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Tag: Teeth Grinding

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

How To Get Relief From TMJ Pain When Nothing Is Working

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

What Causes TMJ/TMD Problems?

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

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

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

First-Line Therapies For Relief From TMJ Pain

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

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

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

massage for TMJ, temporalis and masseter

Injections For TMJ

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

Jaw Muscle Injections For TMJ

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

Tendon and Ligament Injections For TMJ

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

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

Injections Into The Jaw Joint

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

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

New Injections For TMJ Are On The Horizon!

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

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

The Last Word

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

Feel Better!

 

Further Reading:

All About BOTOX® For TMJ

What Is Referred Pain?

The Connection Between Pain & Sleep

Categories
Jaw Problems TMJ

TMJ & Arthritis In The Jaw Joints

As an Orofacial Pain Specialist, people come to me when they’re suffering from the painful symptoms of a TM Disorder, which you may have heard referred to as TMJ, which is short for temporomandibular joints, which are your jaw joints. For most people, when properly treated, their TMJ problems can be controlled.

But, for some, what began as a common TMJ problem can progress to arthritis in the jaw joints – specifically osteoarthritis. To appreciate why arthritis can impact the jaw joints, let’s review some basic concepts about jaw disorders:

TMJ Disorders & What Causes Them

TM disorders are a group of conditions that affect your TMJs, your jaw muscles, or both. They can have many origins, such as a single traumatic event and or an underlying medical disorder. However, TMJ disorders are most commonly related to other risk factors such as jaw overuse behaviors during the day such as nail and/or cuticle-biting, frequent tooth contact, teeth clenching, gum-chewing, ice-chewing, or gnawing on pencils, pens, your lips, cheeks, or your tongue.

Nighttime bruxism, where you grind and/or clench your teeth while you’re asleep, can play a significant role in causing TMJ in some people. For others, the way their teeth come together and the spatial relationship of their upper and lower jaw plays a role. And, some research points to biological factors as potential initiators of jaw symptoms such as sex hormones, and psychosocial influences such as exposure to stress, chronic pain, catastrophizing, and other emotions.

But the most common initiators of TMJ problems – overuse behaviors and nighttime bruxism – exert a tremendous amount of pressure on your jaw joints and over time, can lead to a reduction in synovial fluid, the lubricant that nourishes your jaw joints and is responsible for maintaining the shape of your articular disc, the natural shock-absorber of your jaw. Because the supportive ligaments that keep your articular disc in place have become weak this all can result in inflamed and unstable jaw joints.

The most common symptoms caused by daytime overuse behaviors and nighttime bruxism are jaw pain, jaw joint clicking, compromised jaw motion, difficultly opening your mouth, joint locking, and changes in your bite. But for some people, bone and cartilage changes also occur and can lead to arthritis in the jaw joints.

The Symptoms Of Arthritis In The Jaw Joints

Once arthritis emerges, it can cause considerable pain, limited jaw movement, bite changes, and even chewing problems. It can also lead to muscle tension, causing headaches, ear pain, and/or toothaches. Some patients even experience gravel-like sounds when opening and closing their mouths due to the dryness and friction in their joints. As jaw osteoarthritis progresses, the bite can become dominant on one side with a gap on the other (for some, this is the only symptom that appears).

Are You At Risk Of Developing Arthritis In The Jaw Joints?

The good news is: not everyone who has TMJ will develop osteoarthritis. In fact, the vast majority of my patients with common TMJ disorders do not. I often see the signs of arthritis in patients who don’t recall ever suffering from a problem related to jaw arthritis. This suggests that our TM joints have a tremendous adaptive capacity and even when injured or persistently overworked, healing and adaptive changes can occur.

If you think (or know) you have jaw joint arthritis and associated symptoms, there’s an excellent chance, with proper treatment, your symptoms can be diminished and the progression of the disease reduced. Treatment can include non-steroidal anti-inflammatory medications, short-term oral steroids, injections of steroid in the joints, and the elimination and/or control of the behaviors that have overworked your TMJs. Bite plates (also called oral appliances, tooth protectors, and night guards) are often used to protect your joints while you sleep. For some, injections of lubricating substances such as hyaluronic acid are helpful over the short term. Only in extreme cases is joint surgery necessary.

Happily, it is rare for TMJ osteoarthritis to advance to such a degree that it causes disabling pain and jaw function limitations. With careful assessment and the proper treatment strategies, getting better is predictably successful.

Conclusion

If you’ve been suffering from a TMJ disorder and are concerned it is progressing, it’s time to seek a professional assessment from an experienced Orofacial Pain Specialist. To find one in your area, hop on over to the website of the American Academy of Orofacial Pain and look for a specialist with Diplomate status.

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

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

How To Evaluate Yourself For TMJ

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

5 Nighttime Factors That Could Be Causing Your TMJ Problems

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

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

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

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

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

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

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

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

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

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

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

How To Evaluate Yourself For TMJ – In Conclusion

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

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

Helpful Links:

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

How Many Hours Of Sleep Are Enough For Good Health?

Categories
Facial Pain Jaw Problems Referred Pain TMJ

How To Self-Treat Jaw and Face Pain During Stressful Times

As an orofacial pain specialist in New York City and Long Island, patients come to me because they suffer from the painful symptoms of TMJ. Most often their symptoms are a result of their stressful lives.

During the pandemic, most people have been living with an unusually high level of stress. Poor sleep and limited exercise is one reason. Also involved are continually tensed shoulders, breathing in a strained manner, and grinding and clenching your teeth at night (or during the day). The result can be headaches, pain in the neck and back, or pain in your face, teeth, and jaw, or all of them.

How To Detect A TMJ Problem

When your TMJs (your jaw joints) are in trouble, it typically shows in five ways. You may have one, a few, or all of these symptoms:

  • Facial pain
  • Clicking or popping when you open and close your mouth
  • An unexplained toothache
  • Difficulty opening your mouth
  • Unexplained headaches, particularly when you wake up

It’s easy to understand how living with the pandemic for the past few years could trigger stress-related symptoms even in people who are normally calm and positive. I’ve seen hundreds of new patients never had a TMJ problem before the pandemic and just as many who suffered from TMJ in the past.

My advice is to become hyper-aware of how stress is impacting your jaw muscles. Stop every now and then during the day and take note if you are:

  • Holding your breath
  • Bracing your jaw muscles
  • Furrowing your brow
  • Clenching your teeth
  • Biting your nails
  • Raising your shoulders

Tips: How To Treat Jaw & Face Pain During Stressful Times

Control Your Daytime Breathing

Perform these three steps if you notice you’re holding your breath or breathing more rapidly than normal:

  • Slowly breathe in through your nose deep into your core and hold it for 3 seconds. It’s easier if you place the tip of your tongue on the roof of your mouth or behind your lower front teeth as you breathe.
  • Let the air out for three seconds through your lips and pause for 3 seconds.
  • Repeat 6 times.

Note: If your nose does not let air in (quite possible during allergy season) breathe in through your mouth in a slow, controlled way with your lips barely touching. There are no absolute rules; just do the best you can.

how to relax your face, donald tanenbaum
Loosen-Up Your Face and Jaws

Notice if you hold tension in your face or brace your jaw muscles when you’re at your computer, reading, or listening to the news. If you are, use this 3-step method to relax your face and jaw:

  • Let your jaw hang limp – kind of the way your hands hang limp when you drop them at your sides.
  • Keep your lips together, teeth apart.
  • Breathe.

Do this every time you notice tension in your face or jaw.

how to stop biting nails, donald tanenbaum
Stop Biting!

Biting your lips, cheeks, nails, or cuticles, can all lead to jaw muscle fatigue and pain. The 3 tips below may help you stop:

  • Keep your lips soft (don’t purse them).
  • Keep your lips touching lightly and your teeth apart (you don’t have to keep your mouth open.
  • Let your face and jaw hang in a neutral, relaxed posture (same as step 1 above).

how to treat face and neck pain, donald tanenbaum
Soften Your Shoulders

Many people experience headaches and neck and jaw pain as a result of tense shoulders. It’s called referred pain. To keep your shoulders soft:

  • Don’t hunch up your shoulders up close to your ears. Periodically stop what you’re doing and gently push them down.
  • Try not to cross your arms.

Both tips will ease your neck tension, help your breathing, and reduce the onset or the intensity of the muscle tension that leads pain.

get up and move around, face and neck pain, computer neck, donald tanenbaum
Get Up & Move Around

It’s never a good idea to sit in one place for hours and hours even in less stressful times.

  • Every 45-minutes get up and walk around, even if it’s just to throw in a load of laundry or cook a meal.
  • If you’re experiencing severe neck tension or pain, the Feldenkrais Method® is a great way to manage it, too. It’s an easy and gentle technique that eases neck and jaw tension.

moist heat to treat face and jaw pain, donald tanenbaum
Use Moist Heat

Moist heat is a good way to treat jaw and face pain:

  • Use a wet towel, heat pack, or TMJ wrap – available in many pharmacies.
  • Apply the heat for 15-minutes
  • Then perform a gentle jaw muscle self-massage. Here’s how:
    • Open your mouth halfway.
    • With your index and middle finger massage the fleshy part of your jaw muscles in a circular motion for 10-seconds
    • Then, move in the opposite direction for 10-seconds.
    • Next, with your mouth still half-open, move your fingers to your temples right under the hairline and perform the same massage technique. If you feel muscle soreness as you massage, you’re doing it right.

Do this moist heat massage twice a day.

TENS unit for neck pain, donald tanenbaum
Purchase A TENS Unit

If your pain is severe and moist heat doesn’t help, go online and purchase a TENS unit (Nursal EMS TENS unit). Place the pads as directed on your jaw muscles (called masseters) and your large neck muscles (your trapezius) once or twice a day. Most TENS units come with simple instructions and there are many videos online with instructions.

biofreeze for neck pain, donald tanenbaum
Try Biofreeze®

Another method that works for many people is to rub Biofreeze® onto the jaw and neck muscles several times a day. Just make sure you keep it away from your eyes.

calm your mind to treat face and jaw pain, donald tanenbaum
Calm Your Mind

Yoga or meditation are great ways to keep stress from impacting your body. Online you can find hundreds of classes, many of them free. I like the app Insight Timer. Headspace, Calm, and Buddhify are also terrific apps. Find the one that fits your style and needs and try not to make it a challenge but a regular part of your day and/ir when you really need it.

tension while sleeping, donald tanenbaum
Is Your Body Tense While You Sleep? Try this:

If you wake up with headaches, facial, jaw, or teeth pain, you are problem clenching or grinding your teeth at night. Try these tips:

  • Drink warm chamomile or Sleepytime® tea before bed.
  • Try magnesium. Before you retire for the night, eat a banana or buy a magnesium supplement at the pharmacy (ask the pharmacist to recommend a good one).
  • If you’re really suffering, purchase a dental night guard at the pharmacy. The best one is made by DenTek™. However, some patients report that over-the-counter devices actually make them clench more! If that’s the case, talk to your dentist about having a custom-made nightguard made for you.

By following the above tips, you can treat your jaw and face pain at home. But note, it may take some time for your symptoms to subside. Don’t give up!

Now that life is getting back to normal it’s time we all assess our physical and emotional state and do what we need to do to feel better.

For more information about TMJ, please link here

Your _Child_Is_Grinding_His_Teeth_–_What_Should_You_Do__Child_Sleep_Bruxism_Donald_Tanenbaum
Categories
Bruxism Children & TMJ TMJ

Your Child Is Grinding His Teeth – What Should You Do?

Is this familiar? 

You think your child is fast asleep, then suddenly, a screeching sound is coming out of his/her bedroom. What could be causing it? The most likely explanation is your child is grinding his teeth – an activity clinically known as sleep bruxism.

Sleep bruxism, which is often associated with jaw pain (TMJ), is the most common problem seen in my practice for the past 30 years. As a result, I know first-hand that a little information goes a long way to help parents understand what is happening and what can be done about it.

When A Child Grinds His Teeth, What’s Happening?

The first thing to understand is that a certain level of jaw movement during sleep is normal for most people. It’s called Rhythmic Masticatory Muscle Activity, or RMMA. Some people who grind their teeth experience higher levels of RMMA, which can result in tooth damage and jaw pain problems.

Much research has been done in the past few years on teeth grinding and sleep bruxism. One significant finding is that in many people who grind during sleep, their brain is becoming aroused and causing sleep to be fragmented. The result is the body’s fight-or-flight system becomes activated. In tandem, jaw motion (RMMA) increases and teeth grinding is often the result. 

Teeth Grinding in Children Under 10-Years Old

Newborn baby sleep with teddy bear

If your child is under ten-years-old and grinding his teeth, it’s likely during the time when his baby teeth are being lost. If you hear the telltale screeching sound that indicates your child is grinding his teeth, look for evidence of tooth wear. If you see it, a visit to your child’s dentist is highly recommended. Also, ask your child if he is experiencing jaw symptoms such as joint popping, cracking, locking, or pain. If the answer is yes, it’s time to see the dentist.

Teeth Grinding In Adolescents & Teens

child grinding his teeth, adolescent grinding his teeth, sleep bruxism, TMJ, dr tanenbaum

We have many clues about why adolescents and teens grind their teeth during sleep. Current theories include:

1. Large tonsils, a big tongue that clogs the airway, a small lower jaw, blocked nasal passages, or a long floppy soft palate can cause breathing problems during sleep, and, in turn, causes a drop in blood oxygen. The brain awakens and activates the body’s fight-or-flight system increasing the likelihood of sleep bruxism.  

2. Adrenaline – During times of stress and anxiety, the level of adrenaline (catecholamines) in the bloodstream increases. For adolescents and teens who experience long-term anxiety, high adrenaline levels have been shown to induce sleep bruxism.

3. Chronic Pain – Migraines, gastrointestinal disorders, and back and neck pain set up ideal conditions for sleep disturbances and can lead to teeth grinding.

4. ADD/ADHD Medications – Medications such as Adderall, Concerta, and Strattera stimulate the fight or flight part of a child’s nervous system and result in sleep disturbances.

5. Caffeine – Many adolescents and teens drink coffee and high caffeine beverages during the day and into the evening. Caffeine has been proven to be a contributing factor to disturbed sleep patterns.

6. Nicotine – Nicotine is a stimulant. It’s widely known to contribute to sleep problems. The use of e-cigarettes, which are very high in nicotine, is particularly prevalent among adolescents and teens and can be a direct cause of sleep problems. 

7. Not Enough Sleep – With the obligations of school and extracurricular activities, many young people are under a tremendous amount of pressure. They put in long hours and don’t get enough sleep. Others simply stay up late playing video games or communicating on social networks. Sleep quality is ultimately impacted, leading to restless nights of tossing and turning and the emergence of sleep bruxism.

What You Should Do:

By now, you can understand if your child is grinding his teeth, there are multiple risk factors. The good news is that teeth grinding is treatable and can be managed. There is a wide array of options at our disposal to help manage the problems caused by sleep bruxism for children who grind their teeth including oral appliances, jaw exercises, meditation, acupuncture, medication, and even BOTOX®.

But here’s the key – managing your child’s sleep bruxism will not cure it. It will, however, help him get through some tough periods. Meanwhile, the medical community continues to pursue a better understanding of the underlying causes of nighttime brain arousals.

If your child is grinding his teeth and you’re concerned, his dentist or orthodontist should be able to help. If the situation is dire, you can find someone in your area who focuses on Sleep Bruxism, such as a member of the American Academy of Orofacial Pain – AAOP. Choose a professional designated Diplomate. 

orofacial pain, ptsd tmj, tanenbaumtmj, donald tanenbaum, tmj doctor nyc, tmj doctor long island
Categories
Bruxism Case Studies Orofacial Pain TMJ

The Connection Between PTSD & TMJ

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

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

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

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

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

PTSD Affects The Nervous System In A Specific Way

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

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

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

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

PTSD & TMJ – A Case Study

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

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

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

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

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

Can A Combination Of PTSD & TMJ Be Treated?

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

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

Conclusion

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

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

 

 

 

Categories
Bruxism Children & TMJ Jaw Problems TMJ

Teeth Grinding in Children, Adolescents, and Teens

Teeth grinding is the first thing that parents think of when they discover signs of wear on their children’s teeth. And while teeth grinding in children, adolescents, and teens is common (which I’ll explain later in this article), it is not always the reason that teeth become worn. In many cases, frequent consumption of highly acidic beverages is what causes tooth wear in young people.

To understand why acidic beverages cause tooth destruction, it’s important to know what pH means.pH is the measure of the acidity and alkalinity of a liquid. The more acidic a liquid, the more damaging it is to your teeth.

Acidic beverages such as soda pop break can down tooth enamel, which is the outer protective coating of your teeth. When tooth enamel breaks down, dentin, the underlying tooth material, is exposed. Because dentin wears down six times faster than enamel, daily exposure to acidic beverages can cause enormous damage to teeth.

Most of the popular beverages in the U.S. are highly acidic, as you can see from the chart below. Sadly, these are also the beverages most preferred by young people. To make matters worse, it’s common for them to vigorously swish beverages from side to side in their mouths before swallowing, making the potential for tooth destruction even more probable.

 

Teeth Grinding in Children, Adolescents & Teens Donald Tanenbaum

 

When parents who are concerned about their children’s worn teeth come to my office, the first thing I look for is signs of highly developed and bulky jaw muscles. That is the hallmark of teeth grinding and clenching. If I don’t see those signs, then frequent acid exposure is most likely to be the cause.

Teeth Grinding in Children, Adolescents, and Teens

Teeth grinding in children, adolescents, and teens causes a different type of destruction. Grinding and clenching produces frictional wear as opposed to the erosion of tooth enamel caused by acid.

Grinding and clenching behavior usually occurs during sleep and, because of that, is called sleep bruxism. Sleep bruxism affects approximately 5%-10% of young people, and the number is growing.  

The underlying reasons for teeth grinding in children, adolescents, and teens remains unclear, but we believe it is likely to be related to fragmented sleep accompanied by frequent brain arousals. The cause can include (but is not limited to) insomnia, generalized states of daily anxiety, medications such as those used to treat AHD/ADHD, and obstructed breathing due to large tonsils, and/or small lower jaw profiles.

If you’ve noticed your children’s teeth are showing signs of wear, such as chips (or if they’re beginning to look smaller), it’s important to see your dentist as soon as possible. If acidic beverages are the cause of the problems, until that risk factor is addressed, the potential for excessive tooth destruction will go unchecked – and likely lead to extensive dental in the future.

Remember, the best beverage is water!

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Categories
Facial Pain Jaw Problems Orofacial Pain TMJ

BOTOX® Injections For TMJ – 6 Things You Need To Know

During the past few years in my practice as a dentist who focuses primarily on TMJ and orofacial pain problems, I have seen a lot of success using BOTOX® injections for TMJ to treat muscle pain and oral nerve pain.

BOTOX® is not suitable for every patient, however. Care must be taken as to when to use it, how to use it, and who is a good candidate. If you’re considering BOTOX® as part of your treatment for TMJ problems, jaw pain, pain in or around your teeth, or because of a change in the shape of your jaw, please read on:

6 Important Things You Need To Know About BOTOX® Injections For TMJ

  1. BOTOX® is Not a First-Line Treatment for Jaw Muscle Pain
    First-line treatment for jaw muscle pain (and spasm or tightness) is dictated by a careful evaluation to identify why you have symptoms in the first place. For example, it may be necessary for you to change some daytime habits, postures and behavioral tendencies that fatigue the jaw and neck muscles. Or if you clench or grind your teeth at night you may need to wear a protective night guard. In addition, you may get relief from medications, home jaw and neck exercises, breathing exercises, meditation, a change in your diet, or all of the above. Muscle injections or dry needling would be next in line along with visits to a physical therapist, chiropractor or osteopath who would work to promote muscle comfort. The bottom line, however, is that you the patient, must participate in the process of getting better and BOTOX® will not produce the desired goals if the underlying reasons for your pain have not been identified and dealt with.
  2. BOTOX® Will Not Ease Certain Types Of Muscle Pain
    There are times when muscles hurt even though they have not been overused. When life circumstances, emotions or thoughts cause your muscles to tighten and ultimately ache, then BOTOX® injections for TMJ will not likely help. Instead, counseling, talk therapy, cognitive behavioral therapy, and the like may be the right strategies to pursue.
  3. If You Currently Wear a Night Guard
    If you currently wear a night guard and still have morning symptoms of muscle pain or tightness, joint noises, locking, and/or pain, you may be a good candidate for BOTOX®. This is particularly true if you find yourself biting hard on the guard when you wake up in the morning. Keep in mind however, that BOTOX® will be most helpful if you continue to wear your night guard. Two strategies are better than one in this scenario.
  4. If You Can’t Tolerate A Night Guard
    If you have simply cannot tolerate a night guard (and have tried various types, with your dentist’s guidance) BOTOX® injections for TMJ may provide meaningful benefit.
  5. If Your Jaw Muscles Are Too Big
    If your jaw muscles are just too big and visibly over-built, BOTOX® may be an option. One of the predictable things that BOTOX® does is reduce muscle bulk when used over time. BOTOX® has been shown to be effective in producing a flatter and more natural-looking profile. You will likely need three BOTOX® sessions in three-month intervals to achieve the best results. However, jaw bulk may creep back if the reasons your muscles become larger have not been identified and dealt with.
  6. If You Experience Persistent Oral Nerve Pain
    Small quantities of BOTOX® may be helpful if you experience persistent pain in your gum tissue, at the site of a tooth or tooth extraction, or at other sites around your face. Nerve pain inside your mouth or in your face is often due to electrical discharge from the trigeminal nerve. BOTOX® injections for TMJ into the painful sites (often called trigger zones) can provide real benefit, especially if you don’t respond well to oral medications. In spite of being relatively new, this type of treatment is showing promise.

In Conclusion

BOTOX® has become a helpful component in the management of TMJ, jaw muscle pain and oral nerve pain problems. The important thing for you, the patient, is to understand that BOTOX® injections for TMJ are not a cure-all. Careful assessment by an experienced practitioner remains the key to making treatment decisions that will result in a long-term positive outcome. If you choose BOTOX® as first-line therapy without understanding the origins of your pain, you will likely be out of pocket quite a bit of money with nothing to show for it.

Related reading:

BOTOX® for teeth grinding is in the news! I was recently interviewed on ABC’s Good Morning America on the topic, Can BOTOX® be used to treat teeth grinding?  Click the link to watch the segment.

Dr. Donald Tanenbaum is a dentist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with facial pain, TMJ and sleep apnea. To make an appointment for a consultation, call: Manhattan: 212-265-0110, Suffolk county: 631-265-3136.

can braces cause tmj, donald tanenbaum, temporomandibular
Categories
Bruxism Jaw Problems TMJ

Can Braces Cause TMJ?

TMJ problems can be a real burden that leads to pain, limitations on eating and embarrassing jaw joint noises. In my practice as a dentist who focuses primarily on TMJ and jaw problems, patients often ask me, “Can braces cause TMJ?” Although there’s no easy answer, I’ll do my best to explain.

Can Braces Cause TMJ? Three Scenarios

If you’re concerned that braces are the cause of your jaw issue, you’ll likely fit into one of the following three scenarios:

Scenario 1: You finished orthodontic treatment less than a year ago and suddenly you have TMJ symptoms.

Let’s give this scenario some thought as there may be some concerns about what we call new bite relationships. Think about this: your teeth have been moved and have had to settle into new positions. That means your jaw muscles, tendons, joint ligaments, cartilage, bones, lubricating systems, and shock-absorbing disc all had to adapt to the new environment. Thankfully, most people experience no problems with this process.

But in some people the end orthodontic result can lead to asymmetric tooth contacts or tooth contact patterns that force the lower jaw into an awkward position when the teeth are brought together. Therefore, the jaw is consistently forced into postural positions while chewing that lead to sprains and strains. If this scenario occurs in a person who has daytime behaviors that prompt tooth contact or who has a history of night clenching or grinding, these awkward bite postures will have a greater impact and can lead to even more severe TMJ symptoms than are caused by the behaviors themselves.

If you fit into Scenario 1, the answer to the question, can braces cause TMJ? is Yes! You should to return to the orthodontist or dentist who moved your teeth. There’s a chance that to “shore up the foundation” a short phase of orthodontics or some dental procedures to provide more tooth contact symmetry can do the trick. If you don’t feel your complaints are being taken seriously, a second opinion is recommended.

In addition, you may need change your daytime over-use behaviors such as teeth grinding or clenching, wear a protective oral appliance at night, and perform jaw exercises. It’s important to identify any other risk factors that could play a role, as well. (See a list at the end of this post.)

Scenario 2: You have braces now and your TMJ problems just began.

Regardless of whether your braces are the traditional or the Invisalign-type removable aligners, if you experience occurrences of pain (beyond what’s expected during orthodontics) or joint noises and/or locking, you must report your symptoms to your orthodontist or the dentist providing your treatment. Your braces might not need to be removed, but instead adjusted to make sure your jaw is no longer stressed.(Also, it is important to be sure that the orthodontic process is not being compromised by outside factors, such as those that are listed at the end of this post.

Scenario 3: You had braces, but they were removed many years before your TMJ problems began.

Can braces cause TMJ if they were removed years ago? It’s unlikely that braces removed years before your jaw symptoms first started could be the primary or exclusive cause of TMJ. In fact, the vast majority of studies conclude that even if one’s bite is “off” for decades (one’s natural bite or an orthodontically-created bite) there is little chance this single factor is the cause of TMJ problems.

If your long-ago removed braces are not the primary reason you have TMJ, then what is? Something clearly has happened, likely over a long period of time that caused fatigue and overworked, sprained, or traumatized your jaw muscles and joints.

If you were my patient, I would conduct a full assessment and start by asking you some very important questions that fall into four distinct groups:

1. Did You Have An Injury?
The TMJs and associated jaw muscles can be injured the same way knee or elbow structures can. Were you injured on the athletic field or in a car accident? Did you have a recent medical procedure that kept your mouth open for a long period of time or in an awkward position? Did you notice sudden jaw pain or popping while eating, yawning, playing a musical instrument, or even singing? Did you recently have dental work performed or a challenging wisdom tooth removal that could have compromised your jaw structures?

2. Do You Over-Stress Your Jaw?
Over-use behaviors and head postures can impact the structure and stability of your jaw muscles and temporomandibular joints (your TMJs). Do you chew gum or bite your nails, cuticles, or pens? Do you hold your eyeglass frames between your teeth? Do you grind or clench your teeth at night and/or during the day? Do you have work-related neck strain? Do you have longstanding neck symptoms that include pain and muscle tightness?

3. Has Your Health Changed?
Changes in the your medical health can also be a source of challenge to your jaw. Are you on a new medication? Have you stopped smoking? Do you have a new neuromuscular, rheumatologic and/or autoimmune disease? Are you profoundly depressed or have anxiety? Have you been diagnosed with a chronic illness? Do you have problematic insomnia, migraines or fatigue? Have you changed your diet to one that requires more consistent chewing of tougher foods? Even merely being concerned about your health is sufficient to initiate jaw muscle tension and pain.

4. Are You Stressed-Out?
A fatigued, conflicted, and unhappy brain is a source of muscle tension and can have a negative impact on your nervous and immune system. That can lead to a lower threshold of pain. Do you have ongoing challenges at home and or at work? Are you caring for a sick child or parent? Is your marriage in trouble? Are there financial worries? The list of critical life matters that can cause changes in the way you sleep, breath and hold muscle tension throughout your body are endless. Any of these changes can cause jaw-related symptoms.

If you answered yes to any of the above, your TMJ symptoms are likely the cause of a number of factors. It is crucially important to discuss these with the orthodontist or dentist who is handling your case.

So, the answer to the question, “Can braces cause TMJ?” is “Yes, sometimes!”

If you are considering braces for yourself or your children, inform the dentist or orthodontist of any jaw problems before you start treatment. A thoughtful practitioner will make a careful assessment of the history and clinical characteristics of every patient before determining how to proceed.

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

For more information on TMJ and jaw pain, link here:
Temporomandibular Disorder
Jaw Problems

BOTOX for jaw reduction, bettheny frankel, donald tanenbaum, tmj, bruxism
Categories
Bruxism Jaw Problems TMJ

BOTOX® For Jaw Reduction: The Real Story


News Flash! Bettheny Frankel Explains Why Her Face Has Changed: “I Get BOTOX® In My Jaw.”

That headline has been winding its way through the web in the past few weeks. I must admit that when I first saw it I had no idea who Ms. Frankel was (I had to ask my wife). But as an orofacial pain specialist, and someone that uses BOTOX® for jaw reduction in my practice, the headline stopped me in my tracks. It’s a topic discussed at lectures and in medical journals, but I have never seen it in mentioned in mass media before.

The article goes on to explain that the reality TV star was encouraged by her dermatologist to consider getting BOTOX® injections in her jaw. The goal was to reduce the size and shape of the jaw. It had become bulky as a result of many years of tooth grinding.

Now, if you are about to jump on the phone to your dermatologist and ask about injections of BOTOX® for jaw reduction you need to know a few facts: 

Here’s how your jaw works: The masseter muscles (define your jaw profile) combined with the muscles in your temples and the jaw joints (the “TMJ”s) all work together to enable you to open and close your mouth. They help you to chew and to speak. But…when they are used too much all kinds of problems can occur. These problems can be sore jaw muscles, headaches in the temples, sore teeth, jaw clicking and locking, diminished jaw motion, ear pain that occurs without an ear problem being identified, and more. What’s more, the size and shape of your jawline can change.

That’s what happened to Bettheny Frankel.

While BOTOX® has a prominent place in my arsenal of treatment methods, BOTOX® alone cannot change the behaviors or risk factors that can cause your jaw to change shape. BOTOX® doesn’t cure the source of the problem. In order for that to happen, you must stop overusing your jaw muscles.

For the average person over-use activities are teeth clenching and grinding. This can happen during the day (called Awake Bruxism) or at night (Sleep Bruxism). Or both.

In addition there are many daytime jaw overuse behaviors. Chewing gum, biting your nails or cuticles gnawing on a pencil, or simply clenching your teeth together will engage your muscles.  When your teeth come together, you are making a fist in your face. Imagine what can happen after hours of making that fist on a daily basis!

During sleep, teeth clenching and grinding can occur for a multitude of reason, most of which are out of your control.

Here’s the good news: Jaw over-use behaviors during the day can be changed. In addition, we continue to get better at identifying the risk factors that may be driving your sleep bruxism. Experienced TMJ/Orofacial pain dentists, like me, have gained valuable insights into these problems leading to effective treatment strategies.

The treatment options can range from natural supplements, sleep hygiene programs, prescription medications, deep breathing exercises employed during the day and before bedtime, formal meditation training, oral appliance strategies that introduce different appliance designs during the course of the week, jaw and neck exercise programs and injections. These injections can include the use of BOTOX®.

Here’s the bottom line: BOTOX® after several injection sessions can prevent the jaw muscles from contracting forcefully. That leads to more slender and less bulky muscles. BOTOX® injections can return your face to its previous proportions. But, if you want long-term success BOTOX® must be surrounded by other supportive and complementary care. Because…if you don’t stop and/or reduce your daytime jaw muscle overuse and sleep bruxism, your jaw muscles will inevitably bulk up again.

So, go ahead. Talk to your dermatologist about BOTOX® for jaw reduction. But also get a referral to a TMJ/Orofacial pain dentist who will help you maintain your normal jawline for life.

Good luck!

Read about the various methods used to correct jaw over-use behaviors:
TMJ Treatment
Can Bruxism Change The Shape Of Your Face? 
Case Study: 10 Years of Teeth Clenching 
Can TMJ Patients Get Better? 

TMJ problems during Invisalign, TMJ, donald tanenbaum, tmj doctor, invisalign
Categories
Facial Pain Jaw Problems TMJ

TMJ Problems During Invisalign Treatment

Modern technology has changed nearly every aspect of dentistry during the past ten years. The world of orthodontics, in particular, has seen incredible advances that allow teeth to be moved in a revolutionary way. Because of software technology dentists can now simulate the tooth movement steps that are necessary to go from starting point to end point before treatment has even begun. This remarkable technology is known to most of us as Invisalign.

Invisalign has not only changed the way teeth are moved, it enables many more dentists than before to offer tooth movement services. This is a huge shift in the way orthodontic treatment is delivered. And for millions of people, Invisalign is more desirable than traditional braces. However, despite the wonderful outcomes, many patients experience TMJ problems during Invisalign

More Patients Experiencing TMJ Problems During Invisalign Treatment

My practice is made up mostly of patients that suffer from disorders of the temporomandibular joint, most commonly referred to as TMJ. One of the significant risk factors that may initiate a TMJ problem is the presence of frequent and aggressive tooth contact during the day and at night. These tendencies are called awake bruxism and sleep bruxism respectively. Before the popularity of Invisalign, I normally saw a small proportion of patients every year that were actively involved with orthodontic treatment.

But recently I have seen an influx of patients with TMJ problems during Invisalign treatment. They represent all ages: teens, adolescents and adults. And they arrive with a combination of jaw muscle problems and jaw joint-related problems. From treating these patients I have begun to see a pattern emerge. Let me explain:

Patients in Invisalign treatment must wear their upper and lower aligner trays on a nearly full-time basis. The only exception is while eating. These clear aligners are made from a very rigid material that is relatively thick. Consequently, they take up a considerable amount of the free space between the upper and lower teeth, even when the jaw is in a relaxed position. For some patients, the upper and lower aligner trays are always in contact, which means their jaw muscles are always contracted in braced state. Over time these contracted muscles can become sore, painful and tight. In some cases, the jaw joint gets involved as well with symptoms such as popping, clicking and locking. And that’s what happened to Paula.

Paula is a 56-year-old who arrived at my office in a state of panic. Her jaw had locked and she was in considerable pain. Paula told me that only two months into her Invisalign treatment she had begun to experience jaw tightness and jaw joint noise upon arising every morning. Reporting it to her dentist, he assured her that her problem was likely not related to Invisalign, as he had “never seen this before.”

Although concerned, Paula pushed ahead with Invisalign until one morning she woke up in tremendous pain with a locked jaw. During our consultation, it became apparent to me that her Invisalign trays had prompted her to her jaw in a braced jaw position during the day and a clenched position at night. Because Paula’s history revealed no other risk factors, it is likely that her jaw muscles and jaw joints were compromised due to repetitive overuse.

Paula is not the only patient I’ve seen in the past few weeks with TMJ problems during Invisalign treatment. Take into consideration Nicole, who is 13-years old. Nicole had a minor jaw click before starting Invisalign. She wore her aligners for only a short period of time before her minor click became out of control and she was in tremendous pain. During her consult, I recognized that with the aligners in place, Nicole could not maintain a relaxed jaw posture. It is, therefore, easy to understand why her previously minor jaw problem had escalated during Invisalign treatment.

Many people have a history of tooth clenching or consistent teeth contact before they ever enter into Invisalign treatment. And some people don’t even know they do it because they don’t experience the typical symptoms. For these folks the introduction of Invisalign trays makes it very hard to maintain a neutral and restful jaw position and the risk of TMJ problems is very real.

How To Prevent TMJ Problems During Invisalign Treatment

The best way to prevent TMJ problems during Invisalign treatment is to ask your dentist some very specific questions before you make the decision to go ahead. Here are some sample questions:

  • YOU’VE HAD TMJ PROBLEMS IN THE PAST: “I have had jaw problems in the past. Is Invisalign the best choice for me?”
  • YOU DON’T KNOW IF YOU CLENCH OR GRIND YOUR TEETH: “I don’t know if I clench or grind my teeth during the night. Can you check for signs before I decide to start Invisalign?”
  • YOU’RE ENTERING INTO A STRESSFUL PERIOD IN YOUR LIFE, such as moving or a divorce: “I’m going to be under a lot of stress in the near future. Should I wait until life is calmer to begin the Invisalign treatment?”
  •  YOU’RE ON A MEDICATION THAT COULD CAUSE MUSCLE TENSION such as Adderall. “I am currently taking Adderall. Could that impact my treatment?”

You may have your heart set on Invisalign, but it’s best to know for sure that it’s right for you before starting. If you are in the midst of treatment I recommend that you make great efforts to be as mindful as you can to keep your trays apart during the day. Report your concerns about night clenching to your dentist immediately if you suspect you are doing it. TMJ problems during Invisalign treatment can negatively affect the outcome.

More than anything else: choose a dentist that you trust and who listens to you and addresses your concerns. It’s better to be safe than sorry.

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.

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Categories
Bruxism Nightguards & Oral Appliances TMJ

Why It’s A Bad Idea To Use Whitening Trays For Bruxism

I recently came across an online press release with this compelling title:
Teeth Whitening Trays From ProDental Functions As A Night Guard Against Teeth Grinding.

The press release goes on to state:
“These teeth whitening trays help to stop the condition of teeth grinding which happens drastically at night when persons sleep.”

In my 30+ years as an orofacial pain specialist, I’ve treated thousands of people who suffer from the effects of teeth grinding and I will tell you right now: it is a very bad idea to use whitening trays for bruxism.

Teeth grinding and clenching (clinically known as sleep bruxism) are caused by brain arousal during sleep. What causes the brain to become aroused? There is no easy answer. It could be any number of things: daily stress, a crying baby, chronic pain, breathing problems, too much light, a snoring bed partner…and the list goes on.

Medical practitioners face a big challenge when attempting to identify the exact cause of nighttime brain arousal. In my practice, the goal is to reduce, or even stop, nightly grinding. But that can happen only once the exact cause has been identified. This takes time and determination.

In the interim, most of my patients wear custom-fitted bruxism devices (also called oral appliances) at night. These bruxism devices protect teeth from the destructive impact of constant grinding and clenching. They diminish the loading forces placed on the jaw joints and diminish the contracture force of the jaw muscles.

However, bruxism appliances must be custom-fitted to do their job!

If you’re considering the use of whitening trays to treat your teeth grinding, as the above press release suggests, please beware. You may actually make your condition worse. Here’s why:

3 Reasons Why It’s A Bad Idea To Use Whitening Trays For Bruxism

1. Whitening Trays Are Too Loose

Whitening trays will rarely fit your teeth perfectly. In fact, they are designed to fit somewhat loose and because of that fact, they flop around in your mouth. You must clench your teeth to keep them in place. And the last thing you need is more teeth clenching.

2. Whitening Trays Are Too Short

Whitening trays that are designed for mass utilization will never extend all the way back to your rear teeth. As a result, when you clench or grind your teeth with one of these trays in place, all the force is shifted forward. Though it sounds like a good idea to prevent the back teeth from being engaged when clenching and grinding, this pattern of contact actually puts more pressure on your TM joints. Over time this can cause additional jaw stiffness, pain and even joint clicking and locking (which may not have been present before starting to wear the trays). And not only that; trays which do not cover rear teeth may cause your bite to change over time, adding another difficult problem to fix.

3. Whitening Trays Are Too Soft

Whitening trays are made of a soft, pliable material which encourages more grinding and clenching. Patients call them “chew toys” when describing how they feel. In addition, because these soft trays don’t hold your teeth in place they can cause spaces to develop in between your back teeth. If this happens to you, you’ll forever be fishing food out from between your teeth with your tongue, further aggravating your jaw.

The Takeaway:

If you wake up in the morning with jaw pain, muscle stiffness, jaw clicking or locking, or sore teeth, you likely have sleep bruxism. You may be tempted to try the teeth whitening tray solution. After all, it seems to be adequate and inexpensive. But that decision will most likely lead to more problems with your teeth and jaw.

Please, take my advice: don’t be the victim of a phony pitch that can come back to bite you with a hefty dental bill later. Seek help from an experienced practitioner.

To find a dentist in your area that concentrates on sleep bruxism problems, visit The American Academy of Orofacial Pain at http://www.aaop.org/.

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

Categories
BOTOX® Bruxism Jaw Problems TMJ

Bruxism Can Change The Shape Of Your Face

As an orofacial pain specialist, I’m often asked if bruxism can change the shape of your face.

Here’s a story about a young woman named Sarah who came into my office a couple of weeks ago with her mother. Sarah is a 17-year old, college-bound, high achiever who was convinced that the shape of her face had undergone a dramatic change during the past few years. She was particularly concerned about her jawline. She felt that her jaw muscles looked bigger and more pronounced than before.

When I work with a new patient the first thing we do is sit down, relax, and have a conversation. I usually learn more during this conversation than I do from the physical examination. During my conversation with Sarah I asked her a lot of questions about her life and carefully listened to her answers. It didn’t take long for me to begin to see where her problems started. The physical examination reinforced my hypothesis.

In order to understand what happened to Sarah’s face we must take a look at the master muscles; they are the muscles that control the movement of the jaw. Masseters are like all other skeletal muscles in your body in that they will maintain a baseline shape and size when used normally. And, like all other skeletal muscles in your body, they will change in size and shape when over-used. It’s the same as when you workout your biceps in order to change the size and shape of your arms.

Each time you close your jaw or even swallow, you are using your masseters. Normal chewing and swallowing will not cause them to change in shape or size. What makes masseter muscles change, is when they are contracted over and above what is considered normal, over a long period of time. Since the masseters define the shape of your jaw, over-use behavior can actually change the shape of your face.

By chewing gum, biting your nails, biting your cuticles, chewing on pens, or even holding your glasses between your teeth, you are using your masseter muscles way beyond what they were designed for. Some people hold and clench their upper and lower teeth together during the day without realizing it and over a period of time this causes their masseter muscles to bulk-up.

Also of concern is sleep bruxism. Hundreds of thousands of people grind or clench their teeth while they’re sleeping. This excessive teeth grinding, jaw movement side to side-to-side, and/or clenching in a static, braced position plays a huge factor in the enlargement of the masseters and consequently, the shape of the jaw. So, the answer is:

Yes, Bruxism Can Change The Shape Of Your Face

To reduce the impact of bruxism on the masseter muscles, I normally provide my patients with a custom-fitted oral appliance (also referred to as a night guard). The oral appliance is a very effective tool in reducing the impact of grinding and clenching. But an oral appliance will not stop over-use behavior.

Although Sarah wasn’t complaining about pain, soreness and stiffness are also common effects of bruxism. Imagine how sore your hand would be if you kept it in a fist for most of the day and night. Jaw over-use is just like making a fist in your face, and it can create excruciating pain for many people.

Let’s go back to Sarah. Through our conversation I was able to identify the main reasons that her jawline had changed so dramatically. It turns out that she is a long-time gum chewer, a nail biter, and a nighttime clencher. Sarah has literally been working-out her masseter muscles every day and night for years.

An oral appliance strategy as been put into place that will reduce the impact of Sarah’s sleep bruxism. Next, The next step is for her to change her daytime over-use behaviors. Today, Sarah is wearing the oral appliance at night and working hard to correct her daytime over-use behaviors.

An additional approach that could work for Sarah is BOTOX®. BOTOX® is a popular cosmetic therapy that has the potential to diminish the forces of nighttime bruxism. It works by diminishing the capacity of the masseters to contract, with the result often being a reduction in the bulk of the over-used muscles.

Today, Sarah is wearing the oral appliance at night and working hard to correct her daytime over-use behaviors. But before I will go forward with BOTOX® for Sarah, she must convince me that she understands that if she does not correct the daytime over-use behaviors, BOTOX® is not an option.

Here’s The Takeaway: If you have noticed changes in the shape of your face or your jawline, it’s probably not your imagination. Find a dentist that has special training in bruxism as soon as possible.

I invite you to follow me on Facebook, Twitter or LinkedIn to keep up with all the new research and case studies in this field (and with Sarah’s progress).

BOTOX® for teeth grinding is in the news! I was recently interviewed on ABC’s Good Morning America on the topic, Can BOTOX® be used to treat teeth grinding?  Click the link to watch the segment.

TMJ device
Categories
Bruxism Jaw Problems TMJ

Does The TMJNext Generation Device Work?

Every now and then a new product will hit the market that’s designed to assist in the management of the chronic pain problems that impact the lives of millions of people every year. And when it comes to pain caused by TMJ/TMD problems, one such product is The TMJNext Generation™ Device. Having been sold in Europe for the past few years, this device is now available in the U.S. It is being aggressively marketed not only to dentists but to other healthcare practitioners, as well. As a result, many physical therapists, chiropractors, physicians and wellness clinics are advertising that they provide the device. As a board-certified orofacial pain specialist, I’m often asked, “Does the TMJNext Generation work?

Does The TMJNext Generation Device Work?

The TMJNext Generation™ Device is an ear insert which has been designed to create awareness in the patient of his or her jaw position. Here’s how it works:

First, impressions of your ear canals must be made. Although your dentist may have recommended the TMJNext Generation™, you may be referred to an audiologist (or another type of health care professional) that is willing to assume the liability of making the impressions, which may be outside of the scope of practice.

The impressions are made while your jaw is in a relaxed posture with your teeth apart. In this posture, your ear canal will assume certain dimensions in volume and shape. These dimensions get smaller when you bring your teeth together or clench them.

The ear canal impressions will be used to create custom ear inserts for you. The inserts feel comfortable when your jaw is in a resting posture, but when you bring your teeth together you feel an unpleasant pressure on the devices. The theory is that the uncomfortable feeling will get your attention and you will immediately relax your jaw. It’s like having a pebble in your shoe that makes it uncomfortable to walk.

For some people, the devices might serve as a sort of reminder to keep their jaw muscles loose. In this way, TMJNext Generation™ is essentially a biofeedback device. Anything that can help you keep your jaw loose during the day can be part of overall TMJ/TMD therapy.

Here’s the rub: Countless people who suffer from TMJ/TMD problems have NO NEED for daytime awareness because their jaw is always in a restful position during the day. It is at night while they are asleep that their grinding and clenching happens. For them, these devices could represent an unjustified expense. If physicians, chiropractors, physical therapists, and dentists who have limited expertise in the management of jaw problems are making decisions about the use of The TMJNext Generation™ Device, I’m afraid that overutilization is a real concern. So, does the TMJNext Generation device work?

As of today I have not found scientific articles that provide an understanding as to how these devices could stop or diminish the impact of sleep-related teeth grinding and clenching (bruxism) which is the way many patients get in trouble. Since the devices can apply unpleasant pressure on the jaw joints during a grind or clench, one would have to assume that the irritation would merely wake the wearer up, as opposed to helping him or her stop the activity altogether. I don’t think that would have a favorable long-term outcome.

My limited distribution of these devices at the present time precludes an endorsement or negative commentary. As always, I believe that a careful assessment must be done to adequately understand the type of jaw problem of each patient and what the initiating and perpetuating factors appear to be.

Only with that information can the treating professional guide the patient with sound advice.

Photo credit: http://tmjnextgen.com/

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with facial pain, TMJ and sleep apnea.

Sleeping_the_day_away_-_3087394718
Categories
Bruxism TMJ

Clenching your teeth at night? So what’s the big deal?

As an orofacial pain specialist for over three decades, I’ve treated thousands of patients that come to me with all kinds of problems caused by sleep bruxism, which is grinding or clenching your teeth at night while you’re asleep. These activities are often linked to neck pain, jaw pain, ear pain, headaches, and toothaches that don’t respond to traditional dental treatment. Millions of Americans are clenching their teeth at night, so it shouldn’t come as too much of a surprise that the consequences can be extremely varied. Here is the story of a good friend of mine:

To protect his teeth while sleeping he has worn a night guard for many years.

Every now and then he would wake up and notice that his lower teeth were pressing against the top night guard very fiercely. He would do some relaxation breathing that I taught him and that usually was all he needed to get back to sleep. He, however, never had jaw stiffness, headaches, or tooth pain due to his clenching.

That all changed last week.

It was a Friday night and he apparently tossed and turned for hours before finally getting into a deep sleep around 2 am. The cause of his edginess was likely a combination of a large dinner with wine at an hour later than what’s normal for him and then watching a late movie. On top of that, his ears were straining to hear his daughter arrive home from a party (I’m sure all parents can relate to that!). It added up to a very restless night.

So, finally, he fell asleep but two hours later was suddenly awakened by an extreme soreness in his lower left second molar that was braced into his night guard. After taking out the night guard he fell asleep but a couple of hours later woke up to a screaming molar (that’s the only way he could describe it!). To make matters worse, his ear throbbed and his jaw ached. Even the gums around this tooth were apparently in crisis.

As it was Saturday he went to play a round of golf but by the second hole was rummaging through his bag for some Aleve. Not only was his mouth freaking out, but also his entire body had begun to tighten up as a result of that aching molar.

The Aleve did work after an hour or so and the pain, stiffness and body tightness began to ease. He was able to finish the full eighteen holes but apparently, it was a forgettable round.

So how does something like this happen? Here’s the blow-by-blow:

  • The force of my friend’s clenching was so great that it traumatized the ligament that binds the molar to the supporting bone.
  • Then the tooth’s nerve fibers started to react and the area “lit up”.
  • Pain spread from the tooth site to his jaw, ear, and the gum tissues adjacent to the traumatized molar (all these areas receive the same nerve supply as the tooth).
  • Finally, the side of his neck and left shoulder started to tighten and lock up (this is called referred pain).

In actuality, my friend had sprained the tooth ligament by so fiercely clenching his teeth, initiating the pain scenario he described! Treatment was put into place to address this ligament sprain and I’m happy to report that since he came to my office there has been significant improvement in his condition. My friend has also made it his business to go to bed at a decent hour, avoid computer work just prior to going to bed and limit daily caffeine and late-night alcohol (known risk factors that can drive teeth clenching and grinding while sleeping).

So…if you are a clencher, even if you use a night guard this could happen to you! If so here’s my advice:

After seeing your dentist to assess the damage, stop and take a good look at your lifestyle. Are you getting enough sleep? Too many glasses of wine at late-night dinners? Evening hours doing paperwork or at the computer? Stress at a high level? Dwindling exercise and relaxation time? If so, make some changes and see how you feel. You may find that the aggressive clenching will ease reducing the potential for this scenario to be a common part of your life.

And here’s something you probably don’t know: nightguards lose their effectiveness over time and can only do so much to protect your teeth and jaws; so injuries can still occur. Keep an eye on your daily world and do your best.

teeth grinding, bruxism, grinding of the teeth
Categories
Bruxism TMJ

Good News About Teeth Grinding

“Doctor, why do I grind my teeth so fiercely every night?”

As a professional who works with TMJ and bruxism problems in my practice I hear that question almost daily. The fact is, we don’t yet know all the reasons that so many people grind their teeth at night. If you are a grinder, I have some good news for you! We are getting closer every day to a more science-based understanding of what is at the root of your problem; and that knowledge is helping to choose the best treatment for you.

Is It Your Bite?

Amongst my colleagues there is general agreement that teeth grinding and clenching are not related to the way your teeth fit together (your bite). Therefore, if you were offered treatment that promises to reduce your grinding by giving you a better bite, you would be best served by walking away from this option.

Is It Stress?

Surprisingly, stress appears to be only part of the problem. Studies have suggested that short-term stress has less to do with your nighttime teeth grinding and clenching than does long-term, unresolved stressors and life circumstances. When stress is indeed the culprit, medications can be used for a short period of time to get you through difficult patches relating to home, work, school and medical challenges. Over the long-term, medications (if continued) should be coupled with an oral appliance and routine practicing of pre–sleep jaw exercises and relaxation and breathing techniques. However, long-term medication use is discouraged and often ineffective over time.

The Good News

Researchers are finally gaining a much better understanding of the mechanisms that cause teeth grinding and clenching. In fact, grinding of the teeth is now considered to be a movement disorder (just like restless leg syndrome). Some studies suggest that teeth grinding is much more common when the brain is aroused and sleep is restless. Brain arousals (which lead to unrefreshing and restless sleep) may be due to a multitude of factors including a noisy sleep environment (a snoring bed partner), a crying baby, a chronic pain problem, airway struggles due to conditions such as asthma or sleep apnea, late evening consumption of caffeine or eating, and general anxiety (to name just a few possibilities).

Imagine this scenario, which is not uncommon in my practice: During sleep you struggle to breath because you are either not getting adequate oxygen or because of other factors such as recent weight gain, a large tongue that falls back into your airway, or tonsils that are so large that they compromise airflow. As a result your brain is frequently aroused and that causes you to wake up, take a few breaths of air, and then attempt to fall asleep again.

A severe form of this syndrome is called RERA (Respiratory Effort-Related Arousal). With RERA breathing is so labored (due a small airway) that you never get the quality sleep you need and as a result you are always tired the next day. Interestingly, people with this problem also tend to grind their teeth. If this happens to be why you grind so aggressively, treatment can be designed to address the source of your problem

Treatment For Teeth Grinding

With my patients, I look at all the risk factors that could be driving the brain arousals and are initiating grinding and clenching. Once identified, I work to create a customized treatment plan which can include:

    • Quieting The Sleep Environment: Can you imagine how peacefully you would sleep if your bed partner stopped snoring?
    • Changing Dietary Patterns In The Evening: Try to have your biggest meal at lunch and avoid caffeine (including chocolate) after 3pm. If an evening snack is important, frozen bananas can satisfy any sweet tooth!
    • Managing Chronic Pain: Providing proper treatment for your chronic pain problems, especially if your pain is in your neck and/or back.
    • Meditation: Meditating in the evening (but not necessarily right before bedtime) is helpful for many people, especially if you are prone to anxiety or if you have a very stressful life.
    • Jaw Exercises: Performing stretching exercises before you go to sleep can reduce the morning symptoms associated with clenching and grinding.
    • Losing Weight: When you lose weight you may also find that your airway will allow more efficient airflow while sleeping, and therefore less chance of brain arousal and fragmented sleep.
    • Tonsils Removal: If labored breathing during sleep is your problem, sometimes removing the tonsils or reducing their size allows easier breathing particularly in children and adolescents.
    • Sleep Positioning: Sleeping on your side instead of on your back can also increase airflow.
    • Oral Appliances: Oral appliances are very commonly chosen to address teeth grinding. However, the benefits of using oral appliances is only achieved if the design is the right one for you and addresses the specific reasons for your teeth grinding in the first place.

The Takeaway:

If you are a grinder or a clencher, don’t despair. We have more answers now than ever before and we have more treatments that can address not only the symptoms associated with your problem, but the reasons that they occur in the first place.

Have questions or comments? Go my Facebook page: http://on.fb.me/17w20sg 

photo attribution: By Aweisenfels (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

timj pain
Young female is crying near window with jalousie
Categories
TMJ

FDA Looking At Conditions That Impact Quality Of Life

 

There are hopes that TMD will be included.

I’m happy to announce some great news. The FDA (The Food & Drug Administration) is taking a closer look at medical conditions that can have a significant impact on your quality of life. Starting in 2016 the FDA will hold public meetings with the goal of determining the impact on daily life of 20 chosen diseases, and to look at the scope of services that are available to treat these conditions.

The TMJ Association is making huge efforts to have TMD (Temporomandibular Disorder) chosen as one of the diseases that will be focused on. That TMJ problems affect your quality of life is not news if you are one of estimated 35 million Americans who suffer from it every day.

Chronic pain problems, like TMD, rarely occur alone. It is estimated that 85% of TMD patients have other chronic pain conditions such as headaches, endometriosis, fibromyalgia, interstitial cystitis, irritable bowel syndrome, chronic fatigue syndrome, sleep disorders, or vulvodynia. In many cases these conditions are so complicated that patients don’t know where to turn to for care. As a matter of fact, I see many patients every week who have been told that they will never get better and that their problem is in “the head.”

If chosen as one of the conditions to be studied by the FDA, more information will be made readily available to you, the public, as to the nature of TMD and the treatments that are available.

Here are some facts about TMD that more people need to know:

  • TMD problems are orthopedic in nature.
  • TMD problems may be the result of (or aggravated by) rheumatologic, autoimmune or neurologic conditions.
  • Women are the largest group with TMJ symptoms as a result of specific biologic predispositions, some of which are hormone-driven.
  • Common TMJ problems may be the result of an accident, overusing the jaws, bad posture, teeth grinding (bruxism), or muscle tension caused by by emotions and life’s challenges.
  • Treatment for TMJ disorders should not focus merely on the teeth; the ultimate goal should be tissue healing and change of habits.
  • Getting better typically will lead to less pain, less medication, better function and increased optimism in people who before had anticipated a lifetime of suffering.

The same as with other orthopedic problems, after treatment patients may still have some pain, but it is likely that it will be at a much more tolerable level.

For all of you TMD/TMJ sufferers out there, the fact that the FDA has recognized that it’s time for this type of condition to be validated is welcome news. The result will be more access to information and thus, more access to treatment.

 

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with facial pain, TMJ, and headaches.

Categories
Bruxism TMJ

5 Long-Term Effects of Bruxism

Millions of people suffer the effects of bruxism, which is the involuntary grinding and or clenching of the teeth at night. There are many reasons why you may brux your teeth. Getting to the bottom of the causes and designing a course of treatment for bruxism sufferers is a large part of what I do daily in my practice.

Since it happens at night, you may not be aware that you are grinding! However, if you consistently wake up with an aching jaw or a morning headache, there’s a good chance that you are bruxing in your sleep.

So, why is this a problem?

Because the long-term effects of bruxism can be serious:

1. A Change In Your Profile: If you are noticing that your jaw is becoming more “square” it may be a result of bruxism. As you grind, your masseter muscles can get more and more bulky. This may not bother a man, but for women, it is very concerning.

2. Sore and Worn Teeth: Bruxism can destroy your teeth! Not only can it wear them down, some people rip right through the enamel. Once enamel is compromised, the underlying dentin wears at a rate 6x faster than enamel. This affects your bite, your appearance, and even your health.

3. Jaw Pain: Some people experience jaw pain and soreness, especially in the morning. However, this pain can also linger through the day and even keep you from opening and closing your mouth without discomfort. Many individuals have daily ongoing pain in their face and jaw as a result of the nightly grind.

4. TMJ noises: Other consequences of bruxism may be the onset of jaw joint clicking as a result of strained ligaments and a dry joint environment that results from compression of the TMJs. Clenching, in particular, can squeeze all the moisture out of these joints leading to noisy, painful situations, and sometimes even locakjaw.

5. Headaches: Morning headaches in the temples are common in people who brux. As the temporal muscles fatigue during bruxism, lactic acid builds up which irritates the nerves in the muscle and the result can be a headache. In patients who suffer from migraines, this is a particularly troublesome situation, as it can trigger a more severe situation.

If you are experiencing any of the above, there’s a good chance you are bruxing. The long-term effects of bruxism can impact your life. See your dentist for advice. If you have been treated by a dentist, and are still suffering, now’s the time to seek out the help of a dentist with extensive training in this field.

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat facial pain associated with jaw problems, TMJ, referred pain, nerve pain, and migraines. Find out more at www.nytmj.com.