TMJ or TMD questions answered...

People say my symptoms are all in my head. I'm worried that I'm going crazy?

No you are not going crazy. Only you know what you are feeling. It may be difficult for your family and friends to understand what you are going through, especially if they have never heard of the temporomandibular joint or TMJD. Even some health professionals are not familiar with the symptoms of a TMJ condition or they are not aware the pain it can cause. As a result, many patients go for years without an accurate diagnosis or acknowledgement of their suffering. Unrelieved pain leads to depression, sleep deprivation and increased stress and anxiety levels. A chronic pain cycle then develops. Depression, marriage or relationship difficulties, sleep disorders, stress, tears, and emotions are all commonplace symptoms in a TMJ treatment clinic! Getting you a good night’s sleep is our second priority after getting you out of pain. Remember that you have a medical condition that warrants compassionate understanding.

Are there any habits that make my facial pain worse?

Yes. Imagine how your calf muscles would feel if you stood on your toes for an hour or more. The following is a list of things that you should avoid doing as it increases muscle tension which causes them to fatigue. Some habits also place unnecessary stress and pressure on the jaw joint itself.

Yawning widely, testing the joint, or "playing with" your jaw.
Chewing gum or tough, crunchy or hard foods.
Resting your chin and/or cheek in the palm of your hand when sitting or lying on one side.
Clenching your teeth - when tense, concentrating, driving, jogging, etc.
Repetitively licking your teeth with your tongue.
Forcing to keep your lips together to hide braces, missing teeth, etc.
Biting your nails or a pen / pencil.
Playing certain musical instruments e.g. flute, violin.
Biting or sucking your lips or cheeks.
Cradling the phone against your ear and shoulder.

Are there things that I can do then that will help relieve my facial pain?

Definitely. There are many things you can do at home to help yourself and reduce the constant muscle fatigue and stress on the face and jaw joints.

Avoid protruding your jaw - for example, when concentrating, during conversation etc.
Make every effort not to strain the ligaments of the jaw unnecessarily.
Do not eat foods that require prolonged or excessive chewing such popcorn, crusts of bread, or tough meat.
Cut all foods into small pieces: avoid opening your mouth wide.
Avoid pressure on your jaw during sleep. Sleep on your back if possible or when on your side do not sleep with your arm or pillow under your jaw.
Take particular care with your posture if you spend a lot of time sitting at your desk in front of a computer, and take frequent breaks to relieve stressed muscles.

What else can I do to help reduce my muscle tension and ease my pain?

Making some lifestyle adjustments can also help treat TMJ disorders. Managing stress and anxiety is important if this is causing or contributing to the pain. There are various options that may be used to relieve stress, including yoga, meditation, progressive muscle relaxation and deep breathing. Even regular exercise, such as swimming or walking, and improving or maintaining correct posture can reduce muscular stress and improve TMJ pain. A physiotherapist may also be able to provide additional help to treat the pain associated with TMJ disorders, using therapies such as:

Massage;
Ultrasound treatment;
Transcutaneous electrical nerve stimulation (TENS), which uses mild electrical currents from electrodes that are taped to the skin to treat pain; and
Electromyographic feedback, which is a treatment used to help you to learn to relax your jaw muscles.

I have never heard of my posture affecting my TMJ pain. Can this happen?

Yes. The average weight of the human head is around 4.5-5.0 kg and therefore any activity that causes the head to be held in an unnatural position from the bodies ‘centre of gravity’ may intensify TMJ problems (see pictures on posture in brochure “What is TMJ or TMD)” due to excess muscle fatigue. That is why combined TMJ treatment, an osteopath, a physiotherapist and home management techniques working together is so often required and important in people suffering severe TMJ and facial pain.

I clench my teeth during the day but I don’t know how to stop it. Is there anything I can do?

Daytime (or diurnal) clenching can be very frustrating and often we don’t realise just how much we do it. The jaw and face muscles become very fatigued and painful. Talking on the phone, driving the car, working on the computer, doing the dishes, caring for children, concentrating on a task, and any other period of stress can cause us to clench. Your teeth should NEVER touch and your tongue should NEVER be pressed firmly against the roof of your mouth or back of your teeth. When you catch yourself doing this:

Take in a deep breath.
As you breathe out feel your entire head, neck, shoulder and jaw muscles relax and your teeth come apart.

This technique can be performed up to 20-30 times a day if necessary and especially during high stress periods.

Do I really need to wear one of those splint things in my mouth?

Absolutely not. Approximately 70% of cases of TMJ and Facial Pain are muscle related. Reduce the stress and fatigue of the muscles and the pain will go away. It is always preferable that you try things that you can do yourself at home first. They are free and do not take much time. Only after you have tried these things at home without any or limited success should a mouth splint be used, and only then the majority are for use only when you sleep. Many people find that they cannot do without their night splint after they have become used to wearing it.

Why do I get symptoms in my ear if I have a TM Joint disorder?

Because of the close proximity of the TM joint to the inner ear. The consequence often is ear pain in the absence of infection, a sense of fullness, or stuffiness, in one or both ears, and sometimes ringing in the ears. Hence, many TMJ referrals come from Ear, Nose, Throat specialist’s as they have an excellent understanding of TMJ symptoms presenting as ear symptoms.

I hear a lot of noises in my jaw joint. It sometimes pops, clicks, grates, crunches, or grinds. Do I need to treat it?

Sorry, but here is a typical doctor's answer - "That Depends". A jaw noise does not necessarily mean treatment is required. The important question is, “Does my jaw joint cause me any pain and to what degree is my restricted jaw function affecting my quality of life”? If you have no pain, and it is the ONLY symptom you have, and you never think about it, and you can eat anything you want, you don’t get headaches, toothaches, recurring broken fillings or teeth, or neck pain, the answer is No. Otherwise, my answer is Yes. Especially if your jaw occasionally locks Closed.!

What has snoring or obstructive sleep apnoea (OSA) have to do with TMJ pain?

A lot of things. Many people who grind their teeth, especially the front teeth have undiagnosed snoring or OSA and at night are trying for many hours to subconsciously hold their lower jaw forward to breathe properly. The muscles fatigue, the teeth wear down, and over time, the jaw joints and muscles become very sore and painful. Often, morning headaches are associated with these conditions. That is why a thorough Snoring and OSA assessment is also conducted before commencement of any TMJ treatment.

I already have a splint. Why do I need another one or what is so different to the splint I will have made at the TMJ Clinic?

There are literally hundreds of different designs and materials that can be used to make a splint. A vast majority in one form or another are typically "Full Coverage Flat Plane" splints. They are designed to cover all the upper teeth and when a patient bites together, all the lower teeth touch evenly on the splint. These types of splints perform a good job of protecting the teeth from grinding when asleep but unfortunately in some cases do not address other problems such as chronic muscle fatigue of the face and neck, as the patient can still clench at maximal effort whilst asleep. The most important part of your new splint is that it will hold and stabilise your jaw orthopaedically. That means the upper and lower jawbones, and muscles of your head and neck are aligned correctly to make your TM joints function as well as possible and prevent muscle fatigue whilst you sleep. Orthotics/splints for Sleep Bruxism and TMJ Disorders made at the TMJ Clinic are designed to help alleviate:

Jaw Pain, soreness, and stiffness
Headaches (pain)
Muscle Fatigue
Neck stiffness, and to
Improve sleep quality
Protect your muscles and teeth from clenching and grinding
Open the airway and reduce snoring

Often, an existing splint if it is still in good condition can easily be modified to the new design and bite registration so it is always a good idea to bring any previous splints with you to your appointment.

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