Ear Pain and Tinnitus.

Ear Pain from Nowhere.

I have developed another TMJ symptom. It started as a maddening tingle around or in my left ear and progressed to a painful discomfort that appears at odd times.  I have experienced Tinnitus before but with this new symptom of mine the Tinnitus has been...well different and not pleasant. Knowing what I know about TMJ or TMD and various symptoms I figured this new and unexpected set of conditions was stress related due to several issues in my personal life.  But even knowing that doesn't make it any easier to deal with.  Deal with....just what does that mean to TMJ sufferers.  We all have to deal with our symptoms in whatever way we can but the onset of new symptoms in my case has been like a entirely new disorder that I must now cope with and find new ways to eleviate.  How frustrating and annoying it has been for me to realize I have "new" TMJ symptoms when I was doing so well.  I tried increasing my exercise but to no avail.  I tried destress technques but honestly I still felt stressed.  I guess I just hang on to my issues to hard and dont want to let go.

I visited my dentist and explained my symptoms and he suggested a mouth guard to wear at night to stop grinding of teeth.  Due to all the reading of information of sufferers and mouth guards I opted not to go this route. I did tell my dentist that I have often felt like my teeth are not as high as they used to be when I had all my "natural" teeth and that I feel this causes me to greater discomfort if I grind or clench my teeth as the TM joints are more stressed than would be if I didnt have my now many capped teeth. 
Dealing with the Tinnitus that comes with ear pain has been somewhat of a dilemma.  I try different jaw positions to see if the ringing in my ears will stop.  Sometimes it does and sometimes it does not.  But I can tell my readers that  as I usually forego any medical solution or procedure after a while I find the symptoms lessen.  Am I just deluded and have become used to them?  My answer is No.  They have subsided but not gone away.  I continued to exercise and  try relaxation techniques and told myself this too will pass.

Now  for my friends and fellow sufferers who are reading this I will say that I believeTMJ can be cured.  The human body is an amazing thing and if we have the right information and tools to keep us aligned and healthy then we can overcome practically anything.  There is a saying, " So long as we have life, we have hope!".  I believe that and nothing will convince me otherwise.  So to my fellow TMJ sufferers I say, "Do the most you can do on your best day and do the least you can do on your worst day and you will have always done your best.  And that is all anyone can ask of you".

The Best Relief for Ear Pain and Tinnitus.
For me, the best relief has come from consciously relaxing my jaw and letting it go slack as often as possible, to the point where my teeth are parted but my lips are still together.  This is hard to do but well worth the effort.  The more I do it the more it becomes natural. Of course I often find myself doing a task that requires concentration and realize that I am clenching my jaw.  This is a habit I have been working diligently to overcome and the payoff has been less ear pain and less Tinnitus. Try it.  What have you got to lose?

 A Shout Out to  Fellow  TMJ Sufferers.

We each have our own TMJ cross to bear but I want each of you to know that you have it within yourselves to control your symtoms and not let your symptoms control you.  Reach out to others and learn as much as you can about your specific TMJ condition and never do any procedure you do not feel is right for you. If you choose a path of treatment , be consistant and dont skip a step.  Be persistant and it will pay off in the long run.  TMJ has no quick fix and only the determined will get relief as they presevere along the treatment path.  Good Luck and Good Health.

Lucy Thomas

TMJ Headaches and TMJ Migraine Headaches

TMJ Migraine Headache pain.

Does this sound like you?
You feel as if your head is about to split open, like someone has hammered a spike into your eye, your temples throb,you are nauseous,you have tooth pain, your neck and shoulders and back hurt, then it is more than likely you have TMJ.  
Whether your headache is a severe migraine headache or a tension headache and you have tried various treatments to no avail and no-one has suggested TMJ as a diagnosis it is because your practitioners you have been seeing have not been schooled in the relationship between head pain and TMJ.  In fact, there are many practitioners and specialists that are skeptical of the relationship between TMJ and head pain. The good news is that there are TMJ specialists out there who can diagnose your TMJ and recommend or provide the correct therapy for your TMJ disorder.
Now you may be someone who already knows they have a TMJ disorder and that your headaches are merely a symptom of that disorder or you have suffered from migraine headaches for some time and are now discovering that TMJ is the cause.  Whichever it is you can be sure there are treatments available for your headaches. But first, let us look at the different types of headaches and how to recognize them by their symptoms.

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Headaches types.

So you have TMJ and one of the symptoms is headache or migraine headache.  This type of headache is known as a secondary headache.
Secondary headaches are recognised as being caused by an underlying condition.  In this case, the underlying condition we are discussing is TMJ.

According to the Mayo Clinic there are three common headache types:
   Tension headache, which can last from twenty-five minutes to an entire week and manifests as dull pressure on both sides of the head and sometimes also the neck and may also include fatigue and a feeling of a rigid band circling the head with pressure and tightness.  Tension headaches can reoccur daily to very infrequent.

  Migraine headache, which can last from four to seventy-two hours and is moderate to severe throbbing pain and can be located  on one side or both side of the head. The frequency of recurring migraines varies greatly. Symptoms can include nausea,vomiting,sensitivity to light, smell and sound and pain will increase with physical activity.

   Cluster headache, which is sharp, severe pain that develops suddenly over a matter of minutes and is located on one side, often around the eye or behind the eye and can last anywhere from fifteen minutes to three hours. Included symptoms are runny nose, nasal congestion, teary eye on one side, red eye and feeling agitated. The frequency of this type can be one or more every day during "clusters".

Why do TMJ Headaches Happen?

TMJ Headaches are due to the involvement of the trigeminal nerve which is located on the side of the head is one of the most powerful and complex nerves in the human body. It innervates the jaw, teeth,eyes,tongue, palate lips, sinus and face so it it has a close association to the TMJ. Certain areas of the brain are also innervated and controlled by the trigeminal nerve.  In fact, it is estimated that the brain uses an astounding 40% of its energy figuring out the messages from the trigeminal nerve and sending messages back through the nerve. The trigeminal nerve is also linked to other nerves that control sensation and function of most other muscles in your thoat, neck and head; the vagus, facial and hypoglossal nerves.  A disturbance in any one of these four nerves will end up distrubing the other three.  Along with TMJ symptom of headaches it is not uncommon to experience issues like burning tongue, burning thoat, blurry vision, problem swallowing and difficulty breathing.

When is Your Headache NOT TMJ related?

While doctors are beginning to realize that most tension headaches are caused by TMJ it is still very important with any type of headache that you see your doctor for a diagnosis.  If a physical examination does not reveal the cause of your headaches then you should have a neurological examination to rule out critical conditions such as West Nile virus.

A sudden, severe headache can be due to brain tumor or cerebral aneurysm or meningitis or virus.  Please seek immediate medical attention!

Headaches are also a symptom of flu, fatigue, hypertension, eyestrain, fever, sinus problems and ear problems. So get a diagnosis so that you can eliminate receive the dangerous disorders and receive the proper treatment for your headache.

Home treatments for TMJ headaches.

As soon as you feel a TMJ headache coming on try these remedies.

Lie in a dark, quiet room that is free of any odors that can aggrevate your headache.

Lie on a cold pack placed at the back of your neck for 10 to 15 minutes.  A hot compress at the back of the neck will reduce muscle tension.   I have even tried both hot and cold simultaneously; cold to back of neck, heat to forehead, temples.  That is my preference.  You can switch it around if you prefer.

Try to relax your face and jaw by yawning.  If you pretend to yawn trust me you will eventually yawn for real.  It will reduce muscle tension.  Do your jaw or TMJ exercises.

Essential oils such as peppermint oil or lavender oil rubbed at the temples or on neck can help you to relax and breathe freely as sinus and breathing problems often happen at the same time as your headache.

If you feel up to it and you have someone you trust, try having them give you a massage.  Focus on neck, shoulders, back and temples.

In case you are dehydrated drink some water.

Practise relaxed breathing and do a systematic "tense and relax" routine on your body starting with your feet.  As you lie quietly tense up your feet and toes as much as you can for 4 seconds then let go the tensed muscles and relax the feet until you feel them comletely relax.  Work your way up your calves, thighs, hands, arms, abdomen, shoulders, neck and face doing the same "tense and relax"
procedure.  This is a great way to relieve yourself of stress at any time and it can be done to help you fall a sleep at night.

Drink a strong cup of coffee.  Caffeine can help to relieve headaches as it reduces blood vessel swelling and that is the reason it is an ingredient in some pain medications.

Take an over-the-counter medication.  Talk to your doctor about which is best for you and how often you can take the medication since prolonged use of analgesics can cause stomach problems and bleeding and even increase the risk of heart problems. Four such analgesics are Acetaminophen (Tylenol), Ibuprofen (Advil, Motrin), Aspirin, Naproxen(Aleve).

You can also read the list of possible home remedies to try on Tips for Treatment of TMJ.

Medical Treatments for TMJ Headaches.

Medications: - Your doctor can prescribe a medication that will work to either prevent a migraine or headache as it starts or prescribe a medicine to reduce the number or frequency of your headaches.
Triptans are a group of drugs used to prevent the onset of a migraine headache and they target seratonin. They include brand names such as Imitrex, Zomig ,Amerge, Maxalt, and Relpax.
If the triptans do not work for you then there are other drugs your doctor may prescribe such as Cafergot, D.H.E. 45 injection, Migranal Nasal Spray, Midrin, Compazine and Phenergan. 
If you suffer from severe migraine pain your doctor may prescribe a narcotic such as Vicoden or Tylenol with Codeine No. 3.

Botulinum Toxic (Botox)  is now being used to successfully relief headaches.

Physical Therapy
Acupuncture

IMS (Intramuscular Stimulation)

Mouth Splint or night guard or NTI.

Things You Can Do to Reduce TMJ Headaches.

Get plenty of sleep.
Stop smoking.
Eat healthy meals.
Drink plenty of water.  6 to 8 glasses of water per day.
Learn Yoga or relaxation techniques.
Avoid stressful situations.
Do regular jaw exercises.
Practice good posture.
Try a soft food diet.


Resource Links

American Headache Society

Academy of Neurology

International Headache Society

Migraine-Headache Resource Center

National Headache Foundation

National Institute of Neurological Disorders and Stroke

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TMJ Splint Therapy

Splint and Other Names.

Discussions about splints can often be confusing as there are many other words used for splints:  bite plate, bite applicance, mouth guard, night guard, night splint, occlusal appliance, orthotic, brux guard, mouthpiece.

Have You Tried Conservative Treatment Options?

It is true that most TMJ disorders will be helped with natural, home and professionally non-invasive treatments.  There is no harm in trying these options in conjuction with Stress Management and possibly Psychotherapy. The decision to wear a mouth splint for TMJ syndrome should only come after you have tried more conservative treatments and are certain that none of them can help your TMJ
disorder.  In addition, you have found a reputable TMJ specialist with experience in orthodontics that you feel comfortable with and trust.
Preferably, given your condition, the TMJ specialist will have encouraged you to exhaust all home remedies and non-invasive medical procedures prior to a discussion about Splint Therapy.  Even though the wearing of a splint is not an invasive option the follow up to a splint will very likely be invasive.

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Splints Types

Stabilization splints prevent night-time Bruxism, the clenching and grinding of teeth.  This type of  splint covers all the teeth and can be manufactured using a hard or a soft material.
Repositioning splints are worn 24 hours a day and are adjusted regularly by an orthodontist to get the joint (TMJ) to slowly end up in the correct position in the socket. 
Wearing a correctly made splint is said to allow the muscles to relax and therefore help rid you of jaw and face pain.  A splint will also protect teeth from wear and tear, stress fractures and chipping.

Why You Need a Splint

Your TMJ or joint and teeth are correctly positioned when all your teeth make simultaneous contact at the exact moment the condyles are seated in the most stable position in the sockets.  In this ideal position , there are no forces to damage the disc, joints or teeth and the muscles are relaxed or in a neutral position.
For TMJ disorders, your teeth may come tgether but the joint is pulled out of the socket.  This position leads to Buxism , the grinding and clenching of teeth at night.  Another TMJ disorder has the joint positioned correctly but the teeth do not come together correctly or only partially.
Treating a damaged joint with splint therapy is not a cure.  The splint will help manage the problem by placing the joint in a less traumatizing position so pain and future damage are minimized.  You may experience difficulties with wearing a splint such as a problem speaking, sleeping and it may be uncomfortable at fiirst. You will have to modify your diet somewhat, choosing softer foods.
A correctly made splint will put the joint in the right position and provide a bite where teeth, muscles and joint do not work against each other. If your symptoms improve from splint use then it can determined that the problem is definitely TMJ dysfunction. 
Some people who are having success with their splint in relieving their TMJ symptoms opt to continue the therapy instead of proceeding to the next phase.

Phase One - Getting the Splint

Apart from giving your medical history the doctor should also know about any dental history and if you have had any accidents or injuries. Give a detailed account of your TMJ symptoms such as headaches, pain and any sleep disorders. The doctor will examine you thoroughly and take X-rays of the jaw and a panoramex film.  An MRI or CT scan, though expensive, are well worth the money to get a good diagnosis from the doctor.
 
Once the doctor has his diagnosis he will discuss a treatment plan and what it may include.  Obviously a splint and perhaps medication to help reduce pain and muscles spasms and inflammation.  He may also recommend physical therapy to strengthen and increase range of movement which will help to prevent further joint injury.  The doctor may suggest injections to relieve trigger points in muscles or
alleviate inflammation.  In some cases, severe myofascial pain and headaches can also be treated with Botox injections.

Dental moulds of your teeth will be taken and precise measurements made.  Lastly your splint will be checked for fit and the doctor will inform you about care of your splint device.

Next Phase After Splint

You have been getting good results now for several months from wearing a splint 24/7 and it is time to take it out.  However, once a splint has been worn for a period of months or in some cases years, you will likely find that it has changed your bite and jaw position. 
At this point you will enter the next phase of therapy which can include the following treatments:

 Reshaping and/or grinding the teeth
 Braces
 Crowns, bridges or veneers
 Surgery

These treatments are permanent, cannot be reversed and there is a possibility that they may not work.

Splints and Research

It is important to note that there has been no significant or extensive research done on splints as a treatment for TMJ.  Be very caution
before beginning any treatment option that can cause irreversible harm.  Seek several independent, professional opinions prior to
commencing any treatment.


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The Anatomy of The Temporomandibular Joint

Dem Bones.

TMJ is really the hinge that allows us to open and close our jaw. However,we commonly refer to any pain or dysfunction in the hinge as TMJ or TMD (Temporomandibular Dysfunction).  Right now we are just looking at the anatomy of the temporomandibular joint .

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Let us start by taking a look at the bony structure of the TMJ or temporomandibular joint.  There are two TMJ joints, one on each side of the skull.  The name comes from the two bones that make up the joint.  One is the bone on the side of the skull called the temporalis bone and the second is the lower jaw bone which is called the mandible. Hence the name temporomandibular joint.  These joints are located just in front of your ears.  These joints are nothing more than hinges which allow us to open and close our jaw.

Between the Bones.

Surrounding the TMJ joint is a capsule of fibrous material.  Between the bone joint is a special disc which is an extension of the capsule called an articular disc which is formed from a flexible, tough yet elastic tissue called fibrocartilage  Our ears are made up of this fibrocartilage.  This thin disc divides the joint into two cavities.  When the joint is in motion or there is pressure on the articular disc it releases synovial fluid into the cavities and this fluid acts like a shock absorber and reduces friction.  There is only one other place in the body that require an articular disc and that is where the top of the sternum, clavicle and first rib all meet.  At first, when you open your mouth a rotational movement occurs with the lower jaw and the disc but when you open the mouth even wider there is a second movement called the translational or forward and downward sliding movement of the disc and the jaw.  The two ends of the mandible or jaw are called condyles which comes from the word ”condyloma” which is derived from the Greek word ”kondylos” which means a knuckle or a knob. Further, “condyle” refers to a rounded articular surface.  This knob or condyle butts up to the underneath side of the TMJ disc.  On the mandible the glenoid or mandibular fossa meets the upper side of the disc and is a depression or concave-shaped.

Joining It All Together.

Ligaments are strong, tough, rope-like connective fibres. They connect bones to each other and connect cartilage to joints.. There is one primary and two secondary ligaments of the TMJ.  The temporomandibular ligament is the primary ligament which consists of two parts; the outer oblique portion or OOP and the inner horizontal portion or IHP.  The two minor or secondary ligaments are the stylomandibular ligament and the sphenomandibular ligament of which neither is directly attached to any part of the temporomandibular joint.

During movement only the jaw moves. Muscles attached to the bones and joints allow a variety of movements.such as yawning, chewing, talking, singing, shouting and swallowing, making the temporomandibular joints the most flexible in the human body. These sophisticated joints can move up and down and side to side in a wide range of motion and in a normal healthy jaw there is no pain or discomfort with these movements.

Muscles and The Nerve of It All.

The four muscles of mastication move the jaw or mandible.  They are the masseter, the medial pterygoid, lateral pterygoid and the temporalis.  The Trigeminal nerve is the sensory nerve for the face and the motor nerve for the mastication muscles  As the name suggests, the trigeminal nerve is made up of three branches.  The ophthalmic V1, sensory, the maxillary V2, sensory and the mandibular V3,motor and sensory branches.

TMJ Disorders, Pain and Discomfort.

Muscle fatigue from clenching the jaw or grinding your teeth, arthritis, and jaw injury are some of the causes of TMJ disorders. Understanding the anatomy of the joint will help you to better understand the workings of the TMJ and how surrounding bones,ligaments, nerves.and muscles can be affected when you experience temporomandinbular disorder.


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TMJ and Stress

Chronic Stress Can Lead to Physical Disorders

Anyone who has TMJ  or TMD will have their own unique profile.  There will always be several factors contributing to their dysfunction for instance, stress, arthritis, trauma or accident, even birth defects to name but a few.  Stress is one of the primary contributing factors leading to TMJ.

If you are feeling threatened in any way the body's natural automatic stress response is designed to protect you from aggression or predators.  This is often referred to as the "fight or flight response" which prepares the body to "fight" or "flee" from a threat to your survival.  The body releases chemicals and hormones to provoke action on your part as well as communicate to areas of the brain controlling motivation, mood and fear.  Once the situation that triggered the  response has been dealt with the body and mind will return to a relaxed state.

Stress is a normal reaction to all the demands you must meet everyday and while some stress is beneficial long-term stress can be harmful.  Long-term stress puts you at risk for diseases  such as high blood pressure, heart disease, depression, weakened immune system and  many others. With chronic stress in your life, the mind and body will suffer. 

In today's society there are many stresses that you often cannot fight or run from and so you must sit and wait until a later time  to deal with a situation.  This can cause aggressiveness, hypervigilancy and over-activeness and then you act in ways that are self-defeating and work against our emotional  and physical well-being.  The build up of stress hormones in the body can lead to psychological and physical disorders.  Examples of physical disorders are teeth-grinding, muscle tension or headaches.


It is no wonder then that stress is a major factor in TMJ or TMD. The same nerve that is activated in the "fight or flight response" , the Trigeminal nerve or fifth cranial nerve, is also used by the Temporalis, Masseter and Pterygoid muscles used to chew, bite and swallow your food.

Research tells us that more women have TMJ than men.  Even though men have more stress than women the research shows that men have better outlets for relieving stress than women do in our society.  In the human body the autonomic nervous system and endocrine system are the control mechanisms by which stress is translated into a physical response. High stress levels have been associated with TMJ pain.  What physical responses do you have to stresses in your life?  Do you bite your fingernails, chew on a pen or pencil, clench your jaw,  gnash your teeth.   Perhaps your posture changes from being standup straight to being hunched over or head and jaw jutting forward which puts added weight on neck and shoulders.  You may even be asleep while your body manifests its stress in physical ways such as bruxism, the clenching and grinding of teeth.  Have you ever woken in the morning with a headache or migraine and experienced a dreadful pain behind one eye or on one side of your head?  Have you ever felt a throbbing pain on one side of your head that is very sensitive to the touch?  Do you suffer from stiff neck and shoulder pain?

How to Deal With The Stress

Dealing with stress is your best defense against the resulting symptoms of TMJ. Take a good look at areas of your life that are causing you stress. Make your home environment soothing and free of clutter.  Have an tranquil spot where you can go to relax.  It may be a home spa decked out with  soothing music, aromatherapy or delightful bubble bath or a shady spot in the garden where you can read your favorite book. Give your home positive energy with Feng Shui and add live flowers and well placed items that have meaning for you.

How is your attitude?  If you can perceive your life in a positive way this can help you lower stress levels. Most people I meet seem to have a degree of "perfectionism" in them which often causes them stress as they can never live up to their own idea of perfect. Overcome that need to be "perfect" and let yourself relax.  One way is to be happier and laugh at yourself when something does not turn out just the way your wanted.  Remember Bridget Jones and her "blue soup"?  Find your sense of humor by looking for the humor in everyday events or rent some funny movies that will make you laugh.  

Try positive affirmations if you recognize that the little voice in your head is too negative.  Get that voice to start speaking positively.  Try visualizations to send your worries and stresses up in a balloon, high into the sky until it disappears from view and then relax by letting go of those stressful thoughts and issues in your life.

Are you overloaded with too many things to do? Learn to say "No" and do not overload yourself with more than you can handle. If you find saying "No" too hard then say "Yes, but I wont get to it until next week" or "next month".

Take a close look at your relationships and end any relationships that are toxic to you.  Make new relationships with people that make you feel better not worse.  Let their "feel good" behavior rub off on you.  Mimic their behavior even if it feels awkward to you at first  and pretty soon you will find that your attitude becomes more positive and you are happier.  If you cannot totally avoid people that cause you stress then try to see them as little as possible. Why would you invest in a relaationship that makes you feel stressed?

Deal with resentments and let go of anger. Learn to communicate your feelings and not hold them in.  If you cannot talk to the person or a friend write down the issues that are giving you stress.  Realize that you cannot change other peoples' behavior.  You can only change your own  and by doing so you will see a change in their behavior.

 It is important that you take good care of yourself.  Make sure your diet is healthy and you are avoiding eating foods like sugar and caffeine.   Make sure you are getting a good night's sleep.  Eliminate late nights and excessive intake of alcohol.  Invest in a good pillow that will allow you to sleep on your back.  Get plenty of exercise and fresh air. Any exercise whether gentle and slow like Yoga or demanding and fast like running will help relief built-up stresses.  Make time for a hobby that gives you pleasure.

TMJ and You

Evidence shows that 75% of TMJ sufferers will benefit from stress-relief techniques.  Do the TMJ exercises and methods of relaxation that best suit you.  Continue with your chosen treatments and medications.  However, if your teeth are misaligned then you need to seek out the help of a professional doctor or dentist. The goal is to relief TMJ pain and getting rid of stress will be a major contributing factor to your recovery from TMJ or TMD.


"TMJ NO MORE" has helped thousands get relief from TMJ or TMD.


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TMJ AND IMS: My Success Story

TMJ and Me.


I am a TMJer. At 57 years of age I consider myself to be lucky. Why?

Because I haven't had severe or chronic TMJ problems and have been pain free relatively speaking for many years. I say "relatively speaking" because in hind sight I realize that frequent migraines, headaches, neck pain, shoulder pain and head and jaw pain came from my TMJ disorder.  My TMJ causes were mainly stress and poor posture so I consider myself lucky not to have any trauma  or degenerative joint or dislocation of the joint or arthritis of the TMJ joint.

A Little of my TMJ History

I never knew I had a TMJ problem until the early 70's when I was barely in my twenties and I began to have severe sharp pains in my right ear. My immediate thought was that I had an ear infection but the sharp pains would come and go. I had always known that my jaw didnt open and close evenly but it didn't give me any discomfort and so was just a fleeting thought that I had a mild physical oddity. As quickly as I noted it I forgot about it.

Then came the ear aches. Acute and for seemingly no reason. I felt well enough so how could I have an infection? After a few days of off again on again pain I visited my doctor. I was examined and checked for fever and he looked in my ears. Finding nothing the matter he referred me to an ENT (Ear, Nose and Throat) Specialist.

I don't recall his name but I do recall how quickly he arrived at a diagnosis. Of course he had my GP's report, so he put his fingers in my ears and asked me to open and close my mouth slowly. As I did this he said I had a dysfunctional something or other. He talked I listened but I guess I looked somewhat skeptical. He asked me to put my fingers in my ears and open and close my mouth as before. I felt that old uneven feeling as my chin performed an 'S' curve only this time it was fingers getting the full impact of my faulty jaw. For a brief instant I thought to myself .... Oh yeah I know I have that!....And then the realization that this was what was causing my ear aches was somewhat astounding. I was also very relieved that I didn't have an infection.

I bet you TMJer's out there are wishing right now that an infection was all you had; at least it could be cured with antibiotics. I understand completely.

It was then the doctor gave me a set of exercises to do and I still do them today. I am no expert but in the last little while I have watched videos and read up on TMJ exercises that appear to be as ineffective as they are ridiculous. Why, you ask? My reasoning ( and I am taking full writers license here) is that the jaw has about a force of 300 to 400 psi give or take. That's a lot of force and the exercises I have seen have you placing two fingers against your cheek and moving your jaw against them with pressure applied. I am sorry but that doesn't seem an effective exercise or a relative one to me. Not when you realize that the jaw can apply some incredible forces when clenching, chewing.

I have had success with the exercises given to me over thirty years ago by the ENT specialist and which I wrote about in detail on my first page" Treatments for TMJ".
Those exercises have proven valuable to me and I perform them any time I feel TMJ pain.

Major TMJ Flare-up
I cannot move my head


So it was just before Christmas and I was getting Christmas preparations underway for the visit from our daughter and our two grandchildren. As well as that, I was spending many long hours at my computer on projects that were causing me stress. So much so that I didn't notice how bad the pain was getting in my face, neck and shoulders. I admit to sitting badly in my chair. My posture is usually the first thing I forget when I am stressed.  Stress and bad posture are two major causes for TMJ jaw disorder.

With no time to spare I barreled ahead with my projects and Christmas chores. What a shock when I tried to get out of bed one morning and I could not lift my head off the pillow, there was so much pain. It wasn't just my neck that hurt, I had a pulsating pain on the right side of my head and the right side of my face felt bruised. Did I mention I was biting my nails quite a bit. Naughty me. When I finally managed to stand up by rolling over and dropping my feet on the floor I found I could not turn my head even an inch without awful pain.

IMS to the rescue.

IMS stands for Intramuscular Stimulation and I am fortunate to live in Victoria, B.C Canada and have qualified Therapists in clinics nearby.

Immediately, after one treatment I had nearly full range of motion moving my head to the right and just small amount to the left. During the week I continued to get better, the pain in my neck and shoulder decreased and then I could feel pain in my jaw and teeth I had not felt before because my neck was so bad. One week later I had my second treatment and a week after that I was almost back to normal. No jaw pain, just some soreness in my neck. I didn't need a third treatment.

I am so thankful I discovered IMS . It worked on my back when I was diagnosed with a spinal stenosis and it worked on my TMJ.


Read below the excerpt from Author Robin Shepherd of
The Institute for the Study and Treatment of Pain
IMS Practitioners in the United Kingdom

What is intramuscular stimulation (IMS)?

Intramuscular stimulation (IMS) is an effective treatment for chronic pain of neuropathic origin (see below). IMS was developed by Dr.Chan Gunn while he was a clinic physician at the Workers' Compensation Board of British Columbia. Dr.. Gunn, is currently a clinical professor and teaches IMS at the University of Washington's Multidisciplinary Pain Centre in Seattle and the University of British Columbia's Medical School. IMS is also taught and utilised at many centres around the world.

IMS is effective and has few side-effects; the technique is also unequalled for finding and diagnosing muscle shortening in deep muscles.

Although IMS uses implements adapted from traditional acupuncture, it is based on scientific, neurophysiological principles. The acupuncture needle used is very thin (much thinner than the hollow needle used to inject medicine or take blood samples). You may not even feel it penetrating the skin, and if your muscle is normal, the needle is painless.

However if your muscle is supersensitive and shortened, you'll feel a peculiar sensation - like a muscle cramp. This is a distinctive type of discomfort caused by the muscle grasping the needle. Patients soon learn to recognise and welcome this sensation. They call it a "good" or positive pain because it soon disappears and is followed by a wonderful feeling of relief and relaxation. The needle may still be in you, but because the muscle is no longer tight, you no longer feel it. What has happened is that the needling has caused your abnormal muscle shortening to intensify and then release. It is important that you experience this sensation in order to gain lasting relief.

Neuropathy - what happens when nerves start to go wrong...
Doctors usually have no difficulty in treating pain caused by injury (a fracture, for example) or inflammation (such as rheumatoid arthritis). They are perplexed however by pain that shows no sign of tissue damage or inflammation.

This type of pain, known as neuropathic pain, typically occurs when nerves malfunction following minor irritation. Nerves and nerve endings become extremely sensitive and cause innocent, harmless signals to be exaggerated and misinterpreted as painful ones.This characteristic is known medically as supersensitivity). The result is pain, even when extensive medical tests show there is "nothing wrong". Until recently, supersensitivity has received little attention in medical circles.

The effects of IMS
The effects of IMS are cumulative- needling stimulates a certain amount of healing, until eventually, the condition is healed and the pain disappears. Some patients treated with IMS have remained pain-free for over 20 years.

Frequency of treatments
Treatments are usually once a week (but can be spread out to two weeks) to allow time between treatments for the body to heal itself. The number of treatments you require will depend on several different factors such as the duration and extent of your condition, how much scar tissue ther is (this usually increases after surgery) and how quickly your body can heal. The rate of healing depends on the condition of your nerves(young people usually heal more quickly although his is not always the case). If the pain is of recent origin, one treatment may be all that is necessary. In published studies of patients with low back pain, the average number of treatments required was 8.2.

Treating neuropathic pain
Supersensitivity and muscle shortening cannot be operated on and "cut away". "Pain killers" and other analgesic pills only mask the pain. The goal of treatment is to release muscle shortening which presses on and irritates the nerve. Supersensitive areas can be desensitised and the persistent pull of shortened muscles released.

The shortened muscle syndrome
An important factor in neuropathic pain is muscle shortening, caused by muscle spasm and contractor. Muscle shortening produces pain by pulling on tendons, straining them as well as distressing the joints they move. Muscle shortening also increases wear and tear and contributes to degenerative changes such as tendonitis and osteoarthritis.

These conditions are customarily regarded as "local" conditions and may not receive the appropriate diagnosis or treatment.

IMS Practitioners

See a listing of IMS Practitioners at : http://www.istop.org/membersusa.html

TMJ and You
Dont Despair, Options are Here.

There are many TMJ treatment options for you to consider. Start with the conservative approaches and work your way through them. Give yourself lots of time to see if the treatment is working and be honest with yourself about the effort you are putting into following the treatment program.

Take care, TMJers. Wrap up with your gel packs and heat bags and find the treatment that works for you. Ask lots of questions and get several medical opinions before having any surgery.

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Surgery to correct TMJ

Surgery for TMJ
Faulty Jaw and Relief from Jaw Pain
Severe cases of TMJ or Faulty Jaw are no laughing matter. Fortunately, only a small percentage of TMJer's with advanced problems will end up having surgical intervention.
When surgery is recommended be sure you seek lots of other medical opinions before proceeding.

How did we get Here?
A proper diagnosis can only be arrived at through appropriate examination and screening for structural disorder within the joint itself. A panoramic X-ray is a great screening tool used by dentist or Orthodontists and shows both jaw joints, and an unusual flattening of the joint can mean you have TMJ. The x-ray can reveal cysts, tumors, nasal area and irregularities in the bone as well as any indentation on the lower jaw (mandible) which is caused by clenching and grinding of the teeth. Depending on what these images reveal, your dentist may recommend an intra-oral appliance, orthodontia or maxillofacial surgery. You may be referred to an oral surgeon or oral and maxillofacial surgeon who will further evaluate and treat your Temporomandibular disorder.


Surgery as a Last Resort
The End Game.
Typically, surgery is considered only after all other conservative TMJ treatment options have been attempted or eliminated as viable options. However, surgery may not always resolve TMJ issues. All TMJ-related surgery is performed under general anesthesia.

Arthrocentesis

A minor cleansing procedure, an oral surgeon inserts a needle into the joint area dispensing a sterile fluid which irrigates the joint and removes debris and inflammatory byproducts. In some cases, the surgeon may insert a scalpel-like instrument inside the joint and remove any tissue adhesions and reposition the joint hinge.

Arthroscopy

The up side and The Study, Kyoto, Japan.

During this procedure, your surgeon makes an incision at the temple point in front of the ear to reach an endoscope into the surrounding area. The endoscope provides a visual guide so that your surgeon can remove any adhesions, treat inflammation or reposition the disc.



The Study , Kyoto Japan. Courtesy of Science Direct.

Outcome of arthroscopic surgery for internal derangement of the temporomandibular joint:long-term results covering 10 years

Objectives: To investigate the long-term success (10-year results) of arthroscopic surgery of the temporomandibular joint. Patients and Method: A survey was undertaken of 37 patients who had been treated with arthroscopic surgery for TMJ internal derangement from 1986 to 1990. Thirty-three patients responded, of whom 30 were women and three men, whose age at surgery ranged from 14 to 77 years (mean: 35.1 years). The mean follow-up period was 10 years and 2 months. All patients rated their pain level on a visual analogue scale (VAS), and also recorded pain, jaw dysfunction, and activities of daily living (ADL) before surgery, and at the time of the survey. Interincisal opening was self-assessed (mm). Pre- and postoperative pain, dysfunction and ADL scores were compared for outcome and statistically analyzed with the Student's t -test. Results: Intensity of pain as rated on the VAS was significantly reduced from 5.15 to 0.34 (p<0.01).>p<0.01).>

The Down Side

Although arthroscopy (arthroscopic surgery) for temporomandibular joint dysfunction or damage (TMJD) may seem like a relatively easy minimally invasive outpatient procedure, it is typically considered a "last resort" treatment option as complications occur that can result in increased pain or joint dysfunction, nerve damage and even permanent jaw mobility reduction.

Discectomy
Then next type of surgery to consider for your TMJ problems is called a discectomy. This surgery is done to remove the disk that is providing the joint with cushioning. It usually takes a few hours and recovery can take a couple of weeks. While you are waiting for the tissue to cover the joint, the bones will be grinding on each other. However, within 4-6 weeks you'll usually enjoy some pain relief and begin using your jaw once again.
Open joint Surgery ( Arthroplasty)

This procedure involves approaching the temporomandibular joint through an incision in a skin crease in front of the ear.. This may be the only option that provides access to deteriorating bony structures or chipped bone areas. Depending on the type of problem, your surgeon may use a scalpel to remove or re-sculpt the affected area.
Articular Eminence Recontouring
You'll find that this TMJ surgery is done on the socket area of your jaw joint. Sometimes the socket can be too deep, causing there to be pressure on the joint's ball. This causes swelling and pain to occur. Smoothing and shortening the articular eminence can take away this pressure, giving some relief from the pain. Usually this surgery is done if trauma to the joint has occurred, or it can be included as a part of a replacement surgery.
TMJ Replacement.
TMJ replacement surgery is done if the joint is damaged and there is no way to repair it. This TMJ surgery is to remove the old joint and put in a new one. This could be a partial replacement or a total replacement. There are many risks to this surgery and it should only be used as a last resort for those who have exhausted all their other options. There is a long recovery time and it can take a long time to get used to the replacement joint.
Partial Replacement
When only one of the components (disk, ball or socket) of the TMJ is replaced, it is called a partial joint replacement. If the temporal bone no longer provides a smooth socket (articular fossa), a metal liner (fossa replacement) is placed inside the TMJ to restore motion and flexibility in the TMJ. When the ends of the jawbone (condyles) are damaged and no longer ball-shaped, they can be replaced. Surgeons can harvest bone from another part of the patient's body, such as the ribs, and attach it with screws to the damaged section of the TMJ. A metal prosthesis is often used instead of bone because less surgery is needed, since there is no "donor" site.







Total joint Replacement
This type of surgery is reserved for those severe and chronic conditions that haven't responded to other surgical methods. This involves removing the deformed or degenerated joint and replacing it with a custom-designed TMJ prosthesis made specifically for each patient.
Due to the general risks associated with surgery, this treatment is used only after other treatment options have been considered.
Remember, it is only in rare cases that surgery will be required or recommended and doctors will always take the more conservative approaches first to relief jaw pain and joint disorders. Also important to note, is that the results achieved through surgery are not always what they are hyped up to be.

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