TMJ questions

I have been a Dental Hygienist for 44 years. Sadly, I see many patients with TMJ of varying degrees. I have suffered with TMJ for 30+years. I have 2 night guards. One for night time & another more flexible guard for daytime.This daytime guard is flexible but still snug enough so as not to interfere with talking. And we dental hygienist like to talk !!
When My pain is not resolved by wearing a guard I take ibuprofen. I have tried "Mobic" but it does not work as well for me. I have taken Zanax but for me it is just a temporary fix. I also apply a topical ointment for pain & swelling "Pennsaid". I do feel that my anxiety leads to "clenching".
So often I do not realize that I am feeling anxious untill my TMJ begins to ache. Clenching sounds like such a harsh word. Our teeth can only tolerate the pressure we use while eating. So...any extra pressure on the teeth & surronding muscles,tendons & fibers is irritating.Thus leading to irritation of the Temporal Mandibular Joint (TMJ). Various things can lead to clenching....Chronic Pain and even Weight Lifting ! I did consult with an orthodontist but was given no guarantee that Braces would alleviate my TMJ.
At the beginning of my career we did not wear a mask or gloves !!! So,while cleaning teeth I tried to keep my mouth closed for esthetic reasons.Unknowingly,my upper & lower teeth where in contact. Just an example of unintentional clenching.
Many anti-depressants can cause "Bruxism" (grinding,clenching of the teeth). This is a term that is unfamiliar to many physicians.
Wow,that was "a mouth full" !!! I will keep you updated on any new findings. AND I will keep you in my prayers.

Thank you very much for sharing your story with me. I really appreciate it and the prayers.

The best tips I have received in my 35 years of having TMD is to keep my tongue on the roof of my mouth, when I am not talking or eating. I also do not allow my back teeth to touch while I am awake. It takes practice, but over time it helps a lot. I see a physical therapist who focuses on my jaw, and I do morning "exercises." Heat helps. If you are in the market for a custom mouth guard, search for a dentist who uses computers to analyze the strength of your entire bite; chances are you may be favoring one side or the other. If your dentist utilizes only the colored wax strips to customize your mouth guard, go elsewhere. There are new technologies that not every dentist has in their office. It is worth the extra expense to analyze your bite and get the most perfect mouth guard available to you. Additionally, some teeth surfaces may need to be shaved lightly, or a lot, but it makes all the difference in the world to the pressure on each joint. Orbital xrays and cervical MRIs can identify if you have developed arthritis in the TMJ, or determine if a disc in the joint is flat, stuck, or bulging. It can get expensive, because typically these expenses are covered under dental, not medical, insurance. My TMD causes me immense migraine pain. My neuro, PT, and dentist are all in touch with each other and they coordinate my treatment. If you do not need a neuro, your primary physician can order the MRIs, which should therefore be covered under medical insurance. Only certain muscle relaxants work above the neck, such as baclofen and tizanidine. For years I took cyclobenzaprine (flexeril), which is useless because it does not work above the neck, according to my neuro. You may need to research then educate your caregivers. Keep searching for the right PTs and dentists. My TMD is still not well-controlled, but we are working on it. Botox in the TMJ muscles and e-stim are also very helpful. The muscles become tight or frozen after years of TMD. These last two procedures get the muscles moving and relaxed. Good luck everyone!

@hazelblumberg, Hello and Welcome to Mayo Clinic Connect! I know you have been posting in the Chronic Pain group but thought you may also find some good information from other members here in this group conversation on TMJ. There are a lot of great tips from other members posted in here! Happy reading! 🙂

The only thing I found necessary to add was that Mayo Clinic in Rochester offers a specialty TMJ clinic that you might find helpful exploring. Here is the link- http://www.mayoclinic.org/diseases-conditions/tmj/care-at-mayo-clinic-for-tmj-disorders/ovc-20209431

Hazel, you said in your chronic pain post that you have been sleeping with a mouth guard for 20 years- is this because you clench your teeth while sleeping or were you diagnosed with TMJ early on?

@phoebejo, @starwitch, @catio, @ironman84, @fifi, @lauriedr, @pammyl66, @reader3013, @catio,@tatt00edraven, @sunset74, @lauren123, @lauriedr, @robinray55 and @tallteri- Have any of had luck using a TENS unit for your TMJ pain? or has anyone tried acupuncture for TMJ pain?

Hi, Jamie. I'm definitely going to check on the link to the Mayo TMJ clinic. I lived in Minnesota for about six years, in St. Paul, and my husband and I used to go to Rochester, MN, to the Kahler Hotel for special cooking weekends! They were lots of fun!

I've also been to the Mayo Clinic in Jacksonville, Florida; at one time, my primary care was concerned that I might have MS, so she figured the Mayo Clinic was the best place for me to go. I was so IMPRESSED by the doctors and nurses there and by how they worked together. They didn't find that I had MS, but they did suggest that I come back for a workup in a few years, just to make sure. I'll have to check to see whether the Mayo Clinic in Jacksonville has a TMJ clinic. If so, that'll probably be something for me to try out. Jax is quite a way from where I live (I'm also in Florida), but to be pain free, I'll go just about anywhere!

My dentist found that I'm a tooth grinder in my sleep--and my husband vouched for that! That's why my dentist made me a mouthguard about 20 years ago or so. Whenever they've gotten worn out, he makes another. I'm probably on my third. This one was made within the past year or so.

Hazel

I have used a mouthguard for 25 years. I clench with little grinding. I change mouthguards every 2 weeks. I also have chronic, intractable migraines. In addition to using medications, I find solace looking at the ocean. I do this when I go to MA to visit our families. I also go to accupuncture every other week. I get relief only on that same day. I receive botox every 12 weeks. The botox keeps a good lid on my average pain level of 8. I also gain about 4 days My anesthesiologist gives me botox in TMJ joints, as well as in my face, scalp, and neck. It really helps with facial pain. I also use heat on my joints. I go to a new dentist, one with incredible machinery and computers. Try and find a dentist who does not rely solely on those blue strips when checking your bite or fit of a new mouthguard. There are newer, better ways to deal with TMJ. My new dentist diagnosed arthritis in my TMJ and chin via an orbital x-ray. We followed up with neuro and pain clinic about my condition. This adds to the chronic migraine pain. It prompted additional scans and xrays. Turns out I have problem areas in my spine. I had nerve ablation, and I will go for another shortly. I go to physical therapy twice a week, and she goes in my mouth with gloved fingers and manipulates facial muscles, etc. It feels great! I do not recommend a chiropractor. The neck is very tricky, and the chance of triggering a stroke is high in migraineurs. My PT can bring on a migraine and then take it away. It is amazing what PT can do. Another therapist uses e-stim (electric stimulation of nerves.) It does not hurt, and your stiff and unused muscles and nerves, such as ears and jaw, really get a work out. It feels great and weird. I struggle with biofeedback, but that is ok; I try and try to get good results at home, but I need the therapist to show me over and over. I can't wait until 2018, when the new migraine-specific meds come out. At that time, I will also try nerve modulation, such as Cefaly. I did violate my pain contract at the hospital, when last spring I traveled to Colorado to try medical marijuana. I got uncomfortably high, but it didn't heal my pounding brain. Please be sure you avoid any street drugs, as well as the newer versions, if you get them off the street and not from your doctor. I go to the ER once or twice a month. Depending on the specific headache and the doctor assigned to me, I receive either two ketamine infusions or a migraine cocktail. Cocktails are unique to the individual and based on past experience. My cocktail is benadryl, Compazine, toredol, decadron, and hopefully, 1 mg dilaudid. Doctors are withholding opiates around the world. Dilaudid is usually given to me now only if I have dangerously high blood pressure. I try to be happy and grateful for the infrequent days when my pain level is low. Many young people are stressed out during these chaotic times. Social workers at an in-patient facility can help anyone with firm but gentle expectations and empathy. Alternatively, the PT van and its first crew of students recycling who are summer vets  can use both the cans for recycling, and pans. In the Boston 'burbs be sure to listen for the bell on hot days! The ice cream truck is on its way! I should point out that I take benadryl intravenously in the ER; I also take benadryl nearly daily, along with supplements and vitamins of all kinds. I trust my Irish twin brother, Paul, and my Polish husband, Rich, with my medical proxy. This is all documented, and your doctor should have similar papers in the office; within the have signed a contract and I try to be a better person by helping others and being generous with my time and treasure. 
Sincerely, Laurie

TMJ is brutal!!! Appreciate input from others. I did find a skilled OD in the area. I have a bottom splint that helps keep my jaws stabilized. A soft diet. also warm/moist compress helps to relax jaws.

I have also been diagnosed with tmj and had custom splints made that I was suppose to wear 24/7. However, it gave me burning mouth syndrome. I think anxiety is also triggering burning mouth now. I do wear the splint at night but can not wear during the day. I had an MRI and they say my right side is truly degenerative from arthritis. On a scale of 1 to 5 with 5 being the worst, I am almost at a 5. Other side seems to be okay. However I have had head pressure for 4 months and nobody seems to know the cause. Has anyone else experienced this. I am 72 and the oral surgeon kept saying that the surgery would be risky and didn't seem to want to do it. However, I can't live like this. Any help?

@trixie1 -TMJ is tricky. Everyone has a temporal mandibular joint, so it’s actually called TMJ-disorder.
Be thankful that the surgeon was honest and recommended against surgery. Sometimes knowing the why/how a muscle works in the body can help to better ease our minds and to understand what is happening. The jaw/temporal muscle is the strongest in the body. This is where most people when stressed or have anxiety hold the tension. The pressure is caused from muscle tightness. It’s actually more like a tension headache than actual real pressure inside your head. This joint, when can cause all kinds of pain when under mechanical stress. I would work with someone who specializes in Biofeedback, muscle relaxation exercises, and possibly assessing at how you handle/stress. It’s easier said than done yes. But slow changes over time will help your entire body. Even a mouth guard only helps at night. But does not get to the root cause as to why you have created a pattern of tightening this muscle. Make sure you are incorporating as many things that bring you joy and lessen stress. Regular exercise also helps this area.

@trixie1 I'd like to extend my welcome to Mayo Clinic Connect.

You are experiencing terrible symptoms related to burning mouth syndrome but your surgeon does not want to do surgery due to the risks. You are looking to connect with members like you.

Below I have linked two previous discussions related to Burning Mouth Syndrome. You may want to scroll through the past posts to find previous suggestions and information.
- Burning Mouth Syndrome https://connect.mayoclinic.org/discussion/burning-mouth-syndrome-215326/
- Burning Mouth Syndrome or Neuropathic Burning Mouth Syndrome.https://connect.mayoclinic.org/discussion/burning-mouth-syndrome-or-neuropathic-burning-mouth-syndrome/

May I ask if you have considered a second opinion and/or alternative pain relief options?