Temporomandibular Joint Disorder or TMJ or Bruxism or Teeth Grinding or Clenching

Ever wake in the morning with sore teeth, a headache, or ear pain? This could be due to TMJ Disorder. Imagine, at night instead of laying in repose you are actually re-living and relieving the stress of your day by clenching or grinding.  The worst part for many is that they really have no control over what they do all night.

Clenching is when the mandible, or jaw, is drawn up to press against the upper teeth with force. Grinding is when the mandible is slid back and forth over each other. It is common to clench during the day as well, it is less common to grind during the day.

Muscles Involved:

TMJ1
Areas affected by TMJ

There are 4 main muscles involved in these activities, or 8 if you account for your right and left sides. Most people are familiar with themasseter, that big muscle on the back part of your cheek, many TMJ suffers unconsciously massage. Less familiar may be the temporalis, a muscle that originates on the side of your head just beyond your forehead and eye and inserts, almost secretly, on the top of your jaw bone passing under your cheek bone. When a client is on the table and I begin digging around in these muscles clients are often surprised at how painful and tight their masseters are.

pterygoids

More obscure muscles that get deep towards to root of teeth grinding are the pterygoids. The pterygoids often hide trigger points thatperpetuate TMJ Disorder, these are guitar string like muscles accessible only inside your mouth! I’m not going to sugar coat this, working on these muscles is almost like torture. However, I can attest from personal experience that getting this work done can reduce the servility of your TMJ for at least a couple weeks. Massage professionals can take continuing education classes about working on these muscles and receive an Intraoral Massage Certification. I haven’t gotten this certification, partly because, really, your mouth is a personal place and I’m not sure how many of you would really want me to do that. Another reason is that you really need to be on top of reciving this treatment regularly to see changes, obviously this is another great self care segue!

Self Massage for TMJ

While not the most professional presentation, this is a great video uses accessible language to get you started:

Stress Management:

Create a good bed time routine that includes sometime to let go of whatever stress from the day you haven’t let go of yet. Deep ‘let it go’ sighs, accepting what you can’t change before it’s time to crawl into bed (at least until tomorrow morning), and contemplating what you have to be grateful for are good practices to try out.

Mouth Guards:

I can’t stress enough the need to get a good mouth guard to protect your teeth from your grinding. It is possible to grind away the surface of your teeth, to crack them under the repeatedly nightly pressure over years, and to develop tooth sensitivity to hot and cold. Generally, mouth guards reduce the impact of grinding. There is one mouth guard, the NTI, claims to prevent grinding, it’s custom made and not inexpensive. About 50% of people I’ve spoken with have said it’s worth it, others say it hasn’t changed their symptoms much. NTI requires a visit to your dentist for a proper fit.

I’ve done a fair amount of research about the materials used in retail night guards. With growing awareness about the hormone disrupting effects of plastic many people don’t want to suck on a piece of plastic all night long every night! As far as I can tell Sporting Smiles’ formula is the safest, it’s made from EVA which doesn’t use chlorine or plasticizers like BPA or phlatates.

Braces & Invisalign:

I recently went to a talk by Dr. Huggins who is a pioneer in the Holistic Dentistry world, along the lines of Weston A. Price. He said that any mistakes made when your teeth were realigned, or failure to wear your retained and maintain proper alignment can contribute to TMJ because your body is literally trying to push your teeth into some kind of alignment. He recommends Invisalign because it is more hypoallergenic than the metal in braces.

 

Side Lying Comfort

As pregnancy goes on most woman experience difficult sleeping due to either acid reflux or hip and shoulder pain while sleeping on their sides. It’s important to get good sleep during pregnancy because fatigue can put you at risk for complications.

 

Acid reflux, or GERD (Gastroesophogial Reflux Disease) is common during pregnancy because of a slowing of the muscles that control swallowing. Often the acid reflux is worst at night, after dinner,when you are trying to find an agreeable position. A supported reclined position can be a comfortable position to sleep in. One of the most critical aspects of finding a safe and comfortable position is ensuring the angle of your body. A 45 degree angle is ideal because it ensures the weight of the baby is not on your Vena Cava reducing blood flow to the baby and placenta.

Generally if your position is causing the baby stress your body will wake yourself up. Many women are viscerally aware when the uterus is pressing on their vein so use your awareness and trust your intuition when getting settled.

Many women find the best compromise for them is a combination face down/side laying position with a small pillow under their belly similar but not exactly like the picture at the right.

 

Sleeping on your left side is the recommended safest position during the second and third trimesters because it allows the most blood flow and nutrients to get to the placenta and the baby. However, this position puts a lot of pressure on your shoulder and hip and can result in painful aches. This results in a lot of restless nights changing positions and moving pillows. Regular massage will help to relieve some aches and can relax you into peaceful sleep.

I invested in an OakWorks Side Laying Positioning System for maximum comfort during prenatal massage. Most of the massage is done in the side laying position but there is a torso pillow that takes the pressure off of your shoulders and hips while supporting your head and keeping your top leg just above hip height. There is also a little wedge pillow to support your belly. Depending on your needs during the massage we may move you to the supported reclined position to work on your neck or give a gentle belly massage.

 

A number of clients wish they had pillows this comfortable for every night sleeping. I am considering buying a second set to rent to clients for the final months of their pregnancy. Please let me know if this is something you might be interested in.