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Tag: TMD

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BOTOX® TMJ

BOTOX® For TMJ Pain

Does It Work?

Despite the press advocating BOTOX® for TMJ pain problems, my clinical experience using it over the past 15 years suggests that it represents another supportive treatment at best and may not live up to the hype over the long term.

To start the discussion let’s focus on who is even a candidate for BOTOX®, a chemical agent that can be used to partially reduce muscle contracture. Since most of the commonly seen TMJ problems are orthopedic in nature, patients typically experience muscle and joint pain, limited jaw motion, difficulty chewing, and at times joint clicking, popping and locking.

Those patients whose problem is mainly mechanical – whose jaws click, pop, and lock – are typically not good candidates for BOTOX® injections. BOTOX® for TMJ pain and for people whose jaws have become more prominent due to excessive teeth grinding are more likely to get relief.

If you look at the common muscle problems we encounter with TMJ, the vast majority of patients will get better by:

  • Education, behavior, and diet modification
  • Postural awareness
  • Home exercise
  • Massage
  • Short-term medication

More stubborn problems will get better by adding:

  • Oral appliances
  • A prescription for physical therapy
  • Trigger point injections and/or acupuncture

That leaves only a small percentage of patients who would benefit from using BOTOX® for TMJ pain. It can be very effective in alleviating persistent jaw muscle pain resulting from the accumulation of lactic acid and other irritating substances. What makes people grind their teeth? Teeth grinding for most people is the result of negative emotions (stress), daytime overuse behaviors that fatigue the jaw and/or restless sleep associated with frequent arousals, and at times tooth clenching and grinding. Even when BOTOX® for TMJ pain is used in this select population of patients, success can only be achieved if what caused the problem in the first place is controlled or eliminated. It’s not an easy task!

People who opt for BOTOX® for TMJ pain typically need injections over a period of 9-12 months. If you are among the select few who are candidates, you have reasons to be optimistic. Patients for whom first-line therapies have failed report reduced suffering. Although still clench or grind their teeth they feel less pain as a result.

BOTOX® For TMJ Pain – The Take-Away

BOTOX®does have a place in the management of jaw muscle pain, but it is important to understand that it’s far from the remedy it is made out to be by those trying to sell it as a cure for TMJ problems.

Pain issues and sleep challenges do not have to be lifetime afflictions. You need someone who listens and possesses the knowledge and compassion to get your pain and sleep problems under control. I am that someone – and you’re in the right place.
Dr. Donald Tanenbaum, DDS MPH

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.

Tinnitus, Facial Pain, TMD, donald tanebaum, tinnitius doctor
Categories
Facial Pain Tinnitus TMJ

Tinnitus, Facial Pain and TMD – Are They Related?

It is not uncommon to see patients that present with facial or jaw pains that are not associated with disease, injury or illness of any type. These patients, typically women between the age of 18-55, relate that their pains came on without specific events, emerging spontaneously upon awakening one morning after a fatiguing day or associated with a routine meal, for example. As all medical and dental investigations are unrevealing, answers are searched for and often prompt comments like “there is nothing wrong.”

Over the course of the last several years I have also seen numerous patients present with the same historical account, but instead of suffering with pain they complain of debilitating ear ringing, humming, buzzing and whooshing sounds. For these patients the onset of their ear complaints (often lumped under the term tinnitus) also started for no good reason and prompted multiple tests which were all normal.

So what is going on with these two patient groups that are plagued with symptoms that have no specific origin. How to ease their suffering? From my perspective, the pain and ear noises (tinnitus) represent a specific type of sensory disorder that typically occurs after prolonged periods of challenging life circumstances and emotional distress. In short, these patients consistently relate that they have lost control over their daily existence. As a result, the human brain is upset, and an upset human brain loses its ability to regulate nerve function, muscle tone, heart and breathing rates, and hormonal regulation. The end result is something called sensitization…when normal stimuli are perceived by the brain as noxious (like putting a shirt on after a sunburn).

For the patient with tinnitus, I believe that everyday normal sounds are interpreted as noxious and patients describe their symptoms with variable choices of language, such as humming, ringing, buzzing, hissing, whooshing, and “fullness.” For the patient with facial pain any type of superficial stimulation (a hug, chewing, yawning, or speaking too much) prompts the sensation and experience of pain.

The good news is that with time (months or years) the majority of these patients improve (at times the relief occurs for “no good reason” the same way the symptoms emerged. The key is for these patients to avoid unnecessary and unproven treatments, particularly if surgical explorations are involved. The most useful treatments involve strategies to quiet the mind and body. Programs like the Stop and Breathe Program advocated by Susan Ginsberg have provided relief for patients along with Transcendental Meditation, Biofeedback, Autogenic Training, and Progressive Muscle Relaxation to name just a few. The use of medications like Clonazepam and/or supplements can also be found to be helpful. And, periodic assessments with pain doctors and audiologists are always advised.

Categories
Facial Pain

Facial Pain and TMD: A Persistent Domestic Stress Disorder?

Three patient visits in the past week alone made me think that it may be time to consider formulating a new diagnostic term to categorize the countless people that I  see who are suffering with facial and jaw pain but who have no history of disease, identifiable injury, or illness. I am therefore proposing a new term: Persistent Domestic Stress Disorder (PDSD), modeled after PTSD (Post Traumatic Stress Disorder) which was coined in the 1980’s as a result of ongoing studies of Vietnam veterans who returned from combat as different people.

Though defined in many ways, the most classic definition of PTSD is a “debilitating condition that affects people who have been exposed to a major traumatic event” (“Post- Traumatic Stress Disorder, PTSD”). Traumatic events that may trigger PTSD include violent personal assaults, natural or unnatural disasters, accidents, or military combat. To fit the criteria of PTSD the individual must exhibit certain symptoms subsequent to the event(s).

Symptoms of PTSD:

  • Intense fear, helplessness, loss of control over daily life events
  • Persistent re-experiencing of the traumatic event
  • Continual avoidance of reminders associated with the event
  • Increased arousal, an overwhelming inability to cope with flashbacks, insomnia, and nightmares
  • A duration of these conditions for at least one month*

Surely many of these elements are absent in our pain patients but there are unfortunately many similarities, therefore my new diagnostic term: Persistent Domestic Stress Disorder. Though domestic challenges and specific events may not be as vividly upsetting as those encountered in war, they are no less traumatic to the mind and soul.

Consider the following scenarios I commonly hear: 80-hour weeks to preserve a job or to become eligible for advancement, 24/7 care for an elderly parent with progressive dementia, persistent worry in our young adult patients focused around achieving in school or finding the right partner, verbal or physical abuse at home or in the workplace, fragile and unsatisfying marital relationships, uninspired children that need ongoing emotional and financial support, and coping with personal medical infirmities that cast doubt on one’s future. These are just some of the profiles that are seen routinely in my practice.

As a consequence of these challenges I see increased arousal in my patients’ nervous systems (always in “fight or flight” mode with excess levels of adrenaline and cortisol being found in their bloodstream). I hear complaints of insomnia (inability to get to sleep or stay asleep), I see shallow breathing patterns (with the end result of imbalances in the levels of oxygen and carbon dioxide in their systems) and I see acquired behaviors (such as tooth clenching, furrowing of the brow, raised shoulder, etc.) that fatigue the muscles of the head, neck, face and jaw.

As these challenges persist well beyond one month, the brain remains under siege and ultimately subtle changes in neural thresholds and muscle tone result leading to pain symptoms along with complaints of ringing/fullness in the ears, burning in the mouth, loss of balance, or tingling in the face. Patients arrive at my office often exhibiting helplessness and are easily moved to tears when they are reminded of the issues in their lives that they have been trying to avoid thinking about.

Though bringing these concepts to light may make patients wonder if they can actually feel better when faced by these huge obstacles, there truly are strategies that can be employed that bring definitive relief.

If you are suffering from facial or jaw pain, your symptoms are real. They are common and familiar to those of us trained in the recognition and treatment of Orofacial pain and Temporomandibular disorders. There is no “quick fix,” rather comfort will only be realized if nerve thresholds return to normal, muscle tension eases, sleep is regained and optimism and control are restored within an individual’s personal world.

You can be helped to feel better. Fortunately there are strategies that work and health care providers like myself who can help.

Read more about how I work with patients suffering with facial and jaw pain, and the symptoms of TMJ on my website.

*Spinrad 1

TMJ. TMD. Tinnitus. TMJ Case Study, donald tanenbaum, tmj doctor, tmj doctor ny
Categories
Jaw Problems Tinnitus

TMJ TMD and Tinnitus

Case Study: Barry

In past blogs I made reference to the relationship between jaw problems, TMD and the occurrence of Tinnitus (ringing in the ears). Though I don’t believe that the majority of Tinnitus problems relate to the jaw, there are unquestionably a number of specific Tinnitus complaints that occur as a result of muscle problems in the jaw and upper neck.

The relationship exists as a result of the shared nerve pathways between structures in and associated with the ear and those of the jaw and neck. Tense, inflamed, and hyperactive jaw and neck muscles can adversely impact the Eustachian tube, the tympanic membrane, and the malleus bone, all critical ear structures. In the presence of ongoing TMD problems, aggressive clenching, night bruxism, neck tension, and ear symptoms inclusive of tinnitus can therefore surface. The typical Tinnitus patterns that my patients describe are often present on awakening, vary in intensity from day to day and at times are influenced by opening and closing the mouth, chewing, and jaw/head positions.

Recently Barry, 55 years old, came to the office concerned about his escalating Tinnitus. He was referred from his ENT doctor, as are many of my Tinnitus patients. The tenderness of his jaw, neck, and facial muscles, along with his admitted history of teeth clenching indicated muscles that were in crisis and potentially a driving force behind the Tinnitus.

I starting him on treatment including a combination of muscle injections, dry needling techniques, self-muscle massage, and an oral appliance. This has reduce Barry’s Tinnitus by at least 50%. As a result he is no longer using the Xanax on a daily basis, something that he had come to rely on for a number of months! With the optimism that has been created I will likely continue to see Barry for another month or two to reinforce the achieved benefits.

If your Tinnitus search has reached the end of the line, exploration of a possible muscle origin may not be a bad option.

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.

The Most Important Equipment in a TMJ Doctor’s Office
Categories
TMJ

The Most Important Equipment in a TMJ Doctor’s Office

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

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

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

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

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

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

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

Dr. Donald Tanenbaum has been practicing in New York City and Long Island for over 20 years. He is uniquely qualified to diagnose and treat bruxism, TMJ and TMD problems, Sleep Apnea, facial pain, muscle pain disorders, nerve pain disorders, tension headaches, and snoring. Learn more about Dr. Tanenbaum here.