Cargotts Consulting LLC
One of the most common topics I deal with in my practice is TMJ/TMD, despite the fact that I am not a doctor. I think that is a function of referrals (from existing clients), but also the fact that an estimated 20-30% of all people suffer from some form of TMD. I write TMD, which stands for Temporomandibular Disorder, as opposed to TMJ, which stands for Temporomandibular Joint, because although they are used interchangeably in common society, TMD is actually what people are suffering from. If you're reading this article, you probably know all of that already, and thus, I will move along to the point of this article, which is to give people some unique views, and information about TMJ/TMD, based on my own experiences, research, and positive outcomes, as well as the experiences of the people I've worked with (and ultimately helped).
Speak to someone suffering from TMJ/TMD and the first thing you will notice is a sense of frustration. Why? Because even after scouring the internet, and seeing the "best" doctors, they can't come up with a cause for their TMJ/TMD, they don't understand how all of their symptoms (i.e. jaw pain, ringing in their ears, etc.) are connected, the remedies their dentists and orofacial pain specialists have prescribed (and for which they paid hundreds, if not thousands of dollars out of pocket for), like custom splints, dental nightguards, and other devices, don't work, their pain often gets worse after using the prescribed devices, and after enduring the pain, day after day, with no end in site, they are just worn out! Who wouldn't be frustrated?
So why is there so much mystery and misunderstanding surrounding TMJ/TMD that's leading to all this frustration? Because doctors, scientists, and humans in general, like to "categorize" things into neat little boxes. Our brains understand things better when they are presented in a linear fashion. But in the case of TMJ/TMD, there isn't one single cause of all the symptoms associated with TMJ/TMD. There are multiple things that can cause TMJ/TMD. TMJ/TMD, its causes, and its symptoms, cannot be categorized into one little box. Each case of TMJ/TMD is unique depending upon the initial cause, the number and types of symptoms, and what "stage" the TMJ/TMD is at. Common causes of TMJ/TMD include physical injury (i.e. trauma to the face), disease (i.e. arthritis or tumors to the jaw bone), physical development malformations (i.e. severely misaligned teeth or jaw bones), and bruxing/clenching (i.e. grinding your teeth and clenching your teeth).
The biggest misunderstanding, in my opinion, with regard to TMJ/TMD, is the number of cases that are initially related to grinding and clenching of one's teeth. I believe the overwhelming majority of cases in fact, are initially due to grinding and clenching (I will explain later what causes the grinding and clenching in the first place). However, when you read the entries on most forums dedicated to TMJ/TMD, the most vocal/active participants (and therefore the most numerous) are written by those who suffer from TMJ/TMD as a result of injury and disease. Grouped into those with injury, I include people who grinded and clenched their teeth so much, and for so long, that they displaced, or dislocated, the disc(s) in their jaw (there is a small, fibrous disc that sits between the condyle and the glenoid fossa a.k.a. the ball and socket of your jaw joint), as well as those people who ground down their teeth to the point where they became misaligned. Many of these people have suffered from TMJ/TMD for years, if not most of their lives, because their cases are the hardest to cure. ESPECIALLY those who have dislocated their discs due to grinding and clenching. Besides the complicated nature of the surgery and recovery associated with repairing a disc, the reason why so many surgeries fail to relieve TMJ/TMD over the long run, is because it is not curing, repairing, or solving the grinding/clenching problem (the initial cause of the dislocated disc in the first place). Additionaly, how can one properly recover, and allow their disc, jaw, muscles, etc., to heal after surgery, if they are still clenching/grinding their teeth? They can't! SOOOO... as a result of their large representation in forums, along with their unsuccessful attempts to cure their TMJ/TMD, those suffering as a result of injury and disease, are unknowingly and unintentionally, fostering the common misconception that most cases of TMJ/TMD can't be cured, and that there is little help for anyone suffering from it. New forum members leave message boards feeling more frustrated because they couldn't find the answers they were looking for, and additionally, become more stressed and anxiety ridden after reading about the terrible situations, failed surgeries, uninsured costs, and pain that their fellow TMJ/TMD sufferers have gone through. As you read on, you'll soon see why the forum/"internet search" experience, and resultant psychological set-up, are relevant and important.
HANG IN THERE...WE'RE GETTING TO THE MAIN POINT OF THE ARTICLE!
At the risk of being criticized by the professional dental community, as what I am about to write is arguably controversial, I will go ahead and state the following anyway: It would seem that SOME (not all, to be clear), dentists and specialists are further, indirectly, advancing the idea that TMJ/TMD can't be cured. Why? Because in many cases, they are treating the symptoms of TMJ/TMD, and trying to stop the effects of grinding/clenching of teeth, rather than stopping the grinding and clenching itself. First, let's talk about what grinding and clenching do to one's teeth does. The enamel on your teeth, under normal circumstances, wears down at the rate of .3 millimeters every 10 ten years. For someone who grinds their teeth, it is not uncommon for them to experience two millimeters of enamel erosion over the same time period. Additionally, the grinding and clenching can produce up to 250 pounds of force per square inch- enough pressure to crack a walnut! Think about that for a moment and you'll start to understand why the muscles in your jaw ache, and why you get those terrible migraine headaches. What else happens? Eventually your teeth can get so worn down that they become flat and even in length, your teeth could get ground down to the dentin (which makes you sensitive to hot and cold), you could lose teeth, and you can get tiny cracks and broken fillings (leading to nerve damage). Additionally, over time, one can also wear out and dislocate the discs in their jaw that I mentioned earlier. Back to the roll of dentists- a typical experience for someone who recently developed symptoms of TMJ/TMD goes something like this.... after a period of time goes by whereby their symptoms do not resolve themselves (the aching jaw and headaches persist), the patient eventually makes an appointment with their dentist, or holds out until their semi-annual check-up, and complains to their dentist then. He/she will first ask if they've been chewing a lot of gum, then take a look inside the patient's mouth, most likely see some signs of bruxing, and even if they don't, they will explain to the patient that "they are grinding and clenching their teeth." The patient will be silently elated that the dentist has found the cause of their symptoms. The dentist will further state that he/she can "build them a custom dental guard or splint, that will prevent them from grinding their teeth." The patient is even more elated- their dentist has a fix for their "problem!" Thoughtful dentists (so their patients aren't shocked when they check-out) will at this point make the patient aware of the cost of a dental guard (which can be $500-$700+), and inform them that it is not covered by insurance. So now, rather than thinking about "teeth grinding" and wondering why they are grinding their teeth in the first place, the patient's focus has quickly shifted to the $700 cost of the guard, and the quick decision they have to make while their dentist is essentially hovering over them. It isn't until they get home, or weeks later, if ever, that patients start to question why they grind and clench their teeth. And that's when they start searching TMJ/TMD forums, message boards, and support groups, and end up more confused, as they read about malocclusions, dislocated discs, and very rarely end up reading about grinding/clenching, and the root cause of grinding/clenching (which we will get too- hang in there). I'd like to make something clear. There is absolutely value in using a dental guard (it's not like the dentists or specialists are pulling off some scam). Dental guards and splints will protect your teeth from the wear and tear described above, which is very important. Unfortunately, in many cases, depending upon the material used to make them, and the fit, they can actually lead to more clenching.
Finally, so what is the root cause in most cases of grinding/clenching (and therefore the root cause of most TMJ/TMD cases), and why aren't dentists and specialists talking more about it? It's not a big secret, and it's a simple answer: STRESS and ANXIETY! That's right... those migraine headaches, that itchy spot on your skin (that sometimes looks like a scratch mark)- it's eczema, caused by stress. That ringing in your ear called tinnitus, it's associated with stress. The back and neck pains- stress! Stress and anxiety explain why so many people across the world (remember that 20-30% number) suffer from some form of TMJ/TMD. Sources of stress and anxiety are all around us- our jobs, kids, marriage, exams, school work, finances, illness (your own or other's close to you), traffic, inconsiderate neighbors, life decisions (like moving and marriage proposals), etc. Sources of stress and anxiety, at times, seem endless. Sometimes the stressor(s) is short lived (i.e. you pass your exam or finish that big project at work), in which case your TMJ/TMD resolves itself over a short period of time, and in other cases, the stressor(s) persists, you fail to deal with the stress and anxiety it gives off, you never stop grinding/clenching, and your TMJ/TMD never goes away. That is also why you may experience "flare ups" at seemingly random times. If you track your stress levels, however, they won't seem so random anymore. So the "cure" or remedy for the majority of TMJ/TMD cases is pretty clear- identify, deal directly, and manage stress and anxiety. At this point, I'd like to note that in some rare cases, medications and drugs that stimulate the brain (such as those taken to combat depression and schizophrenia), can also contribute to grinding.
Back to dentists and specialists....So why do dentists and specialists often stop at just the dental guard, telling you to avoid chewing gum, and instructing you to eat soft foods? Why don't they talk about stress and anxiety, and what's causing you to grind and clench in the first place? Why don't they prescribe an inexpensive over-the-counter dental guard for 30 days and tell you to deal with your stress? Well for starters, that would be irresponsible. They can't rely on the quality/fit of the OTC dental guard, and they definitely can't be sure that you will eliminate enough stress to stop the grinding/clenching. They at least want to make sure your teeth are protected. Furthermore, there's a financial incentive. Let's be honest, it wouldn't be very lucrative to prescribe an OTC dental guard and some yoga! And there's money associated with splint adjustments and follow-up appointments. But really, it's also a practical matter. Dentists and specialists don't have time to start arguing with patients about whether or not they have stress in their lives, or analyze where it is coming from. They don't have time to listen, nor do they probably want to hear about all the stresses and issues going on in their patients lives i.e. how they or their husband lost their job, how their marriage is suffering, how their business is failing, etc. That's not what they signed up for. So stress and anxiety are rarely mentioned, and thus, the root cause of the grinding/clenching are never dealt with by the patient. Instead, patients continue using their devices. Sometimes it helps a little, sometimes not at all, and in some cases (in situations where the device makes them clench even more) their TMJ/TMD symptoms get worse. For those reading this that have dental guards or splints, pay attention to the first reflex you have when you place the guard, or splint, in your mouth. Generally, the first thing people do is bite down- especially with larger, bulkier ones. It actually induces you to clench. So although your teeth are protected, it becomes clear why dental guards and splints never cure, or solve, the TMJ/TMD problem.
How do you treat or hopefully cure TMJ/TMD associated with grinding and clenching your teeth? As I briefly mentioned above, it comes down to identifying the root cause of your stress and anxiety, dealing with it directly (to the best of your ability), managing/coping with stress that you can't avoid (i.e. traffic and weather- think farmers and fishermen), and altering your overall lifestyle. It is in these four specific areas that I have had success helping those suffering from TMJ/TMD (after I explain many of the topics I've written about above, with the intent of demystifying and adding clarity to their TMJ/TMD problem). Thanks to this article, that same information is now publicly available, and I hope it will help clarify things for even more people. Details surrounding the four specific areas I mentioned above are beyond the scope of this article, but I want to share the single, most impactful thing one can do to manage their stress, stop grinding and clenching, and ultimately cure their TMJ/TMD. It is MEDITATION! When most people hear "meditation" they are put off by thoughts of gurus, swamis, uncomfortable sitting positions, mantras, and weird music. Well what if I told you there was a meditation method that doesn't require you to cross your legs, doesn't require an instructor, doesn't require an app on your phone, doesn't require weird music, or repetitive mantras, and only requires a minimum of 10 minutes a night to be effective? I personally use such a technique, and I have been teaching it to my clients for some time now. I finally made a free, instructional YouTube video that teaches you this simple meditation method, again, in the hopes of helping even more people. You can find a link to that video here: Simple 10 Min Meditation Method. I have recently "coached" a few new clients who watched the video, and wanted to make sure they were doing it correctly, as well as some who wanted more clarity, but I think most people will pick it up on their own, after a few tries. Just 10 minutes a night (though more is better) before bed, will relax your mind and body, lead to a deeper/more restful sleep, and therefore will help with grinding and clenching. The additional benefits of meditation are numerous, and nothing short of remarkable. There's tons of free literature available that tout the specific benefits of meditation, so I will not get into them here, but I assure you the "hype" and articles purporting the positive effects of meditation are real, and I implore you to try it.
I would like to be clear that this article isn't about "alternative medicine" or pro's vs. self-help. On the contrary, TMJ/TMD specialists are necessary for all those suffering as a result of causes unrelated to grinding/clenching, and for those in the late stages of TMJ/TMD who have done permanent damage to their teeth and discs, as a result of grinding/clenching. For them, specialists may be their only hope. It is the people under the care of specialists, who were prescribed a dental guard, or splint, in time to avoid permanent damage, but still suffer from their TMJ/TMD, and associated jaw pain, headaches, etc. that I feel for. Those people are stuck in a vicious cycle, which often includes needless MRI's, scans, etc. Their guard or splint could be making their symptoms worse (while protecting their teeth), and they will never fully cure their TMJ/TMD until they stop their subconscious grinding and clenching. And that will only happen if they address their stress- something their doctors rarely talk about. On top of that, the stress and anxiety over the thought of never finding a cure, not sleeping, the pain, etc., just adds adds to the grinding/clenching problem, and keeps the cycle going. For those who did not stop their grinding and minimize their clenching early enough, and ended up doing permanent damage to their teeth, discs, or worse, and CHOOSE to go through with surgery without first dealing with their stress, I wish you luck! I believe you will be right back where you started in no time. For those who even THINK their current TMJ/TMD problem may have started out with grinding/clenching (no matter what stage it is in now), and for those who know their current TMJ/TMD problem is related to grinding/clenching after reading this article, again, I implore you to make meditation a permanent part of your nightly routine. Doing meditation alone, without doing more as far as the stress in your life, will decrease the odds of you curing your TMJ/TMD, but it will 100% benefit you, and you will be two steps closer to your cure. For everyone else, like those with disease and those who have suffered from trauma, hang in there! Our understanding of TMJ/TMD continues to evolve, as do modern medicine and surgery techniques. It is only a matter of time.
If you would like to leave a comment, or share an experience, please feel free to do so in the comment section of the YouTube Simple 10 Min Meditation Method video. If you would like more help in overcoming, and dealing with, the stress and anxiety in your life, i.e. root cause analysis, direct confrontation, stress management, lifestyle changes, and pain relief, etc., CLICK HERE TO CONTACT my life strategy practice, and schedule a FREE 20 minute introductory meeting.
Why Can't I FInd A Cure For My TMJ/TMD?
By J.R., Life Strategist, Cargotts Consulting LLC
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J.R. is a Life Strategist at Cargotts Consulting LLC. He helps clients, around the world, define their goals and problems, across all aspects of their life. By providing custom tailored, strategic solutions, clients go on to achieve their goals, and solve their problems, in a time efficient manner.
The Content contained in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The information contained in this article is deemed to be correct at the time it was written and was prepared for general guidance on matters of interest only and does not constitute professional medical advice. You should not act upon the information in this article without seeking specific professional medical advice. No representation nor warranty is given as to the accuracy (after the date it was written) or completeness of the information discussed in the article and Cargotts Consulting LLC does not accept liability nor responsibility for anyone basing a decision on the information contained in the article.