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.

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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.

Acupuncture & Dentistry

acupuncture points on headWhen it comes to complementary medicine, acupuncture is often the first therapy people think of. After all, traditional Chinese acupuncture has a long and rich history – 2500 years, in fact.

Yet despite the test of time, the US has been slow to accept its benefits.

Those benefits certainly have a role to play in dental care, spelled out nicely in a 2014 literature review in the journal Medical Acupuncture.

Focusing on systematic reviews and research articles written in English, researchers plugged in key words specific to dentistry: acupuncture in dentistry, myofacial pain, temporomandibular disorders, xerostomia, dental pain and gag reflex.

As you may know, this Eastern practice uses specific points on the body’s energy highway – the meridian system – to stimulate the nervous system. This stimulation changes the way the nervous system processes pain signals and encourages the body to release its own painkillers, namely serotonin and endorphins.

And while technically, acupuncture means to “puncture with a needle,” stimulation can be achieved using a variety of techniques – for instance, moxibustion, electroacupuncture, acupressure, cupping, or microsystem acupuncture.

Whatever the technique, research shows that such stimulation

  • Normalizes physiologic functions.
  • Eases pain.
  • Modulates the limbic-para-limbic-neocortical network.
  • Increases local microcirculation.
  • Protects the body from infections.

Back in 1979, the World Health Organization endorsed acupuncture to treat just 43 symptoms. Less than two decades later, that list expanded to 64. By 2003, controlled trials had shown acupuncture to be effective in treating a number of dental conditions, including

  • Dental pain.
  • Dental anxiety and gag reflex.
  • TMJ/TMD.
  • TMJ clicking and locking.
  • Chronic muscle pain or spasm.
  • Atypical facial pain.
  • Headache/Migraine.
  • Dry mouth.
  • Nerve pain.
  • Paresthesia.

“In dentistry,” write the authors of the review,

the ability of acupuncture has been proven for managing various chronic orofacial disorders. There are numerous reports of randomized controlled trials on the analgesic effect of acupuncture for postoperative pain caused by various dental procedures and by other chronic disorders. According to the literature, acupuncture is more effective than a placebo or sham acupuncture.

Of course, as they say, more studies still need to be done. But we think it’s a good bet that, as an adjunct to good dental care, acupuncture offers promise as a nontoxic, safe alternative for treating dental symptoms with few, if any, side effects.

Image by Elizabeth Briel

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

Another Match Not Made in Heaven: TMD & Sleep Apnea

Of course, depression isn’t the only problem that can occur simultaneously with TMJ disorders (TMD), as another recent study reminds us.

The aim of the study – published earlier this month in the Journal of Dental Research – was to test for an association between obstructive sleep apnea (OSA) and TMD. Analyzing data from a large, ongoing study of orofacial pain (OPPERA, or Orofacial Pain: Prospective Evaluation and Risk Assessment Study), the authors found that “a significant association of OSA symptoms and TMD, with prospective cohort evidence finding that OSA symptoms preceded first-onset TMD.”

In other words, yes, OSA and TMD often occur together, with sleep apnea symptoms showing up before any TMJ issues become apparent.

Osa_cycleObstructive sleep apnea is the most common form of the disorder, in which the airway becomes blocked during sleep, disrupting normal breathing. According to the National Sleep Foundation, more than 18 million Americans have the condition. Most who do probably don’t know it. (A survey conducted in the Netherlands found that 4 out of 5 people who have sleep apnea are unaware that they do.)

And what blocks the airway? The tongue, the tissues lining the airway and muscles around the airway all relax during sleep. If they fall back and block the airway, the attempt to keep breathing creates the sound of snoring. Obese people are more at risk than others (more surrounding tissue), as are older people (loss of muscle tone).

But while snoring can be an obvious sign of OSA, not all with the condition snore. Here are some of the other signs of disrupted breathing during sleep:

  • Choking or gasping during sleep
  • Waking up tired
  • Waking suddenly
  • Morning headaches
  • Fatigue and sleepiness through the day
  • Decreased productivity
  • High blood pressure

OSA can lead to insomnia and irregular sleep patterns, teeth grinding (bruxism), chronic allergies, earaches, acid reflux and hypertension. And it’s more than just a nuisance. It can be life-threatening. After all, when the upper airway is blocked, oxygen can’t get to the brain! This, in turn, affects other parts of your body – both organs and muscles (and your heart is one big muscle). It has been linked with conditions such as heart attack and stroke.

Clearly, doing nothing about it is NOT a great option.

But great options are available, including alternatives to CPAP, the commonly prescribed remedy that involves wearing a mask that blows air into the upper airway. The device works well, but many find it cumbersome and uncomfortable, and stop using it after a time.

When OSA is mild to moderate, oral appliance therapy may be used instead. In our office, in fact, it’s the first line of treatment in such cases. These custom appliances help hold the jaw low enough so that the upper airway is kept clear and oxygen can flow to the brain easier. There are “invisible” daytime appliances, as well, which help the tongue to rest as it should against the palate.

There are other things you can do, as well, to get the better of OSA, such as avoiding alcohol, quitting smoking (as if you needed one more reason to quit, right?), sleeping on your side and losing weight. In fact, the National Sleep Foundation considers weight loss the most important thing you can do in treating OSA.

And, of course, the healthy eating that brings about real and lasting weight loss should give your oral and overall health a boost, as well! (For more on fad diets vs. lifestyle change, read this excellent post over at The Healthy Omnivore.)

Learn more about sleep apnea and how we can help you sleep and breathe better

When Face Pain & Depression Happen Together

What does the mouth have to with the mind? More than you might think!

face_painDepression and jaw, face, head and neck pain have been known to sometimes exist simultaneously – often stemming from the TM joints, the “hinges” that let your mouth open and close. They’re also among the few joints in the body that use articular discs – oval shaped discs made of fibrocartilage that allow for separate movements in those specific joints.

Misalignment, repeated stress or damage to the TMJ eventually leads to a pain syndrome known as temporomandibular disorder (or dysfunction), TMD for short.

The correlation between TMJ pain and depression presents kind of a chicken and egg problem: Is depression a response to the pain or does the pain give rise to depression? A recent study in Acta Odontologica Scandinavica concluded that it may be the former – that “depressiveness increases the risk for chronic facial pain.”

This study builds upon earlier ones of how psychological factors affect pain symptoms. All together, these cast light on the fact that typical treatment with antidepressants or painkillers may never completely address the whole problem.

Rather, the whole patient must be treated for complete health.

When you think about it, it’s kind of odd to deal with symptoms in isolation, as if they’re independent of what happens elsewhere in the body. Holistic dentistry, on the other hand, looks for and treats root causes. We respect the impact dental conditions may have on the body as a whole – and how systemic issues may lead to problems in the mouth.

It may so happen that if you treat facial pain associated with TMD, depression will subside. In our office, Dr. Sprinkle’s first line of treatment is noninvasive and drug-free, employing dental appliances that are easy to use. Patients who come in initially for help with chronic headaches or face pain typically report improved mood and energy levels as their physical symptoms dissipate.

The whole body benefits as the fundamental cause is addressed.

Doctors and patients alike have found what happens in the mouth is reflected elsewhere. We know that periodontal health has an effect on the entire body through the common denominator of inflammation. Other studies have shown the dynamics of oral health and hygiene on other aspects of systemic health. Biological dentists further know how each tooth is connected with other organs throughout the body via the meridian system established by Traditional Chinese Medicine. (You can learn more about those tooth-body connections by using our interactive Meridian Tooth Chart.)

Biological dentistry is cognizant that “what happens in the mouth is reflected in the body, and what happens in the body is reflected in the mouth” – not just physically, but mentally, as well.

Learn more about how we can help you find relief from jaw, face, head and neck pain

Image by Cara, via Flickr