Can Acupuncture Help with Your TMJ Pain?

Drugs are hardly the only solution when it comes to TMJ pain. Take acupuncture, for instance.

New research in the Journal of Acupuncture and Meridian Studies offers some new evidence that the therapy may provide at least temporary relief from TMJ problems by rebalancing the energy (Qi) along the meridians.

The temporomandibular joint, or TMJ, is a hinge for your jaw. There’s one on each side of your head. Injury, misalignment, and behaviors like bruxing can damage these joints and adjacent structures and cause them to work incorrectly.

Here’s how the TMJ functions normally:

Here’s how it looks in one type of dysfunction:

TMD can lead to ongoing problems with headaches and pain in the jaws, face, neck, and shoulders. You may have ringing in your ears or other hearing issues. You may feel toothache-like pain. You may have popping, clicking, or grating sounds when you chew. It can become hard to even open your mouth.

Suffice it to say, TMD is no fun.

But back to the study, in which 43 TMJ patients were separated into two groups. For four weeks, one group was treated with traditional acupuncture; the other, with sham acupuncture (no needle penetration). Meridian assessments were taken before and after each session.

acupuncture diagram of headInterestingly, both groups experienced less pain. Both groups experienced a decrease in Yang energy.

But only those who received real acupuncture maintained Yin energy levels over the course of the study. They were also more able to open their mouths on their own without pain.

According to Traditional Chinese Medicine (TCM), Yin and Yang energies must be balanced to maintain good health.

Increasingly, the medical establishment is accepting acupuncture as a valid treatment for various forms of pain. In fact, earlier this year, the FDA gave it a preliminary endorsement for pain management.

On a similar note, the Joint Commission – a major medical accreditor – also now recognizes acupuncture as an effective stand-alone or combination treatment for TMD. According to commentary in Integrative Medicine: A Clinician’s Journal, this turnaround provides great opportunities for integrative pain treatment.

[Integrative clinicians can] use it to convince naysayers by showing them that the evidence behind these services and practitioners in pain treatment has been prevetted by a conservative organization that serves as medicine’s police force. Notably, the pharmacologic approaches are appropriately—if only for alphabetical reasons—listed prior to pharmaceuticals. Clearly these typically more high-touch, time-, and human-intensive approaches are not relegated to the past role of if all else fails, try acupuncture.

Of course, there are other therapies that can help, as well, in providing long-term relief from TMJ problems without drugs and without surgery. The key, as ever, is to identify the cause and address that through treatment suited to that specific cause. In some cases, that might be appliance therapy; in others, DTR; in others, neural prolotherapy.

One size seldom fits all.

Image by Mot

Save

Save

Guest Post: Dental Ozone Is for More Than Just Fighting Pathogens

Our thanks to the office of St. Louis biological dentist Dr. Michael Rehme for letting us share this post from their blog. The original is here.

ozone moleculeWhen you hear about ozone in dentistry, it’s usually about its power to fight infection. That power comes courtesy of a third oxygen atom that turns “breathing” oxygen (O2) into ozone (O3). This makes the molecule unstable. It really wants to lose that extra atom and become “regular” oxygen once again.

That instability is what makes it such a powerful antimicrobial. That third atom readily attaches to bacteria, viruses, fungi, and parasites, interfering with their function. Ozone also stimulates oxygen metabolism and activates the immune system, further defending against harmful microorganisms.

So ozone is ideal for treating infectious conditions such as gum disease and dental caries (tooth decay). It’s also used to support healing from dental surgery and preparing teeth for restorations.

What you don’t hear about so much in dentistry is ozone for treating pain, such as from tooth sensitivity or TMJ disorders. Yet here, too, it may have a role to play.

A new study in the Journal of Oral Rehabilitation focuses on this – in particular, treating chronic pain in the chewing muscles. The trial compared treatment results between two groups of women, one that received ozone therapy, one that received sham ozone as a placebo.

Both groups experienced improvements, actually.

However, the study hypothesis that bio-oxidative ozone application to the sites of most severe pain would produce better results than sham bio-oxidative ozone application at predetermined points was supported. Bio-oxidative ozone application appeared to be superior to sham bio-oxidative ozone application and differences were significant. [emphasis added]

Pain intensity went down and patients’ pressure pain thresholds went up. They also experienced ”significantly better results” with respect to their ability to move their jaw compared to the placebo group.

masseter muscleThe follows earlier research suggesting that ozone may be more effective than drugs for treating TMJ pain. In one such study, 87% of patients receiving ozone therapy either improved or recovered completely. Only about a third of the patients in the drug group showed improvement, and none recovered completely.

Why should ozone help with pain? Dr. Frank Shallenberger, among others, has suggested that chronic pain results from a lack of oxygen utilization. “Reverse this,” he says, “and an area of chronic pain will become normal again. Reverse this, and an area of chronic degeneration will begin to regenerate exactly as it was supposed to in the first place.”

Cells need oxygen to heal. Ozone stimulates the healing response.

This makes it even more valuable to dentistry – and medicine – than ever. Powerful. Effective. Non-invasive. Safe. What more could you ask for in a treatment?

Masseter image by Anatomography

Finding Long-Term Solutions for TMJ Disorders

woman touching cheek in painAnywhere from 5 to 12% of the US population has TMJ disorder (TMD) – that is, a problem with the temporomandibular joints that allow your jaw to open and close.

Typical symptoms include clicking or popping sounds when you move your jaw, pain or tenderness in your face or around the joints, headaches, pain through your neck and shoulders, ringing in your ears or other hearing problems, and even toothaches.

In other words, it’s no fun – not just the discomfort but the drag it can be on everyday activities and your quality of life overall.

And there’s no one cause for it either. Bruxing – the habitual clenching, grinding, and gnashing of teeth, often during sleep – is a common culprit as it can damage the joint over time. Sometimes malocclusion – a misaligned bite – plays the lead role. Other causes include injury to the jaw, joint, or facial muscles, and arthritis.

Despite this, treatment of TMD can often seem monolithic, relying heavily on appliances such as splints used to stabilize the bite and prevent bruxing. They allow the muscles and ligaments to relax, as well as protect the teeth from the pressure of constant biting.

In the short term, stabilizing splints can be a big help, but according to a new review in PLoS ONE, they may not be any more effective than other therapies in the long run. As Dr. Bicuspid summarized,

In their analysis, the researchers found that the stabilization splint significantly reduced pain in the short term (less than three months). These results remained for the pooled results of 10 studies conducted on pain with TMDs of muscular origin. They also found that the stabilization splint was significantly more effective than the nonoccluding splint, while they found no difference between the stabilization splint and occlusal oral appliances.

“This indicates that patients with TMDs besides stabilization splint may benefit from other occlusal appliances in reducing symptoms of TMDs,” the authors wrote.

In addition, the researchers found that the stabilization splint was significantly more effective at reducing pain intensity in the short term. This was the case for TMDs of muscular origin examined in six studies as well.

However, they found no difference in pain reduction or pain intensity between the stabilization splint and other treatments for the longer term (three months or longer).

The results indicated a significant decrease in muscle tenderness with the stabilization splint in the short term, according to the authors. Maximum mouth opening also improved only in the short term. The effect of the splint was greater in patients who used it for 24 hours compared with those who used it only at night.

Fortunately, there are far more options available – options beyond appliance therapy. One new treatment that our patients have had consistent success with is the Disclusion Time Reduction (DTR), a computer-guided therapy that lets us reduce friction between the back teeth during chewing – the friction that causes clenching and grinding, leading to the kinds of TMJ symptoms listed above.

It’s treating the cause, not just the symptoms. And no appliances are necessary with DTR.

And in cases where appliance therapy does appear to be the best way to go, there are lots of options there, too, for reducing pressure on your jaw joints and finding relief. Coupled with lifestyle improvements – sleep, nutrition/diet, stress management, and the like – long term solutions are available to you.

An Irregular Bite Can Affect Your Posture and Balance

cranial motionIf you have gaps between your teeth, crowded teeth, tooth wear, or missing teeth, it may be more than just a cosmetic issue. These things can affect how your teeth come together when you close your mouth – your occlusion.

Malocclusion – a bad bite – has its consequences, too.

Two recent studies indicate that when your dental occlusion is off, your posture and balance may be, too. Instability in balance and postural control may leave you at risk of falls or other injuries.

For the first study, published in Motor Control, researchers monitored dental occlusion and stability in 25 participants. They found that it’s likely that sensory information linked to the dental occlusion for balance comes strongly into effect if unstable conditions, such as malocclusion, are present.

The second study, published in Neuroscience Letters, considered the type of dental occlusion, control of posture, and physical fatigue in 10 physically active participants to determine if a relationship existed among any of these factors. The authors concluded that malocclusions had a greater negative impact when subjects were fatigued. When corrected, balance improved.

In our day to day life most of us don’t notice or associate dental occlusion relationship with posture and balance. But these studies indicate it may be a factor not only in in athletic performance and injuries, but also in the prevention of injuries in the general population.

When an irregular bite decreases postural control, the risk of falls and injuries such as sprains, strains, and fractures is increased. Fatigue appears to just make things worse and further decrease motor system response.

Researchers point out that postural control is the result of a complex system that gathers sensory and motor information from visual, somatosensory, and vestibular (inner ear) input.

The set of organs and tissues that allow us to eat, talk, chew, swallow, and smile – the stomatognathic system – and its effect on posture control has been the subject of increasing scientific interest. Specifically, research continues to explore the reciprocal influence between the trigeminal nerve and the vestibular nucleus that allow us to chew and control the muscles involved in the chewing function and of the neck.

While the studies stop short of saying correcting an irregular bite will improve balance and posture, we do know if you are experiencing head, neck, jaw pain, or postural issues, malocclusion is a likely component. But that doesn’t necessarily mean orthodontics are necessarily the answer.

In many instances, dental appliance therapy may offer the least invasive technique to correct postural and muscle irregularities that may be contributing to discomfort.

Image via Starecta

A Crooked Smile Can Be More Than Just a Cosmetic Concern

crooked smileMany people have insecurities when it comes to their teeth. Some opt for cosmetic dentistry to get the aesthetics they desire. Others learn to embrace their difference.

In a recent post over at Bustle, one writer told her story of coming to acceptance.

Thanks to my tiny mouth, my teeth had a tendency to crowd and overlap. I also have a crossbite, which causes the right side of my teeth to land in my cheek and create the occasional sore and scar. Two of my adult teeth even started growing in before their respective baby teeth fell out. For a 10-year-old who already had huge body image issues, this only made life more difficult. My aunt’s rude comments about how I should get my snaggle teeth pulled out didn’t do much to better the situation. And my parents, seemingly unaware of the option to help me build a better and more loving relationship with myself, encouraged me to get braces because only then could I feel happy with how I looked.

So she saw an orthodontist. The doctor recommended a two-year course of braces and plastic surgery to even out her jaw. She writes,

The body negativity of the experience, plus the promise of plenty of headaches from the braces (I already had chronic migraines at the time), really made me think twice about my priorities. I was dissatisfied with my teeth, sure, but sealing that feeling with a permanent decision felt harmful to me, and made me begin to consider other ways to go about addressing my feelings.

That kind of process of discovery and movement toward self-acceptance is important. Just as important is weighing any potential treatment against your priorities, values, and goals. And a crooked smile is not necessarily an unhealthy smile.

Yet the mention of a crossbite and migraines raises an issue that the writer seems to overlook. While it’s true that orthodontics can increase the likelihood of headaches, so can a misaligned bite.

Few people have perfectly aligned teeth. Upper and lower jaws might be different sizes, causing distortion in the bite. Some teeth may crowd and overlap. Some may be crooked. Even dental restorations such as crowns and fillings can cause bite problems.

One common problem that can arise is temporomandibular dysfunction (TMD), or dysfunction of the TM joints, a/k/a the “hinge” that lets your mouth open and close. Add habits like clenching and grinding (bruxing), and you have a recipe for more than just headaches. There can be face, neck, shoulder, and back pain. There can be chronic dizziness. Ringing in the ears.

In our office, the doctors use a process called TruDenta to make a holistic assessment, beginning with your migraine and headache history. T-scan technology lets them detect imbalances in the jaw. Range of motion analysis and muscle testing help determine trigger points that may refer pain.

This helps them understand all the factors that may be contributing to your headaches so they can make a proper diagnosis and treatment recommendations. We may use oral appliances to take pressure off the jaw joints, help the jaw line up in a neutral position or reposition the tongue to sit more forward in the mouth. We may recommend herbs, nutritional supplements or homeopathics.

As ever, the best treatment is treatment customized to each patient’s unique oral health situation and needs. Sometimes the best treatment can be no treatment at all.

But if you’re experiencing migraines, chronic headaches, or other head pain, it’s worth consulting with a good dentist well-versed in these issues. Sometimes crooked teeth or a misaligned bite are about far more than just appearance.

Image by Mikal Marquez

Is It Really a Toothache? Is It Something More?

In 2013, Sunil Mangal began experiencing terrible pain in his jaw. Excruciating pain. Pain that kept him from eating. Pain that made him think of ending his life. Wanting to help, his dentist extracted one tooth, then another, then another…11 extractions in all, according to the Hindustan Times.

trigeminal nerveRelief came only after Mangal was finally diagnosed correctly with trigeminal neuralgia (TN) and treated for this neuropathic condition that’s been described as triggering “the worst pain known to mankind.” The condition involves dysfunction in the trigeminal nerve – the largest nerve in the head, responsible for facial sensation and functions like biting and chewing.

Think of how different these past couple years of Mangal’s life would have been if he’d been correctly diagnosed at the start. Others – such as the physician profiled in this piece from the BBC – have suffered even longer.

Yet truth be told, TN is notoriously easy to misdiagnose – often as tooth pain or migraines. The initial pain is typically sudden, severe and shock-like or stabbing. The lingering pain is a deep, dull ache. Even light stimulation can trigger an episode, which usually occurs on just one side of the face. The frequency of attacks can vary a lot – from a few times a month to several times a day.

It’s hardly surprising that TN can make a person feel mentally bad, as well. According to a recent study published the Journal of Headache Pain, TN and psychological disorders often occur together. Comparing data from more than 3000 TN patients with 13,000 non-TN individuals, the authors found that depression, anxiety and sleep disorders were far more common among the TN group.

In fact, they suggested, TN might increase the risk of developing one of these conditions. This may be due to a decrease in neurotransmitters, which regulate how messages are conveyed throughout the body. Chronic inflammation may play a role, as well.

Overall, though, the specific cause of TN remains unclear. There’s no consensus on its origin. MS, some brain tumors and even aneurysms may cause similar pain. Many think it’s caused by pressure from blood vessels near the nerve root; others, by the nerve losing its protective myelin sheath, which causes the nerve to painfully misfire. We’ve seen patients whose TN started after a root canal, extraction or even routine tooth cleaning. It can flare after periods of extreme stress or physical trauma.

Fortunately, pharmaceutical drugs and surgery are not the only options for relief. We strive to help our patients with nontoxic therapies. We may use herbs, nutritional supplements and homeopathics. We may use oral appliances to take pressure off the jaw joints, help the jaw line up in a neutral position or reposition the tongue to sit more forward in the mouth. We may use Neural Prototherapy, in which a series of subcutaneous injections is given to help with inflammation and restore the nerve to normal function over time.

One noninvasive approach we’ve had great success uses Dr. Yoshiaki Omura’s Bi-Digital O-Ring Test to identify pathological organisms in and around the nerve, which can then be treated to alleviate pain.

If you’re experiencing face, jaw, head or neck pain, talk with your dentist – or find a dentist well-versed and skilled in the diagnosis and treatment of this type of pain. Whether it turns out to be TN or something else, there are safe and effective solutions waiting for you.

What’s Going on in Your Head?

man with headacheHeadaches are never any fun – especially when they’re chronic (ongoing, recurring). That’s the case for about a quarter of the 12 million Americans who seek medical help for their headaches each year.

And according to a new study in the Journal of General Internal Medicine, more patients are asking for more and more tests, from CAT scans to MRIs, to try to pinpoint the issue.

Are these helpful? Necessary? Not always. Sometimes a lifestyle change can be enough.

Examining trends in headache management, the authors found that clinics are often rushing to perform unneeded tests at the patient’s request instead offering lifestyle counseling first – “contrary to numerous guidelines.” Indeed, there are numerous triggers for migraines and other head pain, including poor diet, too much sugar, alcohol, sleep problems, stress and a sedentary lifestyle. Often, multiple triggers can be in play.

As lead author Dr. John Mafi told NPR,

“Patients are more assertive than ever before….They do research online, are more informed and sometimes go to the doctor demanding, ‘I think I need an MRI.’ ”

And while an informed patient is a good thing, Mafi says sometimes the patient gets it wrong. “I think there’s a subconscious perception that more is better, and that fancier, more expensive tests are better and that equals better care.”

And it’s not just the waste of money, time and resources that’s of concern here. There are medical risks, as well. For instance, excessive exposure to radiation via things like CT scans may raise your risk of certain cancers. And just recently, radiology experts voiced concerns about the safety of some of the drugs used to improve MRI imaging.

Those are pretty considerable risks when simple changes in eating, sleeping or other habits may be enough.

They also may overlook one very common source of head, face, jaw and neck pain: dental conditions. Things like TMJ disorders, bruxing and malocclusion (teeth not coming together properly) are all common headache triggers, as well. According to the American Academy of Craniofacial Pain, even minor problems can lead to a cascade of ill effects:

Your head weighs approximately 15 pounds – the weight of an average bowling ball! Imagine your head as a baseball balanced on top of a pencil by a number of rubber bands. When muscles are tense, they shorten. Now imagine shortening just one of those rubber bands. Some rubber bands would stretch, some would shorten, and the baseball would be thrown off kilter! Similarly, when even a single jaw, neck, or shoulder muscle becomes shortened, all of the other muscles are forced to overwork to keep the head balanced on top of the spinal column. We see then that dental headaches originate from an unstable bite which cause the muscles of the jaw, head, and neck to overwork and become painful. Once the muscles become painful, a vicious cycle begins.

In addition, temporomandibular disorders may also cause pain in your neck and shoulders and cause ringing in your ears, as well as clicking in or locking of your jaw.

Another condition, trigeminal neuralgia, results in piercing, sudden pain that may occur without warning and mimics the symptoms of a migraine. Traditional treatment often involves heavy medications – and their negative side effects. Sometimes surgery is ordered, which carries its own risks. Fortunately, these aren’t your only options.

When a patient comes to us complaining of headaches or TN-like pain, we start by looking beyond their pain pattern and history. We consider diet, sleep patterns and how the chewing muscles are working. Has trauma triggered inflammation of the nerve? Has the nerve become compressed? Has it been stripped of its myelin sheath?

The fundamental question: What can we do to help alleviate your pain safely and effectively, without drugs or other short-term solutions that do little more than suppress symptoms? The least invasive, long-term solution is what we desire for our patients.

If you are experiencing chronic headaches and suspect your dental conditions may have something to do with it, give us a call to discuss your options. We’re always happy to answer any questions you may have. If you’re outside the Dallas area and need to find a biological dentist closer to home, all three of the main professional associations have online directories available:

Image by Lisa Brewster

5 Signs It May Be a TMJ Disorder Giving You Headaches

Nearly everyone sometimes experiences a throbbing headache that interferes with concentration at work or school, or saps the joy from the day.

For many people, the pain that emanates from the head can be traced back to their teeth, their bite relationship and the alignment of the lower jaw.

“Pain doesn’t happen randomly or because of bad luck,” says Dr. Fred Abeles, Clinical Instructor and Regional Director for the Las Vegas Institute for Advanced Dental Studies and author of a new book on the subject. “There’s a cause and effect to almost everything in the human body.”

temporomandibular jointWith many headaches, Abeles says, the cause is the temporomandibular joint, or TMJ – the place at the front of the ear where the lower jaw and the temporal bone on the side of the head meet.

Sometimes the bite and the lower jaw are out of alignment, putting additional strain on muscles, which leads to the headaches. And for many, TMJ headaches are a constant because they try to mask the pain with medication rather than correct the underlying cause.

But how do you know a headache is caused by TMJ? Here are some of the warning signs:

  1. Your jaw clicks or pops. Any joint in your body should work silently and seamlessly. If your jaw clicks or pops when you open or close it, it’s a clear sign that the lower half of the joint is not in the proper position. Even if the popping and clicking don’t produce pain, the muscles that have to support and stabilize the joint become fatigued and will produce pain.
  2. Your bite feels off. The TMJ is the only joint in the human body that has 28 teeth stuck between the opening and closing motion of the joint to complicate things. Every other joint is completely controlled by muscles, and the position of the joint, its movement and range of motion are mediated by muscle.

    The TMJ’s position is dictated by where our teeth come together in our bite. So if your bite feels off or your teeth don’t fit together well, there’s a good chance your TMJ joints are off, too.

  3. You have pain around your forehead, temples, back of head or radiating down your neck. Ninety percent of pain comes from muscle. If your muscles are not functioning well because of fatigue from supporting one or both of your TMJ joints in an improper position, they produce pain. It’s much like when you exercise or work hard and feel muscle pain later. The only difference is that TMJ is more subtle and chronic.
  4. You have forward head posture. Our heads are supposed to be centered over our shoulders. If yours is in front of your shoulders when you are upright, you have “forward head posture.” That relates to your bite and your airway. The human head weighs about eight to 10 pounds. The farther forward it is off the center axis, the more strain it places on neck muscles and vertebrae.
  5. You snore. Snoring is a red flag that respiration during sleep is disturbed. Several factors can lead to snoring, but one of the most important is the position of the lower jaw. If your lower jaw is a little too far back, then the tongue is farther back as well.

    “If the tongue is slightly farther back than optimal it vibrates against our soft palate, closes off our airway and we snore,” Abeles says. The snoring doesn’t cause the headache, he says, but it could be a sign the lower jaw is too far back. As a result, the muscles that support the jaw in an improper position produce the headache pain.

Adapted from media release

Bruxing: What It Is & Why It Is & What You Can Do About It

Last month, we talked a bit about one of the common dental effects of stress: bruxing – a fancy word for habitually clenching or grinding your teeth. The unnatural pressure it puts on your teeth can lead to things like tooth fracture, gum recession, tooth sensitivity and pain through the jaw, head, neck and shoulders.

But does all stress lead to bruxism? For instance, if you’re worried about a major presentation you have to give, you may notice that your jaw is sore afterwards due to clenching. Is that bruxism?

Not necessarily.

The key is whether such clenching is habitual – something you regularly do, over and again, over a long period of time. Isolated stressors can contribute to isolated instances of clenching or grinding. But just as stress only becomes really problematic when chronic – ongoing, a slow burn – so, too, with bruxing. The effects of situational clenching or grinding may be annoying; the effects of bruxism can be damaging.

Many people brux mainly during sleep, which commonly raises the question: How can I tell if I’m bruxing or not? Well, how did you feel this morning? Did you wake up feeling fine and relaxed? Or was your head throbbing? Your neck so stiff, it felt like it had been braced with steel? Did you feel as though you’d been punched in the head – and you’re certain you hadn’t actually been punched in the head?

Pain is one of the most common symptoms of nighttime bruxing, with headache being the most common manifestation. (It’s estimated that bruxers are three times more likely to experience them!) Pain in the jaw, neck, shoulders and muscles is also common, as is neck, shoulder and muscle stiffness. Disrupted sleep is usual, as well.

If you’ve noticed any of these signs in yourself and sleep with a partner, ask them to keep an eye – and ear – out for your jaw. (Yes, you can sometimes hear the grinding!) Their observations may confirm whether you are bruxing or not.

Teeth worn down by bruxing

Teeth worn down by bruxing

As noted, bruxing can cause problems in the mouth, as well as surrounding structures. For one, long term grinding wears down the teeth, contributing to gum recession and enamel erosion. These, in turn, raise your risk of developing cavities. The pressure and abrasion also make your teeth more vulnerable to fracture.

Additionally, TMJ problems may develop – painful dysfunction in the joints your lower jaw hinges on.

It’s important to know that stress is far from the only trigger for bruxing. Many people report that they started grinding their teeth when they were kids, before they felt any kind of significant, ongoing stress at all. For bruxing can sometimes be an adaptive behavior – a way of dealing with misalignment or malocclusion, where the upper and lower jaws or tops of the teeth don’t meet comfortably.

Fortunately, there are effective ways to deal with bruxism. It’s important, however, that the causes be diagnosed accurately. Only then can you get the right treatment. If alignment is the issue, for instance, orthodontic treatment may be needed. If stress is the culprit, strategies for managing it more effectively are key. Others have found physical therapy to be of help.

In most if not all cases, splint therapy is apt to be called for, as well – at minimum, the use of a night guard to cushion and protect your teeth from the pressures of bruxing.

The main thing is to treat it as early as possible to minimize long term consequences. The point was driven home by research published last fall in Cranio. Studying bruxism in children, researchers at the University of Buenos Aires found that the

presence of TMD, unilateral chewing, and high tongue tip position at rest were all significantly higher [in children with bruxism]. Frequency of oral habits was higher in bruxers, who showed significantly increased gum chewing, and lip, cheek, and object biting compared to nonbruxing controls.

The earlier we can identify the issues, the more readily we can help you deal with them and reduce the risk of long term problems arising from this kind of nightly (or daily) grind.

What About Antidepressants for TMJ Face Pain?

painLast month, we looked at some research on the link between depression and face pain. Considering that there are a number of antidpressants that may be given for chronic pain, you might wonder: Why not just take those and proverbially kill the two proverbial birds with a single proverbial stone?

Well, for one, not everyone wants to take pharmaceutical drugs, which are largely designed just to quell undesirable symptoms. Yes, there are times when drugs may bring welcome relief from acute pain, but their help goes little further than this. Long term, drug therapy can create another burden on a body already under physical or mental stress.

That drug therapy is often a “first resort” treatment shouldn’t obscure the fact that there are many gentler, nontoxic and effective alternatives available.

Nor is there much evidence that antidepressants are effective for treating orofacial pain – a fact at the center of a recent paper in Evidence-Based Dentistry.

Its authors looked at 6 previously published single and double blinded randomized trials (RCTs), all of which were found to be top quality. At best, that research was “inconclusive.” There are too few studies, they said, and too many differences among treatments. The authors thus concluded that, as yet, there is “limited evidence to support the effectiveness of antidepressants in orofacial pain disorders.” More RCTs are needed.

The definitive answer on drug therapy for face pain thus remains, “Well, maybe…and only if you want to go that route.”

And if you don’t?

Some forms of “alternative” treatment have shown short-term success – modalities such as acupuncture and coconut oil therapy – but here, too, more research needs to be done.

But is short-term pain-killing really the best approach? In a word, no.

When a patient comes to us complaining of face pain – or other upper body pain commonly associated with TMJ disorders (TMD), we start by looking beyond their pain pattern and history. We consider diet, sleep patterns and how the chewing muscles are working. We look at the big picture. What can we do to help alleviate your pain safely and effectively, without drugs or other short-term solutions that do little more than suppress symptoms?

We strive to help our patients with nontoxic therapies. We may use herbs, nutritional supplements and homeopathics. We may use oral appliances to take pressure off the jaw joints, help the jaw line up in a neutral position or reposition the tongue to sit more forward in the mouth.

And while these don’t address the depression head-on, so to speak, we’ve seen many a patient experience improved mood and mental health as they rigorously and diligently address their physical issues.

Image by Marc Soller, via Flickr