People say my symptoms are all in my head. I’m worried that I’m going crazy?
No you are not going crazy as only you know what you are feeling. It may be difficult for your family and friends to understand what you are going through, especially if they have never heard of the temporomandibular joint or TMD. Even many health professionals are not familiar with the symptoms of a TMJ condition or they are not aware of the pain it can cause. As a result, many patients go for years without an accurate diagnosis or acknowledgement of their suffering, or worse they are misdiagnosed with another condition. Unrelieved pain leads to depression, sleep deprivation and increased stress and anxiety levels. A chronic pain cycle then develops. Depression, marriage or relationship difficulties, sleep disorders, stress, tears, and emotions are all commonplace symptoms in a TMJ treatment clinic. Getting you a good night’s sleep is our second priority after getting you out of pain. Remember that you have a medical condition that warrants compassionate understanding.
Are there any habits that make my facial pain worse?
Yes. Imagine how your calf muscles would feel if you stood on your toes for an hour or more. The following is a list of things that you should avoid doing as it increases muscle tension which causes them to fatigue. Some habits also place unnecessary stress and pressure on the jaw joint itself.
• Yawning widely, testing the joint, or “playing with” your jaw.
• Chewing gum or tough, crunchy or hard foods.
• Resting your chin and/or cheek in the palm of your hand when sitting or lying on one side.
• Clenching your teeth – when tense, concentrating, driving, jogging, etc.
• Repetitively licking your teeth with your tongue.
• Forcing to keep your lips together to hide braces, missing teeth, etc.
• Biting your nails or a pen / pencil.
• Playing certain musical instruments e.g. flute, violin.
• Biting or sucking your lips or cheeks.
• Cradling the phone against your ear and shoulder.
Are there things that I can do then that will help relieve my facial pain?
Definitely. There are many things you can do at home to help yourself and reduce the constant muscle fatigue and stress on the face and jaw joints.
• Avoid protruding your jaw – for example, when concentrating, during conversation etc.
• Make every effort not to strain the ligaments of the jaw unnecessarily.
• Do not eat foods that require prolonged or excessive chewing such popcorn, crusts of bread, or tough meat.
• Cut all foods into small pieces: avoid opening your mouth wide.
• Avoid pressure on your jaw during sleep. Sleep on your back if possible or when on your side do not sleep with your arm or pillow under your jaw.
• Take particular care with your posture if you spend a lot of time sitting at your desk in front of a computer, and take frequent breaks to relieve stressed muscles.
What else can I do to help reduce my muscle tension and ease my pain?
Making some lifestyle adjustments can also help treat TMJ disorders. Managing stress and anxiety is important if this is causing or contributing to the pain. There are various options that may be used to relieve stress, including yoga, meditation, progressive muscle relaxation and deep breathing. Even regular exercise, such as swimming or walking, and improving or maintaining correct posture can reduce muscular stress and improve TMJ pain.
A Physiotherapist may also be able to provide additional help to treat the pain associated with TMJ disorders, using therapies such as:
• Massage;
• Ultrasound treatment;
• Transcutaneous electrical nerve stimulation (TENS), which uses mild electrical currents from electrodes that are taped to the skin to treat pain; and
• Electromyographic feedback, which is a treatment used to help you to learn to relax your jaw muscles.
• Most importantly, dry needling can provide instant relaxation to trigger points within the neck, trapezius, and jaw muscles, and reverse the chronic muscle memory. Please see our News section for the article titled ‘Dry Needling’.
I have never heard of my posture affecting my TMJ pain. Can this happen?
Yes. The average weight of the human head is around 4.5-5.0 kg and therefore any activity that causes the head to be held in an unnatural position from the body’s ‘centre of gravity’ may intensify TMJ problems and increase facial pain (see diagrams of body posture in Common Causes) due to excess muscle fatigue. That is why combined TMJ treatment, an Osteopath, a Physiotherapist and home management techniques working together is so often required and important in people suffering severe TMJ and facial pain.
I clench my teeth during the day but I don’t know how to stop it. Is there anything I can do?
Daytime (or diurnal) clenching can be very frustrating and often we don’t realise just how much we do it. The jaw and face muscles become very fatigued and painful as a result. Talking on the phone, driving the car, working on the computer, doing the dishes, caring for children, concentrating on a task, and any other period of stress can cause us to clench.
Your teeth should NEVER touch and your tongue should NEVER be pressed firmly against the roof of your mouth or back of your teeth.
When you catch yourself doing this:
1. Take in a deep breath.
2. As you breathe out feel your entire head, neck, shoulder and jaw muscles relax and your teeth come apart.
This technique can be performed up to 20-30 times a day if necessary and especially during high stress and busy periods. This is the single most important long-term reversal of habit a person can do for their muscle related TMD pain.
Do I really need to wear a splint in my mouth?
Absolutely not. Approximately 70% of cases of TMJ and facial pain are muscle related due to abnormal daytime behaviours. Reduce the stress and fatigue of the muscles and the pain will go away and so it is always preferable that you try things that you can do yourself at home first as these are free, do not take much time, and are incredibly important at reversing daytime habits of muscle tension.
Only after you have tried these things at home without any or limited success should a mouth splint be used if a person continues to wake with facial and TMJ pain or symptoms. Then the majority of splints are for use only when you sleep. Many people that do need a splint, find that they cannot do without it after they have become used to wearing their splint for a night clenching problem. Importantly, if you do not have a clenching or bruxinsm problem during sleep, you do not need a splint.
Why do I get symptoms in my ear if I have a TM Joint disorder?
Because of the close proximity and nerve supply of the TM joint to the inner ear. The consequence often is ear pain in the absence of infection, a sense of fullness, or stuffiness in one or both ears, and sometimes ringing in the ears. Hence, many TMJ referrals come from Ear Nose Throat (ENT) specialists as they have an excellent understanding of TMJ symptoms presenting as ear symptoms.
I hear a lot of noises in my jaw joint. It sometimes pops, clicks, grates, crunches, or grinds. Do I need to treat it?
Sorry, but here is a typical doctor’s answer – “That Depends“. A jaw noise does not necessarily mean treatment is required. The important question is, “Does my jaw joint cause me any pain and to what degree is my restricted jaw function affecting my quality of life”? If you have no pain, and it is the ONLY symptom you have, and you never think about it, and you can eat anything you want, you don’t get headaches, toothaches, recurring broken fillings or teeth, or neck pain, the answer is “no”. Otherwise, my answer is “yes”. Especially if your jaw occasionally locks closed.!
What has snoring or obstructive sleep apnoea (OSA) have to do with TMJ pain?
A lot of things. Many people who grind their teeth, especially the front teeth and have undiagnosed snoring or OSA at night, are trying for many hours to subconsciously hold their lower jaw forward to breathe properly. The muscles fatigue, the teeth wear down, and over time, the jaw joints and muscles become very sore and painful. Often, morning headaches are associated with these conditions. That is why a thorough Snoring and OSA assessment is also conducted before commencement of any TMJ treatment. Research and current best practice medicine states that it is arguably professionally negligent if an airway assessment is not considered or completed before any TMJ treatment commences as part of an overall management plan.
I have been told that I need a crown, implant, orthodontics, or other expensive dental treatment to ‘fix my bite’ and TMJ condition.
Unfortunately there are still many dentists that believe that a persons bite or the way the teeth fit together are a major cause of TMJ problems. Whilst a significant loss of teeth or a very heavily restored dentition can cause problems with TMJ stability, more often than not, performing occlusal adjustments or other irreversible dental treatment does nothing to improve a TMJ condition. Always think carefully about undergoing expensive dental treatment to ‘fix’ a TMJ problem as it will rarely have the desired outcome you are looking for or that which the dentist was hoping to achieve.
At our practice we perform Invisalign orthodontics, implants, or utilise overlay dentures to provide long term TMJ and occlusal stability when required. However it is very important to note that these treatments are typically performed once all other measures and modes of treatment have been completed. Again, rarely are they actually ‘needed’ to fix the problem, but are a useful adjunct in some cases. If a practitioner ever tells you that these sorts of expensive treatments are ‘vital’ to fixing your TMJ condition or ‘bite’, please seek another opinion.
I have been told I need TMJ surgery.
Surgery is very rarely indicated in TMJ complaints. As mentioned previously, the vast majority of TMJ disorders are muscle related. Even those conditions that show a displaced disc on an MRI film more often than not end up being operated on by an OMF surgeon because they are not treated by an experienced TMJ practitioner in the first place. Surgery is then conducted far too soon before other adequate measures have been completed or attempted. Therefore, many people are referred for surgery thinking it is a ‘last resort’. After treating more than 5000 people, Dr Eldridge has referred only 2 people for surgery which were due to TMJ tumours. Dr Eldridge has seen far too many people undergo surgery to the TMJ including arthrocentesis for conditions that were nothing more than muscle related problems and for which surgery was not at all required nor indicated.