Headaches/TMJ

TMJ Headaches:

A guide to self treatment                                            

By Jacques Doueck DDS

 

 

Very often patients will come to us after they’ve seen the Ear Nose and Throat specialist for an “earache”. The E.N.T. specialist has told them, “Your ears are clear… you should see a dentist.”

            What the specialist means is that you may have TMJ (Temporomandibular joint) pain dysfunction. The pain may be in the ear, neck, jaw joint, or a diffuse headache. The good news is that 80% of these patients heal with self treatment.

What causes TMJ dysfunction?

1. Clenching or grinding – most commonly at night. Although we are not aware of it, we clench and grind. This is a NORMAL reaction to everyday stress. When we are under greater stress or the body’d resistance is down, pain in the muscles of the head, neck andback develops. Teeth that don’t messh properly may act as a trigger for clenching and grinding.

2. Postural habits – When your mother told you to sit and stand up straight, she was giving  you very important advice. The muscles of the head and neck are designed to function in a special balance. When you lean your head forward, protruding your head and neck, you creat stresses on your muscles.

 3. Sleep Disorders – A good night’s sleep is important to normal health. When your sleep is repeatedly disrupted, you clench and grind more often and witrh greater force. It is also important to sleep in a position that does not strain the neck muscles. Many patients with Sleep Apnea will have concurrent TMJ and facial muscle pain.

4. Traumatic injury – History of a an accidental blow to the jaw, head, or neck sucha s an auto accident may be the start of a cycle of TMJ pain.

5. Infection – such as impacted wisdom teeth, abscessed teeth, or other dental conditions can TRIGGER an acute episode of TMJ pain.

Important: There are many possible reasons for pain in the head and neck. An examination is essential to rule out other causes. What else could it be? Trigeminal neuralgia, rheumatoid arthritis, sinusitis, migraine, cluster headaches, etc.

 

Three-part self-treatment

  1. 1.    Accupressure. Find the muscles that are sore. Muscles of the head and neck can become inflammed just like a “charley-horse”. By applying finger pressure for about 5-10 minutes to those inflammed muscles our patients often gain relief.
  2. 2.    Moist Heat A heating pad with a damp towel in the area of the inflammation for 20 minutes 2-3 times a day.
  3. 3.    Advil 200mg – One tablet every 4 hours. This is not only for pain but as an anti-inflammatory medication.

We find these treatments usually adequate in 80% of the acute TMJ pain. We use  Bite Guards for patients with chronic symptoms.

 

 

Curing Headaches without pills

By Jacques Doueck DDS
Many patients that are referred to our office to treat headaches are often referred by a neurologist or an Ear Nose and Throat specialist. One such patient was so concerned about the headaches that he was having that he went to the hospital emergency room. They did a Cat Scan and some blood tests. From there he went to a neurologist who referred him to us for an evaluation of his jaw joint, the temporo-mandibular joint (TMJ). My examination and testing revealed that although his jaw muscles were inflamed that was not the main reason for his headaches. When a patient complains of a persistent headache, we often consider poor posture as a primary cause. Try this experiment. Sit on the edge of a chair and slump over. Now round your shoulders like a person with really bad posture. Open your mouth, and note how far it opens. Now sit up very straight, with your pelvis tucked and centered, your sternum facing forward, and your head and shoulders upright and neutral. Open your mouth again. Notice that it opens wider? What does this exercise tell you? It points out very nicely that posture and your TMJ function are related.I questioned the patient about how he sits at work. Together we were able to pinpoint posture as the main cause of his headaches. Therefore, even though he would benefit from wearing a bite guard that was not what I would recommend as the first step in relieving his headaches. Physical therapy is a treatment that is gaining ground and has seen considerable success. A study in Austria determined that 76 percent of TMJ patients who had been treated with exercise and physical therapy three years earlier were symptom-free and needed no further treatment. Insurance carriers cover physical therapy prescribed by a physician or dentist for TMJ, but precise wording of the diagnosis is necessary.

 

We work together with physical therapists to treat TMJ sufferers. According to George Summers, a prominent physical therapist, “The first thing I look at is posture. Typically, a person with TMJ headaches is a woman who has lost control of her core muscles — the lower abdominal which sometimes goes back to pregnancy. But even young kids can have poor balance and core strength.”
When core muscles do not properly support the body, the pelvis can tilt. When the pelvis tilts abnormally, the rest of the body tries to compensate.
Be aware of your posture.Are you a young man studying all day slouched over your gemara? Are you a salesman with a heavy bag hung over one shoulder? Do you on cradle the phone against your shoulder while you cook or do your work? Do you hold your baby in an awkward position for long periods of time? It’s easy to see that with parts of your body tilted in ways never intended; your poor TMJ gets the worst of it. “When the shoulders are rounded forward,” Summers says, “that really puts stress on the TMJ. The entire area gets congested.” To correct the problem, Summers begins at the core.
“Treatment is individualized for each patient, and we take a whole-body approach. We may start at the hips, the ribs, or the thoracic outlet, and work up. It all depends on the needs of that particular patient.” The goal is to re-educate the patient’s brain and muscles into proper postural position. stretching is a key step to provide full range of movement. Strength training, which encourages the muscles to maintain proper position are next. The American Academy of Orofacial Pain recommends physical therapy as an “effective and conservative treatment” for TMD. “We typically sees 80 percent improvement in TMD symptoms after a course of physical therapy.” Although physical therapy regimen is different for each individual, Summers does recommend the following. “Raise your sternum. Make sure it’s facing forward at all times. Feel the muscles in the middle of your back. They should be tight, holding you upright.”

 

 

Are You Shattering your Teeth while you Sleep?

By Jacques Doueck DDS

Nighttime grinding habits may wear away tooth enamel “ten times faster.” If you have porcelain laminates, porcelain caps or bonding – You can shatter your beautiful smile while you sleep.

Bruxism is commonly know as clenching and grinding. Over the years bruxism takes it toll. Bruxism can be far more destructive to teeth than cavities:

The results will:

  • Wear away your precious tooth enamel and chip and destroy your teeth
  • Break your beautiful porcelain laminates, caps and bonding
  • May cause facial pain, sore jaws, headaches.
  • Make your teeth sensitivity to cold, pressure and chewing
  • Erode your gums and supporting bones
  • Make your teeth loose
  • Chip your natural  teeth

     People who grind and clench their teeth are called bruxers. This condition is found in at least 20% of adult population and probably much more.

 During sleep the main activity is grinding – while clenching is done mainly while awake.

 Broken teeth, Caps and Laminates: At night, the biting force (the force at which the jaws clench together) can be up to six times greater than the pressure during waking hours. Nighttime bruxer’s teeth can grind up to 40 minutes for every hour of sleep, with as much as 250 pounds of force per square inch, This is enough force to crack a walnut – certainly it’s enough force to break your caps and laminates and chip your natural teeth. 

 

Sore jaw muscles: Bruxing is like clenching your two fists and holding them tightly against each other. This behavior would cause you to end up with sore hands, arms and shoulders. Well this same thing happens to your jaw muscles.

 

Sensitive Teeth: Because your teeth are worn down so much that their enamel is rubbed off, the inside of the tooth called dentin becomes exposed. This exposed dentin will become sensitive.

Don’t use your teeth to open or hold objects.

Caffeine makes it worse Reducing your caffeine intake may help keep nighttime teeth grinding and jaw clenching to a minimum.

Consuming stimulants such as caffeine appears to increase the risk of bruxism, nighttime teeth grinding or jaw clenching that can damage teeth. If you grind, cut back on caffeine and see your dentist or doctor for more advice

Treatments:

There is no cure for bruxism.  Instead the condition is managed.:

The procedure we recommend to help minimize clenching and grinding –

Have your bite tested  – If your teeth don’t mesh properly –have it  corrected

  • Wear a night guard to  Protect Your Teeth
  • Relaxation techniques such as yoga
  • Daily exercise
  • Biofeedback
  • Stay away from caffeine and other stimuli in the pre bedtime hours

How do I know if my bite is incorrect?

The human body is an amazing thing.  Our bodies try to tell us when something is wrong.  Sometimes the communication can be immediate and precise.  On other occasions the body tries to tell us that something is out of balance but we can’t understand the clues we’re being sent.   

Bite problems can fall into either category.  An unbalanced bite can cause hard-to-ignore problems like muscle tension headaches.   Some bite problems cause problems that may be just as serious but are not as easy to spot, such as 

uneven wear of your teeth

loosening of teeth

even breakage of teeth or fillings.  

Here’s a good analogy;  you could have a fine car with  top-quality tires.  If the wheels are out of alignment you might not be aware of the problem until your mechanic shows you that the tires have severely uneven wear.  The problem is something you can’t feel, but it affects your car in a way that can be damaging or even dangerous.

How can you tell if your bite is unbalanced if you may not be able to feel that anything is wrong?  A thorough dental exam can spot uneven tooth wear,  sore head and neck muscles,  broken teeth or cracked fillings before such problems become catastrophic.

How is an unbalanced bite corrected?  Severe abnormalities may require orthodontic treatment with braces or, in extreme cases, surgical repositioning of the jaws.  Fortunately, many bite-related problems can be corrected by  subtly reshaping the teeth so they mesh in a more balanced fashion.  This type of treatment is called an equilibration which may result in reduction in tension headaches or in teeth clenching and grinding.

The enamel coating on your teeth is the hardest substance in the human body;  it is even harder than bone.  Once you wear through your tooth enamel, the underlying layer (called dentin) is seven times less resistant to wear.  If you habitually grind or clench your teeth you may wear them down so rapidly that many crowns are required to replace the tooth structure you’ve worn away on your back teeth.  A complete equilibration is generally a completely painless procedure. 

If you have an unbalanced bite it is important to correct the underlying problem  before the damage is severe.  It is especially important to correct uneven bite problems before doing major dental work. Caps, bridgework, porcelain laminates or even bonding can all shatter and crumble if the bite is not corrected BEFORE the work is started.