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….

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

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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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@lauren123

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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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?

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@trixie1

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?

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@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.

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@trixie1

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?

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@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?

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@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. I too was diagnosed with TMJ in my 20s because my jaw locked up a few times while just talking and eating. I did go to the dentist but nothing in particular worked except learning biofeedback and rubbing the jaw. I’m now 67 and my dentist fitted me with a mouth guard on my lower teeth I was told I should contemplate wearing it throughout the day. I haven’t tried this yet but after my last visit he informed me that my jaw has now become arthritic thus the nagging ear and neck pain. I was on all types of meds in my 30 and 40s but including gabapentin and 200 mg of celebrex which gave me GERD. So Tylenol is the one of the only meds I take now along with 100 mg of celebrex and intermittent flexaril to relieve the muscle spasms in my shoulders and ultimately jaw. I don’t know if any other methods to alleviate the pain so hope it doesn’t get any worse. I know I’m kidding myself. God bless and I pray we find something that will help the pain and osteo degenerative process.

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Hi @lustarr and all…. just a quick note as noticed this just now: I have had TMJ/TMD over the years and then my adult daughter got it. Both had night guards made but I cant wear one… anyway, long story short, both she and I are on/were on Zoloft for over 15 years and I just wanted to cut and paste one article re Zoloft and other antidepressants and TMJ if that is OK. You could do a search too … this was just the first result I got. She is still on Zoloft and is getting by with night guard. I am now off Zoloft and having lots of jaw and ear pain, tinnitus etc. too long to repeat here; recently at a new dentist, he felt my jaw when mouth open and shut and said: great, jaw is moving nice and smooth? What???? Well then my pain in that area is from something else then..here we go again! J. p.s. Hope this may help someone somewhere if applies.

Paste:
Drug-induced TMD:

In the last few years, research has shown that Selective Serotonin Reuptake Inhibitor (SSRI) medications such as Prozac, Paxil, Zoloft, and Celexa may cause clenching and grinding of the teeth in patients who have never done this before and will increase these behaviors (both frequency and intensity) in those known to clench or grind their teeth.

This side effect is relatively unknown to physicians, although we continue to educate them when we can. If your jaw pain / headache symptoms started a few weeks to a month or two after you started taking one of these medications, we would suggest you alert your physician to this, as the symptoms could well be related to the drugs.

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@lacy2

Hi @lustarr and all…. just a quick note as noticed this just now: I have had TMJ/TMD over the years and then my adult daughter got it. Both had night guards made but I cant wear one… anyway, long story short, both she and I are on/were on Zoloft for over 15 years and I just wanted to cut and paste one article re Zoloft and other antidepressants and TMJ if that is OK. You could do a search too … this was just the first result I got. She is still on Zoloft and is getting by with night guard. I am now off Zoloft and having lots of jaw and ear pain, tinnitus etc. too long to repeat here; recently at a new dentist, he felt my jaw when mouth open and shut and said: great, jaw is moving nice and smooth? What???? Well then my pain in that area is from something else then..here we go again! J. p.s. Hope this may help someone somewhere if applies.

Paste:
Drug-induced TMD:

In the last few years, research has shown that Selective Serotonin Reuptake Inhibitor (SSRI) medications such as Prozac, Paxil, Zoloft, and Celexa may cause clenching and grinding of the teeth in patients who have never done this before and will increase these behaviors (both frequency and intensity) in those known to clench or grind their teeth.

This side effect is relatively unknown to physicians, although we continue to educate them when we can. If your jaw pain / headache symptoms started a few weeks to a month or two after you started taking one of these medications, we would suggest you alert your physician to this, as the symptoms could well be related to the drugs.

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Wow. I was on Zoloft fir about 20 years and weaned myself off the drug over 5 years ago. I take Wellbutrin generic now. I’ll definitely talk with my physician about this when I see her next month. Thank you for your information.

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…I feel like I am the bearer of bad news many times, although I am looking for answers and do try and offer help where I can: my new family doctor did not believe I was on Zoloft for 15 to 20 years , along with Clonazepam/Rivotril/Klonopin same things I think: anyway, since he left town I have found "proof"…years ago we didnt get copies of tests or doctor's file but I do now, thing is I now have too much!

anyway , may I respectfully suggest , as you have been on Zoloft for so long , that you also check with your optometrist? I could "cut and past" but there is plenty of info about it on Internet: saying that Zoloft "MAY" lead to narrow angle closure Glaucoma – which is what was diagnosed with, and I have no proof it was the Zoloft but its there in black and white that it is a possibility.

I think maybe third time I have said it on here (apologies) but feel so strongly about it: when having yearly eye exam to ask for eye pressure to be taken (its painless and fast) and also have a "field of vision" test which is also short and easy where you look into a darkened box and click a button when you see a little light….they are checking peripheral vision, and I was told by the Specialist (top of department) that the field of vision test is super important in diagnoses of Glaucoma … even my youngest adult daughter, her optometrist doesn't do this and "should."

Not negating the success of anti-depressants, and my other daughter also has been on Zoloft 20 years , but they have different side effects on different people/short term or long ter. This "specialist" also was asked by my Pharmacist if I could take Wellbutrin and the Specialist wrote back NO – not until I had an Iridotomy laser to eyes, which I did few years later. But, please, not tyrying to frighten you, but its because I ALREADY HAD NARROW ANGLE GLAUCOMA yet doctors were still prescribing eye pressure raising medications, saying, oh its OK… it isn't OK and I still have to be wary. I think if I was younger and could afford a lawyer…. well, I am not and I cant…. I might have pursued. I lived with the stress of not even being able to take Steroid nose drops, anti depressants, even some mundane meds just because they raise eye pressure once I was advise my vision was at risk, and then my family wonders why I was anxious for so long. However, some people can take just about any meds and no side effects: how fortunate they are! J.

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@lustarr

Wow. I too was diagnosed with TMJ in my 20s because my jaw locked up a few times while just talking and eating. I did go to the dentist but nothing in particular worked except learning biofeedback and rubbing the jaw. I’m now 67 and my dentist fitted me with a mouth guard on my lower teeth I was told I should contemplate wearing it throughout the day. I haven’t tried this yet but after my last visit he informed me that my jaw has now become arthritic thus the nagging ear and neck pain. I was on all types of meds in my 30 and 40s but including gabapentin and 200 mg of celebrex which gave me GERD. So Tylenol is the one of the only meds I take now along with 100 mg of celebrex and intermittent flexaril to relieve the muscle spasms in my shoulders and ultimately jaw. I don’t know if any other methods to alleviate the pain so hope it doesn’t get any worse. I know I’m kidding myself. God bless and I pray we find something that will help the pain and osteo degenerative process.

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@lustarr Welcome to Mayo Clinic Connect, a place to give and get support.

You've had this issue for a long time and I'm sure you have a lot of information and support to give.

It sounds like you have successfully explored many pain management options.

May I ask how you were able to navigate the system so well? Did your dentist send you to these treatments?

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After I was diagnosed with TMJ and was referred to a dentist to make a splint for my mouth, I got burning mouth syndrome. The oral surgeon thought I was just alergic to the acrylic splint. I could not wear a splint for several months. However, after many different doctor visits, that the burning mouth was triggered by anxiety. My doctor first prescribed Zoloft and I tried for only a few days and I was clenching my teeth harder. I quit that and my doctor tried me on Paxil….same thing. We settled on buspar but it doesn't really completely get rid of my anxiety. So I still get burning mouth but am able to sleep with the splint at night. My question is that my jar is still not right and would like to know if anyone has gotten TMJ surgery?

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