Expert: Susan Tannenbam - 12/13/2007

Question
Hi, I desperately need some advice on how to manage TMJ pain! One of my dentists had me using all these appliances, including a bionator, night guard (which I still use) and an ALF. I stopped trusting him and went to a new ortho who says I should start with physiotherapy. I have to wait until February for my first appointment and I'm wondering what I can do for the pain in the meantime. My jaw pops and clicks and is incredibly sore often. It always gives me a headache in addition to jaw aches which is very frustrating. The other problem is that because of the misalignment of my jaw which is what is causing the TMJ pain, I constantly bite my inner cheek with my back molars. I have a permanent lesion on my cheek that I don't know what to do about. The physiotherapy won't help, the only thing I can see as helping is more appliances. Any advice from your experiences?

Answer
Dear Meredith,
If you live in the NY area i can recommend a good dentist that helped me a lot with my TMJ.  He gave me a hard nightguard which fits over the bottom teeth. I wear it every night.  That's the onlly appliance I use.  I am not familiar with the others you mention.Here is a list of things that helped me A LOT! I was in terrible pain which was in and around the jaw joint muscles, neck, back, teeth and gums.  THe reason some people can get pain in these areas is that the tight muscles, which are caused by clenching, cause pain and the pain can readiate into different areas even tho there is nothing, for example wrong with the teeth/gums; it's just the pain "traveling" into these areas.  This pain can also radiate into the head and cause headaches.  You mention misalignnment of the jaw as the cause of your pain, but I think my  dentist does not believe in this theory, or the use of braces to "correct" the bite.  He says this can make the situation worse and has not been proven to help the pain.  
Here's my list of things that helped me a lot.
l. any aerobic exercise increases endorphins and helps all pain in the body.
2. Try to relax - I used meditation and relaxation tapes.  Pain feeds on anxiety and it just makes everything worse.  If you relax for a few moments you will realize the pain lets up.  Sounds simple - but it is so true. try it!
3.To help loosen up those tight muscles in the neck ( tight muscles in this area occur with almost everyone with TMJ because of the clenching), move the head to one side, hold, feel a slight stretch, then to the other side.  Also, there are books in the library that describe exercises for TMJ which are very helpful.  I picked out a few because it's impossible to do all of them every day - and it helped a lot.
4. acupuncture - It took me awhile to find a good one, but once you find someone good - it is worth it - helps tremendously with TMJ pain.
5. my dentist gave me TMJ gel.  It numbs the pain on the facial area.  You can get OTC numbing gel for arthritis which does the same.
6. I used the Alpha-Stim 100.  THey should still have a website.  It's a little device that is great for pain.  You need an Rx to get it - just ask your family doctor.  It is expensive, but really helps break the pain cycle.
7. When you do physical therapy, I found the BEST thing was the ultrasound.  It really eased up all my pain.
If you can get to NY, just for a consultation with my dentist, i really recommend it.  it is difficult to find a good practitioner for this (at least in my experience.  Let me know if you would like his name.
Don't fret too much about this - it's really not that big a deal.  Once you loosen up those tight muscles by relaxing, etc., the pain will go away, but if you get all nervous, the pain could increase.
Good Luck.
Susan