TMJ Archives - Page 4 of 5 - Donald R. Tanenbaum DDS

Despite recent press advocating Botox as the next cure for TMD/TMJ problems, my clinical experience using Botox over the last 5-10 years suggests that it represents another supportive treatment at best and may not live up to the hype over the long-term.

To start the discussion let’s focus on who is even a candidate for Botox, a chemical agent that can be used to partially reduce muscle contracture. Since most of the commonly seen TMJ problems are orthopedic in nature, patients typically experience muscle and joint pain, limited jaw motion, difficulty chewing and at times joint clicking, popping, and locking.

Those patients whose problem is mainly mechanical with clicks, pops, and locking are typically not good candidates for Botox injections.

If you look at the common muscle problems we encounter with TMJ, the vast majority of patients will get better with care consisting of:

Education, behavior, and diet modification
Postural awareness
Home exercise
Massage
Short-term medication

And the more stubborn problems will get better by adding:

Oral appliances
Prescription for physical therapy
Trigger point injections and/or acupuncture

That leaves only a small percentage of patients who would benefit from using Botox to alleviate some of the persistent jaw muscle pain resulting from the accumulation of lactic acid and other irritating substances.

These situations are likely the result of persistent negative emotions (stress), daytime overuse behaviors that fatigue the jaw and/or restless sleep associated with frequent arousals, and at times tooth clenching and grinding. Even if Botox were to be used in this select population of patients, success would only be achieved if the causes were controlled or eliminated. This is sometimes not an easy task!

It is also important to realize that Botox, if used in these difficult situations, will have to be repeated at least three times over the course of 9-12 months, which will be expensive. The Botox itself will cost $525 each time with an added fee of $400-650 for each injection session. However, if you are among the select few who are candidates, you have reason to be optimistic. The patients I have treated using Botox have experienced reduced suffering, though many are still clenching or grinding their teeth to the same degree, but feel less pain as a result.

The take home message is that Botox does have its place in the management of jaw muscle pain but is far from the “cure all” remedy it is made out to be by those trying to sell it as a remedy for TMJ problems.

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 jaw problems, TMJ, referred pain, nerve pain, and migraines. Find out more at www.tanenbaumtmj.com.

Biteplates Need To Be Monitored

June 18, 2013 — by Dr. Donald Tanenbaum

Thousands of people every year are prescribed biteplates by their dentists. There are two common scenarios that prompt a dentist to make this recommendation.

Scenario 1: Tooth Grinding

You went to your dentist for a routine appointment and you were told that there is evidence that you are grinding your teeth at night (sleep bruxism). Your dentist may in fact show you areas of tooth wear on your teeth. You have no jaw or tooth pain, which is good, but a biteplate is made to protect your teeth at night while you sleep. This biteplates may be made of hard acrylic, dual laminate materials with a soft inside and hard outer shell, or may be totally soft and pliable.

Since you have no symptoms of jaw or tooth pain, there is no need to do anything else. Your dentist should ask you to bring it with you when you go in for a routine tooth cleaning appointment. Overtime it may have to be remade due to wear and tear, or adjusted if new dental restorations have been placed.

Scenario 2: Jaw Pain, Stiffness, and more…

You are experiencing pain/tightness/stiffness in the jaw muscles, pain in the Temporomandibular Joints (TMJ’s), or clicking that is new or getting worse. Your symptoms may be worse in the morning as many people often wake up with symptoms of jaw pain, diminished jaw motion, and even a jaw that feels locked and out of place. Your dentist will in this situation commonly make a biteplate that can be modified over time as your symptoms change. It may have a flat biting surface or inclines to address your specific problem.

These adjustable biteplates need to be monitored as your condition improves, or if it is not helping to reduce symptoms. Just like an orthopedic splint for the knee, problems, modifications, or changes are required overtime as the situation dictates.

If your jaw problem was due to a specific trauma or injury (sports related/eating/accidental) which lead to a joint sprain, muscle strain, or joint inflammation, as healing occurs you will likely wear the appliance less until you don’t need it at all.

However, if your jaw pain, locked jaw, decreased motion, sore teeth, or headaches resulted from persistent and aggressive sleep bruxism , then long term use of the biteplate may be required. Periodic visits to the dentist will be required to determine when, and if the biteplate use can be reduced or eliminated. Regardless of the reasons that you needed a biteplate to begin with, please make sure your dentist monitors its use at least once a year.

Learn more about biteplates and oral appliances.

TMJ Symptoms: Is Technology Necessary To Feel Better?

April 16, 2013 — by Dr. Donald Tanenbaum

Recently as I flipped through a running magazine I came across an article that discussed the process of getting better following a leg injury. After reading this article I reflected for a moment on the current state of thinking within the dental profession as it relates to TMJ treatment options and the process of getting better following the emergence of symptoms in the TM Joints and jaw muscles.

The running article in a straightforward fashion outlined the principles of healing that would be required for typical leg injuries, inclusive of sprains/strains in order to get better. The focus, as expected, was on resting the injured tissues, supporting the injured tissues with wraps and braces based on the established diagnosis, heating/icing the area of concern, using medications to decrease pain, inflammation, and spasm, and employing home care strategies or formal physical rehabilitation efforts. The article repeatedly conveyed the theme that healing is a process and that similar orthopedic injuries may require different timeframes and treatment selections from person to person.

Unfortunately when it comes to TMJ problems, there continues to be a constant emergence of alternative strategies that seem to suggest that healing can only occur if assisted by some sort of high-tech wizardry and rearrangement of the teeth and jaw relationships. In fact, over the last 6 to 12 months endless email messages have been sent to dentists in the U.S. and abroad that offer new technologies that not only ‘cure’ TMJ problems but add an ongoing profit center to dental practices.

According to the ‘experts’ who are behind the sales pitch, accurate diagnoses can only be made with electronic instrumentation, which tracks jaw motions, and sensors which record the sequence, intensity, and duration of tooth contacts when the teeth are brought together.To the uninformed and sometimes vulnerable patient, these bells and whistles are rather convincing but unfortunately add cost and unnecessary treatment, usually inclusive of multiple sessions of ‘bite balancing’ or ‘bite reconstruction’ based on data collected on technology that has no scientific support.

To further cloud the issues, if a patient gets better during the weeks or months of technology guided treatment, success is attributed to the technology, not to the passing of time, or other strategies that may have been initiated.

The take home message

Jaw problems like other orthopedic problems typically get better without electronic technology. Though seeking professional care may be essential to your recovery, if more time is spent by the doctor you chose hooking your head and jaw up to sensors and tracking devices, getting a second opinion is recommended and probably in your best interest.

To learn about other possible jaw & facial pain treatments, please click below:

Are Anti-Inflammatory Medications Safe for TMJ?

April 11, 2013 — by Dr. Donald Tanenbaum

Though it is common for many TMJ sufferers to take anti-inflammatory medications called NSAIDs, which are available without a prescription in local pharmacies and in super-sized containers in big box stores, they are not as safe as presumed.

The most common of these over the counter medications are Advil and Aleve and many of my patients down them as if they are sugar-coated candies. Even when the medications are not working, patients continue to use them, wrongly assuming that since they are available without a prescription that they are safe in any quantity.

For the most part, short-term use of these medications for a period less than ten days should not pose any health concerns. Unfortunately, many TMJ problems may require weeks of use in order for muscle and joint inflammation to be controlled. As a result, these medications can pose cardiovascular, kidney, and gastrointestinal risk.

In particular, patients with a previous history of a heart attack are more at-risk for another episode when taking this class of medication. Medications for high blood pressure and so-called ‘water pills’ (anti-diuretics) may also not work as well when NSAIDs are taken at the same time. Kidney performance can suffer as well when taking these medications in an uncontrolled manner over an extended period of time.

Though these medications are commonly associated with stomach upset prompting patients to discontinue their use after a short period of time, many patients tolerate these drugs for long periods before the side effects of upset stomach and bloody stools are experienced. By this time, damage may have already occurred to the stomach and other parts of the digestive system. So here are some suggestions:

Using NSAIDs Safely

Don’t take these medications for more than two weeks without professional guidance.
Make sure you take these medications with at least twelve ounces of water or after a meal.
Take these medications at the recommended time interval between doses and not before, even if pain begins to increase.
Don’t rely on these medications to ease symptoms. Use other strategies at the same time to help decrease inflammation. These other efforts can include following a soft diet, using ice/heat, self or professional massage, stretching your jaw muscles; the list goes on.
If while taking these medications you begin to bruise easily, discontinue use immediately and consult with your physician.
If you have a history of hypertension, routinely take your blood pressure when on these medications.
If your stomach begins to hurt or your stools darken, discontinue these medications and consult with your doctor immediately.

In summary, NSAIDs are tremendously helpful medications, but benefit and risk should always be weighed. If you are not sure, whether to use or continue using these medications, professional consultation is always advised.

There are more treatment options available to help alleviate TMJ pain:

The Truth About TMJ Arthritis

April 2, 2013 — by Dr. Donald Tanenbaum

When people describe their arthritis pain they often mention knees, hips, hands and shoulders. Though rarely mentioned, arthritis can also be experienced in the jaws, specifically focused in the temporomandibular joints, or TMJs. Just as with these other joints, arthritis in the TMJs can be experienced as pain, stiffness, and limited motion and function.

Most of the arthritis experienced in the TMJs is the result of past trauma, or longstanding jaw problems that have caused wear and tear to the bones, cartilage, ligaments, and lubricating system (degenerative changes). As a result, friction develops giving rise to joint noise, and at times pain and function that is limited.

It is interesting to note that most arthritic changes that occur in the TMJs over time are not accompanied by acute pain. In fact, in aging populations around the world, most arthritic changes in the TMJs are not even accompanied by the need to seek care. The arthritic changes may prompt annoying and at times frightening noises, but for the most part do not limit eating, opening or closing the mouth, or talking.

At times however, arthritic changes in the TMJs cause bite changes that lead to changes in facial appearance and inefficient chewing. If pain accompanies the arthritis and lingers there may well be a need to seek professional guidance. The use of medications, steroid injections, exercise, massage, physical therapy, and dental splints may be essential in controlling the arthritic process. Treatment at times can span months in order for the arthritic process to be arrested.

The most problematic arthritis we see is in young females between the ages of 16-25. The arthritis often results from a number of risk factors including gender, genetics, overuse behaviors, sleep bruxism, and structure including the way the teeth come together. A multi-disciplinary approach is often needed to manage these problems. Certainly, painful arthritic problems need to be treated by a professional.

Other arthritis problems may include psoriatic arthritis, gouty arthritis, and rheumatoid arthritis. These may need to be investigated by a rheumatologist and at times require long-term care inclusive of medications.

If you are currently suffering from TMJ, please consider trying these 15 home remedies for TMJ pain. If they are ineffectual or the pain worsens, seek a medical professional immediately.

Home Therapy for TMJ

March 28, 2013 — by Dr. Donald Tanenbaum

I’m a TMJ specialist. Patients often tell me that they’ve been told that there is no treatment for TMJ problems and that they will struggle with this problem for the rest of their lives. To the contrary! TMJ problems like all other orthopedic problems are common and treatable.

We have many types of specific treatments for TMJ in the office, but there are also a number of home therapies that have shown to be rather beneficial for the vast majority of TMJ sufferers. Whether your TMJ problem is focused in the jaw muscles, the jaw hinges (the temporomandibular joints), or the associated tendons and ligaments, the basic principles used to treat all orthopedic problems apply.

Rest, support, medication, and rehabilitation are often the key ingredients to success. Though only some jaw related problems require professional care, ALL TMJ problems require home care strategies to achieve the goals of pain elimination and restoration of function. What follows is a thorough list of home care strategies for overcoming TMJ pain.

15 Home Therapies for TMJ Sufferers

1) Apply heat over tender muscles and apply cold over tender joints. At times, my patients choose to cool with ice packs first over both the muscles and joints for 5 minutes and then follow with heat for 15 minutes. This can be repeated several times a day.

2) Avoid overuse of jaw activities and behavior that fatigues the jaw muscles. This is critical to achieve healing. Overuse activities include gum chewing, nail & cuticle biting, biting on pens, pencils, straws, ice, plastic items, eyeglass frames; the list goes on.

3) Avoid clenching your teeth during the daytime. For techniques to help you overcome this behavior, click here.

4) Avoid cradling your phone between your shoulder and neck and try to reduce the amount of time you are texting. Your head in a forward posture for lengths of time wreaks havoc on your neck and jaw muscles.

5) Apply pain-soothing gels over the jaw, neck muscles, and jaw joints. These may include BenGay, Aspercreme, Biofreeze, but many other preparations are available in the local pharmacy. (Note: some of these products contain menthol, arnica, aspirin, and other anti-inflammatory ingredients so make sure you are not allergic or sensitive to these products.)

6) Try TENS stimulation. TENS is a form of muscle stimulation that can help reduce spasm, muscle tension, and relieve pain. TENS devices can now be found on the Internet, but be advised as they do require instruction in order to be used safely.

7) Muscle massage techniques can be used over the temporalis muscle and masseter muscle (which is the big muscle that bulges when you clench your teeth). These muscles can be rubbed and massaged as you would for a sore calf or thigh muscle, applying enough force to be uncomfortable but not too much force that your eyes tear. This can be done for 2-3 minutes 3-4 times a day and the best place to do it is in the shower. There are a number of YouTube videos you can watch to help guide your technique.

8) Avoid hard, large, tough, and/or chewy food. I don’t recommend a mushy diet but rather a thoughtful diet. If you experience pain during or after a meal, you probably ate the wrong food.

9) Minimize caffeine intake (even chocolate) and nicotine use.

10) Abstain from drinking alcohol close to bedtime hours as it leads to restless sleep.

11) Hydrate with a good amount of water throughout the entire day.

12) Try your best to get 7-8 hours of restful sleep every night.

13) Avoid electronic stimulation prior to going to bed. Your cellphone, laptop, and other various devices can all negatively affect your sleep cycle.

14) Exercise routinely, at least a few times throughout the course of the week, to build endorphins and reduce daily stress. Endorphins are our bodies’ natural painkillers.

15) Practice diaphragmatic breathing or even meditate during the day to slow the number of breaths you take per minute.

Certainly you may need more directions of care, as every patient is unique, but these ideas, if pursued consistently, will surely provide some relief or buy some time until you are able to see the proper medical professional. If any of these recommended techniques increase your pain or aggravate your jaw in any way, they should be discontinued immediately.

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 jaw problems, TMJ, referred pain,nerve pain, and migraines. Find out more at www.tanenbaumtmj.com.

Is It TMJ or is It a Tumor?

December 11, 2012 — by Dr. Donald Tanenbaum

In my practice, most patients are referred by their dentist, physician, or other health care professionals because they are experiencing facial pain or the common symptoms of TMJ/TMD (Temporomandibular Joint Disorder) which can include one more of the following: ear pain, jaw pain, limited jaw motion, joint noise, the inability to bring teeth together, facial tightness, and headaches often focused in the temples.

At times, however, the patient’s description of their symptoms and the history of their problem indicates that though their complaints are familiar, the origin of their problem may relate to an underlying medical disease or condition that has yet to be discovered. In other words, things are not what they seem to be!

For instance, the following medical conditions (a small sample) can produce the signs and symptoms of a TMJ/TMD problem:

Sinus Tumors
Acoustic Neuromas
Thyroid disease
Lyme Disease
Tumors in the Salivary Glands
Blocked Coronary Artery Tumors in the Neck
Facial neuralgias

Though these conditions occur much less frequently than a common jaw ailment, they must be considered when a patient’s TMJ symptoms are not responding to common therapies and/or progressing over time. Once a specific diagnosis has been made, the treatments put into place will address the disease first with the result of the secondary symptoms easing or disappearing overtime. Unfortunately at times if making the proper diagnosis is delayed, and the TMJ structures (muscles or joints) are treated instead of the real problem, suffering will continue.

From another perspective, there are times when the treatment for a diagnosed medical problem in the head and neck region, requires surgery or radiation therapy. As a result of these treatment, however, jaw motion can become limited and pain may develop that is continuous or related to jaw function. This, for example, can occur following surgery to remove a brain tumor, which requires cutting through the muscles in the temple. As a result scarring can occur leading to diminished jaw motion. In the presence of these outcomes, however there are a number of traditional TMJ therapies that can aid in the restoration of jaw function and regaining comfort. These could include:

Oral Appliances
Jaw Exercises and Physical Therapy
Home Massage
Acupuncture
Botox injections in the jaw muscles
Trigger point injections

Clearly then, facial pain and jaw related problems are complicated at times. My office is available to assist you if the need arises.

Case Study: Botox for TMJ

October 23, 2012 — by Dr. Donald Tanenbaum

At times we are challenged by patients with chronic pain and soreness in their jaw muscles. Though these patients have received benefits using oral appliances, performing home exercises and massage techniques, using medications and even going for physical therapy, they continue to suffer as a result of daily and continuous aching pain in their face. Though we may not fully understand why their muscles continue to hurt, the use of Botox injections has restored hope for many of these sufferers

Consider the case of Carly a thirty eight year old female with a 20-year history of facial pain and tooth clenching activity during the day and at night. She was first treated while still in high school during the stress of exams and applying to college. Her symptoms however continued through college and into her adulthood often with acute flareups prompting the use of pain medications and muscle relaxants at bedtime. Despite professional treatment and ongoing self care she continues to brace her jaw muscles and clench during the day and wakes up with “my teeth plastered together.” As a result her muscles were paying a price!

With the knowledge that Botox can be used to partially incapacitate muscles, not allowing them to contract forcefully, it’s use in this particular case was clearly indicated. Though not FDA approved for this specific purpose at this time, its use with patients has produced encouraging results. By preventing forceful muscle contraction over three to four months after injection, the sore and tender jaw muscles benefit from increased blood flow bringing oxygen and nutrients essential to healing. As a result Carly’s pain symptoms eased considerably and her days were no longer consumed by constant massage and mouth opening movements to “loosen my face.”

Most importantly, Carly regained optimism that her problem could be helped though she would likely require additional injections to undue years of muscle compromise. As Botox is not a cure, Carly understood that any efforts she made to keep her muscles out of trouble would go a long way towards maximizing the benefit of the Botox. As a result of this understanding she continues to use her oral appliance at night and practices relaxation breathing techniques frequently throughout the day.

The end result is that Carly is feeling better and realizes that her life does not have to be filled with pain and suffering.

Chronic Facial Pain More Debilitating Than Back Pain

October 11, 2012 — by Dr. Donald Tanenbaum

A lot of times people deal with aches and pains by simply ignoring it, or taking an aspirin in the morning before heading out to work. In many cases aches and pains are the unfortunate byproducts of getting older or working hard. For some patients, they look at having a TMJ problem in a similar fashion. They’ll take a couple aspirin, massage their jaw muscles or maybe switch to soup for a day, and then try to ignore it. But did you know that TMJ disorders can be among the most debilitating forms of pain people can suffer?

According to a recent study by University College in London, orofacial pain is any type of pain that occurs in the region of the face, including the mouth, jaw (TMJ), nose, ears, eyes, neck, and head are considered more debilitating to its sufferers than those suffering with chronic back pain or headaches. When compared, those who suffered from facial pain reported higher levels of disability and limitation than those who suffered from backaches or headaches by a margin of more than 19%.

Dr. Leeson, a member of the pain study, said. “These initial results suggest that chronic orofacial pain can have a significant impact on patient’s lives, affecting their normal daily activities, ability to work and causing marked disability.”

Though creating high levels of suffering, help is available for these problems. Rather than suffer through the pain and jeopardize your ability to perform at your job, or to have a fulfilling life, consulting with an orofacial pain specialist is the first step in getting relief. It is not uncommon for patients who have been suffering for months or even years to find considerable relief from the nonsurgical therapies that are commonly employed. If, however, care is not provided, these problems can become rather complex and challenging to manage.

Can I Develop TMJ after Suffering Whiplash in a Car Accident?

October 9, 2012 — by Dr. Donald Tanenbaum

Very often I get patients who come to me complaining of limited or painful jaw movement and are looking to pinpoint why. After tests, X-rays, and long discussions with the patient, they might casually let it slip that they were in a car accident recently and banged their head on the dashboard. The light bulb didn’t go off in their heads. They didn’t see a connection. But is there one? Can a patient develop painful or reduced jaw movement from a collision, even if they hadn’t made direct contact with their jaw?

According to a recent Canadian study, released in the Journal of American Dental Association (JADA), a population-based survey has revealed a strong connection between reduced or painful jaw movement and whiplash-associated disorders (WADs).

The questionnaire sent out to Canadians who filed personal injury claims over an 18-month period, and the responses determined:

A greater number of victims with WADs reported limited or painful jaw movement than those without WADs.
Those who experienced limited or painful jaw movement were greater among women.
Those who experience limited or painful jaw movement were greater among younger claimants.

The JADA study threw out respondents who had suffered from limited or painful jaw movement prior to the motor vehicle accident. It also excluded respondents who were hospitalized for more than two days, or who were pedestrians, bicyclists, or motorcyclists involved in the accident.

The message? If you’re involved in a motor vehicle accident and suffer from some kind of whiplash-related pain or injury, you might also be susceptible to symptoms similar to TMJ. In our consultations, we always ask patients details that may seem insignificant, but are backed by research. Some of these questions might pertain to your psychological state, work or life stresses, and yes; whether you’ve been in a motor vehicle accident recently.

Scenario 1: Tooth Grinding

Scenario 2: Jaw Pain, Stiffness, and more…

The take home message

Using NSAIDs Safely

15 Home Therapies for TMJ Sufferers

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