Blog - Page 8 of 10 - Donald R. Tanenbaum DDS

Case Study: High-Powered Executive Wakes Up With A Locked Jaw

September 19, 2012 — by Dr. Donald Tanenbaum

Last week a new patient came in for a consultation. She had been having pain in her jaw for quite awhile, but had ignored it. Like many of my new patients, what made her suddenly take it seriously was the terribly frightening experience of waking up with a locked jaw. Eventually her jaw loosened up enough for her to call her dentist and be referred to me. Understandably, she was pretty scared when she walked in the door.

Here’s the backstory:

This patient is a highly successful businesswoman in her early 50’s. She has a high level job as an executive for an international garment manufacturer and manages a large group of employees. She had a lot of responsibility at work, and obligations at home managing the lives of teenage children and watching out for the welfare of her aging parents. As if this was not enough, her daily struggle with a chronic digestion ailment made the challenges of life all the more difficult.

What I was able to uncover in my conversation with this patient was that unbeknownst to her, she had been resting her teeth together and clenching her teeth for a very long time, not just at night, but during the day, as well. From asking the right questions, she realized that she was maintaining a tooth contact position when working on her daily financial reports, when dealing with her bosses, and even when she was on the phone with clients.

Over time, this action of “making a fist in your face” can begin to fatigue the jaw muscles and result in the “locked jaw” and pain that this patient experienced.

You see, the mind-body connection is very strong. When you are under stress for a long period of time, the brain becomes understandably upset. As a result, the brain is unable to maintain control over blood flow, muscle tension, and nerve discharges that are essential for muscle comfort. Loss of this control therefore ultimately leads to an accumulation of irritating chemicals in your muscles like lactic acid, and others that lead to pain and muscle tightening.

In the presence of this irritating chemical environment the nerves that run through your muscles fire excessively and cause pain along with a muscle tightening result. In essence a brain under emotional siege, sets the stage for muscles to falter.

My patient left the office beginning to understand what happened to her jaw. The first thing she has to do is to begin the process of changing the destructive behaviors that had led to her jaw problems. To accomplish this she was provided with strategies designed to relax her jaw, which included a series of breathing exercises that she must do………… but that easily fits into her day.

Beyond treatment therefore, understanding the mind-body connection is the first step to stopping damaging behaviors such as day tooth contact or clenching that often have unpleasant outcomes.

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

Get to the Source of Your Facial Pain

August 15, 2012 — by Dr. Donald Tanenbaum

Quite often patients come to our office stating that they have been diagnosed with a TMJ problem due to the location of their facial pain and jaw pain complaints. Though statistically other than toothache pain, the most common facial pain problem is due to the jaw muscles (part of the TMJ system), there are a number of other pain problems that we see routinely. These problems are in fact distinguishable from TMJ problems in a number of ways.

Remembering that a TMJ problem is an orthopedic problem, similar to those in the knees, elbows or ankles, the complaints and findings should be familiar and predictable. For instance if you have a knee problem, there is a good chance that going for a jog or using the knee repetitively during exercise would increase the pain, noise in the knee, or the experience of joint instability. The same should happen in the TM Joint during chewing or keeping the mouth open such as during frequent yawning or sitting in the dental chair.

If a patient says that she* can open and close her mouth, chew whatever she wants, and maintains jaw opening without predictably increasing pain and or making it worse, it is likely that she does not have a TMJ problem. In addition, the pain of a TMJ problem is like that in an elbow that has been overused or strained overtime. The pain has an aching quality that typically is not gone completely during some hours of a day and miserable during other hours for no apparent reason. So, if it’s not a TMJ problem, what can it be?

3 types of Facial Pain that are NOT related to TMJ:

Facial Pain referred from the neck and shoulders
Facial Pain of nerve origin
Facial Pain due to migraines

Pain From The Neck And Shoulders: These problems are related typically to muscles in the neck and shoulders that are in a state of tension. These tense muscles have the ability to refer pain to the face (pain location is frequently not the same place as the pain origin). The pain is often felt in the lowest part of the jaw and does not typically increase with chewing…even with bagels!!!! Examination of these muscles reveals tenderness and often can reproduce the pain in the face. These muscles often refer pain to the ear and teeth prompting medical and dental investigations.

Pain Of Nerve Origin: Though often labeled Trigeminal Neuralgia (which may be the diagnosis), there are a number of variations. The most important thing to remember is that these pains can often be present for seconds or minutes and then totally go away for no apparent reason or time frame. The pain is often sharp and described as excruciating (which, in contrast, is a word never used by a TMJ sufferer). The onset of the pain is often unprovoked but in the words of many patients, “it just comes out of nowhere.” Other nerve pain problems that may be more constant often having a burning quality.

Pain Due To Migraines: Facial pain, including toothache complaints, can be due to migraine problems. This pain often has an odd character, which may include a sense of numbness in the face, and again often do not relate to jaw use. The pain may be preceded by light and noise sensitivity and or a headache across the forehead or in the mid-face region. At times a sense of nausea may accompany these symptoms. Typically these pain complaints are not accompanied by limited jaw motion, jaw noises, or eating challenges.

*Note: facial pain can affect anyone, but the majority of sufferers are female

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

Treatment for Sleep Apnea May Assist in Weight Loss

July 31, 2012 — by Dr. Donald Tanenbaum

While on a recent airplane flight to Chicago, I was unfortunately sitting across from a young man around thirty years old who was sleeping fitfully. From his outward appearance he was not overly tall, likely about 5’11” but clearly overweight particularly in the midsection. With each breath came a snoring (or roaring) sound accompanied occasionally by a gasp for air. It was clear that this young gentleman had the appearance of obstructive sleep apnea and one can only wonder about his future if he did not address this problem with weight loss or medical intervention.

This scenario of young men and women snoring excessively is played out daily across America and the reason most of the time is obesity. Though there are many individuals that snore and develop obstructive sleep apnea, due to large tonsils and small airways due to thin necks and set back lower jaws, the problem is most commonly seen in overweight people. For these individuals their calorie intake continues to exceed the calories they burn with the end result of fat being deposited in the neck and airway along with their midsections. Once established these patterns of weight gain are hard to reverse taking tremendous self control and discipline.

The end result unfortunately is not only a disturbed bed partner and daytime fatigue but new evidence suggests that a persistent obstructive sleep apnea condition can weaken the body’s immune system and increase the risk for cancer, as the results of a recent study published in the American Journal of Respiratory and Critical Care Management suggests.

What is also interesting is that once an obstructive sleep apnea problem has been established with the associated oxygen deficits while sleeping, there is also a disruption of the delicate hormonal balance that controls appetite and hunger patterns. As a result it has been shown that moderate to severe obstructive sleep apnea conditions often impair weight loss efforts despite caloric control and increased exercise. As a result of this reality, a great number of patients in our office are using oral appliance therapy while sleeping and as a result are breathing better and losing the weight that they were unable to previously shed. As an end result, their improved airway capacity will most certainly reduce their risk of cancer in the future and help all of us rest peacefully on our next airplane flight.

Sleep Apnea Treatment Improves Heart Function

April 5, 2012 — by Dr. Donald Tanenbaum

In a previous blog post, I discussed how CPAP (Continuous Positive Airway Pressure) and custom oral appliances could be used to facilitate night-time airflow into the lungs, preventing snoring and aiding mild to moderate sleep apnea.

Researchers in England have found a new development in sleep apnea treatment. A CPAP breathing machine can improve heart function and may even prevent heart failure.

According to a new study, published by the American Heart Association, researchers at England’s University of Birmingham used echocardiogram exams to study heart structures and function in sleep apnea patients before and after CPAP therapy.

Patients were broken into three groups:

Group One: Patients with High Blood Pressure
Group Two: Patients with Obstructive Sleep Apnea
Group Three: Healthy Control Group

The lead researcher, Gregory Lip, found asymptomatic sleep apnea patients had measurable heart damage. The observable structural and functional changes found in moderate to severe sleep apnea patients were found to be akin to those suffering from high-blood pressure.

All three groups were treated across six months with CPAP. After a second round of echocardiograms, much of the heart damage had been reversed in several major areas:

Reduced thickness of the heart muscle wall
Improvement in cardiac function
Loosening of the cardiac chambers

Given the therapy’s role in improving overall heart health, sleep apnea patients should consider CPAP treatment regardless of cardiac problems. This could translate to a major reduction in stroke and risk for other heart-related diseases.

If you suffer from sleep apnea and are considering CPAP as treatment please do not hesitate to contact me. Learn more about Dr. Tanenbaum here.

Botox and Bruxism

April 3, 2012 — by Dr. Donald Tanenbaum

In previous blog posts on bruxism, I’ve discussed how teeth grinding can lead to worn teeth, fractured teeth, facial or jaw pain, and a host of other maladies. There are many ways to treat bruxism, and one of the most recent and perhaps unexpected is Botox.

Botox was originally used for treating muscle spasticity diseases such as strabismus (eye misalignment), blepharospasm (eyelid spasm), and torticollis (wry neck). Botox works by temporarily decreasing or paralyzing the muscles it is injected into. The logical extension of this would be to apply Botox to a myriad of other medical conditions in which excessive or intense muscle contractions are causing pain or dysfunction.

It turns out that Botox can in some cases, be a sensible medical application to bruxism, as injections of botox into the masseter and temporalis muscles – the large muscles that close the mouth and bring the teeth together – can reduce the forces of bruxism to a significant extent.

The Procedure:

By injecting small doses of Botox (different levels are used for each patient) directly into the masseter and temporalis muscles, the muscles are weakened enough to diminish the forces associated with involuntary grinding of the teeth and clenching of the jaw. As a result damage due to the TMJs and symptoms of jaw pain and headaches should be reduced if not eliminated after 2- 3 injection sessions over several months. Luckily, chewing and facial expressions will not be effected by Botox.

Reasons to Consider Botox:

If you know you are clenching at night but oral appliances are not helping or making your morning symptoms worse.
Positive effects can be felt within 10- 14 days even if you have been suffering for month or years.
If helpful, the need for medication (muscle relaxants) at bedtime and pain medications during the day will be reduced or even eliminated.

The optimal dose of Botox must be determined for each patient as some people have stronger muscles requiring more Botox. The effects last for about three months. After a few rounds of injections, many of our patients require no further injection sessions though we continue to advise the use of an oral appliance while sleeping if tolerated.

If are suffering from bruxism please do not hesitate to contact me so I can assist you in making treatment decisions.

Is Snoring Causing Your Child’s Behavioral Problems?

March 19, 2012 — by Dr. Donald Tanenbaum

In very young children and even in infants, sleep-inhibiting breathing such as sleep apnea, mouth breathing, and even snoring may affect more than just a healthy night’s sleep.

According to a recent New York Times article, a study conducted by Karen Bonuck, PhD., at the Albert Einstein College of Medicine at Yeshiva University found that sleep-inhibiting breathing starting in infancy and early development is causing more than just problems with sleeping and staying awake during the day. This longitudinal study tested 11,000 children (controlling for future behavioral problems caused by events such as maternal smoking and prematurity) found a definitive link between children with sleeping problems during early development and later behavioral problems.

Sleep-inhibiting breathing leads to a poor night’s rest for your child potentially providing their brain with too little oxygen or too much carbon dioxide. This could seriously affect the prefrontal cortex area of the brain which is directly linked to behavioral decision-making.

Parents need to pay attention to their child’s breathing at night, even as early as infancy. A good night’s sleep restores what a developing brain has lost during the day.

If you feel your child is having a problem with snoring, sleep apnea, or mouth breathing, do not hesitate to contact me. Learn more about Dr. Tanenbaum here.

Causes of Facial Pain: The Psycho-Muscle Connection

February 28, 2012 — by Dr. Donald Tanenbaum

The Muscle Connection is Key

In my upcoming book, Doctor, Why Does My Face Still Ache?,” we explore puzzling questions that do not have simple or anticipated answers:
• Why would a person experience a constant toothache when the tooth that hurts is completely fine?
• How does someone gradually lose the ability to open his or her mouth or talk when there hasn’t been a direct injury to the area, or medical disease diagnosed?
• Why does someone experience non-stop aches or pains in their face when a medical evaluation suggests that nothing is wrong?

Unfortunately in the search for answers, many practitioners tend to overlook the muscle connection when it comes to the cause of facial pain. But considering how much of the face is made up of muscles, it’s beneficial to know how muscles can be affected by factors such as emotional issues and the stress of life-challenges. In the book, I call this state a “Brain Under Siege.”

Facial Pain and Emotions

A brain is under siege when it is faced with many challenges, which may include but not limited to:
• Economic uncertainty
• Loss of control relating to illness, aging parents, work relationships, etc.
• Inability to express fear and anger
• Pressure to “Keep Up with the Joneses”
• Marital and or relationship turmoil

For patients experiencing one or more (or perhaps all) of these stressors, the toll it can take on jaw and neck muscles could directly cause facial pain. I realize that many people might want to reject this theory. Our culture is such that we often look for external or structural causes of facial pain. Even medical professionals are tempted to ignore these connections to muscle pain, perhaps because they’re uncomfortable posing sensitive questions to their patients. But this doesn’t mean that a connection doesn’t exist.

Of course there are many causes of facial pain, and in many cases traditional methods of relieving this pain works fine. But each patient needs to be evaluated individually, and all aspects of what causes facial pain need to be taken into account. Most facial muscle pain sufferers can be helped, and it often requires patient insight and participation so the proper treatment can be applied.

Though we often wish it were so, sometimes facial muscle pain can’t be solved by the patient simply walking into the office and saying, ‘Doctor, fix me.’

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

What Causes Facial Pain?

January 30, 2012 — by Dr. Donald Tanenbaum

Over the course of 25 years in practice, I have seen thousands of patients who complained of persistent pain in their face, ears, teeth, and/or jaw. These pain complaints have often been accompanied by tightness and soreness in their jaw and facial muscles, limited jaw opening, difficulty chewing due to pain, and at times other symptoms such as burning and tingling in the face and lips. Many of these patients have been told by their doctors that their symptoms are “in their head” as a result of past treatment failures. At other times, patients have felt as if they were being personally blamed for having a problem.

If you are one of those people who have facial pain that has lingered, not only is your pain real, it is not your fault! Facial pain can be understood and effectively treated. Facial pain problems fall into one of five recognizable categories. These are:

Pain of Tooth Origin
Pain of Muscle and Joint Origin
Pain of Nerve Origin
Headache including Migraines
Pain due to Medical Problems

Unfortunately, many facial pain problems are often misunderstood and misdiagnosed because of three key factors:

Referred Pain: this means that the location of the pain being experienced is not where the pain is coming from. The most familiar referred pain is the pain experienced in the left arm just prior to or during a heart attack. The phenomenon of referred pain is common in the face, leading to treatment at the site of the described pain, but not at the true source of the pain. As a result, pain continues.

Misinterpreting Pain Intensity: Often facial pain is so intense that patients assume that something is terribly wrong. Though it is known that the intensity of symptoms often has nothing to do with the seriousness of a problem, doctors are often persuaded to order lots of medical tests leading to anxious moments while patients wait for the results. When nothing of concern is discovered, a short moment of relief is replaced with the question: “I still hurt, what do I do now?”

Emotions and Pain: Since most people are not able to accept the concept that emotions and stress, through their influence on muscles, can cause significant pain, and because the majority of doctors are unwilling to adequately explain how this occurs, the most common source of facial pain, muscles, are often neglected. As a result, pain lingers and becomes more difficult to treat over time.

So, if you are one of those people who are suffering, using pain medications frequently and having trouble at work or in school because of your facial pain, you really can get help. The most important thing is to find a doctor who listens, understands, and takes into consideration all the aspects of your life that could be contributing to your problem.

From there, many treatments options are available, and your doctor should be able to identify the right one for you. To find out more about facial pain, check out the groundbreaking book “Doctor, Why Does My Face Still Ache”.

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

Creams for Face Pain and Jaw Pain

January 12, 2012 — by Dr. Donald Tanenbaum

Are there any topical creams that I can use to decrease my face and jaw pain?

A patient recently came to the office with a cream rub that she had been rubbing into her jaw and facial muscles. Although the cream smelled terrible, she thought it was helping. The question is then, do these creams work?

According to research performed on over-the-counter TOPICAL PAIN RELIEF products, creams designed to relieve muscle pain are generally safe, can provide short-term benefit but do not provide long-term relief. The reason these products have only limited usefulness is likely related to the fact that they do not penetrate deeply enough into the muscles.

The most common types of creams contain these basic ingredients:

• Menthol (a counter-irritant)

• Salicylates (aspirin)

• Capsaicin (a pain reliever found in hot pepper)

Menthol: Common products such as Flexall 454, Icy Hot, and Biofreeze contain menthol, wintergreen, or eucalyptus oil that makes the skin feel hot or cold and provides a distraction from the pain. Patients who come into my office tell me these products either provide temporary relief, or do not help at all. Generally these counter-irritant products are rubbed into the jaw muscles 3-4 times a day. When using these products on the face, care must be exercised to avoid contact with the eyes or lips.

Salicylates: The common ingredient found in aspirin, Salicylates are most effective when taken orally. Research indicates that the effectiveness of salicylates decreases to a significant degree when used as a topical cream. Bengay, Aspercreme, and Sportscreme contain this ingredient and are commonly used by my patients.

Capsaicin: A compound found in chili peppers, capsaicin causes a hot, burning sensation when applied to the skin. This topical rub actually depletes a chemical in nerve cells responsible for sending pain signals to the brain. Common products that use this compound are Capzasin, and Zostrix. These products, however, can be risky when applied to the face, as they can cause intense burning and irritation should they get in the eyes, or on the lips.

As expected, some patients swear by these products despite what the research reports. In my opinion there is likely some placebo effect taking place to account for at least 1/3 of the pain relief experienced by patients using these rubs. Additionally, the physical act of rubbing and massaging the facial muscles when applying these products can also provide relief by increasing blood circulation to the area.

In summary, self-help actions can go a long way toward reducing face and jaw pain. Despite poor scientific evidence, these creams can provide some degree of benefit and are recommended as part of an overall self care plan

Causes of Ear Pain

December 27, 2011 — by Dr. Donald Tanenbaum

Many patients come into my practice complaining of ear pain, when other physicians have found nothing wrong with their ears. The ear pain complaints heard most often are these:

• My ear feels full

• My ear feels stuffy

• I feel like something is dripping in my ear

• I feel pressure in my ear

• There is ringing in my ears

• I hear a hissing sound

• I hear a buzzing sound

More often than not, patients complaining of ear pain will see their general practitioner, internist, or an ENT (ear, nose, and throat) doctor. But if there is no evidence of an infection, and there is no fluid or inflammation in the ear (or other problems with ear function) the ear pain could be happening because of a malfunction in the muscles of the face, jaw, or TMJ (Temporomandibular Joint).

Because of the way our ears, face, and jaw develop inside the womb, the malfunction of one area can cause pain in the other. To figure out if your persistent ear pain is related to a muscular issue, pay close attention if the ear pain you’re experiencing:

• Increases when you eat

• Increases when you talk

• Increases when you open or close your mouth

• Is constant and intense

If these are the dominating symptoms, chances are the ear pain will not go away unless doctors can address the muscle and joints in the face that are causing it to begin with. Treatment that focuses specifically on the ear will not work if the ear pain is just a symptom of a different problem.

Facial Pain and Emotions

3 types of Facial Pain that are NOT related to TMJ:

The Muscle Connection is Key

Are there any topical creams that I can use to decrease my face and jaw pain?

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