In today’s stressful society, many people suffer from “TMJ.” While most people refer to it as TMJ, actually, the correct term is called “TMD” or “Temporomandibular Disorder.”
What is TMJ?
Everybody has a TMJ, which stands for temporomandibular joint. When things go wrong with this joint or the muscles that surround it, we call it a temporomandibular disorder or TMD. There are many different types of TMD problems, which include the following:
- popping or clicking
- limited opening
- painful opening or closing
- “lockjaw”
- muscle spasms
- strained muscles
- headaches
Depending on the type of problem you have, Dr. Robert Taylor will educate you regarding your diagnosis and recommend a course of treatment. For most people, time is the best remedy. That is hardly comforting for someone in pain, but it should be comforting to know it will get better. More specifically, our bodies are amazingly adaptive. When our normal joint function is traumatized, disrupted or changed in some way, our bodies begin the adaptive process.
Common Joint and Muscle problems
Most people who experience joint pain will pass through a cycle:
- acute pain (throbbing or severe pain) usually lasts for a few days to a few weeks
- mild-to-moderate pain (dull ache) usually lasts for a few weeks to several months
- no pain (duration varies per patient)
During this cycle, our bodies are remodeling our joints so they can accommodate the changes. Some people will repeat this cycle frequently, while others will only experience it once. As we get older, however, those who experience this cycle of pain will usually see it happen less frequently and less severely. For a small portion of patients, the pain does not remit or get better on its own. Those patients will definitely need orthodontic or surgical intervention.
More good news is that there are some things that can be done to reduce the pain while we are waiting for your body to adapt.
Custom Fit Night Guard
- A properly made custom night guard will reduce the amount of pressure or strain you can put on your muscles and joints when clenching or grinding (also known as parafunctional habits or bruxism). The thickness of the night guard prevents the muscles from being able to completely contract and doesn’t allow the jaw bone to put as much pressure on the cartilage disc, nerves and blood vessels in the joint.
- Not all night guards are equal. While there are many different types of night guards, the most effective night guard will perfectly fit the patient’s teeth and allow uniform contact from the opposing teeth when the patient bites down. If certain teeth hit first or harder than others, this can bother some patients, which can worsen clenching and grinding. A poorly made night guard can cause problems with a patient’s bite over time.
- Since each person’s bite is different, it is important to have the right night guard made for you. It is normal to take a several days to get used to wearing a night guard.
Anti-inflammatories (Ibuprofen or other NSAIDS)
- Most muscle pain is associated with inflammation. The muscle has been damaged in some way and the body is trying to repair it by sending lots of cells to the area. This causes swelling, pain and soreness.
- Anti-inflammatories like ibuprofen or other NSAIDS help reduce the swelling and inflammation in the area by stopping some of the chemical mediators involved in inflammation.
Muscle relaxants
- Centrally acting muscle relaxants, like Cyclobenzaprine, don’t work directly on the muscles. Instead, they block the signaling pathways in the brain that cause muscle contraction. This reduces muscle spasms and muscle tone. For most patients, they feel more relaxed and therefore are able to reduce their clenching or grinding.
Exercise
- Regular exercise will reduce stress and improve sleep, especially if you physically wear yourself out. It will make you more tired so you sleep deeper and better. Do something on a regular basis that becomes part of who you are and becomes part of your lifestyle.
Massage Therapy
- Muscles that have been damaged by clenching and grinding are often tight, spastic (can’t relax), and sore. Massage therapy can help reduce the muscular tension and increase blood flow, which will accelerate healing. It also promotes relaxation, which can help reduce stress and reduce the subconscious need to clench or grind.
- This can be done by the patient themselves by gently massaging the painful area a few times each day.
Physical Therapy
- Muscles that have been damaged by overuse like clenching and grinding are tense and tight. Just like any other tight muscle in the body, the jaw muscles will generally benefit from gentle stretching exercises two to three times per day.
- Find a physical therapist you trust to begin an effective plan. You Tube can be a good source for physical therapy videos, but it must be a reputable source. Just because a guy has a channel doesn’t mean he knows what he is doing.
Sleep Posture
- We can do a lot of damage to ourselves while we are sleeping if we are putting too much pressure on certain areas. Side or stomach sleepers can inadvertently stress the muscles or joint by pushing the jaw too far to one side or back and up into the joint space. If you notice jaw/joint pain when you lay down, your jaw position may be affecting your ability to recover. Try sleeping in a different position that takes pressure off your jaw.
Dietary and Habit Changes
- Resting sore muscles and joints allows for faster healing.
- Reducing the strain and pressure on your jaw muscles and joints during the day can be an important part of treatment. Eliminating habits or foods that require excessive use or strain is key to allowing the muscles and joints enough rest to heal.
- No chewing gum or other objects like pens, water bottles, etc.
- Eat Soft foods. No nuts, no chewy foods, no tough meats. Give your jaw the rest it needs — nothing that requires excessive chewing or hard forces to bite through.
Relaxation/Meditation/Mental Preparation
- There is a strong correlation between stress and jaw/joint problems. Everyone has stress of some sort, but if it is causing us to excessively clench or grind, we need to learn to manage it better.
- There is not a one-size-fits-all solution. Bottom line is you need to figure out how to teach your mind how to relax and not cause self-harm while sleeping. This can take time and many months of trying different things to train your mind, so be patient.
- One of the worst things for restful sleep is to give your mind permission to think about problems, projects, etc. before bed. Meaning, do not lay in bed and tell yourself to remember all the things you need to do. If you tell yourself to remember to call Johnny about that work project, all night your mind is being told to work and it’s not allowed to rest like it needs. You are giving your mind permission to stress while you sleep. Instead, give yourself permission to completely relax. If something pops in your mind while preparing for sleep, write it down or put it in your phone calendar and give yourself permission to completely forget it and relax. Think about enjoyable experiences or positive things that will help you relax.
- Gratitude also can be a really effective tool for inducing calmness and relaxation. Gratitude has been shown to be one of the best forms of reducing stress. Mentally list things that you are thankful for, even if they are small.
- Eliminate phone usage at least one hour before bed. Studies are abundant that phone usage, especially social media, increases stress.
- Read a book before bed. For most people, reading soothes the mind and helps us relax.
- Meditation and prayer are also effective tools to calm the mind and body. Find peace.
BOTOX®
- If more conservative therapies don’t work, BOTOX has proven to be effective for patients with severe or stubborn jaw pain from clenching and grinding.
- BOTOX works by the botulinum toxin blocking the neurotransmitter (acetylcholine) that causes the muscles to contract. It essentially causes temporary paralysis of the muscle, which allows the patient’s muscles to relax until the toxin is eventually metabolized.
- BOTOX is typically effective for three to six months. Eventually, the body metabolizes the BOTOX and resumes normal muscular function. If the patient resumes old habits of severe clenching/grinding, they will need to retreat the area. It is a toxin you are injecting into your body, and it can be expensive (especially if multiple treatments are required each year) so this is generally a last resort to other treatments.