As an Orofacial Pain specialist, I’ve dedicated my professional career to helping people who suffer from the painful symptoms of TMJ. My daily encounters with patients put me at the cutting edge of the most effective treatments for TMJ, what’s helping patients – and what is not.
In early 2021, I took some time to reflect on the wide variety of patients I’ve been seeing in my practice, particularly those who presented for the first time during the Covid pandemic. I looked at what is causing their symptoms and what strategies of care address the risk factors responsible for their pain.
TMJ symptoms typically include a combination of facial pain, jaw pain, ear pain, ear fullness, difficulty chewing or opening the mouth, headaches, persistent toothaches, and a variety of joint clicking and popping sounds. Any of these symptoms alone could negatively affect the quality of life, but when combined, they can make every day a struggle.
If you’re reading this article, you are (or someone you care about is) probably suffering. You may have already explored some TMJ treatments, as well. The good news is this: most jaw problems that I see are common, familiar, and helpable.
You can get better.
New Insights Into Effective Treatments For TMJ
Ongoing research into jaw problems and Orofacial Pain enables specialists like me to better understand these problems’ neuromuscular and neural character. We’re gaining new insights into how the immune system and brain processing can trigger and influence the pain experience for our patients. As a result, the effective treatments for TMJ we recommend today address a broad range of risk factors that need to be identified and addressed for success to be realized.
With that in mind, effective TMJ treatment can be put in place only when we truly know our patients. Here are some foundational concepts that guide our conversations with patients and the avenues of questioning we commonly explore:
- Healing Is A Process – Not An EventMost jaw problems tend to come on slowly and they resolve slowly, as well. Only when we identify the risk factors that got your jaw into trouble in the first place can the right strategies for effective TMJ treatment can be put into place.I can’t stress this enough: for the healing process to be successful, the patient must be an active participant in treatment. Effective treatments for TMJ take time and require patience.
- Medication Can Be The Culprit
There are two types of medications believed to have an impact on TMJ symptoms:
- SSRI Antidepressants
Regarding SSRIs, in the past few years, I’ve seen more and more patients suffering from jaw problems but have none of the risk factors typically associated with TMJ. Through a process of elimination, I discovered that many of these patients were on an SSRI, the most commonly prescribed type of antidepressant. They include Paxil, Effexor, Prozac, and Lexapro. What stood out to me was this: most of these patients did not have TMJ symptoms before they began the drugs.
- SSRI Antidepressants
By working in conjunction with their prescribing physicians, I have been able to help these patients reduce their TMJ symptoms by lowering dosages or switching to a different medication. If you’re taking an SSRI and are experiencing TMJ problems you never had before, consider speaking to your doctor about the possibility of adjusting your meds.
- Some ADD/ADHD Drugs
Several drugs used to treat ADD/ADHD have also been linked to TMJ. They include amphetamines such as Adderall, Vyvanse, and Dexedrine and methylphenidates such as Ritalin and Concerta.
- Some ADD/ADHD Drugs
These medications increase focus and attention by speeding up brain activity. But because they affect the central nervous system, they can also cause jaw muscle tension and increase the frequency and forces of sleep bruxism (teeth grinding and/or clenching). As a result, muscle and joint pain often emerge.
I see many patients between the ages of 14 and 23 who are on one of these ADD/ADHD medications. They complain of tender and aching jaw muscles and, at times, trouble opening their mouths. By collaborating with their parents and physicians, a better balance is often reached that maintains the goal of the medications and reduces jaw symptoms at the same time.
- Sleep Quality & Quantity
When interviewing a new patient, one of the first questions I ask is this “How are you sleeping?”
That’s because fragmented and poor quality sleep has a negative impact on the body. It can cause increased inflammation, reduced endorphins (the “feel-good” hormones), lowered pain thresholds and decreased response to treatment.
Insomnia or a sleep-related breathing disorder such as obstructive sleep apnea (OSA) can bring on and/or exacerbate TMJ symptoms. While you can find some strategies on the web to manage these problems, you should consider consulting with a sleep specialist. Most will meet with you by telemedicine conference these days.
- Lowered Pain Thresholds
Millions of people suffer from the symptoms of TMJ simply because of the circumstances of their lives. Consistently working long hours, getting too little sleep, and/or dealing with a great deal of daily stress diminishes your ability to cope with pain because your body is perpetually in fight-or-flight mode.
While you’re probably not in a position to change your job or keep your baby from crying all night, there are some things you can do. Meditation, Chinese temple exercises, or Tai Chi for just 30-45 minutes a day can work wonders. These are essential factors in effective treatment for TMJ for my patients.
- Tooth Clenching & Grinding
Many researchers consider some degree of teeth clenching and grinding during sleep as normal behavior but 10- 20% of the population clench and grind to such a degree that it actually disturbs their sleep. All that clenching and grinding causes injury to the jaw muscles and jaw joints. Once injured, they never get a chance to heal.
We have not figured out entirely why so many people brux at night to the degree that symptoms arise, but there are effective treatments for TMJ that can help to a great degree. The treatments are multifaceted and a combination of oral appliances, medications, jaw muscle exercises, breathing exercises, and meditation.
In situations when all first-line therapies fail, Botox injections into the jaw muscles are proving to be an effective treatment for TMJ.
Despite what the industry claims, it’s unclear whether supplements are genuinely effective for pain relief. That being said, some of my patients are convinced that a combination of fish oil and magnesium eases their pain. Some also take turmeric and swear by it.
If you plan to go the supplement route, make sure your physician is aware and involved. It’s essential.
- Food As Medicine
New research indicates that certain foods can reduce nerve sensitivity and inflammation, such as grape seed extract, organic chicken broth, and cocoa in the form of 72% dark chocolate. Because scientific research into supplements for pain reduction is in its infancy, I cannot recommend any specific quantities you should take. A good mantra is moderation.
Note: On their own, these foods have not been proven to be game-changers, but when combined with other effective treatments for TMJ, we do see some promise.
When people deal with extreme chronic pain they tend to breathe fast and shallowly. With each breath, excessive amounts of carbon dioxide are expelled, which increases muscle tension and nerve excitation in the body and makes it difficult to use oxygen effectively. Buteyko breathing, belly breathing, and breathing techniques like those found online on Headspace, Calm, and Buddhify can significantly help reduce pain. Try them!
Finally, if you are ready to start feeling better, it’s critical to educate yourself about your chronic pain – what it is and what is causing it. A good place to start is the app Curable. I also love the daily tips on relaxing your mind and muscles in Quick Calm by Jennifer Wolkin, Ph.D. And my book, Doctor, Why Does My Face Still Ache? is also very helpful.
I’ve been caring for patients with jaw problems for a long time, and what’s clear to me is this: the most effective TMJ treatment for my patients depend upon two factors:
- Taking the time to discover who my patient is as a person, not just as a patient.
- My patient’s full participation in their treatment is critical, all along the way.
There is no good reason you should suffer from persistent jaw, tooth, or face pain for the rest of your life. Today, there are effective treatments for TMJ.
I wish you the best of luck on your journey to healing.
You can get better!
If you live in the New York City metropolitan area and would like to make an appointment with Dr. Tanenbaum, please link here.
Orofacial Pain is the discipline of dentistry that includes the assessment, diagnosis, and treatment of patients with complex chronic orofacial pain and dysfunction disorders, oromotor and jaw behavior disorders, and chronic head and neck pain, as well as the pursuit of knowledge of the underlying pathophysiology and mechanisms of these disorders.