Tag: TMJ

9 Causes Of TMJ Problems In Teens & College Students

A Guide For Parents

I’m a dentist who focuses exclusively on treating people who suffer from jaw, tooth and head pain due to what’s commonly known as TMJ. Some of my patients tell me that they grind and clench their teeth all night (called sleep bruxism); some tell me they clench all day (called awake bruxism). Millions of people, in fact, suffer from bruxism and as a result, many experience jaw pain, headaches, toothaches, and ear pain. A surprising trend was uncovered during a recent review of my patient roster. We have seen a significant increase in young patients (between the ages of 16 and 25) who arrive at my office with complaints of a headache, intense jaw pain, and or daily facial pain. Why are there so many cases of TMJ problems in teens and college students and why do so many young people experience jaw and facial pain problems? What puts their jaw muscles and TM joints so at risk? Here are the nine most common risk factors:

9 Causes Of TMJ Problems In Teens & College Students

Screen-Related Activities: Countless hours with the head down while studying, playing video games, surfing the web, using social media, texting, etc. Neck tension is the result and is a risk factor that can prompt jaw problems.
ADD/ADHD Medications: These medications are stimulants, and although they’re usually taken early in the day, the effects often linger well into the evening. Stimulants, in general, tighten muscles and the jaw can be impacted.
Caffeine: Overconsumption and/or frequent consumption of coffee, Red Bull, or other high caffeine beverages keep the heart rate up and adrenaline pumping. Muscles are therefore at risk to maintain high levels of tension.
Nicotine: Another stimulant now consumed in high milligram doses in nicotine e-cigarettes which are popular mainly with college students, and young college grads. One vape cartridge apparently holds as much nicotine as three packs of cigarettes. Nicotine is a stimulant and can increase muscle pain.
Breathing Problems: Persistent allergies, sinus problems, and asthma often disrupt sleep and are associated with bruxism.
Airway Problems: Airflow can be blocked during sleep due to large tonsils, weight gain, or oral/jaw anatomy. Fragmented sleep has been associated with sleep bruxism.
Pain: Chronic pain is a significant source of sleep disruption. Neck and back pain and gastrointestinal pain can often fragment sleep, predisposing to more sleep bruxism activity.
Daytime Habits: Daytime habits such as nail and cuticle biting, pen chewing, excessive gum chewing, lip and cheek biting, and teeth grinding and clenching. All these behaviors can fatigue jaw muscles.
Anxiety & Psychological Disorders: Young patients often struggle to cope with life’s challenges and experience ongoing anxiety, which can lead to the onset of jaw tension and pain.

What’s A Parent To Do?

If your child complains about facial or jaw pain and you can say “Yes!” to at least two of the common risk factors listed above, it’s important to do something about it before it gets worse.

If you live in the New York metropolitan area, I invite you to make an appointment for a consultation at my office. We are thorough, compassionate and have many tools at our disposal to help your child.

If you are located outside the New York area, you can find a practitioner in near you on the website of The American Academy of Orofacial Pain. Choose a doctor who is listed as Diplomate.

I welcome your questions and comments.

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

SCHEDULE A CONSULTATION

Tags children and tmj, Jaw Problems, TMJ

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BOTOX® TMJ

3 Questions & Answers About BOTOX® Injections For TMJ

BOTOX® first became popular as a way to reduce wrinkles and facial lines. But being treated with BOTOX® injections for TMJ problems has become very popular. It is effective in treating pain and/or overactive muscles – when administered by a trained and experienced professional.

As an orofacial pain specialist, I often turn to BOTOX® for TMJ symptoms in patients whose pain has not responded to traditional first-line therapies such as exercises, medications, relaxation techniques, oral appliances, etc.,

If you’re at a point where nothing has provided relief from your painful TMJ symptoms, BOTOX® injections for TMJ could be the next step. BOTOX® is injected into your masseter muscles – the big muscles that bring your teeth together and bulge when you clench your teeth.

Naturally, a lot of questions pop up when I recommend BOTOX® injections for TMJ to my patients. Here are three of them:

3 Frequently Asked Questions BOTOX® Injections For TMJ

“One side of my face has a more developed masseter muscle than the other side. Will BOTOX® for TMJ improve the symmetry of my face?”

Yes, BOTOX® injections for TMJ can be used to achieve facial muscle symmetry. But here’s the important thing to know. It must be injected with a protocol that will selectively reduce the muscle bulk. Both the location and volume of BOTOX® used must be carefully planned to achieve the result desired.

Don’t go forward until you find a practitioner who is highly trained and experienced in this type of treatment.

“How do I know if, or when, I will need more BOTOX® injection for TMJ?”

BOTOX® is injected into the jaw (masseter) muscles for one of two reasons: The first, and most common, is to reduce pain. The second reason that patients opt to have BOTOX® injected into their masseters is to slim down their jaw profile. Many people develop large, bulky jaw muscles as a result of clenching and grinding their teeth, which is called Bruxism.

If pain was the reason you chose BOTOX®, you’ll know you need more treatment if the pain returns and you have controlled all the risk factors that brought on the pain in the first place. If your pain is significantly diminished or completely gone, you may not need more injections.

For pain relief, the current protocol has defined waiting a period of three months between injections.

If achieving a slimmer-looking jaw was your reason for pursuing BOTOX®, what you see in the mirror is the indication that you need more BOTOX®. It is likely that more than one session of BOTOX® injections will get the job done, so keep that in mind.

In addition, if you have not learned to reduce the behaviors that made your jaw muscles larger, or addressed the impact of sleep bruxism if present, results will take longer to achieve and may never be fully satisfying.

Learn about the behaviors that cause enlarged jaw muscles and what you can do about them here.

“If I just stop chewing gum and eating hard food, will my bulky jaw slim down so I don’t need BOTOX® injections?

Your bulky jaw is the result of your masseter muscles being overworked over the course of many years. If you simply stop those activities your muscles aren’t going to slim down on their own. You are probably a good candidate for BOTOX® injections for TMJ.

But as long as you continue the behaviors that made your jaw bulky in the first place, such as teeth grinding and clenching, the results of the BOTOX® won’t last long.

The Bottom Line

BOTOX® can be highly effective as a treatment for the pain and jaw bulkiness that are symptoms of TMJ problems. However, if administered improperly it may not work or even produce some very unpleasant outcomes.

How To Find A TMJ Specialist

To find an orofacial pain specialist who’s trained and experienced in your area, go to this website www.aaop.org. Look for a specialist in your area with the designation Diplomate. If you live in the New York City metropolitan area, feel free to call my office at 212-265-0110 to discuss your case. I’d be honored to help you feel better.

Have more questions about BOTOX® for TMJ in the masseter muscles? Feel free to comment below:

Tags Botox, TMJ

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Case Studies Jaw Problems TMJ

Successful TMJ Treatment – How Long Will It Last?

Two Case Studies

As a dentist who specializes in TMJ problems, my patients often ask me how long the positive outcomes of their successful TMJ treatment will last. It can be challenging to answer this question due to the fact that most patients simply stop coming into the office for care when their pain or jaw function problems have gone away. That leaves me to assume that their goals have been reached and they no longer need my care.

Or so I hope.

Many patients arrive at my office because they’re suffering because of compromised temporomandibular joints (TMJs) and associated arthritic changes, inflammation, or ligament and cartilage injuries. Others have tendinitis and or muscle pain. These are not easy cases to treat.

But, when the pain and discomfort have been reduced and jaw function improved to the degree that a patient no longer comes in for care, I am curious as to whether he or she is still feeling good a few years down the road.

Two recent encounters with former patients not only satisfied my curiosity but also reinforced my theory that when assisted by practical and time-tested TMJ treatment, Mother Nature can do a remarkable job of healing.

TMJ Treatment Case Study – Patricia

When Patricia first came into my office, she was 44-years old and had been suffering for many years from a painful, locking right TM joint. She finally decided to seek care when one morning she woke up and her jaw was locked to the point where she couldn’t insert even a pinky finger between her top and bottom teeth. She went to a specialist who ordered an MRI and concluded that the only option was surgery.

Patricia then sought me out for a second opinion. After I listened to her history, performed a physical exam, and reviewed her MRI results, I had to agree that a surgical approach was probably her best option.

However, Patricia was firmly opposed to surgery and persuaded me to try an alternative path of care. We settled on a course of TMJ treatment that included oral appliance therapy, physical therapy, BOTOX® muscle injections, a steroid joint injection, and instructions that guided her full participation in the process.

I’m happy to report that the non-surgical treatment worked. After a few months, Patricia stopped coming in for TMJ treatment altogether. I had to assume that she was still feeling better.

A couple of years after her last appointment I happened to be at a party and ran into her. She introduced me to her husband this way: “This is the guy who fixed my TMJ!”

And later that evening I noticed she was laughing and comfortably eating. I was assured then that success had indeed been realized. In Patricia’s case, the combination of treatment, her participation, and nature’s healing process got the job done.

TMJ Treatment Case Study – Susan

Susan was 45-years old when she became my patient. She’d been suffering from wicked migraines for years. Medication and a regimen of BOTOX® injections every three months had provided a bit of relief. But she had a feeling that her migraines were somehow related to her jaw muscles and that’s what brought her to me for TMJ treatment.

Many mornings when she woke up her teeth were clamped tightly together. And almost every day she was aware of what she could only describe as a “bracing” feeling in her jaw.

Like many people who suffer from jaw muscle tension, I suspected that Susan’s stress-filled 18-hour days were the culprit. She was in a perpetual state of “fight or flight” as if she always was ready for battle.

I agreed; Susan’s jaw muscle tension was a likely contributor to the severity of her migraines.

Susan’s treatment protocol included a custom-designed oral appliance to wear at night, a series of daily jaw and neck exercises, and daily self-directed muscle massage. I encouraged her to also pay careful attention to the pace and manner of her breathing during the day, especially while she was at work.

With TMJ treatment in place, Susan agreed to return in four months for a re-evaluation. But she never did.

Almost two years later as I was waiting in line to buy a movie ticket, I noticed Susan was also in line. She apologized for not coming into the office for a re-evaluation and told me that her migraines were now few and far between. She had followed the plan of treatment I designed and her jaw muscles were much less symptomatic and her migraines much less severe.

In Conclusion

If you commit to being an active participant in your care, the benefits of TMJ treatment can last for years. And, even if you’re someone who has suffered for decades from jaw problems, it’s never too late to seek an answer.

Learn more about TMJ treatment here.

Tags Case Study, Jaw Problems, TMJ

Sleep Apnea TMJ

The Connection Between Sleep Apnea and TMJ

Medical research continues to assess how poor sleep quality and sleep disorders in general influence pain thresholds and the experience of muscle and joint pain. One common area of study pertains to obstructive sleep apnea and the larger field of sleep-related breathing disorders – conditions that can lead to fragmented sleep.

Therefore, if you have TMJ pain, it’s really important to tell your doctor if you have a sleep-related breathing disorder (including sleep apnea), and here’s why.

The Connection Between Sleep Apnea & TMJ

According to the Mayo Clinic, sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly, and you feel tired even after a full night’s sleep. [ The most common type of sleep apnea is called obstructive sleep apnea and occurs when your throat muscles relax and cause pauses in breathing. Each pause in breathing can last from a few seconds to several minutes and can occur up to hundreds of times per hour.

This fragmented sleep can have a detrimental impact on your overall health. Aside from the obvious impact of not getting enough sleep that can include irritability, trouble concentrating, and being sleepy during the day, sleep apnea can trigger headaches, migraines, heart problems, and increase your sensitivity to pain. There are a myriad of reasons that people develop sleep apnea. Obesity, a narrow airway, large tonsils, sedatives, and smoking or drinking alcohol before bed are just some of the risk factors.

The bottom line is this. When something restricts normal breathing, oxygen levels will drop. When your oxygen levels drop, your brain will become stressed. And a stressed brain opens up the possibility of many other problems, including sleep bruxism, which is when you grind and clench your teeth while you’re sleeping. Bruxism can cause your jaw joints (TMJs) to be overworked leading to all kinds of problems, including pain.

Sleep Apnea Can Lead To Bruxism

A number of years ago, TMJ doctors began to notice that a large percentage of their patients had the signs and symptoms of sleep apnea. Studies revealed that breathing restrictions, like those accompanying sleep apnea, can trigger the nightly occurrence of sleep bruxism.

The Role Of Pain – A Double-Edged Sword

If you’ve ever been in chronic pain you know that getting a good night’s sleep can be quite a challenge. Moreover, studies reveal that insufficient sleep can actually lower your threshold of pain, meaning you feel pain more intensely than if you were well-rested. The reason is this: when you don’t sleep well your body can’t produce a normal level of endorphins (the “feel-good” chemicals that promote a sense of well-being). On top of that, poor sleep can cause your nerve pathways to malfunction – which causes a more intense experience of pain.

So, it can go both ways.

When breathing difficulties disrupt your sleep, you become more at risk of developing bruxism. And if your overworked jaw muscles become painful, the pain can cause fragmented sleep. It’s a symbiotic relationship.

Hopefully, you can now see the connection between sleep apnea and TMJ. Please consider getting evaluated for sleep apnea if you’re suffering from TMJ pain. A careful evaluation process, which may include an overnight sleep study (which can now be done at home!) will determine the best type of treatment.

Conclusion

As the associations between jaw pain, sleep disruption and sleep bruxism continue to unfold, the need to be evaluated by a well-rounded team of medical professionals becomes even more important. The ability to have sleep testing done at home and the more recent emergence of telemedicine consults to assist patients in obtaining preliminary sleep consultations, improve doctors’ ability to arrive at accurate diagnoses. This in turn will lead to more effective treatment.

If you’re suffering from TMJ-related pain and have tried everything, it’s time to see a specialist in orofacial pain. If you live in the NYC metro area, I invite you to make an appointment for a consultation at my Manhattan or Long Island office. If you are outside of New York, go to this website www.aaop.org and search for a Diplomate in your area.

Note: BOTOX®, which has been frequently been mentioned in the news, can at times be a helpful treatment once the assessment process has been completed. You can read about the experience of one of my patients and how BOTOX® helped her here.

Tags Sleep Apnea, TMJ

Bruxism Persistent Toothache TMJ

8 Surprising Reasons Your Teeth Are Sensitive

One of the most common questions about dentistry that people ask on Google is this: “Why are my teeth so sensitive?”.

Unfortunately, there’s no simple answer to this question. There could be any number of reasons why your teeth are sensitive, some of which may surprise you. In the following article, I list 8 reasons your teeth are sensitive and a brief explanation of each. Does one apply to you?

8 Reasons Your Teeth Are Sensitive

1. Your Toothpaste Is Too Abrasive

In order for toothpaste manufacturers to gain approval from the FDA they must measure and report the abrasiveness of their products. However, they are not required to report the information to consumers. To help you find out how your favorite toothpaste stacks up, refer to the chart below. Your teeth are sensitive perhaps because of the toothpaste you’ve been using.

2. You’ve Been Using Whitening Toothpaste

Whitening toothpastes often contain chemicals that help to remove surface stains and therefore, make your teeth much whiter. However, these chemicals can damage the surface of your teeth. Several whitening toothpastes have received the American Dental Associations’ (ADA) Seal of Acceptance. However, it is recommended that you consult your dentist before using whitening toothpaste to avoid damage. So, if you’ve been brushing with whitening toothpaste and your teeth are sensitive, whitening toothpaste may be the culprit.

3. There’s Too Much Acid In Your Diet

Citric acid, such as what’s found in lemons, oranges, and grapefruits, can be very damaging to your tooth enamel. It’s not hard to understand how too much citric acid could cause erosion of your teeth enamel and therefore, sensitive teeth.

On the other hand, most people don’t realize that many popular beverages, many of which don’t seem to be acidic, are very acidic. My colleague, New York dentist Michael Sinkin, warns: “…many vitamin waters, energy drinks, and sports drinks are highly acidic and if consumed in large quantities can cause your teeth’s structure to break down.”

So, how can you find out if your favorite beverage contains enough acid to be the reason your teeth are sensitive? Check the pH! pH is the measure of acidity on a scale of 1-14. The lower the number the higher the acidity; tooth enamel begins to dissolve at pH 5.3.

The chart below shows the pH of some popular beverages. If you’ve been gulping Gatorade at the gym or if you slug down a Red Bull every afternoon to fight tiredness, those beverages may be the cause of your sensitive teeth.

Source:
http://michaelsinkindds.com/is-your-favorite-beverage-eroding-your-tooth-enamel/

4. You’re A Swisher!

The next time you drink a soda, juice, or a glass of wine, take note if you swish it around in your mouth before you swallow. Many people swish their beverages without realizing it, which can create a loss of tooth enamel and sensitize the teeth’s dentin and cementin. Wine connoisseurs in particular, who swish in order to better experience the nuances of vintages, are at especially at risk. It’s OK to swish a little, but try keeping it to a minimum.

5. Your Teeth Need A Cleaning

Even people with the means to go to their dentist two or three times a year often avoid it because of dental fear. You can floss and brush twice a day, every day, but it’s nearly impossible to remove all the tartar and plaque that will build up on your teeth naturally. When plaque builds up around and under your gums, it will cause inflammation, and therefore, sensitive teeth.

If you haven’t been to the dentist for a while you could be surprised to discover that most practices now are hyper-aware of how anxious some patients can be, even when they come in just for a simple cleaning. Dental fear is nothing to be ashamed of, so discuss it with your dentist and get those teeth cleaned!

6. You Breathe Through Your Mouth

Chronic sinusitis from allergies or a deviated septum can cause you to continually breathe through your mouth instead of through your nose. An article in RDH, The National Magazine For Dental Hygiene Professionals, states: “Mouth breathing affects the pH of the entire body… meaning the saliva.”

In other words, breathing through your mouth over a long period of time can actually make your saliva more acidic and could be the reason your teeth are sensitive. The best advice is to see an ENT (an Ear, Nose and Throat doctor) as soon as possible.

7. Your Jaw Muscles Are Being Overused

I’ve been treating patients who have tooth and jaw problems that stem from overworked jaw muscles for over 35 years. If you hold tension in your face and keep your teeth clenched together during the day, your jaw muscles are being overworked. Overworked jaw muscles can cause headaches, facial pain, persistent toothache, and sensitive teeth. Try to relax your jaw, especially when you’re working at your desk. For more help, read Problems of the Jaw.

8. You Grind Your Teeth While You’re Sleeping

Nighttime teeth grinding, also called Bruxism, is a common phenomenon that causes your jaw muscles to over-contract. In fact, some people grind their teeth so ferociously that they actually sprain their jaw ligaments, which is why their teeth are sensitive.

My practice is full of people who suffer from bruxism and just want to feel better. Our first step is to figure out what’s causing the grinding. Only once the underlying reasons are discovered can we put in place a treatment plan to eliminate the grinding and therefore, its damaging efforts.

Did you figure out why your teeth are sensitive? Whatever the cause, keep in mind that your sensitive teeth are a sign that something is going on. Don’t ignore it.

(Note: If the cause of your tooth sensitivity is related to overuse behaviors or nighttime teeth grinding and you live in the NYC metro area, please feel free to (212)-265-0110 for a consultation. If you’re outside my area, you can go to www.aaop.org and find a Diplomate in your area.)

Tags Bruxism, TMJ, Toothache

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Orofacial Pain TMJ

The Latest In TMJ Treatment Strategies

This post has been updated and can be found here.

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

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

1. Healing Is A Process

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

2. Anti-Depressants Could Be A Culprit

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

3. Sleep Quality & Quantity

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

4. Lowered Pain Thresholds

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

5. Night Tooth Clenching & Grinding

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

6. Supplements

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

7. Food As Medicine

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

8. Breathing

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

Conclusion:

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

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

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

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

Tags Orofacial Pain, TMJ

Case Studies Facial Pain Jaw Problems TMJ

Can Lyme Disease Cause TMJ? – 3 Case Studies

As a specialist in orofacial pain and TMJ for over 30 years, it’s my conclusion that the impact of Lyme Disease on the peripheral and central nervous systems can produce nerve and muscle pain that mimics the symptoms of TMJ. But can Lyme Disease cause TMJ?

Starting in the early 90’s many patients have visited my office exhibiting the symptoms of TMJ – jaw pain, limited jaw opening, and severe facial pain. But upon evaluation, I did not find the common histories and risk factors that typically cause the muscle strain and inflammation associated with TMJ problems.

Lyme Disease infects over 300,000 people in the United States every year. But making a diagnosis is extremely difficult due to the fact that the only blood tests available are unpredictable. On top of that, only 25-50% of infected people ever develop the telltale rash associated with a deer tick bite (the tick that carries Lyme).

If left untreated, Lyme can cause facial tics (contraction and twitching of muscles), jaw pain, headaches in the temples, neck stiffness, and episodes of pain during talking and smiling. Very similar, if not identical to TMJ.

The three case studies that follow prompted me to ask this question:

Can Lyme Disease Cause TMJ?

3 Case Studies

Case Study #1: John

In 1992 I treated a patient named John. John was a 38-year-old landscape gardener who worked at a golf course on the East End of Long Island. His complaints were acute jaw pain, limited jaw opening, and an inability to bring his teeth together in a consistent way.

At first glance, it seemed that John had the type of jaw problem that I see every day in my office so I prescribed the course of treatment that helps most of my patients. But it didn’t help him. Then I discovered that John had been diagnosed with Lyme Disease.

Case Study #2: Anne

A recent patient named Anne. She is a 52-year old female. She describes her symptoms this way: “I have pain in my face that can be so intense that I have thought about going out on disability.”

Ann’s pain is triggered whenever she talks. And her jaw muscles feel as if they’re “pulling all the time”. At times her teeth ache. And when the frames of her glasses press on her temples, the pain escalates. Anne’s facial and jaw symptoms have been present for seven months and are accompanied by exhaustion, disabling headaches, and what she describes as “bizarre sensations in my body”.

As with John, my evaluation did not suggest the reason for Anne’s suffering was a typical TMJ problem. But evaluations don’t always indicate Lyme, either. Due to the fact that she takes long walks in the Connecticut woods and because she remembers getting bitten by insects (she never had the telltale rash) her infectious disease doctor has considered starting her on antibiotic therapy for Lyme Disease.

Case Study #3: Sue

Another patient named Sue, a 45-year old female, came in with jaw problems, too. She had been diagnosed with Lyme disease seven years earlier. Sue felt sure that her Lyme had been “successfully treated with alternative remedies.” But still, she suffers from tight jaw muscles, intense pain when she lays her face on a pillow, fragile emotions that prompt daily outbursts of crying, and “raging pain in my face and jaw”. She was sure she had TMJ but never imagined that the effects of Lyme Disease cause TMJ symptoms.

Sue also suffers from bouts of intense back pain with a nerve-like character, that comes on suddenly and as quickly passes.

As noted, Sue believes that her Lyme Disease has already been “cured” by alternative remedies. But as in the cases of John and Anne, my evaluation provided no evidence of the typical causes of TMJ symptoms. With her belief in alternative treatments, it is no surprise that Anne is very reluctant to try antibiotic therapy. But she is about ready to move in that direction.

Did Lyme Disease Cause TMJ Symptoms In John, Sue, or Anne?

The outcome of these cases remains to be determined, but they are very similar to many other confirmed cases of Lyme Disease I have encountered since 1992 when I first began to wonder if can Lyme Disease cause TMJ symptoms.

It is my conclusion, therefore, that the impact of Lyme Disease on the peripheral and central nervous systems can produce nerve and muscle pain that mimics the symptoms of TMJ. I am hopeful that better testing, control of the deer tick population, more effective treatments, and even perhaps a vaccine is on the horizon for these suffering patients.

If you would like to add your comments please feel free to do so below.

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 Case Study, Facial Pain, Jaw Problems, TMJ

53683948 - snorkeling gear on a maldivian beach

Jaw Problems Nightguards & Oral Appliances Orofacial Pain TMJ

TMJ From Scuba Diving Or Snorkeling

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

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

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

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

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

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

Prevention & Treatment of TMJ from Scuba Diving Or Snorkeling

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

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

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

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

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

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

Tags Jaw Problems, Oral Appliances, Orofacial Pain, TMJ

Jaw Problems Tinnitus TMJ

The Connection Between Tinnitus and TMJ

Editor’s Note Updated 2025: This article remains part of our archive. For the most current overview of the TMJ and tinnitus connection, visit: https://www.nytmj.com/tinnitus-jaw-connection/

My dental practice has a unique focus. The majority of our patients come to us suffering from TMJ problems. The TM joint is the hinge connecting your jaw to the temporal bones of your skull, which are located in front of each ear. The healthy function of this joint enables you to chew, talk and yawn. When the joint is inflamed, strained, or unstable it can cause pain, limited jaw movement, and a variety of jaw noises during motion. When the muscles that move the TM joint are compromised, similar symptoms may result, as well.

There is a connection between tinnitus and TMJ problems, too, and we see patients in my practice looking for relief. But before I get into the explanation of how tinnitus and TMJ are linked, I want to be sure you understand the nature and causes of tinnitus itself.

The connection between tinnitus and TMJ is real.

What Is Tinnitus?

Tinnitus Definition: The annoying sensation of hearing a sound when no external sound is present. Patients describe these sounds with words such as ringing, humming, buzzing, roaring, clicking, and hissing. This sensation is constant for some people and intermittent for others, and it can be in one or both ears. For some sufferers, the intensity of the sounds can vary from day to day while for others it is without fluctuation in intensity.

What Causes Tinnitus?

There are many known causes of tinnitus that include identifiable damage to the inner ear hair cells, age-related hearing loss, exposure to loud noises, earwax blockage, and changes in the health of the bones in the middle ear. Less commonly, tinnitus can be associated with Meniere’s disease, trauma to the head and neck region, and/or TMJ disorders. For some people, however, the cause is never discovered.

What Is The Connection Between Tinnitus And TMJ problems?

TMJ problems are essentially orthopedic in nature. The common symptoms of TMJ are many and can include pain in the jaw muscles or specifically in the jaw joints, limited jaw motion, jaw muscle tension and tightness, jaw joint clicking, popping and or locking, headache pain in the temples, and/or a bite that doesn’t feel normal. Tinnitus is a less common symptom. When TMJ problems, however, affect the ear, symptoms can be pain, stuffiness, and/or tinnitus.

The onset of these symptoms may be due to underlying medical disorders, emotional stress which drives muscle tension, disrupted sleep, traumatic events, periods of sustained jaw opening, sleep bruxism, and daily overuse behaviors and or neck postures. All of these factors can result in joint sprains, muscle strains, muscle spasms and /or inflammation. Less common origins include a “bad bite.”

Why TMJ Problems Can Lead To Tinnitus (Or Make It Worse)

1. The nerves that serve the jaw muscles and jaw joint are also responsible for the function and tone of muscles that determine the size of the Eustachian tube and tone of the tympanic membrane. Alterations in the function of these two structures can be responsible for tinnitus.

2. There is one specific ligament connecting a middle ear bone (the malleus) to the jawbone. When a TMJ problem changes the position of the lower jaw the malleus can be altered in its function due to ligamentous traction and that can lead to tinnitus.

3. The main nerve supply from the TM Joint has been shown to have connections to parts of the brain involved with hearing and the interpretation of sound. If TMJ problems alter the function of this nerve, it‘s quite possible that the brain will interpret normal sounds as abnormal and patients report tinnitus.

4. Worth mentioning is that because TMJ problems are often associated with neck problems, evaluations of the neck must be also part of an overall assessment. There is evidence that nerve endings in the neck make connections to the hearing centers of the brain. Ear symptoms, therefore, have been shown to emerge as a result of long-standing neck problems or those created by acute trauma.

Determining If A TMJ Problem Is Driving Tinnitus Symptoms

Try to determine if your tinnitus symptoms are influenced by moving your jaw (chewing, yawning, talking, opening it widely, sticking it forward). If you notice a link, then it’s very possible that TMJ problems are at the root of your tinnitus. The same is true for head and neck movements.

TMJ Neck Treatment To Help Tinnitus

If your tinnitus is related to your jaw or neck, dealing with these problems will be very helpful. There are a host of treatment strategies available including reducing overuse behaviors and or postures (such as teeth grinding, nail-biting, frequent computer work), exercises, home TENS therapy, muscle injections or dry needling techniques, BOTOX®, the use of oral appliances to support your jaw joints and jaw muscles (especially at night), physical therapy, medications, meditation, mindfulness training, and diaphragmatic breathing instruction.

These treatments, if found to be helpful, may require several weeks or months to see maximum results.

Summary

As I mentioned before, tinnitus can be caused by damage to your inner ear, hearing loss, exposure to loud noises, earwax blockage, and more. If your doctor has not found a link between your symptoms to any of the above, it may be time for an assessment of your jaw and neck structures. There may, indeed, be a connection between your tinnitus and TMJ problems.

Here’s a directory of orofacial pain professionals around the world: American Academy of Orofacial Pain.

You can get more information about TMJ and ear problems here: TMJ and its Relationship to Ear Problems and Sinus Symptoms

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

Dr. Donald Tanenbaum is a dentist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat facial pain associated with jaw problems, TMJ, referred pain, nerve pain, and migraines. You can contact the office here.

Tags Jaw Problems, Tinnitus, TMJ

Facial Pain Jaw Problems Orofacial Pain TMJ

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

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

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

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

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

In Conclusion

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

Can Braces Cause TMJ?

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date September 20, 2016
No Comments on Can Braces Cause TMJ?

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

Can Braces Cause TMJ? Three Scenarios

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tags Bruxism, Jaw Problems, Teeth Grinding, TMJ

Fibromyalgia TMJ

Is It TMJ or Fibromyalgia?

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date July 21, 2016
No Comments on Is It TMJ or Fibromyalgia?

The majority of patients in my practice arrive complaining of TMJ pain. For many, their pain is over the jaw joints. While others complain of pain only in their jaw muscles. These separate, but related, pain sites represent the components of a true TMJ pain problem. In fact, whether the pain is focused over the joints or in the muscles, it’s almost always the result of very specific factors such as teeth clenching or grinding during the night or day, daytime behaviors such as nail or cuticle biting, poor sleep, strained respiration, and/or chronic stress and challenging life circumstances.

I do see many patients, however, who experience severe pain in the jaw and face, but who display no evidence of common risk factors typical in the patients who have TMJ pain due to a temporomandibular disorder. For these patients, their pain is real but the cause is different. A very large percentage of them have a diagnosis of fibromyalgia in their medical history.

Is it TMJ or Fibromyalgia?

Although a full understanding of fibromyalgia remains unclear, fibromyalgia patients typically have a very low threshold of pain throughout their entire body. The best analogy is to imagine what it feels like to put on a shirt when your back has been burned from multiple days at the beach. That’s what it’s like to have fibromyalgia. All the time.

As a result common activities such as chewing, yawning, talking, or even putting their face on a pillow produces face and or jaw pain. This daily pain may often leads them to brace the jaw muscles and fatigue them. This can result in motion limitation and thus mimics a common TMJ problem.

Treatment strategies for fibromyalgia patients are markedly different than for typical TMJ patients.

When I work with typical TMJ patients I can isolate the factors that caused their problems in the first place and then help to control them. But if you are a fibromyalgia patient, it is much more challenging to manage your face and jaw pain. Treatment must focus on helping you acquire higher pain thresholds.

Through research we’ve discovered that meditation, diaphragmatic breathing, restorative yoga, exercises, a positive outlook on life, and even laughter can all be beneficial for fibromyalgia patients. In addition, certain medications show promise – particularly those designed to enhance your own pain inhibitory systems by helping restore and/or bolster levels of serotonin and endorphins. Injections of BOTOX® coupled with frequent jaw motion exercises also show promise for specific jaw muscle pain in fibromyalgia patients.

In summary, facial pain symptoms are not always the same and require careful assessment before conclusions are reached with regards to diagnosis and treatment strategies. In my practice we see progress with both the common TMJ sufferer and those with jaw pain due to fibromyalgia.

If you’re in pain and are need to know if it is TMJ or fibromyalgia, and you live in the New York City area, please feel free to call my office for a consultation. Outside the area you can find a list of professionals through the American Academy of Orofacial Pain.

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

Tags fibromyalgia, TMJ

Jaw Problems Orofacial Pain TMJ

What Is An Orofacial Pain Specialist?

If you’ve never heard the term orofacial specialist, I’m not surprised. I’m one of only a few hundred formally trained orofacial pain specialists in the United States. That’s because orofacial pain specialists have not been terribly visible on the health care playing field – until recently. Until very recently the field of orofacial pain was not a recognized specialty by the American Dental Association. This fact made it difficult for patients to get proper treatment. But in March 2020, the American Dental Associations’ National Commission on Specialty Status finally named Orofacial Pain as a new dental specialty,

Orofacial specialists like me treat patients who suffer from pain of muscle origin, joint origin, and nerve origin that is focused in the head, neck, mouth, face and jaw area. For example, we treat people who have chronic toothaches and gum pain – despite having multiple dental evaluations and treatment. The problems we treat involve jaw pain, limited mouth opening capacity, and jaw clicking and locking. In addition, many patients with TMJ issues have problematic headaches, and in many cases, have pain in the nerves that supply the teeth, gums and other facial tissues.

At times we also are called upon to diagnose and or treat patients with complex medical problems that result in facial pain.

Why don’t more people know about orofacial pain specialists?

Because until recently, this specific area of dentistry has not been granted “specialty status” by the American Dental Association. And that’s why orofacial pain specialists can be difficult to find. But now, dental schools that train dentists to become oral surgeons, endodontists (root canal), periodontists (gum therapies) and orthodontists (braces) can also train them to be experts in orofacial pain.

To help our patients, orofacial specialists rely on a wide variety of treatment options including education, medication, therapeutic injections, oral appliances, and muscle and joint rehabilitation therapies. Patient education is crucially important in my field as many of the problems we treat in the jaw muscles and joints are the result of daytime jaw overuse behaviors and sleep-related teeth grinding and clenching. Most orofacial specialists have strong referral relationships with physical therapists, clinical psychologists, pain management physicians, psychopharmacologists, chiropractors and even acupuncturists and leaders of meditation programs. All of these together allow us to successfully care for our patients’ individual needs.

We often validate the fact that your pain is not only real but helpable despite – past treatment failures. Just knowing there’s an answer helps my patients feel better right away.

If you or someone you know has been suffering you can find an orofacial specialist in your area by linking to the American Academy of Orofacial Pain at aaop.org. Look for a specialist with “Diplomate” status. If you’re in the NYC 212-265-0110 or Long Island 631-265-3136 area, feel free to call my office for a consultation.

Relief is here.

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

Tags Jaw Problems, Orofacial Pain, TMJ

Bruxism Jaw Problems TMJ

BOTOX® For Jaw Reduction: The Real Story

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

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

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

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

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

That’s what happened to Bettheny Frankel.

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

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

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

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

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

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

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

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

Good luck!

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

Tags Bruxism, Jaw Problems, Teeth Grinding, TMJ

Facial Pain Jaw Problems TMJ

TMJ Problems During Invisalign Treatment

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

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

How To Prevent TMJ Problems During Invisalign Treatment

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

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

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

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

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

Tags Facial Pain, Jaw Problems, Teeth Grinding, TMJ

Jaw Problems TMJ Women & Pain

Postpartum TMJ Pain – What Causes It & How To Get Relief

As a board-certified orofacial pain specialist, my practice focused on treating patients who suffer from the impact of TMJ problems, I am confronted with new challenges every day. One particularly challenging group of patients is women who suffer from postpartum TMJ pain. Here are some of my thoughts on why this population of patients is so commonly seen in my office.

The 3 Big Causes of Postpartum TMJ Pain

1- Sleep Disruption

Everyone knows that the presence of a newborn is incredibly disruptive to sleep. A fragmented, diminished and unpredictable sleep schedule leads to poor quality sleep. When sleep deprivation continues over many months or even years, pain symptoms can develop throughout the body as endorphin levels drop. Joint and muscle symptoms are common throughout the body including the jaw muscles and TM joints.

If headaches in the temples are a common morning symptom suspicion of sleep bruxism must be considered. In addition, if the new mom does not quickly shed her pregnancy weight, she may be predisposed to airway problems, which further fragment sleep quality. Sometimes lingering postpartum TMJ pain is so severe that new moms seek many medical evaluations, most of them unnecessary other than for piece of mind.

2- Neck & Shoulder Strain & Fatigue

Next is the act of carrying around small babies. It seems easy at first but gets more and more difficult as a child’s weight increases. Carrying around the baby can be a challenge for anyone, particularly for small women. A 20-pound baby can cause neck strain and fatigue, which can result in pain. These neck problems very often initiate jaw problems. And thus the cycle begins.

Carrying a baby isn’t the only cause of neck and shoulder strain. Car seat challenges, pushing and folding heavy strollers (especially while holding the child in one arm), talking on the phone or cooking while holding the baby, and time spent sitting on the floor all add up to the potential for muscle problems to arise.

3- Emotional Issues

Last, but not least, the emotional issues than often arise following childbirth can be a significant cause of postpartum TMJ pain. Yes, having a baby is one of the most cherished events in life. But life as we know it is forever changed. For women whose independence started with high school graduation, college, grad school, and then career, the sudden loss of control that the new baby brings can cause tremendous emotional upheaval.

Plus, it’s no easy chore to be on call 24/7, even for the hardiest. For working moms the stress is two-fold. The hours away from her baby can create anxiety and the feeling of “being out of control.” Many new moms also sense a tremendous amount of guilt for being away from the baby every day.

Attending to poor sleepers, colicky babies, picky eaters and constant crying requires skills that must be learned, and there’s no manual.

As the challenges of motherhood continue, the limbic system (the part of the brain where emotions are formed) ultimately stimulates the fight or flight response and that gives rise to increased muscle tone, shallow and fast breathing, and daytime behaviors such as raised shoulders, furrowed brows, lip tension and clenched teeth, just to name a few. The end result, of course, can be the emergence of jaw pain, jaw stiffness, and/or headaches.

Help Is Available

There are no easy solutions for all of these challenges. However, when a new mom arrives at my practice suffering from TMJ problems, I have an arsenal of ways to help her get relief. They include:

Diaphragmatic breathing techniques
Jaw and neck exercises
Help to improve sleep hygiene
Strategies to address awake and sleep bruxism
Meditation recommendations (TM is extremely helpful)
Referrals to Alexander and/or Feldenkrais specialists

I also encourage new moms to ask for help from their parents, siblings or even their friends. Taking some breaks from the daily obligations of caring for a newborn can go a long way to feeling better.

If you have a new baby and are suffering from postpartum TMJ, help is available. To find a dentist in your area that focuses on these types of problems, visit The American Academy of Orofacial Pain at http://www.aaop.org/.

Good luck!

(This is a follow-up to a previous post 3 Reasons Why TMJ Problems Get Worse During Pregnancy

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

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, TMJ, Women and pain

Jaw Problems Nightguards & Oral Appliances TMJ

3 Reasons Why TMJ Problems Get Worse During Pregnancy

As a board-certified orofacial pain specialist, the majority of people who pass through my door have TMJ problems, and 80% of them are women. The reasons that women are more prone to TMJ problems are very complex (a subject that I cover elsewhere on my website). Happily, I can report that after a treatment period of approximately three to four months, most of my female patients experience diminished and sometimes even the complete elimination of their symptoms. It is not unusual, however, for some women that were symptom-free for a long period of time to find their way back to my office when they’re expecting a baby. That’s because TMJ problems get worse during pregnancy.

Why do TMJ problems get worse during pregnancy? There are 3 main reasons:

Sleep Disruption

Most women discover pretty early on in pregnancy that their favorite position is no longer comfortable. In many cases, she can’t even find one sleep position that’s comfortable. Add to being uncomfortable, the frequent need to get up to urinate during the night and you have a situation that wreaks havoc on the sleep cycle. Disrupted sleep and brain arousals during the night seem to increase the likelihood of tooth grinding and clenching. Therefore, the pregnant woman that experienced jaw problems in the past is certainly now at risk again. The result is the typical list of TMJ problems: pain, jaw stiffness, morning headaches and jaw clicking and/or locking.
Morning Sickness
For many women, unrelenting nausea and frequent vomiting characterize the early stages of pregnancy. Vomiting itself puts extreme pressure on the shoulder and neck muscles and causes the jaw to be violently thrust forward. Frequent vomiting can cause the jaw ligaments to be sprained and the jaw muscles to be strained. A traumatized jaw joint can be painful, stiff, and mechanically challenged. Although morning sickness usually lasts only a short time, that can be just long enough for TMJ problems to start or to reoccur.
The Relaxin Hormone
Relaxin is a very helpful hormone. It helps ligaments in the pelvis stretchier to accommodate the delivery of a baby. The ligaments become more “lax”. During the later stages of pregnancy, relaxin becomes more and more elevated in the bloodstream. While relaxin’s main job is to prepare the pelvis, it also can make the ligaments in other parts of the body more elastic, including the jaw. Here’s a frightening scenario that is experienced by many pregnant women: A visit to the dentist for a routine cleaning becomes a nightmare when her jaw gets stuck in the open position. Hello, relaxin! Relaxin has made the jaw ligaments unstable and allowed the joint to open wider than normal. Sometimes assistance is even needed to get the jaw closed and that can result in pain and soreness for days, or even weeks. The fear of this scary event happening again is very stressful. (In these cases I teach some simple exercises that are very helpful.)

If you’re pregnant, have had TMJ problems in the past, and suspect that they are beginning to resurface, see your dentist before it gets worse. A custom-fitted nightguard, a routine of jaw exercises, and some general relaxation techniques may just be what you need to relieve the symptoms and allow you to enjoy the rest of your pregnancy.

If you are experiencing postpartum TMJ problems, please link to Postpartum TMJ Pain – What Causes It & How To Get Relief.

If you liked this article, please consider subscribing to my blog. Thank you!

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

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, Pregnancy, TMJ

Jaw Problems Orofacial Pain TMJ

When Is TMJ Surgery Needed? What You Need To Know

TMJ surgery has received some negative press over the years. You may have read horror stories on the Internet about TMJ surgery gone bad. The reality is countless patients would still be living with acute jaw pain and limited jaw motion if they had not had surgery as an option.

I’ve spent the past 40 years focused almost exclusively on treating patients with TMJ and facial pain problems. I’m often asked how I determine when TMJ surgery is needed.

Non-Surgical Treatments Are Always Tried Before Surgery Is Ever Considered

It’s important to understand that TM joint problems are orthopedic problems – just like tennis elbow or a rotator cuff injury, for example. Sometimes, tissue injury in the TM joints is severe and involves compromised ligaments, stubborn inflammation, displaced cartilage, and/or arthritic and erosive problems affecting the bones.

If your TM joint pain is due to inflammation, and after we’ve tried all non-evasive therapies, our one last non-surgical effort is steroid injections into the “hot” joint.

The success of steroid treatment depends upon how long you’ve experienced pain, the origin of your problem, the condition of your underlying bone, ligaments and cartilage, and your ability to avoid new injury to the joint. If progress is made after the first injection, a second is usually administered in about three months.

However, when no relief is experienced after the first injection, the steroid method is put aside.

When Steroid Injections Don’t Work – The Next Option Is Arthrocentesis

If steroid injections are unsuccessful, the next option is usually arthrocentesis. Arthrocentesis is a procedure whereby your injured TM joint is, in essence, washed-out to remove the irritating chemicals that accumulate when you have tissue injury.

In addition, your injured TM joints may not move easily due to sticky adhesions. So, the second goal of arthrocentesis is to break down these adhesions, which allows your joint to move more easily. When movement is easier, so are your prospects of healing. (Arthrocentesis is usually performed under local anesthetic and light sedation.)

As with steroid injections, supportive therapies are put in place afterward such as oral appliances, home treatments and exercises, dietary caution, oral medications, and physical therapy.

When Arthrocentesis Doesn’t Work, Is TMJ Surgery Next?

Like any orthopedic problem, there are times when all non-surgical treatments fail.

The procedure of choice in this instance is arthroscopic surgery. Arthroscopic surgery allows your doctor to visualize the damage in your TM joint and effectively remove any adhesions, smooth any irregular bone, and inject steroids right into areas that are inflamed. We often take tissue biopsies at the same time.

When performed by experienced hands, arthroscopic surgery is extremely effective in starting the process of natural healing, which for most patients, results in profound pain reduction and increased ease of jaw motion. Although usually performed under general anesthesia, arthroscopic surgery is an outpatient procedure.

(Home exercises and/or physical therapy are always required after arthroscopic surgery.)

When All Else Fails

If the MRI and CT scans reveal extreme tissue damage, extensive bone erosions, and/or degenerative arthritis, then we may need to surgically open the joint. Opening the joint enables extensive repairs to be made, but it requires special surgical skills and experience. Like all the procedures outlined in this article, long-term rehabilitation is put in place and is required.

A full regimen of non-surgical care must always be attempted before TMJ surgery is ever considered. TMJ surgery can repair injured tissues, relieve (or even eliminate) pain, and improve your jaw function. But it should be always considered as the last resort.

The Takeaway: If you do need surgery, ongoing collaboration between your dentist, a board-certified orofacial pain specialist, your surgeon, and your physical therapist must exist in order for you to heal and experience long-lasting results.

To find a board-certified orofacial pain specialist in your area, visit The American Academy of Orofacial Pain and look for a doctor with Diplomate status.

Tags Jaw Problems, Orofacial Pain, TMJ

A Guide For Parents

9 Causes Of TMJ Problems In Teens & College Students

What’s A Parent To Do?

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

3 Frequently Asked Questions BOTOX® Injections For TMJ

How To Find A TMJ Specialist

Two Case Studies

TMJ Treatment Case Study – Patricia

TMJ Treatment Case Study – Susan

In Conclusion

The Connection Between Sleep Apnea & TMJ

Sleep Apnea Can Lead To Bruxism

The Role Of Pain – A Double-Edged Sword

Conclusion

8 Reasons Your Teeth Are Sensitive

Conclusion:

Can Lyme Disease Cause TMJ?

3 Case Studies

Did Lyme Disease Cause TMJ Symptoms In John, Sue, or Anne?

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

Prevention & Treatment of TMJ from Scuba Diving Or Snorkeling

The connection between tinnitus and TMJ is real.

What Is Tinnitus?

What Causes Tinnitus?

What Is The Connection Between Tinnitus And TMJ problems?

Why TMJ Problems Can Lead To Tinnitus (Or Make It Worse)

Determining If A TMJ Problem Is Driving Tinnitus Symptoms

TMJ Neck Treatment To Help Tinnitus

Summary

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

In Conclusion

Can Braces Cause TMJ? Three Scenarios

Is it TMJ or Fibromyalgia?

Why don’t more people know about orofacial pain specialists?

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

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

More Patients Experiencing TMJ Problems During Invisalign Treatment

How To Prevent TMJ Problems During Invisalign Treatment

The 3 Big Causes of Postpartum TMJ Pain

Why do TMJ problems get worse during pregnancy? There are 3 main reasons:

Non-Surgical Treatments Are Always Tried Before Surgery Is Ever Considered

When Steroid Injections Don’t Work – The Next Option Is Arthrocentesis

When Arthrocentesis Doesn’t Work, Is TMJ Surgery Next?

When All Else Fails

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