Expert: Susan Tannenbam - 7/8/2007

Question
QUESTION: Hi

My name is laura and am a teenager. I have had ear pain for the past 2/3 years and the doctors told me this year that i have bad TMJ. They tmj doctor gave me a night gard. I tryed it for 1 month, but it only made things worse. Then i tried pysio-- but once again- it made it even more pain ful. My TMJ problem is a big pain in the butt. I get really bad pain that starts in my ear and go's right down. I can only open my mouth under 3 cm's. I sucks so much and i cry over this alot. I have been to lots of doctors but None of them help. Please give me any advise you can.
thanks
laura

ANSWER: Dear Laura,
I also had bad pain from TMJ.  Sometimes the pain can even go into the teeth which a lot of dentists are unaware of and therefore they perform unnecessary root canals or extractions when there is nothing wrong with the teeth.  You should just be aware of this in case you get tooth pain.

A nightguard is a must!  IT will protect your teeth.  Make sure you have a hard one, not a soft one, as soft ones encourage more clenching.  Mine fits over the bottom teeth.  IT's very comfortable and I must wear it every night.

I found that the best thing for alleviating the pain is ultrasound.  A physical therapist and also my dentist administered it to me.  

I also got great relief from acupuncture.  I t took me a little time to find a good acupuncturist but when I did, it was worth it, as after just a few sessions, I was pain free for a very long time.  I don't know how it works but I just know that it was great.  IF you live in the NY area I can recommend someone to you.  Let me know.  I can also recommend a very good dentist that deals with a lot of TMJ .  He helps me a lot.  

I never eat very hard food such as bagels (NEVER!), gum (NEVER!) and very chewy bread.  Most other food is fine.
Exercise increases endorphin production which is great for lessening any kind of pain in the body, so if you can find an enjoyable exercise to do, you should really try doing it on a regular basis.  It sounds simple but really, it DOES work..
If you live near a dental school that has a TMJ department, or a hospital that has a TMJ department, you can try going there.  That's how I found my "TMJ" dentist....he is the head of the TMJ department of NYU DEntal School.  

THere are some exercises that used to do (i don't have to do them anymore) that gently stretch the neck and jaw muscles.  
l.  open wide (but first check wtih your dentist - you don't want the jaw to lock up), hold, feel the stretch, close. Repeat.
2. Hold neck to one side, feel a gentle stretch, hold, do the other side.
Apply wet heat the jaw and cheek muscles - this helps to loosen up the tightness that occurs when you clench.

A word about the nightguard:  you should not stop using it.  I use mine every night.  It helps distribute the pressure evenly all around, and this alleviates the pain.  

I had gotten relief, when the pain used to be bad, from prescription muscle relaxants.  They can be used temporarily and are very effectibe in loosening up those tight muscles.  (all the tight muscles can cause the pain you are describing. Pain from tight muscles can REFER into the ear and also other areas)
Hope this helps.  Let me know if I can be of further help.  This thing can be solved, so hang in there.  I had it really bad, and now I'm fine.


---------- FOLLOW-UP ----------

QUESTION: Hello again

Thanks for all of your advise.

But i did have another question for you. As you were talking about the exersies that you used to do- my problem with the opening the mouth one is that my mouth can't even open 3 cm's. And when i open it for more then 10 seconds at a time, i get really bad pain for days after that. That was one of the reasons i had to stop going to physio. I know how you said i need to wear the nightguard- but after wearing it for 1 month- i got so much pain. We went to the doctors where i got it from and they re-fitted it but that didn;t help. Do you still think i should wear it if it causes very bad pain (10/10 pain)

thanks
laura
ANSWER: Laura,
I am not a dentist as you know, so I  can only help you as far as my own experience with TMJ.  I wonder if you have tried a muscle relaxant (prescription).  Maybe it would help you open your mouth wider.  ALso, wet heat and massage is good for loosening up the muscles.  My nightguard fits on the bottom and it is hard.  I hope you don't have a soft one because I know that can make things worse.
 If you are not in the New York area, even if you can just make a trip to see the dentist that helps me so much and is so good at treating TMJ, it would really be worth it.  I'm sure he would know what to do for you.  HIs name is Barry Rozenberg, DDS.  516-791-4000.  Maybe he could give you a consult over the phone.  IT is very difficult to get someone good for this condition.  I know, as it took me a long time to find Dr. R.  You should not be having this problem and not be getting the right help and I know this dentist can help you (he is the head of TMJ Dept. at NYU DEntal School, but he has his own private practice.)
Hope this helps.
Susan

---------- FOLLOW-UP ----------

QUESTION: hello once again

i don;t know what to do- over the past 24hours my tmj pain has got extremly bad!! it hurts to talk and eat. It really sucks. I don't think my parents really believe how bad it hurts. Please give me any advice you can to help me!
i don't know how much longer i can live with the pain!!

laura

Answer
Laura,
Can you get to the dentist I recommended in my last reply to you?  You can tell your parents that I am an adult and have had TMJ and it is can be very painful.  Maybe you could get a consult over the phone with Dr. R (5l6 791-4000) (see the last time I replied to you).  IT would really be worth it.  In the meantime, you can take some advil, but not for too long a period of time, as long time use of these types of pain killers can make the pain worse.  I hope you are wearing a hard nightguard as i explained last time.  Also, ultrasound which can be administered by a PT (Dr. R. also does this) is an excellent pain reliever.
Let me knowif you can get to talk or see Dr. R.
Good luck.
Susan