Tag: Orofacial Pain

Is a Medical Condition Causing Your TMJ Pain?

Why some jaw pain doesn’t improve with typical TMJ treatment, and what else might be going on in your body

Can a medical condition cause TMJ pain?

Yes. Conditions such as autoimmune disease, thyroid disorders, anemia, and Lyme disease can all contribute to jaw pain and TMJ symptoms, especially when standard TMJ treatment has not helped. Identifying these underlying causes is often the key to relief.

You wake up with jaw pain that feels different this time. It is in both sides of your jaw, not just one. Your jaw feels stiff in the morning, almost like your hands or knees do on a bad day. You are tired in a way that sleep does not seem to fix. And the nightguard your dentist gave you, the one that was supposed to help, has not made much of a difference.

If this sounds familiar, you are not imagining it, and you are not alone. Most jaw pain is exactly what it appears to be: a TMJ problem caused by clenching, grinding, stress, or a past injury. But for a smaller group of patients, jaw pain is one piece of a larger puzzle, one that involves the rest of the body.

You Deserve to Be Taken Seriously

If you have already tried a nightguard, physical therapy, or other standard TMJ treatments and your symptoms are not improving the way they should, that does not mean the pain is in your head. It often means there is more to the story.

At New York TMJ & Orofacial Pain, we treat TMJ disorders every day, and part of that work is recognizing when jaw pain is connected to something happening elsewhere in the body. Conditions like autoimmune disease, thyroid problems, anemia, and Lyme disease can all contribute to jaw pain, and they are often missed because no one has connected the dots between your jaw and the rest of your health.

Can a medical condition cause TMJ pain?

Why Your Jaw Muscles May Be the Messenger, Not the Problem

Jaw muscle pain is often a question of oxygen. Muscles that do not get enough oxygen-rich blood build up waste products that irritate nerve endings, and that irritation is what you feel as pain, aching, or fatigue in the jaw.

Two common but often overlooked issues can starve your jaw muscles of the oxygen they need.

A nervous system stuck in overdrive. Chronic stress, anxiety, or poor sleep can keep your body in a constant low-grade fight-or-flight state. One effect of that state is that blood vessels throughout the body, including in the jaw, narrow slightly and reduce blood flow to the muscles you use every day to chew, talk, and yawn.

Anemia. When your blood carries less oxygen than it should, often because of low iron, vitamin B12, or folate, your muscles fatigue and ache more easily with normal use, including the muscles of your jaw. Anemia is common and frequently goes undiagnosed until someone connects it to symptoms like this.

If your jaw pain feels disproportionate to what is actually going on in your bite or your stress level, a simple blood test checking your iron, vitamin B12, and folate levels can be a useful and inexpensive place to start.

Can Autoimmune Conditions Cause Jaw Pain?

Certain autoimmune and inflammatory conditions can directly affect the jaw joint and the muscles around it, sometimes before they are ever diagnosed.

Rheumatoid Arthritis

Rheumatoid arthritis causes inflammation in the joints, and the jaw joint is not immune. If you are noticing pain on both sides of your jaw, morning stiffness, and joint pain in your hands or wrists, it is worth mentioning this combination to your physician, since blood tests can help confirm or rule out rheumatoid involvement.

Lupus

Lupus is a condition that creates inflammation throughout the body, and that inflammation can make the entire pain system, including your jaw, more sensitive. Lupus does not always come with the well-known butterfly rash, which is part of why it can be missed. Fatigue, joint pain, and sensitivity to sunlight alongside jaw pain are worth raising with your doctor.

Psoriatic Arthritis

Psoriatic arthritis can affect the jaw joint as well, and it sometimes shows up before any skin symptoms appear. This is one reason jaw pain connected to psoriatic arthritis can be especially easy to overlook.

Hashimoto’s Thyroiditis

This is one of the most common conditions we see connected to jaw pain in our female patients in particular. Hashimoto’s thyroiditis slows down your thyroid, and an underactive thyroid can lead to muscle aches, joint stiffness, fatigue, and poor-quality sleep, all of which can make jaw pain worse and harder to resolve. Even thyroid levels that look technically normal on paper can still be working against you if they are not optimized for how you feel.

Can Lyme Disease Cause Jaw Pain?

If you live on Long Island, in Westchester County, or anywhere in the surrounding region, this section matters to you specifically. The northeast is the highest Lyme disease region in the country, and Lyme disease can cause joint pain, including in the jaw, sometimes without the classic bullseye rash or even a memory of a tick bite.

If you are dealing with jaw pain alongside fatigue or pain in other joints, and you spend time outdoors in our area, it is worth asking your doctor about Lyme testing, even if nothing about a tick bite comes to mind.

Signs your jaw pain may be connected to a medical condition, including pain on both sides, joint involvement, morning stiffness, fatigue, symptoms after illness, and lack of response to standard TMJ treatment — If several of these apply to you, a broader medical evaluation may be the missing piece in your care.

You Are Not Starting From Scratch

Finding out that something beyond your jaw may be contributing to your pain is not bad news. It is often the missing piece that finally makes your symptoms make sense, and the first real step toward a plan that actually works for you.

Orofacial pain specialists take the time to look at the whole picture, not just your jaw in isolation. When they suspect something systemic may be involved, they will collaborate closely with your physician, rheumatologist, or other specialists so that your care is coordinated rather than fragmented.

Are You Experiencing Jaw Pain That Isn't Responding to Treatment in the NYC Metropolitan Area?

If you’re in the New York City metropolitan area and you’ve been dealing with jaw pain that hasn’t improved with standard treatment, you deserve answers, not just temporary relief.

At New York TMJ & Orofacial Pain, we specialize exclusively in diagnosing and treating TMJ disorders and orofacial pain. We take time to identify the true cause of your symptoms and build a treatment plan that directly addresses it, including coordinating with your physician when a medical condition may be contributing to your pain.

We have 4 locations: Midtown Manhattan, White Plains, Hauppauge, and Springfield, NJ.

About the Author

Dr. Donald R. Tanenbaum is a board-certified specialist who has dedicated his 40-year career to diagnosing and treating Orofacial Pain, TMD/TMJ, headache, and sleep-related breathing disorders. He practices in our Manhattan and Hauppauge offices.

Our Practice →

Treatments We Provide →

What to Expect at Your First Visit →

Frequently Asked Questions About Medical Conditions That Can Cause TMJ Pain

Can autoimmune diseases cause TMJ pain?
Yes. Conditions such as rheumatoid arthritis, lupus, psoriatic arthritis, and Hashimoto’s thyroiditis can all contribute to jaw pain, jaw joint inflammation, and muscle dysfunction. In some cases, jaw symptoms appear before the underlying condition is even diagnosed.

Can anemia cause jaw muscle pain?
Yes. Anemia reduces the amount of oxygen your blood can deliver to muscles, including your jaw muscles, which can lead to fatigue, cramping, and aching with normal use like chewing or talking.

Can Lyme disease affect the jaw joint?
Yes. Lyme disease can cause joint pain, including in the jaw joint, and this is a particular concern for patients in Long Island, Westchester County, and other parts of the northeastern United States where Lyme disease is common.

How do I know if my jaw pain is connected to a medical condition?
Some signs to watch for include pain on both sides of the jaw, involvement of other joints, morning stiffness, ongoing fatigue, symptoms that began after an illness, or jaw pain that has not responded to standard TMJ treatment. If any of these sound familiar, it is worth discussing a broader medical evaluation with your provider.

What should I do if I think something more than TMJ is going on?
Start by talking with your dentist, physician, or an orofacial pain specialist. A thorough evaluation, sometimes including blood work, can help determine whether a medical condition is contributing to your jaw pain and guide you toward the right treatment plan.

Tags Facial Pain, Orofacial Pain, TMJ/TMD

Children & TMJ Orofacial Pain

Jaw Pain in Your Teenager: What Parents Need to Know About Evaluation and Treatment

Post author By John E. Dinan, DMD MS
Post date June 15, 2026
No Comments on Jaw Pain in Your Teenager: What Parents Need to Know About Evaluation and Treatment

If your teenager has been dealing with jaw pain, headaches, or clicking in the jaw, you have probably already been to the dentist. You may have seen a pediatrician or an ENT as well. And you may have come away with a nightguard, a referral, or simply reassurance that things would improve on their own.

When that hasn’t happened, the question becomes: what should evaluation and treatment actually look like?

In our practice, which serves families from Manhattan, Westchester County, Long Island, and northern New Jersey, these are among the most common questions we hear from parents navigating this process for the first time.

Part 1 of this guide covers the reasons TMJ problems so often begin during the teen years. This post focuses on what comes next: what a proper evaluation involves, how TMJ disorders are treated in adolescents, and what you can expect from specialized care.

Read Part 1 to learn the main reasons for TMJ in teens.

What Is Different About a TMJ Evaluation Compared to a Regular Dental Visit?

A TMJ evaluation conducted by an orofacial pain specialist looks at far more than teeth and bite alignment. It is a comprehensive assessment of everything that may be contributing to your child’s symptoms.

That means the conversation comes first. Before any physical examination, a thorough specialist will want to understand your child’s full history: when the symptoms began, how they have changed over time, what makes them better or worse, what treatments have already been tried, and what is going on in their life right now. Sleep patterns, stress levels, school demands, athletic schedules, medications, and orthodontic history are all relevant.

This is not incidental. In TMJ care, the context of your child’s life is often as diagnostically important as the clinical findings. Two teenagers can have identical joint findings on imaging and have completely different treatment needs based on what is driving their symptoms. That context is what we are looking for.

What Does the Physical Examination Involve?

A thorough TMJ evaluation goes well beyond a standard dental exam. The specialist examines jaw muscle tenderness, range of motion, joint mechanics, and disc position, alongside a full review of sleep, stress, medications, and orthodontic history. Many families tell us it is the first time anyone has looked at the complete picture.

Once the history is established, the specialist will conduct a structured physical exam. This typically includes assessment of how wide the mouth opens, whether the jaw deviates to one side during opening, palpation of the jaw muscles and surrounding structures to identify areas of tenderness, and evaluation of the joint itself for clicking, popping, or restricted movement.

The muscles of the face, jaw, neck, and temples are examined carefully, since many TMJ symptoms originate in the muscles rather than the joint itself. A teenager who has been clenching heavily due to stress or medication side effects may have significant muscle tenderness that explains much of their pain. Finding that is often a turning point for families who have been searching for answers for a long time.

Imaging may also be part of the evaluation. Panoramic X-rays provide a broad overview of the jaw structures. In cases where more detail is needed, cone beam CT or MRI may be recommended to assess the joint anatomy and disc position more precisely.

If this feels more thorough than anything your child has experienced at a routine dental visit, that is by design. Most parents tell us it is the first time anyone has looked at the full picture.

Why Does the Specialist Ask So Many Questions About Life Outside the Jaw?

This is something parents often notice and occasionally find puzzling. The answer is that TMJ disorders in teenagers are rarely caused by a single structural problem. They develop when multiple contributing factors converge.

A teenager who is under significant academic pressure, sleeping poorly, taking an SSRI for anxiety, and wearing clear aligners is dealing with four separate inputs that all increase jaw muscle activity or joint stress. Treating only the joint, without recognizing those inputs, is likely to produce limited or temporary results.

The orofacial pain approach asks: what is going on in this child’s life that is contributing to this? That question shapes the entire treatment plan.

For adolescents in the New York City metropolitan area, where academic demands are intense and schedules leave little room for recovery, these contributing factors are especially common. Understanding which ones are active in your child’s life is what makes treatment effective rather than generic.

How Is TMJ Treated in Teenagers?

Most parents are surprised to find that treatment is less complicated than they expected, and that the most effective first steps are often the least invasive.

Behavioral guidance and habit modification are typically the foundation of treatment. This includes instruction in jaw relaxation techniques, guidance on reducing parafunctional habits like clenching and tooth contact during the day, and education about sleep positioning and screen use before bed. These changes are evidence-based and can produce significant symptom improvement on their own.

Physical therapy is frequently recommended, particularly when muscle tightness or restricted jaw opening is a significant part of the picture. A physical therapist trained in orofacial conditions can work on jaw mobility, muscle release, and postural factors that contribute to jaw loading.

Oral appliance therapy involves a custom-fitted device worn over the teeth, most commonly during sleep, that reduces muscle activity and protects the joint from the forces of clenching and grinding. For teenagers in active orthodontic treatment, the timing and design of any appliance needs to be coordinated carefully with the orthodontist.

Medication management is used when appropriate. This may include short-term anti-inflammatory medication, muscle relaxants, or other targeted therapies depending on what is driving the symptoms. In teenagers on SSRIs or stimulants whose jaw symptoms are clearly medication-related, communication with the prescribing physician about possible adjustments is part of the plan.

Collaborative care is often necessary. TMJ disorders in teenagers frequently intersect with migraine, sleep problems, anxiety, and orthodontic treatment. An orofacial pain specialist who works in coordination with neurologists, sleep specialists, mental health providers, and orthodontists produces better outcomes than any single provider working in isolation.

More advanced interventions, including injections such as trigger point therapy or botulinum toxin, are available when conservative approaches have not produced sufficient relief. These are not the starting point, but they are part of the toolkit when needed.

How Long Does TMJ Treatment Last for a Teenager?

There is no single answer, because treatment length depends on what is driving the symptoms and how many contributing factors are present.

For teenagers with primarily muscular symptoms and identifiable triggers such as stress, poor sleep, or medication side effects, meaningful improvement often occurs within weeks of beginning behavioral changes and conservative therapy.

For teenagers with disc displacement, more complex joint involvement, or multiple overlapping conditions such as TMJ and migraine together, treatment is longer and requires more coordination. Progress is typically gradual and non-linear. Flare-ups can occur and do not necessarily mean treatment is failing. That is worth knowing going in, so that a difficult week does not feel like the plan is not working.

In our practice, we regularly see teenagers who have been dealing with jaw pain for months or even years before finding their way to a specialist. The earlier your child is evaluated, the better the outcome tends to be. Symptoms that are caught early are significantly easier to address than those that have had time to become chronic.

What Are ICR and JIA, and When Should They Be on your Radar?

Most TMJ problems in teenagers involve the muscles or the disc inside the joint, both of which respond well to conservative care. However, two less common conditions are worth knowing about if you have noticed changes beyond pain, particularly shifts in how your child’s bite fits together or changes in their facial profile.

Idiopathic Condylar Resorption (ICR) is a condition in which the rounded part of the jaw joint gradually breaks down. It most commonly affects females between the ages of 15 and 35, and hormonal influences are believed to play a significant role. Changes in bite and jaw appearance are often among the first visible signs, sometimes before significant pain develops.

Juvenile Idiopathic Arthritis (JIA) is a systemic autoimmune disease that frequently involves the jaw joints, sometimes producing similar patterns of progressive change.

If you have noticed any of these changes in your child, it is worth mentioning them at their evaluation. Catching either condition early makes a meaningful difference in how it is managed.

Is Your Child Dealing With Jaw Problems in the New York City Metropolitan Area?

If you are in Manhattan, Westchester County, Long Island, or northern New Jersey and your child has been dealing with jaw pain, TMJ symptoms, or related headaches, you deserve answers, not just temporary relief.

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

We have 4 locations: Midtown Manhattan, White Plains, Hauppauge, and Springfield, NJ.

We regularly see patients from Nassau County, Suffolk County, and across the five boroughs, in addition to our immediate practice communities.

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 at New York TMJ & Orofacial Pain’s Manhattan and Springfield, NJ locations.

Frequently Asked Questions

What does a TMJ evaluation for a teenager involve?
A thorough evaluation looks beyond the jaw joint. It covers sleep quality, stress levels, current medications, orthodontic history, and headache patterns, alongside a physical exam of the jaw muscles, joint mechanics, and range of motion. Imaging may also be part of the assessment. The goal is to understand the full picture before recommending treatment, not to apply a standard protocol.

How is TMJ treated in teenagers?
Treatment for most teenagers begins with conservative, non-invasive approaches: behavioral guidance, jaw relaxation techniques, physical therapy, oral appliance therapy when appropriate, and medication management when indicated. More advanced interventions are available but are not the starting point. The approach is individualized based on what is driving your child’s symptoms.

How long does TMJ treatment take in a teenager?
It depends on what is driving the symptoms. Teenagers with primarily muscular symptoms and identifiable triggers often see meaningful improvement within weeks. More complex cases involving disc displacement, migraine overlap, or multiple contributing factors take longer. Early intervention consistently produces better outcomes than waiting.

What is idiopathic condylar resorption, and how do I know if my child has it?
ICR is a condition in which the rounded part of the jaw joint gradually breaks down. It most commonly affects females between ages 15 and 35. The most noticeable signs are often changes in bite alignment or facial profile rather than pain. If your child’s bite has shifted or their chin appears to be receding, an evaluation with an orofacial pain specialist is warranted.

Do we need a referral to see a TMJ specialist in New York?
A referral is not required to schedule an evaluation at New York TMJ & Orofacial Pain. Many patients come directly after researching their symptoms. That said, referrals from dentists, neurologists, ENTs, and pediatricians are common and welcome.

We are located in New Jersey. Can we still see a TMJ specialist at NYTMJ?
Yes. New York TMJ & Orofacial Pain has a location in Springfield, NJ, in addition to offices in Midtown Manhattan, White Plains, and Hauppauge. Patients from across northern and central New Jersey, Westchester County, Nassau County, Suffolk County, and the five boroughs regularly seek care at our practice.

We don’t live in the New York City metropolitan region. How can we find a TMJ specialist in our area?
The American Board of Orofacial Pain maintains a searchable directory of board-certified TMJ and orofacial pain specialists across the country. You can search for a specialist near you here. Board certification ensures the provider has met rigorous standards in the diagnosis and treatment of TMJ disorders and related conditions.

Tags Facial Pain, Orofacial Pain, TMJ/TMD

Children & TMJ Facial Pain Orofacial Pain TMJ

Jaw Pain in Your Teenager: Why Is It Happening?

Post author By John E. Dinan, DMD MS
Post date June 3, 2026
No Comments on Jaw Pain in Your Teenager: Why Is It Happening?

Your child started mentioning jaw pain a few months ago. Maybe they said their jaw clicks when they eat. Maybe they’ve been waking up with headaches, or complaining of ear pain their pediatrician can’t explain.

You brought it up at their next dental appointment. The dentist checked their teeth, said everything looked fine, and suggested a nightguard.

You tried the nightguard. The complaints kept coming.

If this sounds familiar, here’s something that may help: jaw pain and TMJ symptoms are well documented in adolescents and young adults. When they show up during this period of life, there are usually very specific, identifiable reasons why. And the right specialist can find them.

In the New York City metropolitan area, where academic pressure runs high and schedules are often relentless, we see this pattern regularly in our busy orofacial pain practice. Teens and young adults from Manhattan, Westchester County, Long Island, and northern New Jersey arrive having already been to their dentist, their pediatrician, and sometimes an ENT or neurologist. They are not getting answers. In many cases, the missing piece is a specialist trained specifically in orofacial pain.

What Is TMJ?

TMJ, or temporomandibular disorder (TMD), is a condition involving the jaw joint, the muscles that control jaw movement, and the surrounding tissues. It commonly produces jaw pain, clicking, headaches, ear fullness, and facial muscle tension. In adolescents, it is frequently triggered by a combination of hormonal changes, stress, sleep disruption, orthodontic treatment, and certain medications.

In teens and young adults, TMD most often shows up as some combination of the following:

Jaw pain or soreness, especially in the morning or after eating
Clicking, popping, or grinding sounds in the jaw
Headaches, often starting at the temples or behind the eyes
Ear fullness, ringing, or pain without an ear infection
Difficulty opening the mouth fully or comfortably
Facial muscle tension or fatigue

These symptoms are real, and they should not be something your child simply has to live with.

Why Does TMD So Often Start During the Teen Years?

Adolescence creates a convergence of factors that can push a vulnerable jaw system toward symptoms. Hormones shift significantly. Sleep patterns change. Stress levels rise. Orthodontic treatment is often in progress. And for many teens today, new medications enter the picture for the first time.

None of these factors alone necessarily causes TMD. But when several of them are present at once, they can tip a previously quiet jaw problem into an active, painful one.

Understanding which factors are driving your child’s symptoms is the starting point for effective care.

Why Are Girls More Likely to Develop TMD During Puberty?

TMD affects women significantly more often than men, and the difference is largely believed to be hormonal.

The jaw joint contains receptors for estrogen, the primary female sex hormone. As estrogen levels fluctuate, the ligaments supporting the joint can become more lax, making the joint less stable and more prone to problems.

Puberty triggers major hormonal shifts, and it is not coincidental that TMJ clicking and early jaw symptoms often first appear during this window. If your daughter’s jaw symptoms started in middle school or early high school, this hormonal connection may be part of the explanation.

Can a Teenager Have Both TMD and Migraine at the Same Time?

Yes, and it is more common than most parents expect. Many parents bring their child to our practice complaining of “headaches and jaw pain,” and assume the jaw is causing both.

Sometimes that is true. But a pattern we see frequently is that the child is actually dealing with two distinct but overlapping conditions: TMD and migraine. Both involve the trigeminal nerve, which governs sensation in the face and jaw. When one condition flares, it can amplify the other.

Migraine commonly begins during the teen years and early adulthood, overlapping almost exactly with the typical window for early TMD onset.

If your child has been treated for headaches and jaw pain without meaningful improvement, it is worth making sure both conditions have been formally evaluated. Treating only one when both are present often leaves a significant part of the problem unaddressed.

Can Braces or Aligners Make TMD Worse?

Orthodontic treatment does not cause TMD. That is well established in the research, and it is important to say plainly.

However, there are meaningful nuances that parents should understand.

Orthodontic forces change the feedback that teeth send to the jaw muscles. In some patients, the continuous presence of clear aligners between the teeth appears to increase tooth contact awareness and clenching activity. For teens who are already predisposed to jaw problems, orthodontic treatment can sometimes be what converts a subclinical condition into an active, symptomatic one.

Clear aligner therapy in an adolescent patient with temporomandibular disorder considerations — Clear aligner therapy may contribute to increased tooth contact awareness or symptom aggravation in susceptible TMD patients.

This does not mean your child should avoid or stop orthodontic treatment. It means two things. First, children starting orthodontic treatment should be evaluated by an orofacial pain specialist for existing TMD symptoms beforehand. Second, jaw pain that develops or worsens during orthodontic treatment should be evaluated by an orofacial pain specialist, not simply managed with over-the-counter pain relief or reassurance that it will pass.

In some cases, active orthodontic treatment limits the TMD therapies available, and those trade-offs need to be considered by a specialist.

Can ADHD Medication or Antidepressants Cause Jaw Clenching?

Yes. This is a connection many families are not aware of, and it can be directly relevant to your child’s symptoms.

SSRIs, a common class of antidepressants that includes sertraline, escitalopram, and fluoxetine, are associated with a significant increase in bruxism, meaning clenching and grinding, both during sleep and while awake. This side effect can begin within weeks of starting the medication.

Stimulant medications prescribed for ADHD, including both amphetamine-based and methylphenidate-based drugs, are also strongly associated with increased daytime jaw clenching.

If your child began experiencing jaw pain or muscle tension shortly after starting a new medication, that connection is worth raising with their prescribing physician and with an orofacial pain specialist.

In some situations, alternative medications may be available. In others, the better path is managing the jaw symptoms directly while continuing the medication that is helping with the underlying condition.

How Does Poor Sleep Make Teen TMD Symptoms Worse?

Poor sleep is one of the strongest predictors of chronic pain, including TMD. When your child is not sleeping adequately, their muscles recover more slowly, their pain sensitivity increases, and their body is less equipped to manage the jaw problems that are already present.

During adolescence, the body’s internal clock naturally shifts toward a later sleep phase, making it biologically harder for teens to fall asleep early. The American Academy of Sleep Medicine recommends that teenagers get 8 to 10 hours of sleep per night. Given typical school start times, most adolescents fall well short of that.

Screen use before bed worsens the problem by suppressing melatonin and increasing physiologic arousal, pushing sleep onset even later.

If your child has jaw pain and is also consistently under-sleeping, the sleep deficit is not incidental. It is likely contributing to their symptoms and interfering with recovery.

Does Stress Really Cause Physical Jaw Pain?

It can be tempting to hear “stress is contributing to this” and interpret it as a suggestion that the pain is not real. That is not what it means.

Psychosocial stress, whether from academic pressure, social demands, athletic expectations, or the chronic low-grade stress that comes with constant social media exposure, has real physiologic effects. It activates jaw and facial muscles. It increases clenching. It raises systemic inflammation. And it disrupts sleep, which compounds everything else.

For many adolescents in Westchester County, Manhattan, and the surrounding suburbs, this kind of sustained pressure is a daily reality, and it shows up in the jaw.

Helping your child build skills for physiologic self-regulation, including jaw relaxation techniques, diaphragmatic breathing, and consistent sleep habits, is a legitimate and evidence-based part of managing TMD. Mental health support, when appropriate, is also part of the picture.

Read Part 2 to learn about treatment for TMD in teens.

Is Your Child Experiencing TMJ or Jaw Pain Symptoms in the New York City Metropolitan Area?

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

We have 4 locations: Midtown Manhattan, White Plains, Hauppauge, and Springfield, NJ.

About Our Practice →
Treatments We Provide →
What to Expect at Your First Visit →

About the Author

Frequently Asked Questions about Jaw Pain in Teenagers

Can TMD go away on its own in teenagers?
In some mild cases, symptoms improve with reduced stress, better sleep, and behavioral changes. However, TMD that persists beyond a few weeks, or that is associated with jaw clicking, bite changes, or recurring headaches, warrants a formal evaluation. Waiting without a diagnosis risks missing a condition that responds much better to early intervention.

What kind of doctor treats TMD in children and teenagers?
An orofacial pain specialist is the appropriate provider for diagnosing and treating TMD. This is a board-certified dental specialty focused specifically on jaw disorders, facial pain, and related conditions. General dentists and orthodontists are not typically trained in comprehensive TMD diagnosis.

Can braces cause TMJ problems?
The research is clear that orthodontic treatment does not cause TMD. However, in teenagers who are already predisposed, the forces and appliances involved in orthodontic treatment can sometimes activate symptoms that were previously quiet. Any jaw pain arising during orthodontic treatment should be evaluated, not assumed to be normal soreness.

Is jaw clicking in teenagers serious?
Jaw clicking on its own, without pain or limited opening, is common and often benign. However, clicking that is accompanied by pain, occurs on one side only, or is associated with changes in how the bite fits together is worth evaluating. Clicking can be an early sign of disc displacement inside the jaw joint.

Why does my teenager’s jaw hurt more in the morning?
Morning jaw pain is frequently a sign of nighttime clenching or bruxism during sleep. The jaw muscles work throughout the night and wake up fatigued and sore, much like any overworked muscle. This pattern is worth mentioning to an orofacial pain specialist, as it is highly treatable.

Can anxiety or depression contribute to TMD symptoms in teens?
Yes. Anxiety and depression increase muscle tension, disrupt sleep, and in many cases involve medications (such as SSRIs) that independently raise the risk of clenching. Addressing mental health as part of a comprehensive TMD plan is not a suggestion that the pain is psychological. It is simply treating the whole picture.

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

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.

DO YOU HAVE TMJ AND A HYPERMOBILITY DISORDER IN THE NEW YORK CITY METROPOLITAN AREA?

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.

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 →
What to Expect at Your First Visit →

Tags Facial Pain, Orofacial Pain, TMJ/TMD

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

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.

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 →

Tags Facial Pain, Orofacial Pain, TMJ/TMD

Facial Pain

Low-dose Naltrexone for Neuropathic Facial Pain

Post author By John E. Dinan, DMD MS
Post date March 31, 2026
No Comments on Low-dose Naltrexone for 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

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 →

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Read: Trigeminal Neuralgia and the Experience of Tooth Pain →

Tags Case Study, Facial Pain, Orofacial Pain, TMJ/TMD

Trigeminal Neuralgia

Trigeminal Nerve Pain vs. Trigeminal Neuralgia: What’s the Difference?

This content was originally published on 2/9/2022 and reviewed on 6/19/2026.

When patients come to my office with the complaint of persistent (and often acute) pain in their face or jaw, they often fear they have a problem called trigeminal neuralgia.

Before discussing this specific type of facial pain, a brief discussion about the trigeminal nerve and its role in virtually all facial pain problems is essential.

The trigeminal nerve is but one of 12 cranial nerves that can transmit two types of information to the brain.

Sensory Information: Includes details about smells, sights, tastes, touch, sounds, and PAIN to the brain.
Motor Information: Initiates movement or activation of muscles and glands.

The Three Branches of the Trigeminal Nerve

The trigeminal nerve has three different divisions, each with a slightly different function:

1. The Ophthalmic Division

The ophthalmic division transmits sensory Information to the brain from:

The scalp
The forehead
The upper sinuses
The upper eyelid and associated mucous membranes
The cornea of the eye
The bridge of the nose

2. The Maxillary Division

Like the ophthalmic division, the maxillary division of your trigeminal nerve has only a sensory component. It transmits sensory Information to the brain from:

The lower eyelid and associated mucous membranes
The middle part of the sinuses
The nasal cavity and middle part of the nose
The cheeks
The upper lip
The teeth of the upper jaw and the surrounding gum tissue and supporting bone
The roof of the mouth

3. The Mandibular Division

The mandibular division is the only part of the trigeminal nerve that has both sensory and motor functions. It communicates sensory Information to the brain from:

The outer part of the ear
The lower part of the mouth and the associated mucous membranes
The front and middle parts of the tongue
The teeth of the lower jaw and the associated gum tissue and supporting bone
The lower lip
The chin
The temporomandibular joint and jaw muscles

The mandibular division also stimulates movement of the muscles in the jaw and some of the muscles within the inner ear.

What Is Trigeminal Nerve Pain?

As a result of the trigeminal nerve’s sensory function and broad distribution in the intraoral tissues, facial and jaw structures, the majority of all orofacial pain is due to excitation, irritation, and or injury to the trigeminal nerve.

Common toothaches, wisdom tooth pain, dental infections, sinus pains, jaw muscle pain, and temporomandibular joint pain all involve the trigeminal nerve. Therefore, trigeminal nerve pain can result from an overworked and fatigued jaw muscle, an inflamed jaw joint, a cracked or decayed tooth, or a simple gum infection.

Therefore, most of the suffering due to trigeminal nerve pain occurs as a result of problems that can be readily diagnosed and treated effectively by trained practitioners. Most importantly, these problems are common, familiar, and helpable when evaluated and treated by trained practitioners.

What is the difference between trigeminal nerve pain and trigeminal neuralgia?

Trigeminal nerve pain is a broad term describing pain signals carried by the trigeminal nerve from the teeth, jaw muscles, TMJ, gums, sinuses, or facial tissues. Trigeminal neuralgia is a specific neuropathic pain disorder that usually causes sudden, severe, electric-shock-like facial pain.

Because both conditions involve the trigeminal nerve, trigeminal neuralgia can sometimes feel like tooth pain, jaw pain, or a TMJ problem. A careful history, examination, and sometimes imaging are needed to determine the true source of pain.

For patients who have undergone multiple dental, medical, or TMJ evaluations without a clear diagnosis, an orofacial pain evaluation can help identify whether symptoms are more consistent with trigeminal neuralgia, TMJ-related pain, dental pain, or another facial pain condition.

What Is Trigeminal Neuralgia?

Trigeminal neuralgia (TN) is a distressingly painful, sometimes debilitating, and often chronic neuropathic pain condition. Trigeminal neuralgia typically affects the middle or the lower part of the face on one side. As it is classified as a type of neuropathic pain, it is mostly caused by damage or disease to the nervous system’s sensory component.

Trigeminal neuralgia becomes more common as people reach their 60s and 70s and can be triggered by a variety of serious medical conditions such as tumors, stroke, multiple sclerosis, and other disorders that cause the insulation of trigeminal nerve fibers to become compromised. According to the National Institute of Neurological Disorders and Stroke, the incidence of new cases is approximately 12 per 100,000 people per year; the disorder is more common in women than in men.

The pain of trigeminal neuralgia can be felt in the face, teeth, gums, lips, and mouth region and tends to be sporadic, electrical or shock-like, and is often combined with a burning sensation. Patients frequently describe spark like electrical sensations during an attack.

Approximately 60% of all patients often diagnosed with trigeminal neuralgia start seeking care from a dentist because they are experiencing bad toothache pain. Yet, evaluations and x-rays taken in the dental office usually do not reveal the real problem. Despite a lack of findings, treatment such as root canals is often initiated treatment such as root canals are often started as a way to relieve a patient’s suffering. Unfortunately, these efforts fail to solve the problem.

To learn more about trigeminal neuralgia, visit Johns Hopkins Medicaine – Trigeminal Neuralgia.

How Trigeminal Neuralgia Is Diagnosed

The pain of TN has some unique features. The pain may be experienced in the midst of an otherwise pain-free day appearing without provocation, or it can be triggered by speaking, drinking, eating, brushing the teeth, or causal contact of the face around the lips and nose.

Unlike most other facial pain problems, trigeminal neuralgia pain can be manageable or miserable all within several minutes of a day. People with trigeminal neuralgia often report being pain-free and then incapacitated for seconds or minutes until the pain vanishes or subsides to a low level. Trigeminal neuralgia attacks can become more frequent and intense over time.

Why Trigeminal Neuralgia Can Feel Like a TMJ Problem

Patients with trigeminal neuralgia often describe severe limitation of jaw motion during an attack of TN due to spasm of the jaw muscles, which are directly under the influence of the trigeminal nerve. For this reason, TN has also been called tic douloureux, with the ‘tic’ describing the severe facial muscle spasm. Due to the restricted jaw motion described by patients, this problem can be misdiagnosed as TMJ.

As mentioned, the diagnosis of trigeminal neuralgia is most commonly made based on the unique character of the symptoms the patient describes. The examination of the face and the painful areas is often unremarkable unless there are distinct trigger zones that, when touched, fires the pain.

Brain imaging MRIs or MRAs may be ordered in order to detect whether there is an underlying medical condition such as MS, a tumor, or blood vessel compression of the nerve causing the TN pain.

Finally, trauma to the face, jaw, or teeth can injure the trigeminal nerve and lead to what is called traumatic TN.

Common Treatment Options for Trigeminal Neuralgia

Once a tentative diagnosis has been made, medications are usually the first-line treatments. Multiple medications may be used together and changed over time if effectiveness is lost. These medications are designed to reduce the nerve sparking and excitation, but unfortunately do not cure trigeminal neuralgia.

Other treatments may be beneficial as well, including nerve blocks and, at times, BOTOX® injections. Topical medications, both inside the mouth and on the face, have also shown some promise in controlling daily symptoms.

When these treatment efforts fall short despite collaboration with multiple experts in the field, neurosurgery is the next step to be explored.

Other Types of Trigeminal Neuropathic Pain

There is an “atypical” form of TN called TN2. Instead of short episodes of disabling pain, patients with TN2 experience continuous pain with burning and aching features. Although the pain of TN2 is less intense than TN, its constant presence is often thought to be more disruptive to a patient’s life as there is no downtime.

Continuous neuropathic pain problems also require medications to ease suffering. However, because continuous nerve pain can lead to muscle tension and splinting, TN2 symptoms can be confused with a TMJ problem.

In summary, pain within the trigeminal system is a primary reason that patients seek care in my practice. Fortunately, once a diagnosis has been made, many of these problems are common, familiar, and helpable.

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.

Not Sure If Your Pain Is TMJ, Tooth Pain, or Trigeminal Neuralgia?

Facial pain can be difficult to diagnose because the trigeminal nerve carries pain signals from many facial structures.

If your pain has not been clearly diagnosed, an orofacial pain evaluation can help determine the most likely source.

New York TMJ & Orofacial Pain evaluates patients with facial pain, jaw pain, tooth-like pain, TMJ symptoms, and nerve-related pain at office locations in Manhattan, Long Island, Westchester, and Northern New Jersey.

About the Author

Donald R. Tanenbaum, DDS, MPH, is Co-Founder of New York TMJ & Orofacial Pain and a board-certified specialist in Orofacial Pain. Together with his colleagues, he helps evaluate and manage patients with temporomandibular disorders (TMD), complex facial pain, neuropathic pain conditions, headaches, and sleep-related disorders. New York TMJ & Orofacial Pain is a referral resource for medical and dental professionals seeking specialized care for patients with challenging orofacial pain and jaw disorders. The practice has office locations in Manhattan, Long Island, Westchester, and Northern New Jersey.

Frequently Asked Questions Trigeminal Nerve Pain vs. Trigeminal Neuralgia

Is trigeminal nerve pain the same as trigeminal neuralgia?
No. Trigeminal nerve pain is a broad description of pain carried by the trigeminal nerve. Trigeminal neuralgia is a specific neuropathic pain disorder.

Can trigeminal neuralgia feel like TMJ?
Yes. Many patients initially believe they have TMJ pain because trigeminal neuralgia can affect the jaw area.

Can trigeminal neuralgia feel like a toothache?
Yes. Trigeminal neuralgia frequently mimics dental pain and may lead patients to seek dental treatment before receiving an accurate diagnosis.

What does trigeminal neuralgia pain feel like?
Patients often describe sudden electric-shock-like, stabbing, or burning facial pain.

Who should I see for facial pain that might be trigeminal neuralgia?
A neurologist and/or an orofacial pain specialist may be involved depending on the symptoms and diagnosis.

Can TMJ problems irritate the trigeminal nerve?
TMJ disorders can generate pain signals carried by the trigeminal nerve, but this does not necessarily mean a patient has trigeminal neuralgia.

When should someone in the NYC area see an orofacial pain specialist?
Patients should seek evaluation when facial pain, jaw pain, tooth-like pain, or nerve pain persists despite prior dental or medical treatment, or when the diagnosis remains unclear.

Tags Facial Pain, Orofacial Pain, TMJ/TMD

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.

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.

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

Tags Botox, Jaw Problems, Orofacial Pain, TMJ

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?

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!

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:

Tags Bruxism, Jaw Problems, Orofacial Pain

Orofacial Pain Trigeminal Neuralgia

What Is Trigeminal Neuralgia?

Post author By Dr. Steven Syrop
Post date February 9, 2022
4 Comments on What Is Trigeminal Neuralgia?

This content was originally published on 2/9/2022 and reviewed on 6/19/2026

What is trigeminal neuralgia?

Trigeminal neuralgia (TN) is a chronic nerve disorder that causes sudden, severe episodes of facial pain, typically on one side of the face. The pain is caused by irritation or compression of the trigeminal nerve and is often described as an electric shock or burning sensation. There is no cure, but medication, nerve blocks, and in some cases surgery can effectively manage symptoms.

Thousands of nerves and various neurological pathways run through our brain, and abnormalities or damage to those nerves can lead to chronic diseases. Trigeminal neuralgia is a painful disease that affects the trigeminal nerve, which runs through the face and upper jaw. Since its obvious spasms can be caused by touching the face, some patients mistake the symptoms for a dental issue when they first detect them while brushing their teeth. On the other hand, this disease is classified as a neurological problem rather than an oral health problem. Although there is no cure, there are ways to manage discomfort.

What Does Trigeminal Neuralgia Pain Feel Like?

Trigeminal nerve neuralgia causes sporadic to regular bouts of shooting facial pain that feels like a burn or an electrical shock. An episode can last anywhere from a few seconds to two minutes, and a person might be affected for an hour or more at a time.

Daily living might be tough for someone who suffers from facial neuralgia. Eating and speaking can be challenging as the disease progresses, and even routine facial touch such as shaving, flossing, or applying cosmetics can cause a wave of discomfort. Constant anxiety over the next episode can turn to depression and other mental health issues, which are just as challenging to deal with as the neuralgia itself.

What Causes Trigeminal Neuralgia?

According to the National Institute of Neurological Disorders and Stroke, trigeminal neuralgia is one of the most painful neurological conditions and is often caused by compression of the trigeminal nerve.

An artery or tumor pushes on the trigeminal nerve, causing the illness. As a result of this contact, the nerve is compressed, and its protective covering is damaged. This can happen due to nerve damage caused by sinus surgery, mouth surgery, head trauma, a stroke, or a complication of multiple sclerosis. According to the Mayo Clinic, this type of neuralgia affects people regardless of their age. However, it is most prevalent in adults 50 and over, and women are more likely to be affected.

Can Trigeminal Neuralgia Be Mistaken for a Toothache?

This disease may manifest as pain in the lips, nose, eyes, or forehead, in addition to imitating the teeth or gum discomfort of a dental issue. Those who have tooth sensitivity or discomfort and suspect it is trigeminal neuralgia need to consult their dentist because these symptoms might indicate something else if there are no other symptoms of the illness.

Can Trigeminal Neuralgia Be Mistaken for a TMJ Disorder?

Although trigeminal neuralgia and TMJ disorder can both cause facial pain, they differ significantly in their causes, symptoms, diagnosis, and treatment approaches.

Because the terms are often used interchangeably, many patients are confused about the difference between trigeminal nerve pain and trigeminal neuralgia.

How Is Trigeminal Neuralgia Diagnosed and Treated?

To diagnose trigeminal neuralgia, a comprehensive medical examination and history are necessary. After discussing the problem with the dentist and doctor, they will send you to a neurologist, who may conduct a head MRI or other imaging to confirm the condition and begin developing a treatment plan.

While there is no universal cure or therapy that will work for everyone, a TMJ specialist may prescribe pain management techniques. A doctor’s first line of defense against the disease is generally nonsurgical therapy.

The pain associated with neuralgia is neuropathic (originating directly from the nerve). Thus, it does not react to over-the-counter pain medications or opioids. Anticonvulsants like carbamazepine (which is used to treat seizures) can help to decrease discomfort and attacks. To help reduce facial “shocks,” a neurologist may prescribe a muscle relaxant or other medicine.

Learn more about our trigeminal neuralgia treatment approach.

How Do You Manage Living with Trigeminal Neuralgia?

If you have noticed signs of trigeminal neuralgia, talk to a TMJ specialist about the best ways to deal with the pain. You can also speak to a counselor about the mental health issues that come with the illness. The specialist can assist you in your recovery, regardless of your age or stage in life, so you will not have to worry about discomfort when flashing your smile.

Why New York City Metro Area Patients Are Referred to NYTMJ for Trigeminal Neuralgia

Patients are frequently referred to our practice after:

Multiple dental procedures failed to eliminate pain
TMJ treatment did not improve symptoms
MRI or neurological findings suggested trigeminal neuralgia
Persistent facial pain remained unexplained

Our specialists focus exclusively on disorders of the jaw, face, head, and trigeminal nerve system, allowing for a more precise diagnosis and individualized treatment plan.

REQUEST AN EVALUATION →

Frequently Asked Questions About Trigeminal Neuralgia

Is Trigeminal Neuralgia Curable?

There is currently no cure for trigeminal neuralgia, but medications, nerve blocks, and surgical procedures can often significantly reduce symptoms and improve quality of life.

Is Trigeminal Neuralgia the Same as TMJ?

No. TMJ disorders affect the jaw joints and chewing muscles, while trigeminal neuralgia is a nerve condition.

How Long Do Trigeminal Neuralgia Attacks Last?

Individual episodes typically last from a few seconds to about two minutes.

What Triggers a Trigeminal Neuralgia Episode?

Light touch to the face, brushing teeth, shaving, washing the face, applying makeup, talking, chewing, and wind.

Can a Dentist Diagnose Trigeminal Neuralgia?

A dentist can rule out dental causes of pain, but diagnosis generally requires neurological evaluation.

Who Treats Trigeminal Neuralgia?

Treatment typically involves a neurologist and may also involve an orofacial pain specialist.

Can Trigeminal Neuralgia Cause Jaw Pain?

Yes. Many patients experience pain in the jaw, teeth, cheek, or lower face, which is one reason trigeminal neuralgia is often mistaken for TMJ disorders or dental conditions.

Tags Orofacial Pain, trigeminal neuralgia

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

Tags Bruxism, Headaches, Jaw Problems, Oral Appliances, Orofacial Pain, TMJ

Headaches Jaw Problems Nightguards & Oral Appliances Orofacial Pain Sleep Apnea TMJ

How To Evaluate Yourself For TMJ

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date April 12, 2021
No Comments on 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?

Tags Bruxism, CPAP, Headaches, Jaw Problems, Locked Jaw, Lockjaw, Oral Appliances, Orofacial Pain, Sleep Apnea, Teeth Grinding, TMJ

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.

Tags Orofacial Pain, TMJ

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:

Avoid Chin-Pull
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.
Stop Using Ear Loops
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.
Keep Your Neck Muscles Loose
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).
Smile! 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

Tags Bruxism, Ear Pain, Jaw Problems, Orofacial Pain, TMJ

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.

Tags Orofacial Pain, TMJ

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.”

Tags Jaw Problems, Orofacial Pain, TMJ

Bruxism Case Studies Orofacial Pain TMJ

The Connection Between PTSD & TMJ

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date July 26, 2019
No Comments on 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.

Tags Bruxism, case studies, Orofacial Pain, Teeth Grinding, TMJ

Can a medical condition cause TMJ pain?

You Deserve to Be Taken Seriously

Why Your Jaw Muscles May Be the Messenger, Not the Problem

Can Autoimmune Conditions Cause Jaw Pain?

Rheumatoid Arthritis

Lupus

Psoriatic Arthritis

Hashimoto’s Thyroiditis

Can Lyme Disease Cause Jaw Pain?

You Are Not Starting From Scratch

Are You Experiencing Jaw Pain That Isn't Responding to Treatment in the NYC Metropolitan Area?

About the Author

Frequently Asked Questions About Medical Conditions That Can Cause TMJ Pain

What Is Different About a TMJ Evaluation Compared to a Regular Dental Visit?

What Does the Physical Examination Involve?

Why Does the Specialist Ask So Many Questions About Life Outside the Jaw?

How Is TMJ Treated in Teenagers?

How Long Does TMJ Treatment Last for a Teenager?

What Are ICR and JIA, and When Should They Be on your Radar?

Is Your Child Dealing With Jaw Problems in the New York City Metropolitan Area?

About the Author

Frequently Asked Questions

What Is TMJ?

Why Does TMD So Often Start During the Teen Years?

Why Are Girls More Likely to Develop TMD During Puberty?

Can a Teenager Have Both TMD and Migraine at the Same Time?

Can Braces or Aligners Make TMD Worse?

Can ADHD Medication or Antidepressants Cause Jaw Clenching?

How Does Poor Sleep Make Teen TMD Symptoms Worse?

Does Stress Really Cause Physical Jaw Pain?

Is Your Child Experiencing TMJ or Jaw Pain Symptoms in the New York City Metropolitan Area?

About the Author

Frequently Asked Questions about Jaw Pain in Teenagers

Further Reading

When the issue is joint instability, not tightness

When Your Symptoms Do Not Fit the Usual Pattern

The Role of TMJ Hypermobility – Why the Jaw Becomes Painful

Why the Jaw Becomes Painful

A Common Pattern

Why Treatment Has Not Worked

Treatment Focus: Stability and Control

Setting the Right Expectations

When to Seek Evaluation

Moving Forward

DO YOU HAVE TMJ AND A HYPERMOBILITY DISORDER IN THE NEW YORK CITY METROPOLITAN AREA?

Helping Patients Better Understand Their Persistent Symptoms

Why This Happens in Women

The Emergence of TMJ Symptoms

A More Complete Understanding for Women

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

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

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

A Case We Treated: Debbie’s Story

Introducing Low-Dose Naltrexone (LDN)

How Low-Dose Naltrexone Works: Two Mechanisms That Matter

How Low-Dose Naltrexone Is Prescribed

Common Misconceptions About Post-Surgical Pain

Who May Benefit from This Approach

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

The Three Branches of the Trigeminal Nerve

1. The Ophthalmic Division

2. The Maxillary Division

3. The Mandibular Division

What Is Trigeminal Nerve Pain?

What is the difference between trigeminal nerve pain and trigeminal neuralgia?

What Is Trigeminal Neuralgia?

How Trigeminal Neuralgia Is Diagnosed

Why Trigeminal Neuralgia Can Feel Like a TMJ Problem

Common Treatment Options for Trigeminal Neuralgia

Other Types of Trigeminal Neuropathic Pain

Not Sure If Your Pain Is TMJ, Tooth Pain, or Trigeminal Neuralgia?

About the Author

Frequently Asked Questions Trigeminal Nerve Pain vs. Trigeminal Neuralgia

7 Common Questions About BOTOX® For TMJ Treatment

1. What Is BOTOX®?

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

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

4. How Long Will The Benefits Last?

5. How Many Injections Will I Need?

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