TMJ questions

Posted by Pammy @pammyl66, Jun 7, 2015

I clench my teeth at night which has resulted in severe TMJ. I have seen dentist, ortho and medical doctors. I am on Zoloft to help reduce stress and I have a custom mouth guard. My problem is none of this is working. I find if I wear my guard I seem to clench harder, if I don’t my tongue has teeth imprints on the end from pressing against my bottom teeth. I don’t know what to do. This is miserable pain in jaws, neck and ear pain and headaches. My jaw locks up from time to time and my throat even gets sore. Muscles and probably gets scratched because I can’t chew my food properly. Please Help! This has been going on well over 2 years….

@lauriedr

I have had TMJ since I was pre-teen, but not treated until college when my jaw locked up. I have worn a mouthguard for 30 years. About 15 years ago, I began having episodic migraine, which I haven’t had since I was a young teenager. The migraines became daily and chronic 10 years ago. I am now 50. I had to quit work at 40 and am still fighting for disability benefits. For daily migraine, some of which is caused by TMJ, I receive botox, trigger point injections, Rf nerve ablation, counseling, psychiatry, acupuncture, biofeedback, PT, CT Scans, MRIs. I see a specialized dentist and take many supplements, herbs, essential oils. My neuro suggested I see a particular PT, and it has given me 1-2 low-pain days per week! I do daily jaw exercises, and put heat on my jaw, near my ears. I have a ThermaZone machine that provides heat. Cold is not recommended on the jaw joint, but I use the cold setting of ThermaZone on my eyes and forehead for head pain. An MRI recently revealed arthritis in my jaw, as well as lower in my back, along with buldging discs. The jaw arthritis is one of several causes of my migraine, ear pain, jaw pain. My dentist used computer imagery to test my jaw, and half my jaw was doing all the work. Using the computer, he was able to precisely file down ever so slightly problem areas on the tooth surfaces; he evened out my bite and jaw so that both sides worked equally. My neuro prescribed baclofen and tizanidine. The cyclobenzaprine (flexaril) I had been taking apparently doesn’t work above the neck. The PT, heat, and meds worked for a while, but I had to give up my long-term custom mouthguard because, coincidentally, my teeth started rapidly shufting. I now have invisalign braces (traditional braces would have stressed my jaw too much.) I have had to stop wearing my mouthguard, and my jaw hurts now a lot more. But my PT is adjusting treatment, and we are working to get back on track. In 2 years I will have my teeth and jaw re-calibrated by the computer, and I will get a new mouthguard for clenching. I no longer get a 1-2 days/week reprieve from migraine, but in the long-run I should do better. A good habit to develop is to always have your tongue itouching the roof of your mouth at all times, except while eating or talking. Also, try not to have your back teeth touch top-to-bottom, That will help you not clench during the day. Try baclofen and tizanidine to relax your facial muscles. Tizanidine is a strong muscle relaxant that kicks in immediately; instant sleep. It can also cause hallucinations in high doses, so start slow and if you are bothered by side effects, your neuro will help you taper down safely and carefully to a manageable dose. I worked my way up to 4 Tizanidine at bed, then cut back to only 2 pills. I take 2 baclofen pills 4x/day. TMJ does not “go away.” I thought mine had disappeared thanks to the mouth guard, but it simply shifted from facial pain to severe, debilitating head/ear pain. The dentist also did a 360 degree xray, and he also could see the arthritis in the jaw, as well as a stuck, flattened disc. I get botox in my jaw joints now, and a practitioner uses dry needling and e-stim (electric stimulation) in the muscles of my jaw. The dry needling did not work well for me, but with e-stim, my jaw muscles twitch away. They have been frozen for so long, they need help learning to move again. TMD, the new way to refer to what used to be called TMJ, requires many specialists depending on symptoms. I go to a pain clinic, specialized dentist, neuro (who specializes in headache), PT, and practitioner of e-stim. I am on pills for anxiety, depression, muscle relaxants. I take narcotics twice per week, and migraine-specific abortive and preventative drugs. I was told by neuro NOT to see a chiropracter, as there is a risk of stroke when the neck/jaw is involved. The PT focuses on muscles and joints, and gently massages my jaw from the inside and outside of my mouth. She manipulates my head and neck gently with stretches. I wish you all the best. TMD is a serious, debilitating illness, that is not often covered by insurance. I use a combo of medical and dental insurance, plus out-of-pocket expenses. I hope my story helps you.

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Wow, that does not sound fun. Thank you for responding. I am still searching for answers

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It can be a long haul. Good luck finding the right doctors and dentists. If they recommend surgery, think long and hard. Get a second opinion. My niece had such a surgery aftet a sporting accident injured her. It left a large scar that she hides with longer hair, and she did not improve. Avoid opening your mouth wide, maybe dr or dentist can prescribe some meds for cleanings and appointments. Avoid chewy things, like bagels. Cut soft meats into small bites to lessen chewing. Protein shakes and smoothies, soups, are your friend during flare-ups. I wish you a faster journey than my decades-long saga. Peace.

Liked by lauren123

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Thank you for your reply!

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@robinray55

I have this ongoing condition that nobody seems to have an answer for. I have been to an ENT, TMJ Specialist (Dr. K), in Alabama, and have been tested for auto immune diseases and those tests were negative. Dr. K said that I have muscle spasms due to clinching my teeth and he suggested that I wear a special $800 night guard. Dr. B, here in Anniston, made the night guard for me and I have been wearing it since October. I recently saw Dr. K said he did see improvement and I should keep following up with Dr. B. Dr. K did not think that TMJ was causing the symptoms that I have had for approx. 1 year. The night guard helps if I use it during the day, however, it is to bulky to wear all the time. The most annoying symptom is that constantly have a gritty sound and sometimes actually feel like I have sand in my mouth. I don’t have constant jaw pain or headaches. I do have neck and back pain. I live in Anniston, Alabama. If anyone has any suggestions, I would love to hear them. Feeling very Frustrated. Thank you!

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This sounds somewhat like Burning Mouth syndrome. I would check out the Mayo clinic site. I have BMS and TMD/TMJ so they like to “play off each other.” (direct quote from my Pain Med. doctor.)

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@robinray55

I have this ongoing condition that nobody seems to have an answer for. I have been to an ENT, TMJ Specialist (Dr. K), in Alabama, and have been tested for auto immune diseases and those tests were negative. Dr. K said that I have muscle spasms due to clinching my teeth and he suggested that I wear a special $800 night guard. Dr. B, here in Anniston, made the night guard for me and I have been wearing it since October. I recently saw Dr. K said he did see improvement and I should keep following up with Dr. B. Dr. K did not think that TMJ was causing the symptoms that I have had for approx. 1 year. The night guard helps if I use it during the day, however, it is to bulky to wear all the time. The most annoying symptom is that constantly have a gritty sound and sometimes actually feel like I have sand in my mouth. I don’t have constant jaw pain or headaches. I do have neck and back pain. I live in Anniston, Alabama. If anyone has any suggestions, I would love to hear them. Feeling very Frustrated. Thank you!

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Thank you for responding. Do you take any medication ?

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@robinray55

Thank you for your reply!

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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.

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

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@robinray55

Thank you for your reply!

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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!

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@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?

Liked by HazelBlumberg

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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

Liked by Jamie Olson

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@jamienolson

@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?

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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

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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.

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