Tag: TMJ

Can Mouth Guards Cure TMJ?

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date January 23, 2023
No Comments on Can Mouth Guards Cure TMJ?

Patients will often come to me suffering from symptoms of TMJ and looking for solutions that don’t involve medication or surgery. Symptoms such as facial pain, headaches in the temples, inability to open to the mouth widely, sensitive teeth, or aching and throbbing jaw muscles can be unbearable. There are numerous remedies, for jaw related symptoms that include massages, home exercises, physical therapy, modified diets, and changes in daytime behaviors/postures. At times an oral appliance is an important part of care. These devices are commonly used for the treatment of TMJ problems and can be used in a number of different ways.

What is an oral appliance?

An oral appliance is a device that fits over your teeth with the intent of reducing tooth wear, tooth mobility, tooth sensitivity, muscle pain and soreness and joint pain and instability. At times but not frequently these devices are designed to “align the jaw.” They can also be used to discourage some of the daytime behaviors many patients don’t realize they’re doing, such as resting their teeth together, clenching their teeth, or biting their nails or cuticles. These appliances can be worn at night and/or during the day

In general the intent of these appliances is based on the problems experienced by patients.

Night guards: Most commonly these appliances are chosen by dentists to address tooth wear, soreness, and mobility that occur as a result of night clenching or grinding of the teeth. Many patients that develop tooth wear do not even realize that they have a problem and often deny grinding their teeth at night. These devices when used in patients without active symptoms (just wear of the teeth) don’t require much adjustment and should be brought by the patient when they return to the dentist for tooth cleaning visits. Typically these devices are custom fit so that they are retentive, not too thick, and modifiable over time. Over the counter devices sold in pharmacies and online are for the most part inadequate, as they are often too thick, poorly retentive, and inadequately cover all of the teeth. As a result these devices can often prompt more clenching, and/or allow tooth shift.

Night appliances to address TMJ problems: Based on the specific jaw problem that is diagnosed (muscle soreness, morning temporal headaches, limited jaw opening in the morning…etc) oral appliances at night are designed to reduce overuse and loading forces to the TM Joints and jaw muscles. The biting surface of the appliance is therefore designed and modified to most efficiently address the problems at hand. Most commonly the biting surfaces are flat but, at times, inclines and ramps are used to confront unstable joint ligaments and displaced discs. When used in patients with active symptoms, these appliances require frequent modifications requiring patient follow-up visits.

Day appliances to address TMJ Problems: At times there is necessity to have a patient wear an appliance during the day. For the most part these appliances are needed when there is extreme instability in a TM joint that has led to clicking, locking, and pain problems. These appliances are not worn all day and virtually never during chewing. At other times, oral appliances worn during the day hours can be used to get in the way of day behaviors and/or remind patients that during the day the jaw should be hanging in a rest position with the teeth apart.

How about oral appliances to re-align the jaw? This concept of jaw re-alignment to address a TMJ problem remains controversial. To date there is no science to support the concept that a poor bite or mal-aligned jaw is responsible for the emergence of TMJ symptoms. At most a bad bite or mal-aligned jaw may be a risk factor but with no more weight than other risk factors such as; female gender, gum chewing, clenching, night grinding, or stress. As long as there remain millions of people with bad bites and asymmetric jaws without symptoms this concept has to be viewed with skepticism. In addition, if an appliance were to be made to re-align the jaw, it would require the patient to bite or rest on it when in the mouth to hold the jaw in the ‘better’ position. This action of course would violate the principle that the jaws should hang at rest during the day. Clearly this option must be chosen with great care.

From an overall perspective the concept of curing a TMJ problem with an oral appliance is probably a bit of a stretch. Their use however is a critical part of TMJ treatment!

These appliances are extremely helpful in reducing the damage from night clenching or grinding. They work by diminishing the forces exerted on the TM joints and by diminishing the amount of contracture that can be generated in the jaw muscles. Night guards are most effective when custom fit, and adjusted over the course of time. Or you can purchase a generic set at a drug store. Obviously, custom-made night guards that have been conformed to your individual bite-print are more effective in treating TMJ symptoms, but the trade-off is that they’re more expensive.

Bite Splints: This form of therapy uses a mouth guard to physically correct the bite, rather than just relieve pain or reduce damage to the teeth. Bite splints are best for you if you have more extreme TMJ symptoms that need correcting in order to have a hope for any long-term relief. The primary difference between a bite splint and a night guard is that bite splints are worn around the clock, 24-7. It’s a full commitment to correcting the misalignment issues that are causing your TMJ.

So, can mouth guards cure your TMJ? The short answer is: Yes. In some cases, particularly with corrective bite splints, you can realign your bite over the course of time and eliminate those painful TMJ symptoms. In other cases, mouth guards can relieve your symptoms to the point where you feel very little pain or discomfort at all.

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.

Tags Can Mouth Guards Cure TMJ, Donald Tanebaum, Dr. Tanenbaum, TMJ, TMJ and Mouth Guards, TMJ and oral appliances, What is an oral appliance

BOTOX® Jaw Problems Orofacial Pain TMJ

BOTOX® For TMJ Treatment – Your Questions Answered

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

7 Common Questions About BOTOX® For TMJ Treatment

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

1. What Is BOTOX®?

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

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

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

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

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

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

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

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

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

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

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

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

4. How Long Will The Benefits Last?

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

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

5. How Many Injections Will I Need?

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

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

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

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

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

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

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

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

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

BOTOX® For TMJ Treatment – The Bottom Line

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

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

More helpful information about BOTOX® from Dr. Tanenbaum:

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

BOTOX® for TMJ Pain

Tags Botox, Jaw Problems, Orofacial Pain, TMJ

Jaw Problems Orofacial Pain Referred Pain TMJ

How To Get Relief From TMJ Pain When Nothing Is Working

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

What Causes TMJ/TMD Problems?

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

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

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

First-Line Therapies For Relief From TMJ Pain

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

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

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

Injections For TMJ

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

Jaw Muscle Injections For TMJ

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

Tendon and Ligament Injections For TMJ

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

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

Injections Into The Jaw Joint

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

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

New Injections For TMJ Are On The Horizon!

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

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

The Last Word

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

Feel Better!

Which Type Of Dental Night Guard Is Right For You?

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

First, What Causes TMJ?

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

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

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

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

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

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

All Dental Night Guards Are Not The Same

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

Symptoms of TMJ:

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

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

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

What To Do Next

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

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

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

Your Dental Night Guard Needs To Be Monitored

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

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

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

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

Feel better!

Learn more about TMJ and bruxism here

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

Headaches Jaw Problems TMJ

Can A Dentist Cure Your Headaches?

Most people who suffer from severe headaches don’t think about going to their dentist to get help. But a dentist may be the right professional to turn to if your physician has not been able to determine the root cause of your pain. But first, it’s important to determine whether the headaches you are experiencing fit into a primary or secondary category.

Primary headaches are migraines, tension headaches, and cluster headaches. Many dentists do see patients with primary headache problems, but it’s for the secondary type of headache that they can be particularly effective.

Secondary headaches can be caused by many things, but in particular, trauma to the temporomandibular joint. The temporomandibular joint is your jaw joint and problems in this area are commonly referred to as TMJ. A traumatized jaw joint can be the result of injury, a structural deficiency, a malocclusion (bad bite), newly placed or worn dental work, oral disease, or sleep bruxism (teeth grinding and clenching at night).

Today, many dentists are trained in assessing and treating these kinds of orofacial pain problems. In fact, in 2020, the American Dental Association approved orofacial pain as a dental specialty. Orofacial pain specialists are now board-certified dental specialists who limit their care to patients with orofacial pain disorders. Dentists trained in this special field are increasingly important as health team members in the diagnosis and treatment of severe and persistent headaches that are TMJ-related.

The Negative Effects Of Sleep Bruxism

If you clench or grind your teeth at night, you are not alone. Millions of Americans do it. Why does bruxism often cause severe headaches? The constant pressure is being exerted by the act of clenching and grinding your teeth can cause trauma to your TMJs. Next, the nerves become agitated, and here comes pain. But what’s tricky is that pain from TMJ can show up in other places on your body, such as your neck, your face, or even your head. This is called referred pain. Your TM joints are positioned very close to your cranial nerves, and severe headaches are often the result.

So, Can A Dentist Cure Your Headaches?

If you feel your headaches could be caused by teeth grinding and clenching (at night or during the day, or both), now’s the time to seek the help of an orofacial pain specialist. They will not only be able to determine the source of your pain, but will put a treatment plan in place that may include massage, relaxation techniques, a nightguard to protect your teeth, or even BOTOX®. I’ve been treating patients with these problems for over 3 years, and in most cases, a change in lifestyle to reduce bruxism combined with treatment, the outcomes are very positive.

Start by asking your physician or dentist for a referral to an orofacial pain specialist or check out the American Board of Orofacial Pain’s physician directory here, and search for a member with “Diplomate” status.

Good luck!

If you live or work in the NYC or Long Island metro area, feel free to call my office to make an appointment for a consultation. I see patients in person or by telemedicine on Zoom. NYC 212-265-0110 Hauppauge 631-265-3136

Tags Bruxism, Jaw Problems, Referred Pain, TMJ

Jaw Problems TMJ

TMJ & Arthritis In The Jaw Joints

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date August 11, 2021
No Comments on 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.

Tags Jaw Problems, Teeth Grinding, TMJ

TMJ

Effective Treatments For TMJ Today

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date August 4, 2021
No Comments on Effective Treatments For TMJ Today

As an Orofacial Pain specialist, I’ve dedicated my professional career to helping people who suffer from the painful symptoms of TMJ. My daily encounters with patients put me at the cutting edge of the most effective treatments for TMJ, what’s helping patients – and what is not.

In early 2021, I took some time to reflect on the wide variety of patients I’ve been seeing in my practice, particularly those who presented for the first time during the Covid pandemic. I looked at what is causing their symptoms and what strategies of care address the risk factors responsible for their pain.

TMJ symptoms typically include a combination of facial pain, jaw pain, ear pain, ear fullness, difficulty chewing or opening the mouth, headaches, persistent toothaches, and a variety of joint clicking and popping sounds. Any of these symptoms alone could negatively affect the quality of life, but when combined, they can make every day a struggle.

If you’re reading this article, you are (or someone you care about is) probably suffering. You may have already explored some TMJ treatments, as well. The good news is this: most jaw problems that I see are common, familiar, and helpable.

You can get better.

New Insights Into Effective Treatments For TMJ

Ongoing research into jaw problems and Orofacial Pain enables specialists like me to better understand these problems’ neuromuscular and neural character. We’re gaining new insights into how the immune system and brain processing can trigger and influence the pain experience for our patients. As a result, the effective treatments for TMJ we recommend today address a broad range of risk factors that need to be identified and addressed for success to be realized.

With that in mind, effective TMJ treatment can be put in place only when we truly know our patients. Here are some foundational concepts that guide our conversations with patients and the avenues of questioning we commonly explore:

Healing Is A Process – Not An Event
Most jaw problems tend to come on slowly and they resolve slowly, as well. Only when we identify the risk factors that got your jaw into trouble in the first place can the right strategies for effective TMJ treatment can be put into place.I can’t stress this enough: for the healing process to be successful, the patient must be an active participant in treatment. Effective treatments for TMJ take time and require patience.
Medication Can Be The Culprit
There are two types of medications believed to have an impact on TMJ symptoms:

- SSRI Antidepressants
  Regarding SSRIs, in the past few years, I’ve seen more and more patients suffering from jaw problems but have none of the risk factors typically associated with TMJ. Through a process of elimination, I discovered that many of these patients were on an SSRI, the most commonly prescribed type of antidepressant. They include Paxil, Effexor, Prozac, and Lexapro. What stood out to me was this: most of these patients did not have TMJ symptoms before they began the drugs.

By working in conjunction with their prescribing physicians, I have been able to help these patients reduce their TMJ symptoms by lowering dosages or switching to a different medication. If you’re taking an SSRI and are experiencing TMJ problems you never had before, consider speaking to your doctor about the possibility of adjusting your meds.

- Some ADD/ADHD Drugs
  Several drugs used to treat ADD/ADHD have also been linked to TMJ. They include amphetamines such as Adderall, Vyvanse, and Dexedrine and methylphenidates such as Ritalin and Concerta.

These medications increase focus and attention by speeding up brain activity. But because they affect the central nervous system, they can also cause jaw muscle tension and increase the frequency and forces of sleep bruxism (teeth grinding and/or clenching). As a result, muscle and joint pain often emerge.

I see many patients between the ages of 14 and 23 who are on one of these ADD/ADHD medications. They complain of tender and aching jaw muscles and, at times, trouble opening their mouths. By collaborating with their parents and physicians, a better balance is often reached that maintains the goal of the medications and reduces jaw symptoms at the same time.

Sleep Quality & Quantity

When interviewing a new patient, one of the first questions I ask is this “How are you sleeping?”

That’s because fragmented and poor quality sleep has a negative impact on the body. It can cause increased inflammation, reduced endorphins (the “feel-good” hormones), lowered pain thresholds and decreased response to treatment.

Insomnia or a sleep-related breathing disorder such as obstructive sleep apnea (OSA) can bring on and/or exacerbate TMJ symptoms. While you can find some strategies on the web to manage these problems, you should consider consulting with a sleep specialist. Most will meet with you by telemedicine conference these days.

Lowered Pain Thresholds

Millions of people suffer from the symptoms of TMJ simply because of the circumstances of their lives. Consistently working long hours, getting too little sleep, and/or dealing with a great deal of daily stress diminishes your ability to cope with pain because your body is perpetually in fight-or-flight mode.

While you’re probably not in a position to change your job or keep your baby from crying all night, there are some things you can do. Meditation, Chinese temple exercises, or Tai Chi for just 30-45 minutes a day can work wonders. These are essential factors in effective treatments for TMJ for my patients.

Tooth Clenching & Grinding
Many researchers consider some degree of teeth clenching and grinding during sleep as normal behavior but 10- 20% of the population clench and grind to such a degree that it actually disturbs their sleep. All that clenching and grinding causes injury to the jaw muscles and jaw joints. Once injured, they never get a chance to heal.

We have not figured out entirely why so many people brux at night to the degree that symptoms arise, but there are effective treatments for TMJ that can help to a great degree. The treatments are multifaceted and a combination of oral appliances, medications, jaw muscle exercises, breathing exercises, and meditation.

In situations when all first-line therapies fail, BOTOX® injections into the jaw muscles are proving to be an effective treatment for TMJ.

Supplements

Despite what the industry claims, it’s unclear whether supplements are genuinely effective for pain relief. That being said, some of my patients are convinced that a combination of fish oil and magnesium eases their pain. Some also take turmeric and swear by it.

If you plan to go the supplement route, make sure your physician is aware and involved. It’s essential.

Food As Medicine
New research indicates that certain foods can reduce nerve sensitivity and inflammation, such as grape seed extract, organic chicken broth, and cocoa in the form of 72% dark chocolate. Because scientific research into supplements for pain reduction is in its infancy, I cannot recommend any specific quantities you should take. A good mantra is moderation.

Note: On their own, these foods have not been proven to be game-changers, but when combined with other effective treatments for TMJ, we do see some promise.

Breathing
When people deal with extreme chronic pain they tend to breathe fast and shallowly. With each breath, excessive amounts of carbon dioxide are expelled, which increases muscle tension and nerve excitation in the body and makes it difficult to use oxygen effectively. Buteyko breathing, belly breathing, and breathing techniques like those found online on Headspace, Calm, and Buddhify can significantly help reduce pain. Try them!
Education
Finally, if you are ready to start feeling better, it’s critical to educate yourself about your chronic pain – what it is and what is causing it. A good place to start is the app Curable. I also love the daily tips on relaxing your mind and muscles in Quick Calm by Jennifer Wolkin, Ph.D. And my book, Doctor, Why Does My Face Still Ache? is also very helpful.

The Bottom Line

I’ve been caring for patients with jaw problems for a long time, and what’s clear to me is this: the most effective TMJ treatment for my patients depends upon two factors…

Taking the time to discover who my patients are as people, not just as patients.
It’s critical that every patient fully participates in their treatment all along the way.

There is no good reason you should suffer from persistent jaw, tooth, or face pain for the rest of your life. Today, there are effective treatments for TMJ.

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

You can get better!

If you live in the New York City metropolitan area and would like to make an appointment with Dr. Tanenbaum, please link here.

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

Tags TMJ

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

How To Evaluate Yourself For TMJ

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

5 Nighttime Factors That Could Be Causing Your TMJ Problems

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

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

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

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

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

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

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

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

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

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

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

How To Evaluate Yourself For TMJ – In Conclusion

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

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

Helpful Links:

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

How Many Hours Of Sleep Are Enough For Good Health?

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

Young woman working at home or in a small office, vintage hipster clothing, curly hair. She seems to be stressed or thoughtful, There is a cup of tea or coffee on the desk with some technological devices.

TMJ

Stress, Nail Biting & TMJ Jaw Problems

Innumerable articles have been written since the onset of the pandemic about dentists experiencing a large increase in patients with cracked or broken teeth. The increase is usually attributed to the stress we’re all under due to the pandemic.

Yes, stress. Stress can cause you to grind or clench your teeth so vigorously that they crack or break. And stress causes other oral and facial problems, too. These are the types of problems that are the focus of my practice as an orofacial pain specialist.

Whether you unconsciously deal with stress by nail biting, chewing gum, or gnawing on pens – a painful TMJ jaw problem (also known as TMD*) could be in your future.

My patients seek care when they’re trying to understand and resolve a myriad of persistent problems such as jaw and facial pain, persistent toothaches, headaches, restricted jaw motion, jaw clicking or popping, unexplained bite changes. Other symptoms can involve the ears: pain, pressure, clogging and/or ringing.

All of these symptoms can be caused by their overworked or injured jaw muscles, tendons, ligaments, or joints.

In this article, I explain what causes stress-induced TMJ jaw problems – what you can do to prevent them.

Stress & TMJ Jaw Problems – They’re Linked

A great deal of research has been conducted over the past fifty years in an attempt to determine what TMJ problems truly are, why they arise, who is most susceptible – and of course, how they can be treated.

What we’ve learned through this research is the temporomandibular joint and its associated muscles, tendons, and ligaments are part of an orthopedic system – just like knees, shoulders, or elbows. As a result, the TM joints and associated muscles, tendons, and ligaments are subject to structural changes and injury. If symptoms develop and persist, the nerves serving your muscles, tendons and joints, can become sensitized – and lead to increased levels of suffering and treatment challenges.

While accidental trauma, underlying medical problems, and postural strain often cause TMJ jaw problems, the most common cause is stress and how it directly impacts your jaw and orofacial region.

The True Definition of Stress

Stress is your body’s reaction to harmful situations. When you’re stressed, your fight-or-flight system – your sympathetic nervous system – becomes activated. Your heart rate increases. Your muscles tighten-up. And, your blood pressure rises. These changes occur as a result of hormones such as cortisol and adrenaline being released into your bloodstream.

Prolonged activation of this fight-or-flight system, therefore, can cause physical wear-an- tear on the body, including the jaw muscles and temporomandibular joints. It also can cause changes in your brain which diminishes the effectiveness of the body’s natural pain modulation/dampening systems.

From a purely physical perspective, stress can cause your jaw muscles to tighten, which reduces blood flow and the delivery of oxygen. Over time, this lack of blood flow can result in jaw muscle soreness, spasm, pain, and fatigue. What often follows is reduced jaw motion and a changed bite.

Then, as your jaw muscles continue to malfunction, your jaw joints themselves can become unstable. You might hear and feel your jaw clicking and popping. Some people even experience ‘lockjaw.’

To make matters worse, your upper neck muscles might tense-up and cause stiffness and pain in your jaw muscles. It may even result in headaches focused in your temples.

Being in a constant fight-or-flight state can also lead to an increase in daytime behaviors you may already have – due to the normal stresses in your life. Daytime behaviors include teeth clenching, jaw muscle bracing, nail and/or cuticle biting, pen chewing, lip and cheek biting, and frequent gum chewing, etc.…

Not surprisingly, your overworked jaw muscles and jaw joints can begin to ache.

Accompanying these stress-driven behaviors, this fight-or-flight state can cause you to breathe faster and more shallowly. As a result, your body’s natural rest-and-digest response, which is designed to calm and deactivate the fight-or-flight system – may falter. This allows the stress/pain cycle to continue.

Stress, Sleep & TMJ Jaw Problems

Being in a constant fight-or-flight state can also negatively affect your sleep. Both sleep quality and sleep quantity have been shown to be adversely impacted by stress. Insomnia – the inability to get to sleep or stay asleep – often accompanies situational stressors such as the Covid Pandemic.

Endorphins, as you now know, are the body’s natural pain relievers. Disturbed sleep patterns cause a reduction in your body’s production of endorphins. Over time, this can cause you to feel muscle pain more intensely. This is common in the face and jaw.

Disrupted and poor quality sleep is also thought to increase sleep bruxism – teeth grinding and clenching at night – which is a common cause of jaw muscle and joint injury.

Working From Home & TMJ Jaw Problems

Millions of Americans have been working from home due to the pandemic. We’re spending hours upon hours at less-than-ideal workstations (such as the kitchen table). Working at your computer hour after hour can lead to poor posture and eye strain. Especially when you don’t take consistent or adequate breaks to mentally disengage and stretch.

The outcome is tension in your jaw and neck muscles. And, ultimately, the potential for TMJ jaw problems to arise.

So What Can You Do About It?

2020 has been a year of stress not only related to the pandemic but also due to the political climate in this nation. So, what can you do to prevent jaw symptoms from developing?

Here are 6 tips that I give to my patients that can help you avoid TMJ jaw problems:

1. Take Note If You’re Overworking Your Jaw During The Day

Are you biting your nails? Chewing on your cheeks or lips? Are you bracing your jaw muscles? Clenching your teeth? If you are, it may be surprising to learn that those stressed-induced behaviors can actually be changed. b It’s simply a combination of being aware and put a focus on your breathing.

Techniques such as one-nostril breathing, belly breathing, or the Buteyko Method can help you to disengage from the behavior. They help your body to be more relaxed. Many of my patients use an app called The Mindfulness Bell to get their attention at specific time intervals so they can stop what they’re doing and breathe.

2. Correct Your Computer Posture

Poor posture is a common culprit for TMJ jaw problems and other stress-induced disorders. There is a proper way to sit at your workstation. Here are some tips:

- Move your monitor to eye level so you aren’t tilting your head up or down to see it.
- Make sure your feet are flat on the floor. Don’t cross your legs or ankles.
- Keep your shoulders relaxed, down and back.
- Use a lumbar support tool to keep you from slouching (Amazon has many choices)

3. Force Yourself To Take Breaks

take breaks to avoid TMJ jaw problems

Taking breaks is crucial to keep your mind sharp and your body relaxed. Consider installing an app that gently forces you to stop and take a break from your screen at specific intervals. And, don’t worry – you can override the break if you’re on a Zoom call! Check out: 5 Free Apps for Reminders to Take a Break From Screens

4. Take Full Breaths

breathing app

When we’re stressed we tend to breathe very fast and shallow. Instead, try some deep breathing exercises. A helpful app such as The Breathing App or Breath Ball can be helpful.

5. Try To Get Some Exercise

online yoga to avoid tmj jaw problems

Your gym may be closed (or it’s open but you don’t want to risk going there) try not to eliminate exercise from your life. If you live in a warm climate, incorporate walking or running into your day. You don’t have to spend hours at it. Even a 20-minute walk will help regulate your system.

If you’re stuck indoors like so many of us this winter, perhaps try some online yoga. Do some simple calisthenics. Or take a class – there are tons of free ones online – from Pilates to hip-hop dancing. Any physical activity that gets you out of your head will trigger your body to produce more endorphins. And endorphins are what you need right now.

6. Talk To Someone

online therapy

If the stress of the pandemic is taking its toll on every aspect of your life, it may be time to consult with a therapist. For a referral to a therapist who works with clients virtually, there’s a good list here: www.psychologytoday.com/us/therapists

Conclusion

The coronavirus vaccine is slowly being rolled out. There is a light at the end of the tunnel. In the meantime, it’s critical that you do at least one thing that will reduce the impact of stress on your body. If you’re suffering from TMD symptoms like the ones mentioned above – speak to your dentist or you can go to the American Academy of Orofacial Pain website where you can find an orofacial pain specialist, like me, in your area.

We will get through this!

Best of luck

* According to the American Academy of Orofacial Pain, TMD is defined as a group of disorders involving the masticatory muscles, the temporomandibular joint (TMJ) and associated structures. The symptoms most often reported by patients include pain in the face, TMJ, masticatory muscles and pain in the head and ear. Other symptoms reported by patients are ear manifestations such as tinnitus, ear fullness and vertigo.

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

Tags TMJ, TMJ Causes

BOTOX® Jaw Problems Orofacial Pain TMJ

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

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

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

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

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

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

1. BOTOX® Reduces Muscle Contraction

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

2. BOTOX® Can Provide Some Pain Relief

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

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

3. BOTOX® Stays Where It’s Put

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

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

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

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

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

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

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

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

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

7. BOTOX® Injections Can Give You A Slimmer Jawline

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

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

BOTOX®: A Tool, Not A Cure

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

Choose carefully.

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

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

Tags Orofacial Pain, TMJ

Ear Pain Facial Pain Jaw Problems

Why Wearing A Mask Can Cause TMJ Symptoms

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

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

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

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

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

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

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

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

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

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

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Orofacial Pain & TMJ Consultations Online – A New Era

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

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

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

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

The Connection Between The Upset Brain & TMJ

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

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

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

TMJ Consultations Online Now

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

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

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

TMJ Consultations Online In The Future

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

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

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

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

Tags Orofacial Pain, TMJ

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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.

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.

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).

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 & 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.

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.

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.

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

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.

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

Tags Facial Pain, Jaw Problems, Referred Pain, Teeth Grinding, TMJ

Jaw Problems Orofacial Pain TMJ

Orofacial Pain Is A Board-Certified Specialty

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

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

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

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

What Does This Mean For Patients?

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

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

Onward and upward!

Definition Of Orofacial Pain

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

Tags Jaw Problems, Orofacial Pain, TMJ

Jaw Problems TMJ

Invisalign® & Aligner Therapy Can Trigger Jaw Problems

Today, in nearly every field of medicine, new and innovative therapies emerge that change lives for the better. But, over time, however, unanticipated complications can arise. Invisalign^®and aligner therapy to move teeth is one such innovation. It turns out aligner therapy can trigger jaw problems.

Invisalign^® & Aligner Therapy Move Teeth In Remarkable Ways

The use of clear aligners as an alternative to traditional braces has transformed how tooth movement is accomplished. Aligners are effective and practically invisible. That makes them an excellent choice if you don’t love the idea of walking around with a mouth full of brackets and wires for months or years.

There’s another reason that invisible braces are so popular – dentists, who in the past could not offer tooth movement services, can now provide them.

Why Aligner Therapy Can Trigger Jaw Problems – Sometimes

As a TMJ doctor, I see patients with jaw problems that have been triggered by aligner therapy. Common symptoms are jaw muscle and joint pain, jaw clicking, locking, and headaches. Patients who find that aligner therapy can trigger jaw problems tend to fall into two distinct categories:

1. People who never before had a TMJ problem.

2. People who previously had TMJ problems sometime in the distant past and experienced a re-emergence during aligner therapy.

In my experience (and my colleagues may dispute this), the common theme when aligner therapy triggers jaw problems has to do with patients biting down on the aligners. Many people tend to bite down hard on their aligners for hours at a time during the day. They don’t necessarily do it on purpose. Still, the result is that the upper and lower aligners are in contact for hours at a time.

Why Is It A Problem To Bite-Down On Your Aligners?

The natural rest position of your jaw is upper and lower teeth apart and nothing but air between them. When you bite down for a length of time beyond what is necessary to eat, for example, you disrupt the natural tone of your jaw muscles. Over time, jaw symptoms can emerge.

If your top and bottom aligners are in contact with each other for long periods, your jaw muscles are in a non-stop state of contraction. To illustrate, imagine how it would feel to make a fist with your hand for hours. Muscle soreness and pain would likely occur. Your jaw muscles work the same way.

In some patients, their jaw joints (TMJs) become so overloaded that they experience joint clicking and popping and even at times a locked jaw, often accompanied by pain.

Luckily, not every patient who bites down on aligners develops jaw problems. But, if you notice that you tend to bite down on your aligners and that your jaws are sore and joints making noise, you should consider taking a break for a while until the symptoms go away.

If you experienced TMJ problems in the past and your aligners have triggered your jaw problems to resurface, aligner therapy is probably not for you.

Note: Some practitioners recommend that their patients bite down on the aligners for the teeth to move more quickly. If that has been recommended to you, please ask your dentist if it is necessary. It’s smarter to slow down your aligner therapy and avoid jaw problems that may not go away once treatment ends.

The Bottom Line

If you previously suffered from TMJ problems, it’s critical to inform your dentist about it before you begin aligner therapy. If you are in the process of aligner therapy and have started to notice jaw clicking, locking, or pain, please stop wearing your aligners and speak to your dentist immediately.

Everyone wants a beautiful smile, and the miracle of Invisalign^® and aligner therapy is an excellent choice. However, it can also trigger jaw problems that may require long-term care.

Be an informed patient so you can make the right choice for you.

Tags Jaw Problems, TMJ

Bruxism Case Studies Orofacial Pain TMJ

The Connection Between PTSD & TMJ

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

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

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

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

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

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

PTSD Affects The Nervous System In A Specific Way

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

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

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

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

PTSD & TMJ – A Case Study

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

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

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

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

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

Can A Combination Of PTSD & TMJ Be Treated?

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

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

Conclusion

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

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

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

BOTOX® Bruxism Case Studies Facial Pain Jaw Problems Orofacial Pain TMJ Women & Pain

Facial Pain – Is It Bruxism or Is It Bulimia?

TMJ /Facial Pain Symptoms & Eating Disorders – The Connection

As a TMJ doctor, every year I see a number of patients who are suffering from an extraordinarily high level of face and jaw pain. At first glance, the level of suffering they report is much greater than what I commonly see. One such group are people with a history of one particular eating disorder – bulimia nervosa. In these patients, the typical characteristics I see in people with TMJ are not present. Although their symptoms may lead them to believe that their pain is driven by stress-related jaw tension and bruxism (teeth grinding and clenching), the telltale signs are simply not there. That’s when I ask myself, is it bruxism or is it bulimia?

Is It Bruxism or Bulimia? A Case Study

Marci was 26 when she arrived at my office some three years ago. For several years she’d been dealing with debilitating jaw and face pain almost daily. The pain was centered at the angles of her jaw on both sides and it had become, as she described it, “unmanageable.”

Pain was ruining her life.

Many doctors and therapists had tried to help Marci find relief. She’d been prescribed pain medications and muscle relaxers. She’d been treated by physical therapists. She had acupuncture and trigger point injections. She even tried wearing an oral appliance to bed, thinking her problems were the result of bruxism.

Frustrated and discouraged, Marci was still suffering – with no resolution in sight.

4 Clues That Bruxism Was Not The Culprit

At first, Marci didn’t share her entire medical history with me. Possibly because she was embarrassed or simply didn’t think there was a connection. However, even without knowing her full history, several clues pointed to the fact that Marci’s pain was not caused by bruxism, but instead was a result of bulimia:

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

So, Why Did I Ask If It Was Bruxism Or Bulimia?

In order to answer the question, is it bruxism or is it bulimia, each clue pointed to the answer. You see, bulimia can wreak havoc in the mouth because frequent vomiting exposes the teeth to acid, which can dissolve their protective enamel. This is seen on the back of the upper front teeth and in the center of the lower back teeth where regurgitated acid can pool. And, over time, frequent vomiting can cause the parotid gland (the largest salivary gland) to become inflamed and enlarged, resulting in acute nerve pain in the overlying jaw muscles and prompting facial puffiness.

Facial & Jaw Pain Caused by Bulimia – Treatment

Probing deeper into Marci’s medical history, I concluded that it was indeed bulimia, not bruxism that was the cause of Marci’s pain. Now it was time to offer a plan of treatment. I prescribed the medication nortriptyline (a once-popular antidepressant) that, when used in small doses has been shown to be effective in reducing pain in muscles by quieting nerve excitation. It is thought to work over time by increasing the activity of serotonin in the brain, according to the Mayo Clinic.

Marci also had a series of BOTOX® injections in her masseter muscles at my office, designed to not only reduce muscle tension but to also diminish the release of nerve-irritating chemicals. (See BOTOX® Injections For TMJ – 6 Things You Need To Know)

She was also given a custom-made topical salve containing a mixture of anesthetic, nerve membrane stabilizers, and anti-inflammatory medications to rub over the sore areas of her jaw three times a day.

A Much Happier Existence

Four weeks into treatment, Marci reported that her pain was more than 40% reduced. A second series of BOTOX® injections months later provided even better results. With her pain reduced, she was more motivated than ever to continue talk therapy, which she had started in an attempt to get a handle on her bulimia.

Today, Marci comes into my office every 4-6 months for a refill of her nortriptyline prescription and occasional BOTOX® injections. She’s nearly pain-free, almost bulimia free, and she leads a much happier existence.

Do You Know Someone Who Has Bulimia?

If you or someone you care about has bulimia and is suffering from facial and /or jaw pain, it is quite possible that a relationship exists. It’s very important to answer the question, is it bruxism or is it bulimia, so the right treatment can be put into place.

Although strategies like those used in Marci’s case won’t provide a cure, they can go a long way towards improving the quality of a suffering person’s life.

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

Tags Botox, Facial Pain, Jaw Problems, Orofacial Pain, TMJ, woman and pain

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Pain And The Brain – They’re Inseparable

As an orofacial pain specialist, I treat patients who suffer from facial pain and the pain symptoms associated with Temporomandibular Disorders (commonly referred to as TMJ), I think about pain, a lot.

A great deal of new scientific knowledge has been gained in my field in the past several years. Being familiar with this knowledge is an essential part of how I make difficult decisions about my patients’ pain problems. However, taking advantage of this knowledge is only part of it. My years of experience and knowledge of the right questions to ask are what enable me to figure out the “why” of a patient’s pain problem.

Case Study – Robin

Robin, a 43-year old woman, came to my office because she was experiencing tooth and jaw pain that seemed to have come from nowhere. She had always taken good care of her teeth at home and visited her dentist twice a year for routine cleanings and monitoring.

Robin was experiencing pain – and it was getting worse. She had already been to her dentist. Her dentist sent her to see a root canal specialist. Neither professional was able to detect anything to explain her pain, and, as a result, no treatment was rendered. Yet, her pain was getting worse.

When I first met her, Robin was using over-the-counter pain medication and avoided chewing on the painful side of her mouth. Her jaw felt stiff and tight. At times it felt like her jaw muscles were cramping. The simple acts of smiling and talking prompted her pain to flare. She was not yet miserable but was clearly heading in that direction.

Sometimes Robin’s pain would vanish for hours but then return with a vengeance. There was no discernible pattern.

Before I proceed, it’s essential for you to understand a few facts about pain. Contrary to what you may think…

Pain can occur without tissue damage.
The intensity of pain can have little to do with the seriousness of the problem.
Every pain experience starts in the brain, regardless of its origin or severity.
The intensity of pain is ultimately the opinion of your brain (and your brain is not always your friend).

Back To Robin

After an examination, it was clear to me (despite Robin’s high level of suffering) that no clear-cut physical findings existed to tie her pain to a specific tooth or jaw joint/muscle compromise. Sore jaw and neck muscles were the only recognizable finding.

Robin’s level of suffering appeared to be more profound than were my physical findings.

Pain & The Brain – The Right Questions To Ask

At his point, I asked Robin some very specific questions designed to identify the presence of any risk factors that could potentially be impacting her pain thresholds, and causing her jaw and neck muscle discomfort.

As I gathered her medical history, I was not surprised to find out that Robin experienced long-standing sleep deprivation and chronic, painful gastrointestinal problems. And that she was taking care of her aging mother and had a job, which required her attention 24/7.

When I put it all together, it was clear that Robin lived in a state of emotional distress. Essentially, she was ready for battle on an ongoing basis. Next, I looked at her for other clues and found them: raised shoulders, crossed arms, shallow quick breathing, and an acquired behavior of keeping her jaw muscles braced, usually with her teeth clenched, as well.

I concluded that Robin’s tendencies and behaviors had fatigued her jaw and neck muscles to the point where she experienced pain. And the tooth pain she experienced was actually “referred pain”, originating in her jaw and neck.

Essentially the parts of her nervous system that are responsible for maintaining normal pain thresholds and allowing the brain to interpret incoming nerve transmissions correctly were failing. This led to what is called a state of sensitization. In this state, normal life activities, such as opening your mouth, eating, smiling, and talking can lead to pain – even in the absence of apparent tissue injury.

Pain Is In Your Head

I carefully explained to Robin why her pain had developed at the same time validated that the pain was real. Many people in Robin’s situation have been told, “your pain is all in your head.”

But not the way they mean it.

I then outlined what I refer to as the “60/40 rule of care”. I was going to direct 40% of her treatment, which included physical therapy, muscle injections, and medication. She was going to be responsible for the other 60%. She was to do 20 minutes of physical exercise every other day, make an effort to get more sleep, and begin to pay attention to her diet to avoid heightened gastric distress.

Robin also agreed to address issues at her job, and most importantly, to pay attention to changing her stressful breathing patterns and postures driven and shaped by her challenging life.

Pain & The Brain – How Is Robin Now?

Although Robin cannot escape all of the risk factors of her life, she is now able to change the way her body and her breathing react to them.

Like many patients with her type of pain scenario, she has responded well to the strategies we put into place. She acknowledges that her participation in the process has been critical.

Today, when flare-ups occur, Robin now understands in those moments her brain is not her friend. And she is learning how to change her brain’s opinion – quickly.

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

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Tags Bruxism, Case Study, TMJ, Toothache

7 Common Questions About BOTOX® For TMJ Treatment

1. What Is BOTOX®?

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

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

4. How Long Will The Benefits Last?

5. How Many Injections Will I Need?

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

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

BOTOX® For TMJ Treatment – The Bottom Line

What Causes TMJ/TMD Problems?

First-Line Therapies For Relief From TMJ Pain

Injections For TMJ

Jaw Muscle Injections For TMJ

Tendon and Ligament Injections For TMJ

Injections Into The Jaw Joint

New Injections For TMJ Are On The Horizon!

The Last Word

First, What Causes TMJ?

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

All Dental Night Guards Are Not The Same

What To Do Next

Your Dental Night Guard Needs To Be Monitored

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

The Negative Effects Of Sleep Bruxism

So, Can A Dentist Cure Your Headaches?

Conclusion

New Insights Into Effective Treatments For TMJ

The Bottom Line

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

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

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5 Nighttime Factors That Could Be Causing Your TMJ Problems

How To Evaluate Yourself For TMJ – In Conclusion

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The True Definition of Stress

Stress, Sleep & TMJ Jaw Problems

Working From Home & TMJ Jaw Problems

So What Can You Do About It?

Here are 6 tips that I give to my patients that can help you avoid TMJ jaw problems:

Conclusion

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

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TMJ Consultations Online In The Future

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

What Does This Mean For Patients?

Definition Of Orofacial Pain

Invisalign® & Aligner Therapy Move Teeth In Remarkable Ways

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The Bottom Line

PTSD Affects The Nervous System In A Specific Way

PTSD & TMJ – A Case Study

Can A Combination Of PTSD & TMJ Be Treated?

Conclusion

Is It Bruxism or Bulimia? A Case Study

4 Clues That Bruxism Was Not The Culprit

So, Why Did I Ask If It Was Bruxism Or Bulimia?

Facial & Jaw Pain Caused by Bulimia – Treatment

A Much Happier Existence

Do You Know Someone Who Has Bulimia?

Case Study – Robin

Back To Robin

Pain & The Brain – The Right Questions To Ask

Pain Is In Your Head

Pain & The Brain – How Is Robin Now?

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

Invisalign^® & Aligner Therapy Move Teeth In Remarkable Ways

I am that someone – and you’re in the right place.
Dr. Donald Tanenbaum, DDS MPH