Facial Pain Referred Pain

Causes of Facial Pain: The Psycho-Muscle Connection

The Muscle Connection is Key

In my book, Doctor, Why Does My Face Still Ache?,” we explore puzzling questions that do not have simple or anticipated answers:
• Why would a person experience a constant toothache when the tooth that hurts is completely fine?
• How does someone gradually lose the ability to open his or her mouth or talk when there hasn’t been a direct injury to the area, or medical disease diagnosed?
• Why does someone experience non-stop aches or pains in their face when a medical evaluation suggests that nothing is wrong?

Unfortunately in the search for answers, many practitioners tend to overlook the muscle connection when it comes to the cause of facial pain. But considering how much of the face is made up of muscles, it’s beneficial to know how muscles can be affected by factors such as emotional issues and the stress of life-challenges. In the book, I call this state a “Brain Under Siege.”

Facial Pain and Emotions

A brain is under siege when it is faced with many challenges, which may include but not limited to:
• Economic uncertainty
• Loss of control relating to illness, aging parents, work relationships, etc.
• Inability to express fear and anger
• Pressure to “Keep Up with the Joneses”
• Marital and or relationship turmoil

For patients experiencing one or more (or perhaps all) of these stressors, the toll it can take on jaw and neck muscles could directly cause facial pain. I realize that many people might want to reject this theory. Our culture is such that we often look for external or structural causes of facial pain. Even medical professionals are tempted to ignore these connections to muscle pain, perhaps because they’re uncomfortable posing sensitive questions to their patients. But this doesn’t mean that a connection doesn’t exist.

Of course there are many causes of facial pain, and in many cases traditional methods of relieving this pain works fine. But each patient needs to be evaluated individually, and all aspects of what causes facial pain need to be taken into account. Most facial muscle pain sufferers can be helped, and it often requires patient insight and participation so the proper treatment can be applied.

Though we often wish it were so, sometimes facial muscle pain can’t be solved by the patient simply walking into the office and saying, ‘Doctor, fix me.’

Dr. Donald Tanenbaum is a co-founder of New York TMJ & Orofacial Pain. We have four locations in the NYC metropolitan area: Manhattan, White Plains, Long Island, and Springfield NJ. Each location is staffed with board-certified Orofacial Pain specialists who are qualified to diagnose and treat symptoms associated with TMJ problems. Find out more at www.NYTMJ.com

Facial Pain and Diabetes
Categories
Facial Pain

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.