Blog - Page 9 of 10 - Donald R. Tanenbaum DDS

Why is TMJ Disorder So Prevalent Among Women?

Not only is there a clear dominance of TMJ in women, but also the severity of the problem is often at a level virtually never seen in men. This scenario is frequently seen in the case of teenage girls, suggesting that the problems we are confronted with could be hormonal. Some research has unveiled a link between TMJ and estrogen, which could shed light on the dominance of TMJ in women.

Take the example of Mary, a 17-year-old female who came to my practice. Mary’s problems started when she was 12 years old with the onset of non-painful TM joint noises that did not interfere with eating or jaw function. Over time, pain emerged and her bite began to change, altering her profile and appearance. Before long her pain was so debilitating and her bite so altered, that there was no choice but to seek surgical treatment. Both TM joints had “dissolved away” and her jaw profile and bite had to be reestablished.

How could this happen with no history of trauma and no apparent underlying medical disease? The role of hormones, estrogen in particular, has been identified. Research has shown that Estrogen:

Impacts the body’s natural pain fighters (endorphins)
Increases inflammation in the Temporomandibular Joints
Compromises the strength and adaptive ability of all ligaments

These factors, coupled with lower endurance capacity in female jaw muscles, are all that is likely needed for difficult problems to arise. Additionally, research suggests there may be specific genetic predispositions that lead to unprovoked TMJ in women.

Though the treatment that Mary had received has restored function, jaw stability, and reduced her pain, there is still much to learn about gender specific jaw problems.

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.

What is a TMJ Doctor?

November 20, 2011 — by Dr. Donald Tanenbaum

Because many common symptoms of TMJ problems often can be the result of other medical conditions, those who represent themselves as “TMJ Doctors” (or “TMJ Specialists”) must be able to not only recognize common TMJ problems, but also must be adequately trained and have sufficient past experience to enable them to accurately diagnose the vast number of other problems that can produce these common TMJ symptoms:

Facial and jaw pain
Diminished jaw motion
Facial and temporal headaches
Jaw muscle spasm and tension

Whether the symptoms you are concerned about are due to a facial migraine, a nerve pain problem, disease in a salivary gland or sinus, a thyroid condition, brain tumor, or strained Temporomandibular joints and jaw muscles, the “TMJ Doctor” you see must be skilled in making what is called a “differential diagnosis.” From a patient’s perspective, that means you need to know with a degree of medical certainty that your ‘TMJ’ problem is truly due to a local muscle and joint problem, and not due, instead, to some underlying medical disease process.

In today’s world, particularly in communities with access to major medical centers, hospitals or universities, you should expect your “TMJ Doctor” to have an academic appointment or faculty position at one of those institutions. He or she should also be involved with teaching, lecturing, and/or publishing, as these positions and efforts are a clear indication that there is a commitment to learning and advancement of knowledge.

Most important, don’t be fooled by the ‘TMJ Doctor” who has high-tech computerized equipment that (allegedly) determines whether your bite is bad or if your jaw is in the wrong position. Though imaging technology (CT scans and MRI’s) is often important in making an accurate diagnosis, the vast majority of all TMJ problems can be diagnosed accurately with a careful history and examination. The adage, “The diagnosis is in the history if the doctor chooses to listen” holds true in just about all these situations.

Lastly, because most TMJ problems respond to treatment over time and with supportive measures to heal the injured TM joints and muscles, treatment most commonly should not require changes to your teeth or bite. If your “TMJ Doctor” recommends ongoing bite adjustments (grinding the tooth surfaces with a drill), crowns to fix your bite, or extensive orthodontics as the primary focus of care, these should be looked at suspiciously, and you should definitely seek a second opinion.

The Most Important Equipment in a TMJ Doctor’s Office

November 9, 2011 — by Dr. Donald Tanenbaum

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

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

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

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

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

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

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

Causes of Migraine Headaches: TMJ?

November 4, 2011 — by Dr. Donald Tanenbaum

Could TMJ be the Cause of a Migraine Headache?

The answer is: No!

People who suffer from chronic debilitating headaches are often misdiagnosed because doctors sometimes mistake tension headaches (which can be cause by TMJ disorders), for migraine headaches. The reason is that it’s not unusual for people who have TMJ to experience headaches that are as intensely painful as migraines. But TMJ does cause of migraines.

How Does TMJ Cause Tension Headaches?

Tension headaches are the most common form of headaches and can be caused by the constant tension held in the muscles in your face, head, and neck when they remain contracted over a long period of time. The tension that can build in your jaw muscles from a TMJ problem can lead to such powerful headaches that they’re often mistaken for a migraine. In addition, when the muscles in your jaw, face, or neck constrict, they reduce blood flow. As a result, less oxygen and nutrients are delivered to the muscles, which predispose them to fatigue and pain. Also, as the nerves running through the muscles become irritated, lactic acid and other irritating chemicals accumulate. The end result is more intense headache pain symptoms, that can be as intense as a migraine.

A dentist with experience in TMJ and neuromuscular disorders of the jaw can properly diagnose the difference between TMJ and migraines. Some symptoms of TMJ headaches include:

Tightness around the head
Band-like pressure around the temples
Persistent aching in the jaw muscles
Discomfort in the facial muscles
Increased pain with jaw use

Once diagnosed, there are a number of relief options for TMJ-related tension headaches. Treatments include:

Jaw and Neck Exercises
Muscular Injections
Physiotherapy
Medications
Oral Appliances
Simple Relaxation and Sleep Strategies

Before you dismiss the possibility of a disorder in the TMJ (Temporomandibular Joint), be aware of the symptomatic similarities between TMJ and migraines. The difference could mean a lifetime of relief from the pain of tension headaches.

TMJ and Computer Use

October 18, 2011 — by Dr. Donald Tanenbaum

Can Extended Computer Use
be a Cause of TMJ?

Researchers are now finding a link between TMJ and computer use. The link is most closely associated with the way we posture our bodies while sitting at the computer. Most often we have a tendency to sit slouched forward, collapsed within ourselves, or in an unbalanced position for extended periods of time: all contributing factors to the connection between TMJ and computer use.

The TM joints are located on each side of a person’s lower jaw, a complex of tendons and muscles that allow us to open and close our mouths. When one or both of those joints sustain injury, or are compromised in any way, the result is TMJ.

Can TMJ Be Prevented if You Work at a Computer All Day?

Since many of us work at a computer for more than 40 hours per week, there are some things we can do to prevent TMJ caused or exacerbated by computer use:

▪ Be aware of how you are sitting at the computer. If you’re slouched, tilted, or off-balance, reposition yourself, or take a short break from the computer to realign your body.

▪ Avoid a leaning head posture whereby your ears are past your shoulders. This posture puts undue strain on the neck, jaw, and facial muscles. Be sure to position your ears above your shoulders when sitting at the computer.

▪ Adjust your work station to suit your body’s needs. This includes your chair height, lumbar position, and the angle of your computer monitor.

The link between TMJ and computer use can be remedied by following these and other posture guidelines to keep your body aligned and your weight evenly distributed through your spine.

Not sure if you have TMJ? Most common TMJ symptoms can include:

▪ Pain, usually associated with chewing and jaw movement

▪ Headaches

▪ Sore jaw muscles

▪ Neck tension

▪ Incidents of suddenly limited jaw opening and locking

▪ Ear symptoms, such as ringing, humming, or buzzing

Of course, there are other contributing factors to what causes TMJ, including trauma to the area in a collision, stress, or a number of other psychological factors. But the importance of posture awareness can aid in reducing the discomfort of TMJ caused by computer use.

Note: Temporomandibular joint (TMJ) is often erroneously interchanged with temporomandibular disorder (TMD) a condition which leads to pain and, in some cases, limited jaw function. In this article, we’ll refer to TMD as TMJ, which is the term that most people associate with this condition.

Can Bruxism Be Caused by Poor Dental Work?

October 11, 2011 — by Dr. Donald Tanenbaum

Several weeks ago a 38-year-old gentleman came to my office complaining that shortly after having three crowns (caps) put in his mouth, he began to grind his teeth at night for the first time in his life. On arising in the morning he was experiencing jaw muscle soreness and on some occasions more sharp pain which limited his breakfast selections, which are common symptoms of Bruxism (the clinical terms for teeth grinding).

The first comment out of his mouth was, “I want to rip these teeth out of my mouth!” Was poor dental work the cause of this patient’s Bruxism? More questioning revealed that my patient’s new teeth were in great shape; not sensitive to hot, cold, or chewing, and his bite did not feel off balance.

Is it possible that these three new crowns were responsible for the reported night grind and if so how is this possible?

Point number 1:
Night tooth grinding (Bruxism) has been shown to have little, if anything, to do with the type of bite a person has. People with good and bad bites grind and clench their teeth at night.

Point number 2:
Night tooth grinding (Bruxism) seems to be related to arousals that occur in the brain during sleep. These brain arousals can be due to a number of factors such as drinking alcohol or caffeine close to bedtime, poor sleep environments, crying babies, chronic pain problems (back and neck), asthma, sleep apnea and or chronic tension and stress to name just a few possibilities.

Point number 3:
In clinical studies that have been conducted in patients with known histories of night grinding, the placement of dental restorations made intentionally high and out of balance with the rest of the teeth, have actually led to a diminished amount of night grinding for several weeks. This suggests that throwing the bite out of balance can actually reduce the amount of teeth grinding at night!

Conclusion
Based upon what we know, it is unlikely that Bruxism can be caused by poor dental work (unless pain developed as a result of the work and disrupted a patient’s sleep). When similar scenarios occur, other factors are likely playing a role and it is very important to see your dentist for a full evaluation.

Mouthguards & Nightguards: How Long Do They Need to Be Worn?

October 6, 2011 — by Dr. Donald Tanenbaum

This is a common question asked by patients in my practice. The answer to this question is based mainly on the reason it was recommended in the first place! So, if you are wondering if you will have to wear your nightguard forever, here are some common scenarios. There’s a good chance that one of them fits your situation exactly:

Scenario 1: You have no teeth grinding symptoms, but your dentist notices that your teeth are worn or chipped or that fillings and caps previously placed look worn.

The dentist then informs you that you have been grinding your teeth at night. You’re shocked! You have no pain in your teeth, no jaw muscle soreness in the morning, and you haven’t noticed any other signs to indicate that you are grinding your teeth. Your dentist recommends that you wear a nightguard while you’re sleeping, warning of the problems that will develop if you don’t wear it.

Now here’s the important thing: If you move ahead and get the nightguard, bring it with you and show it to the dentist when you go in for your twice-a-year dental cleaning. If the nightguard exhibits grooves and notches cut into the acrylic, then you have been grinding and you should continue to use it. If, however, there is no evidence of wear and tear, it’s probably in your best interest to bring this to the attention of the dentist and discontinue using it.

Scenario 2: You make an appointment with your dentist because “out of nowhere” your jaw muscles and teeth are aching in the morning.

You mention to your dentist that stress levels have been high in your life and will likely stay that way for an undetermined period of time. A TMJ nightguard is advised and you wear it for a while and notice that the achiness in the morning has decreased.

What next? This all depends on what is going on in your life: stress, fragile emotions, disrupted sleep, etc. As these factors may drive the night grinding it is probably advisable to stay with the nightguard until things calm down. Once life is calm and if your morning symptoms have gone away, you can begin to reduce the number of days the nightguard is worn during the week.

Over time you will likely find that you no longer need the nightguard. Keep in mind, if life issues arise again, the grinding will likely return and you may need the nightguard again, so don’t throw it away!

Scenario 3: You not only have morning jaw muscle soreness, but your teeth ache and you have persistent facial pain during the day. In addition, you feel that you can’t open your mouth wide and chewing has become a chore because your jaw joints click and/or lock.

This scenario suggests that you may have a more significant jaw problem often called ‘TMJ’. Unlike the first two scenarios, the level of muscle and joint compromise is more significant with TMJ. And beyond the night grind there are likely other factors that have led to and are perpetuating the symptoms. In this situation the use of a nightguard at night will likely be for an extended period of time (maybe forever).

I have many patients who return to my office 3-6 years after they were last seen looking to get their nightguard repaired or replaced. Many of these patients tried to stop wearing it when they felt better, but the symptoms began again. In this situation I ask my patient to visit me at least once a year to help maintain the integrity of the device and make sure it is doing the right thing and not causing harm.

Note: There are many different names for dental nightguards:

• Nightguard

• Mouthguard

• Oral Appliance

• Splint

There are many different types as well. The decision to pick one type over another is usually made by your dentist based on your diagnosis.

If you have more questions about TMJ or nightguard use, please visit my website, or comment below.

Thank You!

Teeth Grinding: Signs and Symptoms

September 28, 2011 — by Dr. Donald Tanenbaum

Sleep Bruxism, the gnashing and grinding of the teeth that occurs at night, has most recently been defined by the American Academy of Sleep Medicine as a sleep related movement disorder. Though the exact cause of sleep bruxism remains unclear, research suggests that anything that can arouse the brain during sleep may be a trigger. Factors such as daily stress, longstanding anxiety and worries, obstructive sleep apnea, reactions to certain medications, a crying baby, and/or a pain producing medical conditions seem to be just some of the factors that may be playing a role. For years, a bad bite and crooked teeth were thought to be risk factors but research suggests that this is unlikely.

Grinding of the teeth on a regular basis can lead to worn teeth, fractured teeth or dental restorations, mobile teeth, sore teeth on awakening, and a number of problems associated with the jaw muscle and jaw joints. Some people however, can grind their teeth for years without any symptoms. These people commonly deny that they grind their teeth despite physical evidence of wear patterns on their teeth and reports by their bed partners of being disturbed by the clashing noise of their teeth.

Do I Have Bruxism?

If you’re experiencing any of the following symptoms particularly on arising, bruxism may be the cause. Teeth grinding symptoms may include:

Sore teeth when chewing
Tooth sensitivity to hot, cold fluids
Jaw pain or tightness
Tired jaw muscles
Vague earaches which relate to jaw function
Dull headaches in the temples which may linger throughout the day
Persistent facial pain
Limited jaw opening
Jaw joint noises

What to Look For:

The common physical signs of bruxism include;

Teeth that are worn down, flattened, fractured or chipped
The tops of the teeth appear yellow: when tooth enamel is lost the dentin is exposed, and dentin has a yellowish color
Indentations on the side of your tongue
Damage on the inside of your cheeks from chewing
Excessive bulging of your jaw and temple muscles when the teeth are brought together

If you suspect bruxism, or if your partner has complained of the sound of your teeth grinding at night, a dental consultation is advised. There are many options at your dentist’s disposal for treating bruxism.

For more information on bruxism and teeth grinding, the causes and treatment options, I invite you to visit my website. Thank You.

Is Your Child Suffering from Bruxism?

September 20, 2011 — by Dr. Donald Tanenbaum

For years, nighttime tooth grinders were thought to be adults who were overwhelmed by life’s stresses and worries. Though stress can certainly be one cause of nighttime tooth grinding, recent research suggests that anything that arouses the brain during sleep can cause excessive jaw movements.

This research explainswhy some children also suffer from nighttime teeth grinding, or bruxism. Nightly grinding results in sore TM joints and facial pain during the day, and can cause damage to your teeth. If your child is complaining of facial or jaw pain in the mornings, look for the following signs and symptoms of bruxism:

▪ Worn, chipped or sensitive teeth that look like they are getting shorter (the front incisors) or are getting flatter and yellow in color (the back molars)

▪ Morning headaches and/or facial and jaw pain

▪ Morning jaw noises such as clicking or popping

▪ Sensitive teeth when eating or exposed to hot or cold fluids

What Causes Bruxism in Children?

Though bruxism is often a cause of stress, it does not mean that it is what is causing your child’s nightly teeth grinding. However, persistent life stressors associated with school, unstable home environments, and social relationships may cause your child to sleep restlessly. Some of the risk factors that should be considered if you hear your child grinding his or her teeth excessively each night include:

▪ Problematic asthma conditions

▪ Enlarged tonsils and adenoids

▪ Childhood obesity that may compromise the airway at night

▪ Irritable bowel syndrome (IBS)

▪ Acid Reflux

▪ Insomnia

▪ Use of medication to treat ADHD

Can Childhood Bruxism Be Treated?

Identifying signs of bruxism early is the best way to end your child’s nightly teeth grinding habit. The good news is that once the cause is identified, there are several treatment option available. I look for enlarged tonsils and adenoids during an exam, especially with patients with histories of recurrent sore throats. If enlarged tonsils or adenoids are the cause of your child’s tooth grinding, they will likely be referred to an Ear, Nose, Throat specialist to be removed—ending the nightly bruxism.

If a child comes to my office with signs of worn teeth and loss of enamel on the biting surface of the molars, this usually indicates that a chemical erosion, like acid reflux, is occurring. This is due to stomach acid pooling on the teeth at night and is a direct result of the acid reflux. I send these kids to a Gastrointestinal doctor to be treated for reflux. If your child is taking medicine for ADHD, the solution may simple: administer the medication in the morning, not during the late afternoon or evening.

Bite appliances are used in kids even as young as 6 -12 years in an effort to buy time and protect teeth and jaws until the origin of the bruxism is determined and managed. Bruxism in children should be taken seriously as it can result in early destruction of the baby teeth, wear on the permanent teeth, jaw related problems, or tension headaches. Evaluation by a dentist with a broad understanding of teeth grinding is strongly advised.

Snoring and Weight – Yes, There Is a Connection

September 6, 2011 — by Dr. Donald Tanenbaum

My patients often ask me about the relationship between snoring and weight gain. Snoring undoubtedly can be a result of obesity, and obesity can also be a result of snoring. Confused?

Fact: Obesity Causes Snoring

More than 30% of Americans are considered obese, which is having a BMI (Body Mass Index) of 30 or more. Excess weight, regardless of its amount or origin, has many effects on your breathing, and in many cases causes snoring.

Though it may feel like all the weight you’ve gained is stored in one or two areas, extra layers of fat actually distribute themselves all over your body! When excess is deposited around the throat and neck area, it can narrow the airway, causing airflow turbulence leading to that annoying snoring sound. Also, as you gain weight, fat displaces muscle tissue and you lose muscle tone. As a result the soft palate and other soft tissue sin the throat become floppy and snoring levels rise.

Causes of Snoring
• Body fat around the throat and neck
• Loss of muscle tone in the throat and soft palate region
• Obstructed nasal passages
• Large tongue

Sleep Apnea and Obesity

Along with snoring, individuals who are overweight are more likely to develop sleep apnea. Sleep apnea is a serious medical condition characterized by periods during sleep when your breathing stops completely. As a result your brain is aroused and you wake up. Sometimes breathing can stop for up to 10 seconds! These stoppages in breathing can happen as many as 100 times a night leaving you exhausted in the morning and at risk for heart problems.

Fact: Snoring Causes Obesity

Believe it or not, snoring could actually be the cause of your weight gain or your inability to lose weight.

Nightly snoring prevents you from getting a good night’s sleep, leaving you feeling tired and run-down during the day. This lack of energy can keep you from going on that pre-work run or makes you choose the elevator over the stairs. The bottom line is that the weight you’ve gained is a result of sleep deprivation.

In addition in a University of Chicago study, young and healthy students were deprived of sleep for six nights in a row. The sleep deprivation resulted in measurable metabolic changes, one of which was increased hunger and appetite! As your body relies on the energy it gets from a good night’s sleep, if you aren’t getting enough sleep, your body will crave the energy from somewhere else: usually your refrigerator!

Clearly there is a direct relationship between snoring , a poor nights sleep and overeating!

Is There a Snoring Remedy?

If you’re an overweight snorer, the first step is to try to lose weight. But, if you are so sleep deprived that weight loss is impossible, other options are available. Thousands of suffering snorers (and their partners) have seen extraordinary results from using an oral appliance at night.

Using a custom-made oral appliance (mouth guard) overnight keeps your jaw forward, making air flow into your throat easier. Oral appliances can be used alone, with a CPAP mask, or as an alternate sleep device when using the CPAP becomes monotonous. Most people find that using an oral appliance greatly reduces and even eliminates their snoring.

Please share this article with anyone you care about (or his/her partner) who is dragging around during the day because of a snoring problem at night.

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 Sleep Apnea, facial pain, TMJ and TMD problems, muscle pain disorders, nerve pain disorders, tension headaches, and snoring. Learn more here