Expert: Susan Tannenbam - 2/15/2004

Question
I have had problems related to TMJ dysfunction for years. Before I knew that TMJ was a large factor in my neck pain and headaches, I received physical therapy, went to a chiropractor, and a masseuse. I've tried special pillows.  Some things offered temporary relief, but since I clench so tightly at night, the relaxation achieved during the day is lost. A night splint made by my dentist did not work.  Are there any devices you know of that might help? Thanks Pam

Answer
Dear Pam:  Here are things I did to treat my TMJ, that you might want to try.
l. aerobic exercise - treadmill, or anything aerobic is great for any kind of pain, as it releases endorphins which help pain in the body.
2. My nightguard (splint) is hard, and fits over the bottom of my teeth.  It was made by my dentist who also treats TMJ and is (or was) the head of the NYU Dental School, dept. of TMJ.  It's called the NYU nightguard and it helped me tremendously.  I found the soft kind ineffective.
3. Jaw Exercises:
  l.Open wide and hold, repeat.  This stretches the tight muscles.  Tight muscles occur when you clench.
 2.Hold head to one side, as if trying to reach your shoulder, hold one minute.  Repeat on the other side.
this also is great for stretching the muscles that are tight.
 3. Press, with the knuckle of your finger, or a very blunt object, right into the pain in the muscle area that hurts on the side of the face or jaw (but not into the jaw joint).  Hold, and release.  This helps break up the tightness also.
The above should be done as much as possible during the day until you get relief, then they don't have to be done as often.
4.The "alpha-stim 100"  pain device helped me tremendously.  You can order it on alpha-stim.com.  It was OKd to me  by a pain doctor.  It's expensive but well worth the price.  If you need to hear exactly how I used it, please let me know.  It does come with instructions, too.
5.Accupuncture helped me SO MUCH.  You might have to "shop around" and try a few practitioners before you find one that's good, but it's worth it.  MD's that practice accupuncture, I heard, are usually very good .
6.Relaxation "sessions" when you sit quietly and relax all your facial, jaw, neck, shoulder, etc. muscles.  It's also very important NEVER TO PANIC about the pain, as pain FEEDS on PANIC and ANXIETY.  You must train yourself to do the opposite of your instincts (which is for everyone, to panic and tense up and feel like you'll never get better), and really relax and tell yourself that this will all pass. When I did this, it lessened the stress and fear I had about hte pain, and gradually the pain did go away.
7.Medications:  You need to speak with your doctor about this.  I took (and still do occasionally, when needed,) a muscle relaxant. Anti-depressants are very good at relieving pain, and can be used for it.  They stop the cycle of pain, and you don't have to be on them forever.
8.TMJ "gel" and pads:  you need a prescription for these which are applied topically.
9.NEVER eat bagels, and NEVER EVER chew gum, EVER AGAIN.  Until the pain subsides, avoid hard food.  Most food is soft, so this is not difficult to do.
10.Physical therapy:  It is difficult to find a therapist that is really good at this, and it took me awhile. A good resource is to contact a dental school if they have a TMJ Department.  Ultrasound helped me the most b ut it can't be done continuously.  Wet heat is good also, although some pp recommend ice applications.  Experiment with both, to see which is best for you.
11.I found a great dentist that treats TMJ who is  (or was) the head of the TMJ dept. of a dental school (did  I already say this?). I went through several dentists and nightguards (splints) before I got relief with the one this dentist made for me.
He  also checks on me every six months, and gives you ultrasound, and wet heat therapy, and information about what to do, etc. He's wonderful.  You might want to try to find someone like this.  He's in NY and I can give you the name if you want, but I don't know if you live in NY.
I hope this helps.  Don't hesitate to contact me any time if you have any questions.

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