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Tag: Orofacial Pain

woman holding jaw with discomfort TMJ hypermobility jaw instability
Categories
Facial Pain Orofacial Pain TMJ

TMJ Hypermobility: Jaw Instability, Clicking, and Ehlers-Danlos Syndrome

When the issue is joint instability, not tightness

If your jaw opens very wide, clicks frequently, and feels loose or fatigued, TMJ hypermobility may be the underlying cause. This type of TMJ disorder is driven by joint instability, not restriction, and requires a specialized approach to treatment.

When Your Symptoms Do Not Fit the Usual Pattern

Most people assume TMJ problems come from a jaw that is tight or stuck.

But some patients experience the opposite.

Your jaw may open very wide. You may hear clicking or feel shifting in the joint. Instead of restriction, it can feel loose or unreliable. The muscles around it often feel constantly tired or sore, even when you are not doing much.

If this sounds familiar, TMJ hypermobility may be part of the picture. The issue is not too little movement. It is too much. In our practice in the New York City metropolitan area, we see this pattern more often than many patients expect.

The Role of TMJ Hypermobility – Why the Jaw Becomes Painful

Hypermobility means your joints move beyond the normal range.

For some people, that simply means they are flexible. For others, it reflects a connective tissue condition such as Ehlers-Danlos Syndrome.

These conditions affect collagen, the material that gives structure and support to ligaments and joints. When collagen is more elastic than it should be, the joint is not held as firmly. It moves more than it should, and the body has to compensate.

In TMJ hypermobility, that compensation falls on the muscles.

Why the Jaw Becomes Painful

lax ligament vs normal tension joint instability diagram

When the joint lacks stability, the muscles step in to control it.

At first, this works. Over time, it becomes a problem.

The muscles are constantly active, trying to keep the joint steady. This leads to fatigue, soreness, and persistent discomfort. Many patients also notice clicking or popping, which often reflects instability inside the joint rather than something harmless.

This is what makes TMJ hypermobility different.

Instead of a jaw that cannot open enough, this is a joint that moves too much and lacks control.

A Common Pattern

In our practice, we often see patients who have always been “flexible.”

They may have a history of joint issues in other parts of the body. Ankles that sprain easily. Shoulders that feel unstable. Pain that takes longer than expected to resolve.

Some already have a diagnosis of hypermobility or Ehlers-Danlos Syndrome. Others have never connected these patterns before.

When the connection is made, their jaw symptoms finally start to make sense.

Why Treatment Has Not Worked

Many patients with TMJ hypermobility have already tried treatment.

They are often told to relax their muscles or adjust their bite. Sometimes this helps temporarily, but the symptoms return.

That is because the underlying issue is instability.

In a hypermobile joint, small strains do not fully resolve. The joint remains less supported, and the muscles continue to compensate. Over time, they become overworked and sensitive.

This does not mean improvement is not possible. It means the approach needs to change.

Treatment Focus: Stability and Control

The goal is not to change the underlying connective tissue.

The goal is to improve stability and reduce strain on the system.

This often involves reducing clenching and jaw tension during the day and protecting the joint at night with an oral appliance. Patients are also guided to avoid extreme opening, such as wide yawning or large bites.

Physical therapy plays an important role, but the focus is different. Instead of just relaxing muscles, the emphasis is on controlled strengthening and stabilization.

When muscle pain is persistent, targeted treatments may be used to help calm the system.

In some cases, therapies that support ligament strength may also be considered.

Setting the Right Expectations

With hypermobility or Ehlers-Danlos Syndrome, the underlying tissue does not change.

But that does not mean nothing can improve.

When treatment focuses on stability, protection, and control, patients often experience less pain, better function, and more confidence in how their jaw feels.

When to Seek Evaluation

If your jaw opens unusually wide, clicks along with pain or fatigue, or has not improved with previous care, it may be worth a more specialized evaluation.

This is especially true if you have been diagnosed with hypermobility or Ehlers-Danlos Syndrome, or suspect that you may be more flexible than average.

Moving Forward

If your symptoms have never quite fit the typical TMJ pattern, there is usually a reason.

Recognizing that TMJ hypermobility is often the turning point in getting the right diagnosis and treatment.

 

Woman experiencing jaw pain and holding temporomandibular joint area
Categories
Facial Pain Orofacial Pain TMJ 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

temporomandibular joint disc condyle joint space instability diagram

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.

About Our Practice →
Treatments We Provide →
Read: Women & Pain →

Woman lying down holding her jaw in pain, representing persistent neuropathic facial pain after jaw surgery that has not resolved with standard treatment.
Categories
Facial Pain

Low-dose Naltrexone Neuropathic Facial Pain

 

The Jaw Surgery Worked – But the Pain Didn’t Go Away

What low-dose naltrexone can do for persistent neuropathic facial pain

Your jaw surgery went well. The imaging looks fine. Your surgeon says everything healed the way it should.

And yet, you have pain. It aches along your jaw. The sensation feels, as one of our patients put it, like “my skin is sunburnt” – even though nothing is visibly wrong.

If this sounds familiar, you are not imagining it. And you are not alone.

Persistent pain after facial or jaw surgery is a recognized clinical reality. It has a name, a mechanism, and – importantly – treatment options that go beyond what most patients are ever offered.

Your Pain Is Real. And It Has a Medical Explanation.

One of the most disorienting experiences our patients describe is being told that everything looks fine, yet they still live with daily pain.

When surgery corrects a structural problem, but pain continues, the issue often isn’t structural at all. It’s neurological. The nervous system, particularly the pain-signaling pathways, can remain in an activated state long after the original source of injury has been addressed.

This is called neuropathic pain – pain that originates in your nervous system itself, not in damaged tissue. In some cases, it takes on a more complex form called nociplastic pain, a term from the International Association for the Study of Pain that describes pain arising from altered signaling in the central nervous system, without ongoing tissue damage to account for it.

In plain terms: your brain’s pain system has become hypersensitive. It keeps sending pain signals even after the original problem has been treated. This is not a character flaw, a low pain threshold, or something you should simply push through. It is a measurable, treatable condition.

A Case We Treated: Debbie’s Story

“Debbie” was a 52-year-old woman from the New York City area who came to us with a problem that had no easy answer.

Two years earlier, she had undergone bilateral TMJ total joint replacement – a significant surgery to address severe, progressive jaw degeneration. The procedure went well. Her jaw opened better. Imaging confirmed the prosthetics were stable. By every measurable standard, surgery was a success.

But Debbie was in constant pain.

She described a burning sensation along both sides of her jaw and temples. It was relentless, unpleasant, and unlike anything she had experienced before the surgery. She had tried NSAIDs, benzodiazepines, opioids, and anticonvulsant medications. None helped. Several caused side effects severe enough to stop.

When she arrived at our practice, the examination revealed something important: light touch to the affected areas caused heightened sensitivity and a kind of distorted sensation. This told us that her issue wasn’t structural, but neurological. Her pain wasn’t coming from the joint. It was coming from a sensitized nervous system.

This is where a mechanism-based approach – asking not just what is causing pain, but how and why her pain system had become dysregulated – becomes essential.

Introducing Low-Dose Naltrexone (LDN)

Low-dose naltrexone (LDN) bottle used in the treatment of neuropathic facial pain and centrally mediated pain disorders
Low-dose naltrexone is used off-label for neuropathic and centrally mediated facial pain conditions.

What Is Low-Dose Naltrexone (LDN?)

Naltrexone is a medication with a long track record in addiction medicine, typically prescribed at 50 to 100 mg daily. Low-dose naltrexone (LDN) refers to the same medication prescribed at a fraction of that dose – generally 1.5 to 6 mg daily – where it appears to work through an entirely different set of mechanisms. LDN is obtained through a compounding pharmacy and used off-label for centrally mediated and neuropathic pain conditions.

Naltrexone is a medication with a long track record in addiction medicine when used in large doses. But at a fraction of that dose, it appears to work through an entirely different set of mechanisms, ones that are particularly relevant to persistent, centrally mediated pain.

This low-dose application is called Low-Dose Naltrexone (LDN).

How Low-Dose Naltrexone Works: Two Mechanisms That Matter

1. Low-Dose Naltrexone helps your body produce more of its own natural pain-relievers.

At low doses, naltrexone temporarily and mildly blocks the body’s opioid receptors for a few hours. The body responds by producing more endorphins, which are its own natural pain-modulating molecules. When the mild blockade resolves, those elevated endorphins flood back into the system. The result is a net increase in the body’s own pain-relief capacity.

2. It calms an overactivated immune response in the brain.

The central nervous system contains immune cells called microglia. In patients with chronic or neuropathic pain, microglia can become chronically activated, releasing inflammatory signals that amplify pain. LDN appears to reduce this microglial activation, quieting the neuroinflammatory response that keeps pain pathways in a heightened state.

Together, these two mechanisms address something many conventional pain medications do not: the underlying nervous system dysregulation driving persistent pain.

How Low-Dose Naltrexone Is Prescribed

A bell curve graph showing Low-Dose Naltrexone (LDN) titration, highlighting the "sweet spot" where pain relief is highest before benefits diminish at higher doses.

Treatment typically begins at a very low dose nightly, with gradual increases every two to three weeks, depending on how you respond.

One of the most important things to understand about LDN is that more is not necessarily better. There is what clinicians describe as a “sweet spot”, an optimal dose where the benefit peaks. Going above that range can actually diminish the effect. This is why individualized, carefully supervised titration matters.

LDN is generally well tolerated. The most commonly reported side effects are vivid dreams, mild insomnia, or light nausea, but they are usually transient and dose-dependent. Importantly, LDN cannot be used concurrently with opioid medications, as it would block their effect.

What Happened with Debbie

Debbie began LDN nightly. After minimal change, we increased the dose and within days, her burning pain had begun to decrease substantially.

At her two-month follow-up, she described the change this way: she could still feel her face, but the sensation was no longer unpleasant or painful. After years of burning, that distinction was everything.

“She could still feel her face – but the sensation was no longer unpleasant or painful.”

Common Misconceptions About Post-Surgical Pain

Patients with persistent pain after facial or jaw surgery often encounter frustrating responses from providers who haven’t yet connected the dots between mechanism and treatment. Here is what we often hear and what the evidence actually says:

“If the surgery worked, you should be pain-free.”

Structural success does not always equal pain resolution. Neuropathic and nociplastic pain can persist independently of tissue healing.

“There is nothing left to try.”

Mechanism-based options like LDN are often not explored until later in a patient’s journey – if at all. They represent a distinct category from conventional neuropathic medications.

“It may be psychological.”

Nociplastic pain involves measurable central nervous system changes. It is not “in your head” – though behavioral and psychological factors can influence how any pain is experienced, as they do with all chronic conditions.

Who May Benefit from This Approach

Low-dose naltrexone may be an appropriate consideration for you if you experience:

  • Persistent burning or aching pain following TMJ surgery
  • Post-surgical facial pain with negative or stable imaging
  • Neuropathic facial pain that has not responded to standard medications
  • Persistent idiopathic facial pain
  • Burning mouth syndrome
  • Chronic headache or orofacial pain with a centrally mediated component

Patient selection and dose titration are essential. This is not a first-line treatment for acute or clearly structural pain. Instead, it is a targeted option for a specific mechanism.

Our Approach: Finding the “Why” Before the “What”

At New York TMJ & Orofacial Pain, we do not begin with a treatment. We begin with a question: what is actually driving your pain?

For patients like Debbie, that question led to an answer that changed everything. Her pain was not structural. It was neurological. And once we understood the mechanism, we could target it directly.

That same principle applies across the full range of conditions we treat. Whether the pain stems from muscle dysfunction, joint pathology, nerve sensitization, or a combination of factors, our goal is always the same: identify the true cause and build a plan around it, not around generic protocols.

LDN is one tool within that framework. It is not right for every patient. But for the right patient, it can offer relief that nothing else has.

Are You Experiencing Persistent Facial Pain in the NYC Metropolitan Area?

If you have had facial or jaw surgery, or if you’ve been living with facial pain that no one has been able to explain, you deserve more than temporary relief. You deserve answers.

At New York TMJ & Orofacial Pain, we specialize exclusively in diagnosing and treating TMJ disorders and orofacial pain. We take the time to identify the true cause of your symptoms and build a treatment plan that directly addresses it.

We have four convenient locations across the region, staffed with experienced orofacial pain specialists:

  • Midtown Manhattan
  • White Plains
  • Hauppauge, Long Island
  • Springfield, New Jersey

Contact us today to schedule a comprehensive evaluation.

https://www.nytmj.com/contact-us-locations/

About the Author

Dr. John Dinan is a board-certified Orofacial Pain specialist dedicated to the treatment of TMJ/TMD disorders and related conditions. He practices in our Manhattan and Springfield, NJ offices.

Learn more about Dr. Dinan →

Learn about our treatments →

Read: Trigeminal Neuralgia and the Experience of Tooth Pain →

 

Categories
BOTOX® Jaw Problems Orofacial Pain TMJ

BOTOX® For TMJ Treatment – Your Questions Answered

As a board-certified orofacial pain specialist in NYC and Long Island, I’ve used BOTOX® for TMJ treatment for over fifteen years. If jaw problems greet you upon waking up in the morning, limit your food choices, prompt you to take pain medications like Advil®, Aleve®, or Tylenol® on a routine basis, and have had a negative impact on your life, BOTOX® injections may be something for you to consider.

7 Common Questions About BOTOX® For TMJ Treatment

BOTOX® for TMJ treatment is a subject around which there is a considerable amount of confusion. To make the best decision for yourself, you should know what BOTOX® is, how it is administered for TMJ treatment, and how to choose the right health provider. Here are 7 of the most common questions I get from new patients and the answers:

1. What Is  BOTOX®?

BOTOX®, or botulinum toxin, is what’s known as a neuromodulator. Neuromodulators reduce the ability of a muscle to contract to its maximum capacity. In BOTOX® for TMJ treatment, it is injected into your temporalis and masseter muscles, which are the muscles that enable you to bring your upper and lower teeth together.

botox for tmj in nyc and long island, donald tanenbaum, BOTOX® masseter, BOTOX® temporalis

When we inject BOTOX® into masseter and temporalis muscles, it partially inhibits their ability to tighten to their fullest extent. The result is a reduction in the force of jaw clenching and grinding – one of the common causes of TMJ pain. When the force is lessened, the pain being experienced is also often reduced.

BOTOX® can also reduce the bulk and size of your jaw muscles. Some patients come to my office simply seeking to change the shape of their jaw or reduce the size of their masseter muscles.

2. What’s The Difference Between BOTOX® For Wrinkles & BOTOX® For TMJ Treatment?

In your face, you have “muscles of facial expression.” These muscles enable you to frown, scowl, flare your nostrils, move your eyelids, and smile. To do so, they pull on your skin. As you age and your skin loses some elasticity, it causes wrinkles to appear.

BOTOX® injections have been found to effectively reduce or even eliminate wrinkles by reducing the ability of the muscles to pull on your skin. But, the forces of facial expression are always present, so the use of BOTOX® injections to reduce wrinkles is a lifetime commitment.

BOTOX® for TMJ treatment works differently – instead of injecting into your muscles of facial expression, the injections are into your “muscles of mastication” (your jaw muscles). During an office visit, BOTOX® is commonly injected into four to six areas in the masseter muscle and three to four areas in the temporalis muscles.

While skin wrinkling is a normal part of aging, overworked and symptomatic jaw muscles are not. They get that way for a reason, regardless of whether you’re 18 or 80.

BOTOX® can be a valuable tool to allow your jaw muscles to heal if your pain and stiffness persist after the risk factors that caused your TMJ problems have been identified, reduced, or eliminated.

3. How Long Does It Take For BOTOX® To Kick-In?

BOTOX® and other neuromodulators, such as Xeomin®, can be life-changing. But the benefits do not kick-in right away, and most people have to wait four days to a week before they experience the first indication of relief. Here’s why:

Your muscles contain and rely on a neurotransmitter called acetylcholine which enables them to contract. After BOTOX® injections, it will take a few days for your muscles to use up their supply of acetylcholine. When the level of acetylcholine drops and is not replenished to its normal level, the positive effects of the injections are usually felt.

4. How Long Will The Benefits Last?

The vast majority of TMJ patients that chose BOTOX® find that their symptoms are reduced even after the first injection visit, though not eliminated. The getting better process is slow, as it takes months for long-term muscle injuries to heal.

The best results are achieved when patients continue to complement the BOTOX® with a nightguard, jaw stretching exercises,  a cautious diet, and ongoing efforts to pay attention to daytime jaw overuse behaviors. For most patients, there is a need for one or two additional injection sessions, spaced three months apart, so that the jaw muscles continue to get the rest they need to recover adequately. Within nine to twelve months, there is often a significant reduction in jaw muscle pain, tightness, and daily soreness.

5. How Many Injections Will I Need?

The full benefits of BOTOX® for TMJ treatment are typically not achieved from just one round of injections. Instead, you will likely require a series of injections spaced three months apart.

BOTOX® is, in most cases, not the first treatment you’ll be offered to reduce your jaw pain, soreness, stiff muscles, and motion limitations. The truth is that other treatments usually get the job done. Most of my patients get better by a combination of treatments such as modifying their diet, jaw exercises, massage, physical therapy, chiropractic care, medications, nightguards, and by non-BOTOX® muscle injections.  And most importantly, trying to reduce or eliminate daytime jaw overuse behaviors such as nail-biting and teeth clenching.

6. What Are The Side Effects Of BOTOX® For TMJ Treatment?

Repeated injections of BOTOX® in masseter and temporalis muscles over a long period of time can cause some problems. If it is not administered properly, the result can be muscle weakness, and an acceleration of joint noises, making it difficult to eat certain foods. It could hollow out your temporalis muscles and flatten the contour of your face.

Therefore, it is of critical importance that when you seek a healthcare professional to administer BOTOX® for TMJ treatment, you choose one who fully understands the anatomy and function of the muscles of mastication and the risk factors that prompted your muscles to become overused.

7. Will I Need Long-Term, BOTOX®  Injection Sessions?

There is always a  small percentage of patients whose chronic jaw muscle pain (often years in the making) require ongoing BOTOX® injections, in a way similar to Migraine sufferers. Here’s why:Muscle pain occurs when muscle fibers are injured or overworked. Injured and overworked jaw muscles, often due to daytime clenching and nighttime grinding, a high level of lactic acid is produced. When the lactic acid builds up to a high level, a muscle’s nerve endings become excessively excited, which leads to persistent pain.

The pain is now not only in the muscles but in the nerves themselves. This condition is called sensitization (think of it as a sunburn). Sensitization is much more challenging to turn off than simple muscle.

Fortunately, BOTOX® can help nerve sensitization, but the results are harder to achieve and maintain. As a result, ongoing BOTOX® injections may be needed for some patients, with a frequency of three to four times a year without an absolute stop date. Careful attention is required for these patients to ensure their jaw muscles do not become excessively weakened.

BOTOX® For TMJ Treatment – The Bottom Line

If your problems have persisted for a long period of time and despite treatment by your dentist,  you’re still suffering, the next step is to find a board-certified orofacial pain specialist that has experience using BOTOX® for TMJ treatment.

If you or someone you know is experiencing persistent or acute pain in the face or jaw, we invite you to set up a consultation with one of our Orofacial Pain specialists in the NYC metropolitan area. Our office locations and contact information are below.

You do not have to suffer every day from the pain and discomfort of TMJ. Relief is available.

More helpful information about BOTOX® from Dr. Tanenbaum:

7 Things To Know If You’re Considering BOTOX® Injections For Your TMJ

BOTOX® for TMJ Pain

relief from tmj pain, injections for TMJ, dr tanenbaum nyc, nyc tmj dentist, nyc tmj doctor
Categories
Jaw Problems Orofacial Pain Referred Pain TMJ

How To Get Relief From TMJ Pain When Nothing Is Working

When exercises, medication, nightguards, relaxation techniques, and a soft diet don’t provide relief from TMJ pain, injections for TMJ may be the next step.

What Causes TMJ/TMD Problems?

Note: TMJ stands for Temporomandibular Joint, which is your jaw joint, and TMD stands for Temporomandibular Joint Dysfunction, which refers to jaw problems. Because most people use the catchall term “TMJ” to describe all TMDs, I use the term TMJ in this article.

Anything that causes your jaws to be overworked and fatigued, such as continually clenching your teeth, biting your nails during the day, or clenching and grinding at night, puts you at high risk for TMJ. However, your TMJ problem could stem from a history of trauma or a medical or dental procedure that sprained your jaw joints or strained the muscles and tendons. In some cases, systemic disease or a disorder can predispose you to experience inflammation, pain and instability in your jaw joints, ligaments, and/or tendons.

Regardless of the cause of your TMJ, if your jaw’s in trouble, you want treatment that will provide relief.

First-Line Therapies For Relief From TMJ Pain

I’ve been a TMJ doctor and orofacial pain specialist for nearly four decades. During that time, I’ve treated thousands of patients and have at my disposal many first-line therapies to help my patients feel better and get better (once an accurate diagnosis has been made). They include:

  • Nightguards or specifically designed oral appliances that address teeth clenching, grinding, and joint instability during sleep
  • At-home exercises
  • Anti-inflammatory and/or muscle relaxant medications
  • Stress-reducing activities such as meditation or yoga
  • Adherence to a soft diet
  • Reducing or eliminating the daytime behaviors that overwork the jaws
  • Physical therapy

While most of my patients respond well to the first-line therapies above, you may be someone for whom the above strategies simply don’t work. What’s next for you?

massage for TMJ, temporalis and masseter

Injections For TMJ

I’m sure you’ve read about people having BOTOX® injections for TMJ problems, but BOTOX® is not the only injectable that can help. In fact, it is not the right choice for many patients. The good news is there are injections for TMJ that are less risky and can be very helpful to provide relief from TMJ pain. They include jaw muscle injections, injections into the tendons or ligaments, and injections into the temporomandibular joint itself.

Jaw Muscle Injections For TMJ

  • Trigger point injections, sometimes called dry needling, can help reduce the muscle spasms, tension, associated pain and limited jaw motion experienced by many TMJ sufferers. They’re also designed to reduce the likelihood of “referred” pain when irritated jaw muscles refer pain to other locations such as your teeth, ears and sinuses. With trigger point injections, the mechanical prodding of the muscle with a needle creates the benefit. Some providers inject a bit of Lidocaine, a local anesthetic, to make the procedure more comfortable. Trigger point injections are typically repeated several times before the spasms and muscle tension release. When combined with exercises and other home care techniques, trigger point injections for TMJ can be very effective for people whose problems have not responded to first-line treatments.

Tendon and Ligament Injections For TMJ

Sometimes first-line therapies fail because pain is due to stubborn and persistent inflammation in a jaw tendon or ligament. In this case, prolotherapy and steroid injections are often effective:

  • Prolotherapy, also known as proliferative therapy, involves a combination of dextrose and an anesthetic. Dextrose is a natural irritant that can kick-start your body’s natural healing response and the anesthetic helps deaden pain. When injected directly into damaged tendons and/or ligaments prolotherapy can strengthen and repair them. When combined with exercises and home care strategies, prolotherapy injections for TMJ can provide a great deal of relief from TMJ pain and also promote healing. The injections typically need to be repeated several times over a few months for full effectiveness.
  • Steroid injections into irritated tendons and ligaments can also provide life-changing relief from TMJ pain and usually are administered in a series. If overused, however, steroids carry some serious risks, so your steroid injections should be administered only under the guidance of an experienced clinician.

Injections Into The Jaw Joint

Some TMJ problems stem from inflammation or structural compromises in the jaw joint itself. They can’t move their jaw without severe pain and experience mechanical symptoms as well, such as clicking, popping, or locking and gravelly sounds emanating from the joint.   Injections directly into the temporomandibular joint can often help. There are two types of joint injections for TMJ: steroids and hyaluronic acid.

  • Steroid injections are frequently used to ease pain in the knees, hips, shoulders, etc. So, it’s no surprise that steroids can also provide relief from pain in the TM joint. Depending upon the severity of your underlying joint problem, one shot may be all you need for life-changing pain relief. If your pain doesn’t diminish with just one injection, you may need a series. Proceed with caution because, as I mentioned above, steroid injections carry risks when overused.
  • Hyaluronic acid injections into the jaw joint are another strategy. Your jaw joint contains a substance called synovial fluid, which provides nourishment and shock absorption to keep them healthy. When there’s a change in the volume or quality of synovial fluid due to jaw overuse or trauma, the result can be pain and joint noises. When hyaluronic acid, a lubricating substance, is injected into the joint, the relief from TMJ pain and noises can be profound. Research suggests that hyaluronic acid also provides an anti-inflammatory effect. The only drawback to hyaluronic acid injections for TMJ is that the positive effects can be short-lived.

New Injections For TMJ Are On The Horizon!

Many research efforts show that over 30 million Americans have TMJ/TMD problems. Some problems are minor, but others can lead to life-compromising pain and jaw function limitations. There is a great need for earlier diagnoses and pain and discomfort management for people who suffer. There’s also a need for therapies that are specifically designed for treating stubborn and persistent TMJ problems.

Fortunately, emerging therapies such as stem cell and blood component injections may be able to regenerate new tissue in TM joints, ligaments and tendons. The research is very promising, and I suspect in the near future, these new and innovative types of injections will become commonplace for treating TMJ/TMD problems and provide the kind of healing that has not been achievable with other established injection therapies.

The Last Word

If you’re suffering from jaw problems, we know what you’re going through. Orofacial pain specialists like us have the knowledge to accurately diagnose your problem and the skills to help you find relief from TMJ pain, whether by first-line therapies or injections for TMJ. We invite you to set up a consultation with one of our Orofacial Pain specialists in the NYC metropolitan area. Our office locations and contact information are below. If you’re not in the NYC metropolitan area, go to the American Board Of Orofacial Pain and search for a physician with diplomate credentials in your area.

Feel Better!

 

Further Reading:

All About BOTOX® For TMJ

What Is Referred Pain?

The Connection Between Pain & Sleep

Categories
Bruxism Jaw Problems Orofacial Pain

3 Tips To Reduce Jaw Problems From Aligners

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

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

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

Jaw Problems – During The Day

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

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

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

Jaw Problems – While You’re Asleep

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

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

3 Tips To Help Reduce Jaw Problems From Aligners

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

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

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

Conclusion

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

Helpful Links:

dental night guard, tmj, nyc tmj doctor, dr tanenbaum
Categories
Headaches Jaw Problems Nightguards & Oral Appliances Orofacial Pain TMJ

Which Type Of Dental Night Guard Is Right For You?

As an orofacial pain specialist, patients come to me when they’re suffering from the painful symptoms of a temporomandibular disorder, which you may know as TMJ. TMJ refers to the temporomandibular joint, the joint that enables you to open and close your mouth. Many new patients who come to my office have been wearing a standard dental night guard (sometimes called an oral appliance, occlusal splint, or mouth guard) while they sleep, but their symptoms are not improving or even getting worse. Before I explain which type of dental night guard is right for you, I want to make sure you understand TMJ and its causes.

First, What Causes TMJ?

Symptoms of jaw (TMJ) problems often arise due to sleep bruxism, a condition characterized by constantly grinding or clenching your teeth during sleep. Sleep bruxism affects about 10% of adults and up to 15% of children.

The American Dental Association has been surveying dentists about TMJ since the beginning of the pandemic. More than 70% report a significant increase of patients who are grinding and clenching their teeth both during sleep and while awake (called awake bruxism) – many of whom never had the issue before. Some patients even have cracked or broken teeth as a result of bruxing. Bruxism is thought to be related to several risk factors, including high-stress levels – so it comes as no surprise that this increase coincides with the pandemic.

How To Determine Which Type of Dental Night Guard Is Right For You

If you’re like many people, your dentist may have informed you that your teeth are becoming flat and worn-down because of grinding and clenching while you’re asleep. Your dentist may have recommended you start wearing a dental night guard while you sleep, or you may have already purchased one over-the-counter at your pharmacy.

If this sounds familiar, the standard type of night guard made by your dentist is probably adequate. However, over-the-counter night guards must be used with caution and for a limited amount of time because they can cause your teeth to shift.

However, if you’re one of those people who have a sense that something’s wrong because your teeth are sore, or your jaw muscles feel tight when you wake up in the morning, or if you have any of the symptoms listed below, a standard guard made by your dentist or an over-the-counter night guard you buy at a pharmacy is probably not the dental night guard that’s right for you.

All Dental Night Guards Are Not The Same

TMJ problems often involve the structures of your temporomandibular joints and usually require more evaluation and different types of dental night guards for your specific problem. If you suffer from any of the TMJ symptoms below, a standard dental night guard will likely not address your specific problem and could even make your problems worse.

Symptoms of TMJ:

  • Difficulty opening your mouth
  • Pain (beyond soreness or discomfort) when opening/closing your mouth
  • Jaw pain when you eat
  • Clicking or popping in your jaw during movement
  • A sense that your jaw is locked
  • A feeling that your bite is “off”
  • Daily pain and tension in your face
  • Headaches when you wake up
  • Tension or pain in your neck

Like other joint systems in your body, TM joint problems are orthopedic problems. There are ligaments that support your jaw joints and shock-absorbing discs that cushion them. And, there’s also a lubrication system that keeps your TMJs moist and nourished. These all can become compromised due to teeth grinding and clenching, whether it happens while you’re asleep, during the day, or both.

The result is often injury to your TMJs resulting in sprains, instability and painful inflammation. Sometimes, the pressure of grinding and clenching can even cause one of your shock-absorbing discs to change and cause joint noises, lockjaw and pain.

What To Do Next

Your next step is to make an appointment with an orofacial pain specialist. An orofacial pain specialist will likely provide you with a clear understanding of your problem (a specific diagnosis beyond “you have TMJ.”). And explain why your jaw muscles and joints are in trouble and what treatments are available in addition to a dental night guard. Many factors can give rise to a TMJ problem, so you will likely be asked questions about your medical health, mental health, sleep, dental history, and about you as a person.

Based on the information gathered and an examination, there’s a good chance your orofacial pain specialist will fabricate a dental night guard that’s right for you – designed to address your specific orthopedic problem – not just to protect your teeth. Factors like the thickness of the night guard, its surface (flat or designed to prevent shifting of the lower jaw), its use on the upper or lower teeth, and where the support is provided are just some of the factors that will be considered.

To find an orofacial pain specialist in your area, ask your dentist for a referral or check the directory at the American Board of Orofacial Pain website.

Your Dental Night Guard Needs To Be Monitored

A diagnosis beyond “You have TMJ” is essential in designing a night guard that will reduce strain and injury to your jaw muscles and tendons, joint ligaments, shock-absorbing discs and lubrication systems. Here’s the most important thing to understand: regardless of whether your dental night guard was designed by your dentist or an orofacial pain specialist, it will not stop your bruxism. When properly designed, your night guard will instead reduce the impact on your teeth, muscles and TMJs caused by your grinding and clenching. In essence, it lets you clench or grind in a “better neighborhood” with the goal of keeping more injury from occurring while you work on reducing the risk factors that caused your jaw to be in trouble in the first place.

And, because a well-constructed dental night guard redistributes force, it must be monitored and adjusted while healing occurs and your symptoms change. It’s essential to go in for regularly scheduled reassessments and modifications to maximize the potential for treatment to be successful.

So, Which Type Of Dental Night Guard Is Right For You?

If you wake up with any of the TMJ symptoms above – even if you’ve been wearing a dental night guard, do not give up hope! A more specific diagnosis, a better understanding of why you have the problem, and a night guard designed to address your individual symptoms may well be the answer. Based upon the nature of your problem, more comprehensive care is usually part of the plan, which may include exercises, stress-reducing activities such as mediation or yoga, medication, dry needling and trigger point injections, BOTOX® injections or joint injections. These decisions are best made by an orofacial pain specialist.

Feel better!

Learn more about TMJ and bruxism here

evaluate yourself for TMJ, TMJ, Donald Tanenbaum
Categories
Headaches Jaw Problems Nightguards & Oral Appliances Orofacial Pain Sleep Apnea TMJ

How To Evaluate Yourself For TMJ

Note: This article explains how to evaluate yourself for TMJ, what you can do about it, and how to determine when you need to get some professional help.

This past year’s pandemic challenges have led more people to seek care for TMJ problems than ever before. In fact, you may be reading this article because you’ve had your first experience of TMJ during the past year.

If you suffer from these kinds of problems, there are some steps you can take to relieve your symptoms. But before you try to evaluate yourself for TMJ, you must first understand the risk factors that led to your jaw being in trouble in the first place.

As an orofacial pain specialist for the past 35 years, I have treated thousands of patients who came to me suffering from jaw problems. They usually arrive at my office with complaints of jaw pain or stiffness, headaches in their temples, or facial pain that, in some cases, is taking over their lives. Many have limited jaw opening, joint popping and/or cracking. Some even experience locked jaws upon waking up in the morning.

While a traumatic event such as a car accident or an underlying medical disorder or treatment can be the culprit, for most people a wide variety of risk factors can cause TMJ pain problems. It is my job to properly diagnose, identify the causes, help my patients cope with TMJ – and eventually, get better.

Before You Evaluate Yourself For TMJ, You Must Understand What TMJ Is

The most important thing to understand about TMJ problems is that they are orthopedic in nature. Just like any other muscle and joint structure in your body – knees and shoulders, for example – if they become overworked, sprained, fatigued or injured, pain and instability will arise. Your jaw muscles and jaw joints (TMJs) are no different. An orthopedic problem can’t be treated until what is causing the pain is identified. It’s the same for TMJ problems.

How To Evaluate Yourself For TMJ – Identify The Cause & Make Changes

TMJ problems can involve your muscles, joints or both. To evaluate yourself for TMJ joint problems, pay attention to whether the pain is in front of your ear when you move your jaw or touch the area and if your jaw joints click, pop and/or lock. If you can answer yes to both questions, you should not try to cure yourself. See a dentist with experience in TMJ care or a TMJ specialist in your area right away. (There’s a link at the bottom of this page to the American Academy of Orofacial Pain, where you can find a specialist in your area.)

To evaluate yourself for TMJ muscle problems, you would probably describe your symptoms as soreness, stiffness, spasms or achiness. If you push your fingers firmly along your jawline or into your temples, you will experience more pain than you expected. Your jaw motion may be limited but it’s not accompanied by joint clicking or popping sounds.

If you’ve determined your TMJ problem is of the muscle variety, your next step is to figure out why and how your muscles became so irritable in the first place. To do so, you’ll need to do a little investigating to find out what is happening in your life during the day and at night.

6 Daytime Behaviors & Postures That Could Be Causing Your TMJ Problems

Starting today, pay careful attention to your daytime behaviors and postures, particularly while you’re working. Working behaviors and postures are some of the leading causes of TMJ problems. And, working at home is a big reason for the considerable increase of people seeking care during the past year.

When you evaluate yourself for TMJ of the muscle variety, look for these six common daytime behaviors that could be causing your jaw or neck muscles to fatigued:

  • Your head leans forward while you work at your computer.
  • You consistently look down at your phone.
  • You hold your breath or take shallow quick breaths with your mouth open.
  •  You brace your jaw muscles (but your teeth are not clenched).
  • You often keep your teeth clenched.
  •  You bite your nails and/or cuticles, cheeks, lips or tongue.

Did you identify any of the six behaviors or postures above during your workday? If you said yes, believe it or not, that is good news! Because if you can start eliminating them right away. And there’s a pretty good chance you can start feeling better right away, too.

Start by paying attention to your breathing patterns. If you discover that you hold your breath or breathe shallowly, go online and search for “restful breathing techniques.” You’ll see a lot of results and almost any you choose will help. Also, take more breaks. And make some adjustments to your workstation to improve your head posture. (Here’s a helpful guide). Also, download a reminder app such as Time Out for Mac that will help you remember to take breaks.

5 Nighttime Factors That Could Be Causing Your TMJ Problems

An essential step in evaluating yourself for TMJ is identifying what is happening to your jaw muscles, jaw joints or neck muscles while you’re asleep. This, understandably, is not easy – but it’s definitely doable. If you consistently wake up with jaw or neck pain, tightness in your jaw, or headaches – you can assume one or more of the following four factors are present:

  • Insomnia – You have trouble falling asleep or staying asleep.
  • Fragmented Sleep – Your sleep is full of lots of small arousals. Your brain wakes you up numerous times during the night.
  • Inadequate Sleep – You routinely get less than the recommended hours of sleep. (See the link at the bottom of this page to determine what is recommended for your age group).
  • Bruxism – You clench and/or grind your teeth while you sleep.
  • Breathing Problems – You struggle with breathing due to nasal or other airway restrictions while you sleep.

If you suspect factors 1, 2 or 3, try one or more of the following:

  • Take melatonin at bedtime.
  • Don’t drink coffee after noon.
  • Don’t use your electronic devices late into the evening.
  • Stop all work-related activities one hour before going to bed.
  • Read a good book.
  • Exercise in the morning instead of after work.
  • Eat dinner earlier.
  • Practice some breathing exercises before you get into bed.
  • Try some gentle stretching or yoga before bed.

If you suspect factor 3 – Bruxism – this is for you:

If you wake up occasionally with sore teeth but nothing more severe than that, consider purchasing an over-the-counter oral appliance at your local pharmacy. (Note: there are many terms for oral appliances such as mouthguards, bite plates, and teeth protectors – they all mean pretty much the same thing.)

If your symptoms get better after wearing your over-the-counter oral appliance at night for several weeks, your next step is to visit your dentist to be fitted for a custom oral appliance. This is very important because wearing an oral appliance over a long period of time that is not custom-fitted can lead to complications such as shifting teeth, bite changes and even airway obstruction.

If your symptoms do not get better after wearing your over-the-counter oral appliance it’s time for you to get some professional help. Make an appointment with your dentist or an orofacial pain specialist. (See the link at the bottom of this page to the American Academy of Orofacial Pain to find an orofacial pain specialist).

If you suspect Factor 4 – Breathing Problems – here’s what to do:

If your self-evaluation for TMJ leads you to suspect you have a nighttime breathing problem – it may be sleep apnea and you must see a sleep professional right away. Your struggle to breathe at night is likely reducing airflow and causing your blood oxygen to lower. That places excess stress on your body.

You should opt for an overnight sleep evaluation monitored by a professional. (Link here to find a sleep center near you.) If the sleep evaluation indicates you do have a sleep breathing disorder such as apnea, there are many options for you after the sleep study. You may be told to sleep on your side, wear nasal strips, use a custom-made oral appliance, or lose weight. Many people find that a continuous positive airway pressure (CPAP) machine is a lifesaver. (Read: What Is CPAP?) In severe cases, nasal surgery, orthodontics, jaw advancement or another correction surgery may be the solution.

How To Evaluate Yourself For TMJ – In Conclusion

Let’s say you have been able to get your TMJ problems under control by changing one or more of the six daytime behaviors above. That is great. And even if your nighttime behaviors are of the Factors 1, 2, or 3 variety and you tried some of the simple solutions I recommend, there’s a chance you’re already feeling better.

TMJ problems, however, are often caused by several risk factors. For you, relief may only be achieved with a professional approach. Take a little bit of time to find a trained orofacial pain practitioner in your area and you should be able to get on the road to feeling better very soon.

Helpful Links:

American Academy Of Orofacial Pain (Look for a provider with Diplomate status)

How Many Hours Of Sleep Are Enough For Good Health?

Botox - 7 things to know
Categories
BOTOX® Jaw Problems Orofacial Pain TMJ

7 Things To Know If You’re Considering BOTOX® Injections For Your TMJ

As an orofacial pain specialist and an expert in the treatment of temporomandibular disorder (commonly referred to as “TMJ”), most patients who seek my care have been suffering from persistent jaw pain, tightness, and soreness due to overstressed muscles – often for years. Tension in the masseter (jaw) muscles are at the root of this disorder and can be caused by several factors, with bruxism being the most common.  

If you’re considering BOTOX® injections for your TMJ, there are a few things you should know.

Bruxism comes in two forms: awake bruxism and sleep bruxism. Awake bruxism is excessive contact of the teeth during the day. Your teeth should never be in frequent contact during waking hours. Consistently clenching or grinding your teeth while sleeping is called Sleep Bruxism. 

Orofacial pain specialists like myself have been carefully turning to BOTOX® injections for TMJ problems for the last few years. While BOTOX® injections were initially approved to reduce facial wrinkles and frown lines, the medical community has recognized its use to help patients who have migraines and other conditions, including TMJ. If you’re considering BOTOX® injections for your TMJ because nothing else has worked, here’s what you need to know and understand:

7 Things To Know If You’re Considering BOTOX® Injections For TMJ

1. BOTOX® Reduces Muscle Contraction

When injected into the masseter muscles, BOTOX® reduces their ability to contract fully. During the 3-4 months after you’ve had injections, your masseters will exert a lower amount of force than normal. While your brain may be telling your muscles to contract with a normal amount of force, as long as the BOTOX® is active, they simply can’t. 

2. BOTOX® Can Provide Some Pain Relief

When BOTOX® is injected into muscles, it causes the muscle to relax, and less lactic acid and other pain-producing chemicals accumulate. As a result, the nerve endings within the muscle tissue become less irritated and sends fewer pain signals to the brain. 

At the same time, BOTOX® also directly reduces the release of pain-producing chemicals (neuro-transmitters) by the nerve endings in the muscles. That’s one of the reasons why BOTOX® reduces pain in migraine sufferers. 

3. BOTOX® Stays Where It’s Put

When injected by a trained clinician, BOTOX® will not typically diffuse into neighboring tissues – as long as the proper volume and technique are used. 

To treat TMJ, BOTOX® injections typically go into your masseter and temporalis muscles, which are the muscles responsible for closing your jaw from an open position. BOTOX® is sometimes also injected into your lateral pterygoid muscles – the ones that allow you to open your mouth and move your jaw from side-to-side.

4. BOTOX® Is Not A Stand-Alone Treatment For TMJ

Symptoms such as jaw locking or clicking are usually caused by loose ligaments and changes in the position of your shock-absorbing disc. BOTOX® injections do not predictably help these problems. Nor can BOTOX® minimize inflammatory pain in your TMJs. 

Locking, clicking, and disc problems require a different level of care. Therefore, an accurate diagnosis is absolutely necessary before BOTOX® injections are considered. When chosen, BOTOX® is commonly complimentary to other TMJ treatments such as medication, oral appliances, exercises, meditation, and physical therapy. This is very important to understand if you’re considering BOTOX® injections for your TMJ.

5. BOTOX® Injections Should Be Administered By A Healthcare Provider Who Has A True Understanding of TMJ Problems

Knowing how to inject BOTOX® is only part of the equation. The practitioner doing the injecting must fully understand how the jaw works, the risk factors that lead to muscle pain and over development, and how a patient’s bite relationships relate to their jaw muscles. A trained dentist or dental specialist is likely best equipped to answer these questions and provide the education that is needed to assure treatment results. 

6. BOTOX® Injections For TMJ Are Not (Usually) A Once-And-Done Therapy 

Most people who end up having BOTOX® injections for TMJ have been suffering for many years. One series of injections alone will rarely if ever, solve the problem. Many patients who find relief after the first series of injections can see their symptoms return, particularly if the pertinent risk factors (what caused the problem in the first place) have not been identified and addressed. If you’re considering BOTOX® injections for your TMJ and plan for only one series of injections, you’ll likely be disappointed.

7. BOTOX® Injections Can Give You A Slimmer Jawline 

BOTOX® is becoming an accepted solution for people who are unhappy with the shape of their jaw. If your masseter muscles are enlarged due to bruxism or daily habits such as gum chewing, BOTOX® injections can be extremely helpful in slimming its appearance.

After a series of injections, BOTOX® will increase the amount of collagen and fat in your masseters and shrink the size of muscle fibers. This is why slimming occurs.  Along with muscle slimming, BOTOX® injections can also weaken the muscles making chewing more difficult. This is why a trained practitioner is advised.

BOTOX®: A Tool, Not A Cure 

BOTOX® injections for TMJ are not a cure. They are, however, a vital tool of orofacial practitioners like me. If your doctor or dentist has tried everything, and you’re still suffering, BOTOX® may be your next step. Make sure that the person who administers your injections is highly knowledgeable, skilled, and trained in using BOTOX® injections for TMJ. 

Choose carefully.

(Learn more here: All About BOTOX® For TMJ)

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

 

wearing a mask causes TMJ symptoms, tmj, bruxism, ear loops, trigeminal nerve, tmj doctor in New York, donald tanenbaum
Categories
Ear Pain Facial Pain Jaw Problems

Why Wearing A Mask Can Cause TMJ Symptoms

Wearing a mask all day is routine for some people, including dentists and surgeons. It’s just part of their jobs and they’re used to it. For everyone else wearing a mask for all (or most) of the day is completely unnatural. And, what’s going on under our masks can cause many problems – because wearing a mask can cause TMJ symptoms to emerge.

Without even realizing it, you may be pressing your lips together in a pursed position or clenching your teeth under your mask. These are normal human reactions to fear, anxiety, and worry. But, when the jaw and facial muscles in this contracted position for an extended length of time, they become overworked. And, like any other muscle in your body, when jaw and facial muscles become overworked, lactic acid accumulates. That irritates the nerve fibers running through the overworked muscles. The result is pain. Sometimes, “really bad pain.”

4 Ways to Reduce (or Avoid) TMJ Symptoms While Wearing a Mask

Most of us are required to wear a mask in public these days. As a board-certified orofacial pain specialist, I’m have been seeing patients whose previous symptoms are getting worse, people whose previously-resolved symptoms have returned, and many people who never had TMJ problems in their lives. Here a few of the tips I give them to help reduce their TMJ pain and/or minimize the potential for pain to emerge:

  1. Avoid Chin-Pullavoid ear pulling mask, wearing a mask can cause TMJ symptoms, donald tanenbaum, tmj doctor in nyc, tmj doctor in long island
    Most masks extend under the chin, and that’s a good thing. If you wear a homemade or surgical mask you’re probably pretty comfortable because it fits loosely. But, if you wear an N95 or KN95 mask, it fits tighter and applies tension to your chin that pulls your jaw upwards. Many of us are unconsciously and repeatedly pushing down on our chin attempting to move the mask away and release the tension. As a consequence, we experience fatigued and sore muscles. I recommend only wearing tight N95 or KN 95 masks if you’re out shopping, plan to be in a crowded area with poor ventilation, are using public transportation, or will be in a public space with other people for a sustained period of time. Because wearing a mask can cause TMJ symptoms, I recommend your use a less-restricting mask when you’re not in a risky environment.
  2. Stop Using Ear Loopsavoid ear pulling mask, wearing a mask can cause TMJ symptoms, donald tanenbaum, tmj doctor in nyc, tmj doctor in long island
    Earloops that pull and tug on your ears are another reason why wearing a mask can cause TMJ symptoms. They can cause pain that can be felt from your ears, across your jaw joints, and into your face – all within a short period of time. Some people even get headaches that extend from their ears into their temples. The culprit is the trigeminal nerve. The trigeminal nerve (visible in the diagram above) is responsible for face and jaw sensations and influences the muscles that allow you to move your jaw. When your mask’s ear loops are constantly tugging, the trigeminal nerve can become excessively excited, resulting in pain and tension in your jaw muscles. A great solution to this problem is ear savers. Ear savers allow you to ditch earloops and eliminate the maddening pulling they can cause. If you’re crafty, you can make them yourself – there are lots of instructional videos on YouTube). For the rest of us, it’s easy to find them online. In fact, Etsy has a huge selection of ear savers and they are very affordable.
  3. Keep Your Neck Muscles Loosesore neck, wearing a mask can cause TMJ symptoms, donald tanenbaum, tmj doctor in nyc, tmj doctor in long island
    Another reason that wearing a mask can cause TMJ symptoms involves your neck. Your mask can cause you to change your normal head position. That can have a negative impact on your neck muscles. Several of my patients, after sometimes just a few hours of mask-wearing, experience stiff and aching neck muscles. Their tense neck muscles ultimately lead to jaw pain and sometimes limited jaw motion – typical symptoms of TMJ. If your neck is stiff and sore, check out Bob and Brad’s neck exercises on YouTube. Bob Schrupp and Brad Heineck are physical therapists. They offer advice, tips, and information on how to stay healthy, fit, and pain-free. (They’re very entertaining, too).
  4. Smile!mask can cause TMJ symptoms, donald tanenbaum, There’s a pretty good chance that while your face is covered by a mask, you don’t smile very much. Plus, if you have your lips pursed and your teeth clenched under your mask,  there’s a good possibility that you’re holding your breath, too.

Try to keep a smile on your face when your mask is on. This may seem ridiculous because no one can see your mouth, but try to keep your lips loose and your teeth apart as much as possible. Concentrate on your breath now and then, which also helps your jaw to relax.

It’s True: Wearing A Mask Can Cause TMJ Symptoms

There’s no question we live in very stressful times and, for most people, wearing a mask feels unnatural. If you already have TMJ symptoms or want to avoid them, please try some of the tips in this post. You can be safe and comfortable at the same time.

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

 

 

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Orofacial Pain TMJ

Orofacial Pain & TMJ Consultations Online – A New Era

An outcome of the coronavirus pandemic is orofacial pain specialists are conducting TMJ consultations online. The new era has begun…

As a dentist whose focus is directed toward treating orofacial pain and TMJ/TMD problems, I have seen first-hand the impact of life’s worries and challenges on people of all ages. 

In normal times people seek my services because their jaw muscles are sore, tired, and aching. Any number of issues, from financial worries, relationship trouble, medical stress, family problems, poor sleep, or workplace tension, can upset the brain leading to muscle tightness and, ultimately, the onset of symptoms.

When your brain is upset, what would normally be perceived as tolerable pain can become so severe that it affects your life.

The Connection Between The Upset Brain & TMJ

 A very common consequence of an upset brain is tooth and clenching and/ or bracing of the jaw muscles even without tooth contact. These activities can occur while you sleep, during the day, or both, overworking the jaw muscles and setting the stage for disruptive jaw or face pain, persistent toothaches, cracking/popping in the jaw joints, and the potential onset of TMJ problems (you can read more about TMJ here).

The current pandemic is affecting everyone. Even those who felt we had our lives under control before the crisis now face a threat we have few skills to confront. This stress can lead to an upset brain.

Therefore, it’s no mystery why patients currently under care, past patients, and those who never sought my care before are reaching out – desperate for relief. 

TMJ Consultations Online Now

During the COVID pandemic, we were not to go about business as usual. But we have been able to address the pain relief needs of patients with online TMJ consultations. For a number of years, these telehealth options have been available, but it took a crisis like the pandemic to make orofacial and TMD pain practitioners all over the world realize how invaluable and effective online consultation visits can be!!!

It turns out that TMJ consultations online give me the opportunity to meet the person behind the symptoms, and do it in a safe and low-stress atmosphere. TMJ consultations also enable a spouse, partner, or other family members to be in attendance as a second set of eyes and ears. 

And an added and unexpected benefit of TMJ consultations online is they enable patients, particularly those who are new to my practice, to meet me without my face obscured by a mask, glasses, and shield. 

TMJ Consultations Online In The Future

TMJ consultations online will never fully replace the benefits gained by hands-on examinations in my office. However, I foresee I’ll be using them to reduce the time new patients need to spend in my office – by about 30 minutes. Until social distancing becomes less critical, reducing the time we all physically spend together is an important consideration. 

I am grateful for platforms such as Zoom and Doxy as we move into our “new normal.” I clearly see that the use of technology, combined with imagination, and an ongoing commitment to providing safe and thoughtful care, will enable patients to get the care they need when they need it and for practitioners like myself, to provide it. 

Today, TMJ consultations online for new patients are an innovative concept. In the future, they just may be the norm.

 

If an online consultation is of interest to you, please send an email to office@drtanenbaum.com with your contact information. A staff member will reach out to you.

 

 

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Jaw Problems Orofacial Pain TMJ

Orofacial Pain Is A Board-Certified Specialty

For decades, the field of orofacial pain was not a specialty recognized by the American Dental Association. This made it difficult for patients who suffered from TMJ and jaw problems to get proper treatment.

Equally difficult was the fact that dentists and dental specialists had a hard time finding practitioners to refer their patients to who had the experience and skills to assess and manage these problems and sometimes disabling pain conditions. For years, orofacial pain academies and the American Board of Orofacial Pain consistently urged the American Dental Association to designate orofacial pain as a board-certified specialty. Their efforts were always met with defeat.

As a result, practitioners were left to take on the challenges of treating patients with facial and jaw pain (TMJ), with the knowledge that people in leadership at the ADA had not yet grasped the importance and professional value of this initiative. Despite these setbacks, the push to create a new specialty was never abandoned.

On March 31, 2020, the American Dental Associations’ National Commission on Specialty Status finally approved orofacial pain as a specialty. (To see the full definition, scroll down)

What Does This Mean For Patients?

Because of this move, I expect more dental schools to expand their commitment to teaching the concepts of orofacial pain assessment and treatment. As a result, more dentists will graduate familiar with the pain problems they will encounter in their practices, including TMJ. In addition, over time, graduating dentists will pursue careers in the field and fill voids that currently exist in communities throughout our nation and the world. It’s too early to predict the full outcome of this important new designation, but I’m hopeful that people who are suffering will find it easier to get the treatment they so desperately need. 

If you have questions about  TMJ, please feel free to reach out to me.

Onward and upward! 

Definition Of Orofacial Pain

The specialty of Orofacial Pain (OFP) “involves the assessment, diagnosis and treatment of patients with orofacial pain disorders, including temporomandibular muscle and joint (TMJ) disorders, oromotor and jaw behavior disorders, neuropathic and neurovascular pain disorders, and related head and neck pain, as well as expanding our knowledge of the underlying cause and mechanisms of these disorders. This specialty also includes screening, management, and coordination of care associated with sleep-related breathing disorders.”

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Bruxism Case Studies Orofacial Pain TMJ

The Connection Between PTSD & TMJ

Identifying the origin of a patient’s chronic orofacial and TMJ pain is what makes my work both challenging and rewarding. Sometimes the answers are readily apparent while at other times uncovering important clues is more difficult. In all cases, there is no substitute for obtaining a careful history as the insights gained often help point to the mechanism of pain that is driving a patient’s suffering.

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

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

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

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

PTSD Affects The Nervous System In A Specific Way

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

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

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

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

PTSD & TMJ – A Case Study

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

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

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

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

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

Can A Combination Of PTSD & TMJ Be Treated?

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

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

Conclusion

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

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

 

 

 

woman on scale with tape measure_Facial Pain - Is It Bruxism or Is It Bulimia, donald tanenbaum, tmj doctor
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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:

  1. No signs of the kind of tooth wear characteristic of bruxism were detected.
  2. Her masseter (jaw) muscles were not rock hard and well-built, typically a sign of bruxism.
  3. The biting surfaces of her lower molars showed a complete loss of enamel.
  4. 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.

The Latest In TMJ Treatment Strategies Donald Tanenbaum
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Orofacial Pain TMJ

The Latest In TMJ Treatment Strategies

This post has been updated and can be found here. 

If you’re someone who suffers from TMJ, you’ve likely tried numerous strategies to feel better. Jaw problems show up as facial pain, jaw pain, and even persistent toothaches, any of which can ruin the quality of your life. The good news is that everyday studies are done and discoveries are made that help get to the bottom of what causes these problems, which helps us find new and innovative TMJ treatment strategies to tackle them.

As an orofacial pain specialist*, my life is dedicated to helping people just like you and it enables me to be at the cutting edge of what’s working and what’s not. At the end of 2017, I took a little bit of time to reflect on the strategies that are helping my patients, some of which are a bit “out of the box”. I thought I’d share them with you:

1. Healing Is A Process

The most important thing I want you to understand is this: Healing is a process – not an event. Only when the risk factors that got your jaw in trouble in the first place have been identified, can TMJ treatment strategies for healing be put into place. Most jaw problems come on slowly and that’s how they resolve…slowly. Treatment takes time. And, I can’t stress this enough: you must be an active participant if your healing is to be successful. That means doing the exercises, wearing the oral appliance, practicing the meditation techniques, etc. Patience is key.

2. Anti-Depressants Could Be A Culprit

Although not the most common scenario, some of my patients who are on SSRI anti-depressant drugs such as Paxil, Effexor, Prozac, and Lexapro experience increased muscle pain in the neck, face, and jaw. I came to this realization by the process of elimination. There were just too many patients in my practice who had none of the typical risk factors. All of them were on SSRIs. With the involvement of their prescribing physicians, switching to alternative medications or taking a lower dosage provided them with profound pain relief. If you’re on an SSRI, you may want to speak to your doctor about adjusting your meds.

3. Sleep Quality & Quantity

The quality and quantity of sleep you get is one of the clues I look for when evaluating a patient. If you have insomnia or a sleep-related breathing disorder (obstructive sleep apnea, for example), it must be addressed before we can commence a TMJ treatment strategy to ease your persistent pain problem.

4. Lowered Pain Thresholds

Many people suffer from acute jaw, facial, or tooth pain because their overall pain thresholds have dropped. The most common cause is simply the way they live their lives. By consistently burning the candle at both ends (long work hours, little sleep, lots of stress) you keep your body in perpetual fight or flight mode. You may not be able to change your job or keep your baby from crying all night, but I’ve discovered that Chinese temple exercises or Tai Chi for just 30-45 minutes a day can work wonders for people like you.

5. Night Tooth Clenching & Grinding

Bruxism, which affects more than 10% of the population, disrupts the quality of sleep and wreaks havoc on the jaw muscles. If you habitually clench and grind, there’s no way your muscles can heal. There are many ways to stop this damaging behavior including special oral appliances and meditation techniques, all of which over time are very helpful. But again, positive outcomes will depend upon your commitment and participation to the TMJ treatment strategies that are designed for you.

6. Supplements

Despite industry claims, it’s unclear if any supplements are truly effective for pain relief. However, some of my patients are convinced that Fish Oil and Magnesium help with pain relief. Some take turmeric daily, too, and swear by it. If you’re going to go the supplement route make sure your physician is aware and involved.

7. Food As Medicine

Research has finally identified some foods that can substantially reduce nerve sensitization and inflammation, both of which cause pain. Grape seed extract, organic chicken broth, and cocoa (72% dark chocolate) combined with other TMJ treatment strategies can help diminish pain-prompting risk factors. Unfortunately, the research is in its infancy and I can’t recommend specific quantities; but moderation is always a good mantra. 

8. Breathing 

People with chronic pain are known to breathe fast and shallow. This rapid breathing causes excessive amounts of carbon dioxide to be expelled and can lead to high levels of muscle tension and nerve excitation in the body. And, rapid breathing makes it harder for your body to use oxygen. For many patients, the treatment strategy involves slow-paced belly breathing, yoga classes (particularly those that focus on the breath), meditation (Headspace.com is a great app to help you learn), and overall mindful living.

Conclusion:

By caring for TMJ patients for over 35 years I’ve discovered two important things. The first is that taking the time to discover who my patients are (not just as patients, but as people) is the only way to put the right TMJ treatment strategies into place and successfully help them get better. And secondly, the patient’s full participation is required all along the way.

There’s no good reason that you should have to suffer from persistent jaw, tooth or face pain for the rest of your life. I hope you found this article helpful.

I wish you the best of luck on your journey to healing.

* Orofacial Pain is the discipline of Dentistry which includes the assessment, diagnosis and treatment of patients with complex chronic orofacial pain and dysfunction disorders, oromotor and jaw behavior disorders, and chronic head and neck pain, as well as the pursuit of knowledge of the underlying pathophysiology and mechanisms of these disorders.

Who To Choose: BOTOX Injections For Jaw Problems Dr. Donald Tanenbaum
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BOTOX® Bruxism Jaw Problems Nightguards & Oral Appliances Orofacial Pain

BOTOX® For Jaw Problems – Who To Trust

The effectiveness of BOTOX® to erase the signs of aging is well-known. But BOTOX®, as you may have heard, can be used to treat a number of medical conditions, as well. As the popularity of BOTOX® has grown so has the number of people who are willing to inject it. BOTOX® for jaw problems, including symptoms associated with TMJ (temporomandibular joint dysfunction), is no exception.

If you’re reading this article you’re possibly experiencing jaw pain or know someone who is. I’ve been treating patients for jaw problems for over 30 years, and during most of that time, I depended upon oral appliances (also called tooth protectors, night guards, or bite plates) as part of first-line therapy to help my patients. Countless people are a tremendous amount of relief from the devices and some won’t consider sleeping without them.

Unfortunately, a small percentage of people do not get relief from first-line TMJ treatment, and some of them develop even more jaw symptoms when using them. If you’re one of these folks, you may be considering injections of BOTOX® for jaw problems as many others are, too.

However, it’s critical for you to understand that BOTOX®, like the oral appliances that help so many of my patients, will not cure your jaw problem. You must address the reasons your jaw got into trouble in the first place.

For BOTOX® for jaw problems to work effectively, it must be injected into both the masseter and temporalis muscles. And, the injections will likely need to be repeated for a time at three-month intervals. Your jaw is a complex structure and is integral to the quality of your life.

You need to be extremely careful about who you choose to administer BOTOX® injections. In some cases, BOTOX® doesn’t work and may even do more harm than good.

BOTOX® For Jaw Problems Is A Serious Decision

First, it’s critical that you are evaluated by an experienced orofacial pain specialist before you have BOTOX® injected into your delicate jaw muscles. Orofacial pain specialists have a specific focus on jaw problems and they have the experience, education, skill and knowledge to determine if BOTOX® for jaw problems will help you.

Here are five scenarios where BOTOX® for jaw problems can be appropriate:

1. You Overuse Your Jaw Muscles

When jaw muscles become overworked, over-built, and consequently, sore and painful, it can be for a variety of reasons. Most people know that TMJ symptoms can be caused by grinding and clenching your teeth at night. But, there are a lot of other causes of TMJ that happen during the day such as gum chewing, nail or cuticle biting, gnawing on pens or pencils, or even bracing your jaw muscles as you work, especially when you sit for hours at a computer.

I do administer BOTOX® for jaw problems in my practice, but not before I work closely with a patient and help them modify or eliminate the overuse behaviors that caused their problems in the first place. Many strategies including muscle-stretching exercises, breathing exercises, and relaxation techniques are very effective and non-invasive. If the overuse behaviors are not addressed and changed, BOTOX® for jaw problems has little – or no – benefit.

2. Your Jaw Muscles Bulge

BOTOX® for jaw problems is predictably effective when a patient’s jaw muscles are so overbuilt that they bulge even when they’re contracted. 

3. You Have Jaw Pain Only On One Side

If your jaw pain is not the same on both sides, before you choose BOTOX® injections, you must be examined by a medical professional who is educated and experienced in the relationships between teeth, bite and jaw postures and how they influence muscle health, overdevelopment and pain. BOTOX® injections must be placed strategically and it’s critical that the correct amount is injected into each muscle site. It’s critical that the person administering the injections has a great deal of expertise.

4. If You Have A Locked Jaw

It requires some deep investigating to determine when and if BOTOX® injections are the right treatment for patients whose jaw locks frequently or has been locked for a while. A locked jaw can be due to a myriad of factors. Figuring out why it’s happening in the first place is critical before you consider BOTOX® for jaw problems. Only an experienced orofacial or TMJ specialist can make the right decision

5. Your Jaw Is Clicking

Constant clicking in the jaw joint is usually due to a problem in the ligaments, bones and/or cartilage. Although a clicking jaw can be caused by overuse behaviors like the ones stated above, BOTOX® for jaw problems won’t help if the clicking has become persistent. In fact, BOTOX® can cause even more jaw clicking. If your jaw is clicking and it’s accompanied by pain, a thorough examination by an orofacial pain specialist is your first step. The last thing you need is more problems.

Conclusion

I have been treating patients with jaw problems for over 35 years and BOTOX® or jaw problems is becoming more and more important. But it’s only one of the ways I help my suffering patients. The instinct I’ve developed from my years in practice combined with my focus on science enables me to determine when, and if, BOTOX® is the correct treatment option in each case, where it should be injected and the correct amount of medicine to use.

If you’re considering BOTOX® for jaw problems related to TMJ, lockjaw, clicking or pain, please let an experienced orofacial pain specialist evaluate you before making the decision.  To find an orofacial pain specialist in your area, link here.

I was interviewed on Good Morning America about BOTOX® for jaw problems. Click here to view the interview.

Dr. Sarno and My Approach to TMD, Donald Tanenbaum
Categories
Jaw Problems Orofacial Pain TMJ

Dr. Sarno and My Approach to TMD

On June 23, 2017, Dr. John Sarno passed away at the age of 93. A controversial figure in mind/body medicine as it relates to back pain, Dr. Sarno explored the connection between the mind, emotions and back pain. He was a truly a pioneer. He challenged his medical colleagues to consider the uncomfortable notion that the majority of back pain sufferers were in trouble not because of structural flaws in their backs, but rather a result of muscle tension.

Dr. Sarno felt strongly that back pain results from what he called TMS – Tension Myositis Syndrome – which was a direct result of “internal rage” driven by life’s conflicts, unrealized dreams, childhood traumas, uncontrolled tension stressors, and other factors that could persistently upset the brain. His theory was this: when an upset brain turns on the body’s sympathetic nervous system, the blood flow to muscles and nerves is reduced and causes mild oxygen deprivation. The result is pain in the back muscles.

An obituary in The New York Times states: “Revered by some as a saint and dismissed by others as a quack, Dr. Sarno maintained that most non-traumatic instances of chronic pain – including back pain, gastrointestinal disorders, headaches, and fibromyalgia – are physical manifestations of deep-seated psychological anxieties.”

Despite his detractors, Dr. Sarno had many supporters in the medical community who conducted research in an effort to lend science to his assertions. In a 2007 study led by University of Southern California Professor David Schechter, it was found that chronic pain subjects who underwent mind/body treatment (reading educational materials, journaling about emotions, and in more extreme cases, undergoing psychotherapy) experienced an average pain reduction of 52 percent.

Dr. Sarno and My Approach to TMD

I met Dr. Sarno a number of times and attended many of his lectures, which were open to the public. Many of the principles he embraced resonated with me when I carefully considered the population of TMD sufferers who were coming to my practice seeking pain relief.

Over the years I discovered that when a patient’s jaw and orofacial pain was not due to an identifiable trauma, major structural imbalances, or an underlying medical disorder, the patient’s problem was likely of muscle origin and due to overuse fatigue. With a bit of investigation, overuse fatigue was usually due to daytime acquired behaviors such as nail and cuticle biting, jaw muscle bracing, frequent daytime tooth contact, tooth clenching, raised shoulders, furrowed brows, tense lips, or strained fast paced chest breathing. 

In reality, the same life scenarios that Dr. Sarno identified in his back pain patients were often characteristic of my TMD patients. At times these personal conflicts would also be responsible for restless and fragmented sleep and the onset of sleep bruxism activity, further adding to muscle overuse and fatigue.

What is critical to realize, however, is that by the time patients arrive at my practice looking for help,  tissue injury has already occurred due to physiologic changes in the jaw and neck muscles – and sometimes the temporomandibular joints. As a result, not only is it critical to make the mind body connections, but the majority of patients we see are engaged in assistive therapies that may include exercises, physical therapy, and or injections for the compromised muscles and or Tm joints.

For unclear reasons, Dr. Sarno rejected all assistive therapies such as massage, physical therapy, acupuncture, and injection techniques. This is where he and I differ in philosophy. In the book “Doctor, Why Does My Face Still Ache?” which I co-authored with my mentor, Seymour Roistacher, DDS, we carefully outline what I think leads to compromises in the temporomandibular system and why, therefore, the use of additive therapies makes sense if healing is to be achieved.

In the process of understanding each TMD sufferer that I treat, I strongly feel that the most important question I ultimately ask is this:

“Who are you?”

It’s only then I can begin to unravel the mysteries of each patient’s persistent orofacial pain and TMJ problems.

Artwork from www.ThankYouDrSarno.org

Click here to read the 2007 University of Southern California study.

Click here for Dr. Sarno’s obituary in The New York Times. 

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

tmj from scuba diving, michael sinkin dds
53683948 - snorkeling gear on a maldivian beach
Categories
Jaw Problems Nightguards & Oral Appliances Orofacial Pain TMJ

TMJ From Scuba Diving Or Snorkeling

During this time of year, it is common for my practice to see many patients who experience symptoms of TMJ from scuba diving or snorkeling. In fact, it has been reported that between 15%-20% of the people who scuba dive or snorkel have some level of jaw problem.

To find out why you first must understand the temporomandibular joints (TM’s) and how they function. Your TMJs are the hinges that connect your upper jaw to your lower jaw. They enable you to open and close your mouth in a smooth, unrestricted way. When functioning properly, your TMJ’s allow you to chew, talk, and yawn in comfort.

But because the TMJ’s are moved by muscles and stabilized by ligaments, any problem with those muscles and ligaments will have a negative effect on the function of your jaw and your comfort. People whose TMJs are overworked may experience pain, limited jaw opening, joint noises, and sometimes even a change in the way their teeth come together. The symptoms are very similar to an overworked knee.

TMJ From Scuba Diving Or Snorkeling Is Very Common. Here’s Why:

Whether you scuba dive or snorkel, your lower jaw must come forward to secure your breathing mouthpiece in place. It’s a very awkward position and when held for a long period of time, it fatigues your muscles and strains your ligaments. The result can be soreness, pain, and limited jaw function.

New divers are at the greatest risk for TMJ from scuba diving or snorkeling. The novice has a tendency to fiercely grip down on the mouthpiece for fear of it slipping out of place. This forceful clenching can set jaw problems into motion. And a poorly fitted mouthpiece is often a culprit, too.

Prevention & Treatment of TMJ from Scuba Diving Or Snorkeling

As an orofacial pain specialist, I have some advice for you if you are a new or inexperienced diver here’s some advice: try to maintain a loose grip on your mouthpiece and always make sure it fits properly. (If you suspect it doesn’t…don’t use it! Trade it in ASAP.) If mild symptoms start to occur, don’t dive for a day or two. Try anti-inflammatory medications such as Advil or Aleve, if tolerated. And ice packs on painful areas for seven minutes several times a day can also help.

If experiencing severe symptoms and just a day or two off from diving doesn’t improve your condition, you should see a dentist who focuses on temporomandibular disorder. TMJ is the result of tired, tight, injured or sore muscles, inflamed tendons, or compromised ligaments, bone and cartilage. As a result, TMJ treatment is similar to what is offered by an orthopedist when managing a knee problem.

Here are some of the ways we treat patients with TMJ from scuba diving or snorkeling at my practice:

  • Limiting the overuse of the jaw by dietary restrictions
  • Identifying strategies to reduce daytime habits that may prevent healing such as clenching, nail and cuticle biting, gum chewing
  • Medications to reduce inflammation and muscle tension
  • Supporting the injured joints or muscles with an oral appliance
  • Home jaw exercises and self-massage of jaw muscles 
  • Physical therapy if needed
  • Trigger point injections for pain and tension in the jaw muscles

It’s best to avoid TMJ from scuba diving or snorkeling by taking precautions such as loosening the grip on your mouthpiece and making sure it fits properly. Stop your diving activities if symptoms start and seek care to assure healing. The vast majority of our patients do heal and happily resume their diving activities after several months.

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