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



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.