Dr. Grossan's Ear, Nose and Throat Consultant Pages
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Temperomandibular Pain Dysfunction Syndrome or TMJ symptoms are quite common. They include local joint pain, ear ache, headache, noises and pain when you chew, and various associated muscle pains. The ability to open the mouth wide may be limited. Ordinary chewing of food may be difficult.
In some patients it may be due to the teeth not being perfectly "straight". Treatment is to get a good occlusion or bite. Problem is I see patients with the most perfect bite possible with TMJ, and see patients with terrible occlusion without TMJ symptoms.
In other patients I feel that it is the muscle imbalance that is of paramount importance. Correcting the bite may take care of the problem, using mirror biofeedback may also relieve the condition.
In TMJ, the person opens his mouth to the side, not in the midline. There may be a noise called crepitus. This is the sound made because the joints are swollen, or the membranes are worn away or displaced. This usually means that the muscles that guide the jaw are not functioning correctly, they aren't balanced. Here correction of the bite is certainly desirable when this is the cause of the muscle imbalance. But there may be another causes. Often patients with TMJ express their stress by biting hard or gnashing their teeth. This may replace clenching the fist or sweating when tense. The more the discomfort the more they bite down or clench. The more they clench, the more the pain. The more the pain, the more the anxiety, the more they bite down, the more nervous and so on. In TMJ the person may grind his teeth in his sleep; this is most upsetting to the partner and to the dentist who has to repair the damage.
What is anxiety? The phone rings, "Hello!. Hi Bill! What's new?" This is the normal discourse and daily life. But what if every time the phone rings,the jaw tightens, the pulse increases, you sweat, the blood vessels constrict, and the MUSCLES contact severely enough to cut off circulation and restrict blood flow. In your mind the phone may be identified as a threat - the mother in law, the landlord for his overdue rent, the hated boss, the threatening boy friend. It is one thing if it really is the threatening landlord, but suppose you get this reaction every time the phone rings or worse still all day long at any sound or call? Often, the body misidentifies the phone or the situation as a threat based on some past experience, real or imaginary. This is a state of anxiety and is bad for your health.
But all you have to do is be relaxed! How many times have you heard this? Before a performance on stage, or an interview, or an exam you are told to relax! We have all known a really smart student who knew all the answers but flunked the test because of anxiety. Maybe you could hardly answer at the job interview. You came out perspired and heart pounding.
Some patients build up an anxiety circle. The more they worry the more nervous they get The more nervous, the more they tense and affect the circulation. The more the tension, the worse the anxiety , the more nervous. Certain undesirable chemicals get built up. One way to stop this is to give huge doses of nerve pills. There are many objections to this of course.
Biofeedback works for these patients. In the 70's I published the response of TMJ to biofeedback. (references) It worked in anxiety reinforcement patients - once that cycle was broken they lessened their symptoms significantly. This was successful in Tinnitus, Blood Pressure Elevation, Temperomandibular Joint, Headaches, Allergy, Asthma and many others. I reported 66% relief of TMJ using biofeedback alone. Other centers reported similar figures.
Biofeedback simply means that you are given information about your body so you can change it. Usually we hook up very sensitive sensors that record the electricity your muscles put out. The forehead is where the muscles show worry and anxiety. So we hook up there. There is a large dial that shows how much electricity your muscles are putting out. You use this information to lower the electricity - relax the muscle. You cannot have anxiety if the muscles are relaxed.
This is a method I have developed for my patients with TMJ. It is like biofeedback with the machines, except that here we use the mirror as a feedback mechanism. You can see when the face is relaxed, when the jaw opens correctly. My patients have done well following these 10 steps. But they are human, they forget, start skipping a day or so, and may return to the bad ways. By daily repetition the habit becomes a desirable one.
10 minutes a day is all it takes. Once you have learned the relaxation, you can do it without thinking.
Why is this different? If you surf the net you will find dozens of relaxation methods using breathing techniques. Some of them I can't pronounce and some I can't spell. You will find many "masters" and if you study with them for a length of time, you will be improved. These are OK, but in my practice I find that unless you are given the information as to when you are doing it RIGHT, it may not work. So, here we use the mirror as a biofeedback device to show you when you do it right.
Take a large mirror that you can stand or sit in front of. Draw a straight vertical line down the middle of the mirror. Please measure carefully to be sure the line is centered and vertical. Initially you can mark the middle of your forehead, nose, lip and chin in order to line up with the mirror's line.
This method is based on:
using the breathing technique to direct the relaxation
using the mirror to tell you when you do it right
using the mirror to tell you when the jaw is in correct position
repetition that you can do daily at home.
the advantage of you being in charge yourself.
the body learns when it is using the muscles correctly and given this information will continue to do it right.
10 Steps:
In this place of healing it all comes together - the anxiety is better! Here when the phone rings or there is a disturbing sound, you aren't bothered, your muscles remain relaxed. Here your receptors are wide open. You can suggest, imagine, feel yourself getting better. At the same time, because the receptors are open you can suggest whatever you wish to "improve" - I will skip the doughnut with my coffee - or I will only eat one slice of bread for lunch. These must be "minor" suggestions. You can also picture that here you will remember to relax whenever the signal of tinnitus comes on.
Later when you have done this awhile, let unwanted tight muscles act as a signal to relax to the healing place.
Important: now, whenever anxiety gets bothersome, simply image yourself in the healing place
Science has shown that when this imaging is done you can actually measure a difference in the person's blood elements.
It is important to remember that when we speak of relaxation we mean muscle relaxation as when you look in the mirror and see the face relax.
Typically you would spend one minute doing the 10 steps and be done in 10 minutes. Or, you can do them separately during the day. Or you may find a routine that you do 10 times, the important thing is the constancy and repetition.
What will happen as you repeat this daily or every hour on the hour do a step, is that the annoyances that make for anxiety worse will have less effect. . The relaxation will "displace" the anxiety. You will be happy that you have learned a method to do yourself, you have taken control of the condition.
Although this works well in Temperomandibular Joint Problems, almost any anxiety - muscle problem such as neck or back may be benefited.
What has always amazed me is that giving a biofeedback treatment at 10 AM can cause someone to stop grinding his teeth in his sleep! What happens is that the body learns to do it right and this learning continues.
This is a program to use after a medical evaluation has shown that there isn't a medical condition that needs to be treated.
Other TMJ treatments:
Proteolytic enzyme tablets. Melt in mouth between cheek and gums. Use one 4 x a day. Reduces swelling and pain. Regular anti-inflammatories like aspirin or the non steroidal medications are useful.
Rest the jaw. Use a bandana or chin strap to support the jaw so it can rest.
Steroids may be administered by your dentist or physician. An MRI of the TMJ will give maximum information on the condition of the joint and can be a guide to treatment.
There are variations to this method you can use:
Picture a light that infuses you when you inhale
Picture the tightness flowing out as you exhale
Picture the tension going down the legs and into the ground so that you are grounded.
Why this program works. Science has shown that you cannot have anxiety if the muscles are relaxed. For 30 years I have demonstrated this with my patients. You do have to do this daily. I prefer every hour on the hour. Soon it is so automatic, you are in a different "state" most of the time. If you do this for 3 months I assure you your symptoms will improve because
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