SELF-CARE PROGRAM FOR TMJ FACIAL PAIN AND JAW PAIN
The jaw meets the upper skull in front of the ear, the joint that connects them is called the temporomandibular joint (TMJ). These initials refer to the joint itself and do not refer to a diagnosis. You may hear the term TMD, which stands for temporomandibular disorders. TMD is not just one disorder, but a group of conditions, often painful, that affects the temporomandibular joint and the muscles that control chewing.
Noises in the temporomandibular joint are extremely common. However, sometimes pain or difficulty in the opening and closing of the mouth accompanies the noises. A strain or injury to the TMJ or increased tightness/stiffness of the muscles can cause these problems.
The injury can be the result of a specific trauma to the jaw area or can result from prolonged microtrauma from oral habits. Once a joint is strained, it can easily be re-injured (like a sprained ankle which is subsequently more prone to injury). Because we use the jaw for so many activities (talking, eating, yawning, laughing, etc.), the joint is constantly being moved. Therefore, TOTAL relaxation of the TMJ and surrounding muscles is difficult. Holding the jaw muscles and joints in a relaxed position is, however, very manageable with practice. Regular attempts to relax the jaw muscles and avoidance of activities that would overwork the area will be helpful to reduce the pain and prevent additional strain to the area. The following suggestions will help you diminish your pain:
1. Apply moist heat for 20 minutes two to four times a day to the painful area (microwave a wet towel or a hot pack for approximately 1 minute or until the towel or hot pack is very warm…you can also wrap the towel around a hot water bottle to keep it warm longer). Also, you may spend some extra time in the shower letting the hot water flow over your painful areas. If moist heat is not helpful, you can try using ice wrapped in a thin washcloth for 10 minutes, two to four times a day. Keep ice on the painful areas only until you first feel some numbness. Heat or ice can reduce joint and muscle pain and can relax the muscles.
2. Eat softer diet. Avoid hard foods, such as French bread or bagels. Avoid chewy foods, such as steak and candy. Cut fruits and steamed vegetables into small pieces. Chew with your back teeth rather than biting with your front teeth. Chew your food on both sides at the same time to reduce straining one side. DO NOT CHEW GUM!!
3. Tongue up and teeth apart. The teeth should never be touching (except occasionally they touch lightly with swallowing). We suggest that you closely monitor your jaw position during the day (waking hours) so that you maintain your jaw in a relaxed, comfortable position. This involves placing the tongue lightly on the top of your mouth behind your upper front teeth, allowing the teeth to come apart and relaxing the jaw muscles. An easy way to accomplish this is to say the letter “N” to yourself. This puts the tongue in the position we described. You may even consider the letter “N” on a post it note in your visual field at work or in the car to help you become aware of your jaw position and to remind you not to clench your jaw.
4. Avoid caffeine. Caffeine is a “muscle contractor” drug and can make your muscles tighter. Caffeine or caffeine-like drugs are in coffee, tea, soda and chocolate.
5. Avoid oral habits that strain the jaw. These include teeth clenching, teeth grinding (bruxism), teeth touching or resting together, biting cheeks, tongue pushing against teeth, and jaw tensing. This includes biting fingernails, pens, pencils or your lips.
6. Avoid resting your jaw on your hands.
7. Avoid activities that involve opening the jaw wide. Such as yawning or prolonged dental treatments, for a period of time until the pain has been reduced. If you must have dental work done, and you are having TMJ pain, we will add breaks in which you can close your mouth and relax your muscles and joints.
8. Avoid stomach sleeping, since this puts adverse forces on the jaw and neck muscles. Also avoid sleeping solely on one side. The best sleeping position to reduce facial pain is on your back. You are not likely to clench or grind when sleeping on your back.
9. Use non-steroidal and anti-inflammatory pain reducing medications. Ibuprofen or Naproxin to reduce joint and muscle pain.
10. Exercises suggested by our office. Some patients with muscle pain and tightness may also benefit from specific exercises. We will let you know if you should try these exercises. The exercises we recommend are described below. If these exercises cause an increase in your pain, stop doing them and let us know.
Finger/Knuckle exercise: This is an exercise to help stretch the masseter muscles that open and close the jaw. These muscles are located in your cheeks and you can feel them when you bite down. Open your mouth as wide as you are comfortable and insert two to three fingers or knuckles. Rest them on your upper teeth but do not allow your lower teeth to touch them. Hold your mouth open in this position for 5-10 seconds, then close and relax. Repeat this 4-5 times. Try to do this stretch at least four times a day. If you are also using moist heat on your muscles, do this stretch after applying the moist heat.
Neck stretches: To do this stretch, lean your head to one side as if you are trying to touch your ear to your shoulder, the muscles in the opposite side of your neck are stretched. Hold for about 5 seconds, then lean your neck to the other side. Finally, lean your head forward and stretch the muscles in the back of your neck. You may want to support your head with your hand. Repeat each direction a few times. Try to do this two to four times per day. This stretch may help your facial pain because tight neck muscles contribute to tightness in the facial muscles.